Abdomen Lecture Notes Pt. 3 Flashcards Preview

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Flashcards in Abdomen Lecture Notes Pt. 3 Deck (108)
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1
Q

Common in women after they give birth

A

Pelvic organ prolapse

2
Q

Transmits the force of body weight to lower limbs and helps to protect pelvic visceral structures

A

Pelvis

3
Q

What are the three pelvic ligaments

A
  1. ) Sacroiliac
  2. ) Sacrospinous
  3. ) Sacrotuberus
4
Q

Prevent sacrum and coccyx from rocking posteriorly and superiorly as we stand and move

A

Sacrospinous and sacrotuberous ligaments

5
Q

Bony line where the pelvis communicates with the abdomen

A

Pelvic brim

6
Q

Above the pelvic brim is the

A

Abdomen

7
Q

Below the pelvic brim is the

A

Pelvis

8
Q

Space between the pelvic brim is the

A

Pelvic inlet

9
Q

Located below the pubic bone

A

Pelvic outlet

10
Q

Separates the false pelvis (pelvic fossa) from the true pelvis (pelvic cavity)

A

Pelvic Brim

11
Q

Located from the pelvic brim up to the iliac crest

A

Fase pelvis

12
Q

Suspended by the side walls of the bony pelvis

A

Pelvic Floor

13
Q

Extends from the pelvic floor to the pelvic brim

A

True pelvis

14
Q

Below the pelvic floor is the

A

Perineum

15
Q

What are the three pelvic foramen?

A
  1. ) Greater sciatic foramen
  2. ) Lesser scietic foramen
  3. ) Obturator foramen
16
Q

Connects the true pelvis with the gluteal region

A

Greater sciatic foramen

17
Q

What passes through the greater sciatic foramen?

A
  1. ) Sciatic nerve

2. ) Piriformis

18
Q

Connects the gluteal region with the perineum

A

Lesser sciatic foramen

19
Q

What passes through the lesser sciatic foramen?

A

Pudendal nerve and internal pudendal vessels

20
Q

Connects the pelvis to the medial thigh

-Obturator nerve passes through

A

Obturator canal

21
Q

Which three things pass from the pelvis to the perineum by going directly through the pelvic floor?

A

Urethra, vagina, and anal canal

22
Q

Has a wider pelvic inlet and outlet, and the subpubic (infrapubic) angle is 90 degrees

-transverse dimension exceeds anteroposterior dimension

A

Female pelvis

23
Q

What is the subpubic (infrapubic) angle in males?

A

60 degrees

24
Q

Feeling the ischial spines allows us to measure the transverse diameter of the

A

Pelvic outlet

25
Q

The musculature of the pelvic floor is suspended like a

A

Hammock

26
Q

Forms the lateral side walls of the pelvic floor

A

Obturator internus muscle

27
Q

The extraperitoneal layer is continuous with the

A

Subperitoneal space

28
Q

Continues down into the pelvis and becomes the endopelvic fascia

A

Transversalis fascia

29
Q

Skeletal muscle floor that supports the pelvic viscera (bladder, rectum, uterus)

A

Pelvic diaphragm (pelvic floor)

30
Q

Provides sphincter control over the urethra, vagina, and anal canal

A

Pelvic diaphragm (floor)

31
Q

Increasing intraabdominal pressure increases

A

Intrapelvic pressure

32
Q

Separates the true pelvis from the perineum

A

Pelvic diaphragm

33
Q

During inspiration, the diaphragm descends which increases pressure on the

A

Pelvic floor

34
Q

As the diaphragm descends, the pelvic floor

-contracts around urethra and anal canal

A

Ascends

35
Q

Goes from body of pubis all the way back to the ischial spine

A

Tendinous arch of levator ani (Muscular white line)

36
Q

The attachmentsite of the pelvic floor to the side walls

A

Muscular white line

37
Q

Main muscle of the pelvic floor

covered with fascia called the pelvic diaphragm

A

Levator Ani

38
Q

Forms lateral muscular walls of pelvis and ischioanal fossa

  • superior part in pelvis
  • inferior part in perineum
  • LATERAL rotator of hip
A

Obturator internus

39
Q

Layered on top of the sacrospinous ligament

A

Coccygeus muscle

40
Q

Thickening of obturator internus fascia that serves as the attachment site for the levator ani muscle

