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MD3002 Anatomy > Pelvis: Walls, floor, neurovascular supply > Flashcards

Pelvis: Walls, floor, neurovascular supply Flashcards

1
Q

What is the hip bone made out of?

A
  • Ilium
  • Ischium
  • Pubis
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2
Q

What makes up the pelvis?

A
  • Hib bones
  • Sacrum
  • Coccyx
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3
Q

What does the pelvic brim divide?

A

Greater and lesser pelvis

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4
Q

What diivides the greater pelvis from the abdominal cavity?

A

Ala / wing of ilium

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5
Q

What ligaments form the greater and lesser sciatic foramina?

A
  • Sacrotuberous ligament and

- Sacrospinous ligament

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6
Q

Where does the sacrotuberous ligament attach?

A
  • Posterior- inferior iliac spine, sacrum and coccyx to

- Ischial tuberosity

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7
Q

Where does the sacrospinous ligament attach?

A
  • Sacrum, coccyx and sacrotuberous ligament to

- Ischial spine

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8
Q

What are the pelvic gateways?

A
  • Greater sciatic foramen
  • Obturator foramen
  • Retroinguinal space
  • Lesser sciatic foramen
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9
Q

What passes through the greater sciatic formaen?

A
  • Sciatic nerve

- Gluteal neurovascular bundle

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10
Q

What passes through the obturator formaen?

A

Obturator neurovascular bundle

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11
Q

What passes through the retroinguinal space?

A
  • Femoral neurovascular bundle
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12
Q

What passes through the lesser sciatic foramen?

A
  • Pudendal nerve

- Internal pudendal vessels

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13
Q

What can the pelvic inlet also be known as?

A
  • Pelvic brim
  • Superior pelvic aperture
  • Linea terminalis
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14
Q

What is included in the pelvic brim?

A
  • Pubic symphysis
  • Pubic crest
  • Pectineal line
  • Arcuate line of ilium
  • Sacral ala and promontory
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15
Q

WHat is included in the pelvic outlet?

A
  • Pubic symphysis
  • Ischiopubic ramus
  • Ischial tuberosity
  • Sacrotuberos ligament
  • Sacrum and coccyx
  • Incompletely closed by muscles and membranes
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16
Q

What are the greater and lesser pelvis also known as?

A
  • Greater - false

- Lesser - True

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17
Q

What is the difference between the general structure of the female and male pelvis?

A
  • Female is thin and light

- Male is thick and heavy

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18
Q

What is the difference between the greater pelvis of the male and female?

A
  • Male - deep

- Female - shallow

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19
Q

What is the difference between the lesser pelvis in men and women?

A
  • Female - wide adn shallow, cylindrical

- Male - narrow and deep, tapering

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20
Q

What is the difference between the pelvic inlet in men and women?

A

Female - oval and rounded; wide

Male - heart-shaped narrow

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21
Q

What is the difference between the pelvic outlet in females and males?

A

Female’s is comparitavely larger

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22
Q

What is the difference between the male and female pubic arch and suprapubic angle?

A
  • Female’s is wide (>80deg)

- Males is narrow (<70deg)

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23
Q

What is the difference in shape between male and female obturator foramen?

A
  • Female - oval

- Male - round

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24
Q

What gender has a larger acetabulum?

A

Men

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25
Q

What is the difference between the male and female greater sciatic notch?

A
  • Female - Almost 90deg

- Male - Narrow (-70deg); inverted V

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26
Q

What are the different pelvic inlet shapes?

A
  • Android (males)
  • Gynecoid (females)
  • Anthropoid
  • Platypelloid (males)
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27
Q

How long is the obstetric conjugate?

A

11 cm (measured off of diagonal), this diameter can decide if mother needs C section

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28
Q

How long is the diagonal conjugate?

A

12.5 cm

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29
Q

When would a C-section be done?

A

When the obstetric conjugate is less than 9 cm and the foetus is not underdeeloped, vaginal delivery is not possible

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30
Q

What is the antero-inferior wall made from?

A
  • Pubic symphysis

- Body and rami of pubis

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31
Q

What is the postero-superior wall made up from?

A
  • Sacrum
  • Piriformis
    Divides greater sciatic foramen
32
Q

What is the lateral wall made from?

A
  • Obturator internus with obturator fascia
33
Q

What is the most inferior region of the abdomino-pelvic cavity?

A

Pelvic floor/diaphragm

34
Q

What does the perineal membrane divide?

A

Perineum into deep and superficial compartments

35
Q

What shape is the pelvic diaphragm?

A

Ball / funnel shaped

36
Q

What are the pelvic side walls and floor in contact with?

A

Central pelvic organs

37
Q

What is the pelvic diaphragm formed by?

A
  • Levator ani (iliococcygeus + pubococcygeus) and coccygeus (aka ischiococcygeus) muscles with their fasciae covering their superior and inferior surfaces
38
Q

What is the coccygeus innervated by?

A

S4-5

39
Q

What are the origins of the levator ani?

A
  • Pubis
  • Ischial spine
  • Tendinous arch of levator ani
40
Q

What are the medial gaps between levator ani called?

A

Urogenital hiatus and anal hiatus

41
Q

What is the pubococcygeus subdivided into?

A
  • Puborectalis
  • Puboperineal
  • Pubovaginalis or puboprostaticus
42
Q

What is the levator ani innervated by?

A

S3-4

43
Q

What does the puborectalis do?

A

Makes a sling posterior to the rectum therefore important in fecal continance

44
Q

What are the functions of the levator ani?

A
  • Supports the pelvic organs
  • Makes the anorectal angle more acute and augments the external anal sphincter
    Maintains faecal continence
  • Augments the urethral sphincter
    Maintains urinary continence
  • Forms a vaginal sphincter
  • Actively contracted coughing, sneezing, forced expiration
45
Q

What can weakness of the levator ani cause?

