Abdomen Lecture Notes Pt. 3 Flashcards Preview

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

Common in women after they give birth

Pelvic organ prolapse

2

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

Pelvis

3

What are the three pelvic ligaments

1.) Sacroiliac
2.) Sacrospinous
3.) Sacrotuberus

4

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

Sacrospinous and sacrotuberous ligaments

5

Bony line where the pelvis communicates with the abdomen

Pelvic brim

6

Above the pelvic brim is the

Abdomen

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Below the pelvic brim is the

Pelvis

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Space between the pelvic brim is the

Pelvic inlet

9

Located below the pubic bone

Pelvic outlet

10

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

Pelvic Brim

11

Located from the pelvic brim up to the iliac crest

Fase pelvis

12

Suspended by the side walls of the bony pelvis

Pelvic Floor

13

Extends from the pelvic floor to the pelvic brim

True pelvis

14

Below the pelvic floor is the

Perineum

15

What are the three pelvic foramen?

1.) Greater sciatic foramen
2.) Lesser scietic foramen
3.) Obturator foramen

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Connects the true pelvis with the gluteal region

Greater sciatic foramen

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What passes through the greater sciatic foramen?

1.) Sciatic nerve
2.) Piriformis

18

Connects the gluteal region with the perineum

Lesser sciatic foramen

19

What passes through the lesser sciatic foramen?

Pudendal nerve and internal pudendal vessels

20

Connects the pelvis to the medial thigh

-Obturator nerve passes through

Obturator canal

21

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

Urethra, vagina, and anal canal

22

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

-transverse dimension exceeds anteroposterior dimension

Female pelvis

23

What is the subpubic (infrapubic) angle in males?

60 degrees

24

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

Pelvic outlet

25

The musculature of the pelvic floor is suspended like a

Hammock

26

Forms the lateral side walls of the pelvic floor

Obturator internus muscle

27

The extraperitoneal layer is continuous with the

Subperitoneal space

28

Continues down into the pelvis and becomes the endopelvic fascia

Transversalis fascia

29

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

Pelvic diaphragm (pelvic floor)

30

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

Pelvic diaphragm (floor)

31

Increasing intraabdominal pressure increases

Intrapelvic pressure

32

Separates the true pelvis from the perineum

Pelvic diaphragm

33

During inspiration, the diaphragm descends which increases pressure on the

Pelvic floor

34

As the diaphragm descends, the pelvic floor

-contracts around urethra and anal canal

Ascends

35

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

Tendinous arch of levator ani (Muscular white line)

36

The attachmentsite of the pelvic floor to the side walls

Muscular white line

37

Main muscle of the pelvic floor

covered with fascia called the pelvic diaphragm

Levator Ani

38

Forms lateral muscular walls of pelvis and ischioanal fossa

-superior part in pelvis
-inferior part in perineum
-LATERAL rotator of hip

Obturator internus

39

Layered on top of the sacrospinous ligament

Coccygeus muscle

40

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

Muscular white line (Arcus tendineus levator ani)

41

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

Puborectalis

42

Contraction of the puborectalis maintins

Fecal continence

43

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

Pubococcygeus

44

The pubococcygeus sends muscle slips around the

Urethra and vagina

45

Contraction of the pubococcygeus helps to:
1.) Maintain?
2.) Compress?

1.) Urinary continence
2.) Pelvic portion of vagina

46

Forms the 3rd wall of the levator ani

Illeococcygeus

47

The levator ani is made up of which three levels?

1.) Puborectalis
2.) Pubococcygeus
3.) Illeococcygeus

48

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

Vagina

49

Provides static support of the pelvic viscera

-connects bilaterally to fascial white lines

Endopelvic fascia

50

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

Vagina and cervix

51

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

Fascial white line (Arcus tendineous fascia pelvis; ATFP)

52

Help provide support around the cervix

Uterosacral ligaments

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

1.) Pubocervical fascia (Anterior sheet)
2.) Rectovaginal fascia (Posterior sheet)

54

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

Pubocervical fascia

55

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

Pubocervical fascia

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

Rectovaginal fascia

57

Supports the posterior vaginal wall

Rectovaginal fascia

58

Help to hold up the cervix

Uterosacral and cardinal ligaments

59

Attaches one muscular white line to another

Levator ani

60

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

Uterine artery

61

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

Pericervical ring

62

For the pericervical ring, what is the
1.) Anterior part?
2.) Posterior part?

1.) Pubocervical fascia
2.) Rectovaginal fascia

63

The lateral support of the pericervical ring is from the

Cardinal ligaments

64

The posterior ligament support of the pericervical ring is from the

Uterosacral ligaments

65

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

Pubocervical fascia

66

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

Cystocele

67

Cycstocele will occur when the patient increases

Intraabdominal pressure

68

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

Rectocele

69

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

Rectocele

70

Commonly seen in cystocele and rectocele

-Coughing results in patient peeing

Stress urinary incontinence (SUI)

71

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

Opens

72

How can we fix SUI?

Transvaginal sling

73

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

Transvaginal sling

74

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

Erection

75

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

L4

76

The common iliac artery divides into internal and external branches at

L5

77

Does not go into the pelvis

-becomes femoral artery

External iliac artery

78

Main artery of the pelvis

-divided into anterior and posterior divisions

Internal iliac (hypogastric) artery

79

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

Posterior branch of internal iliac artery

80

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

1.) Umbilical
2.) Obturator (runs with obturator nerve)

81

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

Umbilical artery

82

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

Medial umbilical fold

83

There is TREMENDOUS collateral circulation between the

R and L internal iliac arteries

84

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

Ovarian cancer

85

Will spread to the internal iliac lymph nodes

Cervical cancer

86

The vagus nerve does not innervate anything in the

Pelvis

87

In the pelvis, the parasympathetic fibers are all from the

Pelvic splanchnics

88

In the pelvic viscera, ONLY PREGANGLIONICS run through?

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

89

In the pelvic viscera, ONLY POSTGANGLIONICS run through ?

Ovarian plexus (on ovarian artery)

90

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

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

91

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

Distention and ischemic pain

92

ABOVE the pelvic pain line, pain will manifest as

Low back or suprapubic pain (sympathetic)

93

BELOW the pelvic pain line, pain will manifest as

Perineal pain (parasympathetic)

94

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

T11-L1

95

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

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

96

Ovarian/tubal pain DOES NOT use the

Superior hypogastric plexus

97

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

Retropubic space

98

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

-has periurethral and greater vestibular glands

Vestibule of the vagina

99

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

1.) Pelvic vagina
2.) Perineal vagina

1.) Vaginal artery off internal iliac
2.) Internal pudendal artery

100

There is dual innervation to the vagina. What is the innervation for the:
1.) Pelvic vagina
2.) Perineal vagina

1.) Uterovaginal plexus (autonomic)
2.) Pudendal nerve (sympathetic)

101

The pelvic vagina receives pain innervation from the

Pelvic splanchnic nerves

102

The perineal vagina receives pain innervation from the

Pudendal nerve

103

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

Broad ligament

104

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

Lower uterine segment

105

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

1.) internal OS
2.) Canal
3.) External OS

106

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

Didelphyc Uterus

107

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

Vesicouterine pouch

108

The uterus receives its blood supply from the

Uterine artery (branch of internal iliac)

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