A

Muscular white line (Arcus tendineus levator ani)

41
Q

Innermost layer of the levator ani, which creates the anorectal angle at the anorectal junction

A

Puborectalis

42
Q

Contraction of the puborectalis maintins

A

Fecal continence

43
Q

Second layer of the pelvic floor and also the largest portion of the muscular pelvic floor

A

Pubococcygeus

44
Q

The pubococcygeus sends muscle slips around the

A

Urethra and vagina

45
Q

Contraction of the pubococcygeus helps to:

  1. ) Maintain?
  2. ) Compress?
A
  1. ) Urinary continence

2. ) Pelvic portion of vagina

46
Q

Forms the 3rd wall of the levator ani

A

Illeococcygeus

47
Q

The levator ani is made up of which three levels?

A
  1. ) Puborectalis
  2. ) Pubococcygeus
  3. ) Illeococcygeus
48
Q

The length from the body of the pubis to the ischial spine are important landmarks because this is the length of the

A

Vagina

49
Q

Provides static support of the pelvic viscera

-connects bilaterally to fascial white lines

A

Endopelvic fascia

50
Q

There is a thickening of endopelvic fascia covering the levator ani. This is where we see the fascial support structures on the

A

Vagina and cervix

51
Q

Thickening of levator ani fascia that serves as the attachment to the transverse cervical (cardinal) ligament and uterosacral ligaments

A

Fascial white line (Arcus tendineous fascia pelvis; ATFP)

52
Q

Help provide support around the cervix

A

Uterosacral ligaments

53
Q

The fascial white line serves as an important attachment site for which two fascia sheets?

A
  1. ) Pubocervical fascia (Anterior sheet)

2. ) Rectovaginal fascia (Posterior sheet)

54
Q

Located between the urethra and anterior vaginal wall, back of the bladder, and anterior vaginal wall

A

Pubocervical fascia

55
Q

Helps to reinforce the anterior vaginal wall, preventing posterior movement of the urethra or bladder (preventing prolapse)

A

Pubocervical fascia

56
Q

Part of ururectal septum between the posterior vaginal wall and anterior rectal wall

A

Rectovaginal fascia

57
Q

Supports the posterior vaginal wall

A

Rectovaginal fascia

58
Q

Help to hold up the cervix

A

Uterosacral and cardinal ligaments

59
Q

Attaches one muscular white line to another

A

Levator ani

60
Q

Runs in the transverse cervical (cardinal) ligament on its way to supply the uterus

A

Uterine artery

61
Q

The place where 2 ligaments and 2 fascia come together to provide support to the cervix, uterus, and apex of vagina

A

Pericervical ring

62
Q

For the pericervical ring, what is the

  1. ) Anterior part?
  2. ) Posterior part?
A
  1. ) Pubocervical fascia

2. ) Rectovaginal fascia

63
Q

The lateral support of the pericervical ring is from the

A

Cardinal ligaments

64
Q

The posterior ligament support of the pericervical ring is from the

A

Uterosacral ligaments

65
Q

Tearing or stretching of this fascia allows the bladder to push into the anterior vaginal wall, causing it to protrude outside of the body

A

Pubocervical fascia

66
Q

LAteral detachment from the ATFP, resulting in an anterior vaginal wall prolapse

A

Cystocele

67
Q

Cycstocele will occur when the patient increases

A

Intraabdominal pressure

68
Q

Defect in rectovaginal fascia that allows the colon to push into the posterior vaginal wall and cause prolapse

A

Rectocele

69
Q

Caused by lateral detachment from ATFP or tear in the pelvic diaphragm

A

Rectocele

70
Q

Commonly seen in cystocele and rectocele

-Coughing results in patient peeing

A

Stress urinary incontinence (SUI)

71
Q

In SUI, there is no support to stop the urethra from moving posteriorly and straightening out, and when this happens the urethra

A

Opens

72
Q

How can we fix SUI?