A

Incontinence or prolapse of structures above i.e uterus (pelvic floor exercises needed) can be due to childbirth or menaupause

46
Q

WHat do pelvic diaphragm muscles of each side meet to form?

A

The anococcygeal body (aka raphe or ligament) and perineal body (aka central tendon of perineum)

47
Q

What is the pelvic floor supported anteriorly by?

A
  • Perineal membrane

- Muscles in the deep perinela pouch

48
Q

What is the structure of the perineal membrane?

A

Thick, triangular fascial sheet that fills the space between the arms of the pubic arch, supports pelvic diaphragm

49
Q

What is the lowest point in the pelvic cavity?

A

Rectouterine/rectovesical pouch

50
Q

What are the recesses / pouches of the pelvic cavity?

A
  • Supravesical fossa
  • Paravesical fossa
  • Vesico-uterine pouch
  • Recto-uterine pouch (of douglas)
  • Rectovesical pouch
  • Pararectal fossae
51
Q

What are the prevertebral plexuses formed around the abdominal aorta by?

A
  • Preganglionic and postganglionic sympathetic fibres (T1-L2(3))
  • Preganglionic parasympathetic fibres (vagus or S2-4)
  • Visceral afferent fibres
52
Q

What are the plexuses that condense around the origins of the branches of the abdominal aorta?

A
  • Coeliac plexus
  • Renal plexus
  • Superior mesenteric plexus (aortic)
  • Inferior mesenteric plexus (aortic)
  • Superior hypogastric plexus
53
Q

Where are cell bodies of postganglionic sympathetic cell bodies found?

A
  • Randomly distributed

- Ganglia which are clustered around roots of major branches of aorta

54
Q

Where are the efferent postganglionic sympathetic ganglia found?

A

Branches of corresponding arteries

55
Q

What are the pelvic autonomic nerves?

A
  • Sacral sympathetic trunks
  • Parasympathetic fibres from S2-4 spinal segments
  • Hypogastric plexus
  • Periarterial plexuses
56
Q

What are the sacral sympathetic trunks?

A
  • 4 pairs of sacral sympathetic gangli + ganglion impar
  • Lumbar and sacral splanchnic nerves
  • Both motor and sensory
57
Q

What are the parasympathetic fibres from S2-4 spinal segments also known as?

A 
Nervi erigentes (pelvic splanchnic nerves) 
- both motor and sensory
58
Q

What are the 2 plexuses that make up the hypogastric plexus?

A
  • Superior hypogastric plexus

- Inferior hypogastric plexus

59
Q

What are the different periarterial plexuses?

A

Superior rectal, ovarian and internal iliac arteries all contain there own plexus (contain postsynaptic, sympathetic and vasomotor fibres)

60
Q

Where does the superior hypogastric plexus lie?

A

In front of the inferior part of the abdominal aorta and its bifurication (promontory of the sacrum)

61
Q

What is the superior hypogastric plexus formed as?

A
  • Continuation of the aortic plexus
  • Sympathetic fibres from L3 and L4 sympathetic ganglia
  • Parasympathetic fibres from the pelvic splanchnic nerves
62
Q

Where does the inferior hypogastric (pelvic) plexus lie?

A

On each side of the rectum, the base of the bladder and the vagina
- Seconday plexuses pass to the rectum, bladder, prostate, seminal gland, cervix and vagina

63
Q

What is the inferior hypogastric (pelvic) plexus formed by?

A

Sympathetic fibres from:

- HYpogastric nerves (from the superior hypogastric plexus) and parasympathetic fibres from the pelvic splanchnic nerves

64
Q

When can the inferior hypogastric (pelvic) plexus become injured?

A

Surgical operations

65
Q

What are the senses from the organs carried by?

A

AUtonomics (sympathetics or parasympathetics)

sympathetics usually pain

66
Q

What fibres do all visceral afferent fibres conducting unconscious (relexitive) sensation travel with?

A

Parasympathetic fibres

67
Q

Where is the pelvic pain line?

A
  • Inferior limit of the peritoneum

- Middle of sigmoid colon

68
Q

What do visceral pain impulses from organs superior to the the pain line travel with?

A

Sympathetic fibres

69
Q

What do visceral pain impulses from organs inferior to the the pain line travel with?

A

Parasympathetic fibres

70
Q

What is the somatic innervation of the pelvic muscles?

A

Pudendal nerve (S2-4)

71
Q

Describe the course the pudendal nerve takes?

A
  • Passes through greater sciatic foramen (infraperiform part)
  • Curves posterior to the ischial spine and sacro-spinous ligament
  • Medial to ischial tuberosity
  • Runs forwards into the perineum inferior to levator ani
72
Q

Where is the trochanteric anastomosis found?

A

Between lateral and medial circumflex femoral and superior and inferior gluteal arteries

73
Q

What is the arterial supply of the pelvis?

A
  • Common iliac artery -> internal iliac artery opposite the sacroiliac joint at the level of the L5 disc
  • The internal iliac artery divides into anterior and posterior trunks
  • Supplies buttock and medial thigh, posterior pelvic and abdominal walls, pelvic viscera, perineum
74
Q

What does the internal artery supply?

A

The walls, floor and contents of the pelvic cavity

75
Q

What are all the different lymph nodes around the pelvis?

A
  • Lumbar (caval/aortic)
  • Inferior mesenteric
  • Common iliac
  • Internal iliac
  • External iliac
  • Superficial inguinal
  • Deep inguinal
  • Sacral
  • Pararectal
    Tend to parallel the venous draonage, very interconnected

MD3002 Anatomy (14 decks)

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