A

Transvaginal sling

73
Q

Placing a peice of mesh from anterior vaginal wall to obturator internus

-We want to stay entirely below pelvic floor so as not to perforate the bladder

A

Transvaginal sling

74
Q

Endopelvic fascia surround the prostate, and it is here that we see the nerves responsible for

A

Erection

75
Q

The descending aorta bifurcates into L and R common iliac arteries at the level of

A

L4

76
Q

The common iliac artery divides into internal and external branches at

A

L5

77
Q

Does not go into the pelvis

-becomes femoral artery

A

External iliac artery

78
Q

Main artery of the pelvis

-divided into anterior and posterior divisions

A

Internal iliac (hypogastric) artery

79
Q

Sends branches to the gluteal region, sacrum, and posterior abdominal wall, thus it does not supply pelvic viscera structures

A

Posterior branch of internal iliac artery

80
Q

The anterior branch of the internal iliac artery supplies the pelvic viscera. What are the 2 branches?

A
  1. ) Umbilical

2. ) Obturator (runs with obturator nerve)

81
Q

Takes fecal blood away from the fetus to the umbilicus and also will supply the bladder

A

Umbilical artery

82
Q

After birth, the umbilical artery becomes fibrotic and is renamed the

A

Medial umbilical fold

83
Q

There is TREMENDOUS collateral circulation between the

A

R and L internal iliac arteries

84
Q

Will spread to the lateral aortic nodes, not the pelvic lymph nodes

A

Ovarian cancer

85
Q

Will spread to the internal iliac lymph nodes

A

Cervical cancer

86
Q

The vagus nerve does not innervate anything in the

A

Pelvis

87
Q

In the pelvis, the parasympathetic fibers are all from the

A

Pelvic splanchnics

88
Q

In the pelvic viscera, ONLY PREGANGLIONICS run through?

A
  1. ) Thoracic splanchnics (sympathetic)
  2. ) Lumbar splanchnics (sympathetic)
  3. ) Pelvic splanchnics (parasympathetic)
89
Q

In the pelvic viscera, ONLY POSTGANGLIONICS run through ?

A

Ovarian plexus (on ovarian artery)

90
Q

In the pelvic viscera, PRE- and POSTGANGLIONICS run through?

A
  1. ) Superior hypogastric plexus (sympathetic)
  2. ) Hypogastric nerves (sympathetic)
  3. ) Inferior hypogastric plexus (both)
91
Q

Visceral pain is not typical burn or touch pain, rather it is

A

Distention and ischemic pain

92
Q

ABOVE the pelvic pain line, pain will manifest as

A

Low back or suprapubic pain (sympathetic)

93
Q

BELOW the pelvic pain line, pain will manifest as

A

Perineal pain (parasympathetic)

94
Q

Uterine body and fundus pain will show up in dermatome segments of

A

T11-L1

95
Q

Visceral afferents from structures below the pelvic pain line supply which 4 things?

A
  1. ) Cervix
  2. ) Pelvic portion of vagina
  3. ) Bladder
  4. ) Pelvic portion of urethra
96
Q

Ovarian/tubal pain DOES NOT use the

A

Superior hypogastric plexus

97
Q

Important surgical space located immediately behind the pubic bone and in front of the bladder

A

Retropubic space

98
Q

Space between labia minora where the openings for the urethra and vagina are located

-has periurethral and greater vestibular glands

A

Vestibule of the vagina

99
Q

There are two sources of blood supply to the vagina. What is the blood supply for the:

  1. ) Pelvic vagina
  2. ) Perineal vagina
A
  1. ) Vaginal artery off internal iliac

2. ) Internal pudendal artery

100
Q

There is dual innervation to the vagina. What is the innervation for the:

  1. ) Pelvic vagina
  2. ) Perineal vagina
A
  1. ) Uterovaginal plexus (autonomic)

2. ) Pudendal nerve (sympathetic)

101
Q

The pelvic vagina receives pain innervation from the

A

Pelvic splanchnic nerves

102
Q

The perineal vagina receives pain innervation from the

A

Pudendal nerve

103
Q

Fascial sheet covering the uterus, which is open on both sides (the reason an abdominal pregnancy is possible)

A

Broad ligament

104
Q

The thinnest portion of the uterus and where C sections are performed

A

Lower uterine segment

105
Q

The cervix begins at the cervouterine junction. From deep to superficial, what are the three openings called?

A
  1. ) internal OS
  2. ) Canal
  3. ) External OS
106
Q

When there is NO fusion of the paramesonephric ducts, we get a double uterus and double vagina. This is called

A

Didelphyc Uterus

107
Q

If you have a retroverted and retroflexed uterus, you may have loops of bowel in the

A

Vesicouterine pouch

108
Q

The uterus receives its blood supply from the

A

Uterine artery (branch of internal iliac)

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