Anatomy Of The Pelvis

Question 1

Renal arteries are at the level of?

Answer 1

L1-L2

Question 2

Visceral pain afferents return to the spinal cord from the kidneys at what level? What are the referred cutaneous areas?

Answer 2

T12 to L2

Pain is referred to the cutaneous areas supplied by T12 to L2. - posterior and lateral abdominal wall below the ribs and above the iliac crest into the scrotum and labia majora and proximal anterior thigh.

Question 3

Psoas major is innervated by?

Answer 3

L1 to L3

Question 4

The psoas joins the iliacus at what level? What’s the innervation?

Answer 4

Joins illiacus L2-L4 - femoral nerve to become the iliopsoas

Question 5

Quadratus lumborum is innervated by?

Answer 5

T 12 to L4

Question 6

Supine the kidneys are approximately at what level? Is the right or left one lower?

Answer 6

Supine -Around T12 to L3 vertebrae,

Ribs 11-12 to L3-4 - When erect they are slightly lower

The right is lower than the left.

Question 7

The right kidney is close to what structures?

Answer 7

Descending duodenum, posterior liver, hepatic flexure of the colon.

Question 8

The left kidney is close to what structures?

Answer 8

Kidney is close to the the stomach, spleen, pancreas, and splenic flexure.

Question 9

What muscle is medial to the kidneys?

Answer 9

Psoas

Question 10

The kidneys are surrounded by what? Are they retroperitoneal or intra?

Answer 10

The kidneys are retroperitoneal and they are surrounded by renal fascia

The fascia is a perinephric (perineal) fat.

Question 11

The True (lesser) and false (greater) pelvis are separated by what?

Answer 11

Separated by the pelvic inlet

Question 12

The dermatomal sacral segments of the pelvis are what?

Answer 12

S3 to S5

Question 13

The skeletal muscle in the perineum and pelvic floor including urethra and anal sphincters are innervated by what?

Answer 13

Innervated by S2-S4

Question 14

Much of the somatic motor and sensory innervation of the pelvis is innervated by what nerve?

Answer 14

Pudendal nerve - s2-s4

Question 15

Where do you numb the pelvis in a female?

Answer 15

Go through the vagina and go to the ischial tuberosity and then inject. This will numb the pudendal nerve.

Question 16

What nerve plexus innervates the pelvis area?

Answer 16

Inferior hypogastric (pelvic) plexus - has SNS, PSNS, and visceral afferent components

Question 17

What blood vessel does the pelvis get its blood from?

Answer 17

Basically from the internal iliac artery, anterior and posterior branches.

Question 18

Deep pelvic structures drain into what lymph chains?

Answer 18

Deep pelvic structures drain into the internal and external iliac chains.

Question 19

Deep perineal structures drain into what chain?

Answer 19

Deep perineal structures drain into the internal iliac chain.

Question 20

Superficial structures like the penis, scrotum, clitoris, labia majora drain into what?

Answer 20

Drain into the superficial inguinal nodes.

Question 21

Other superficial perineal structures - like the glans penis, glans clitoris, labia minors, and the inferior end of the vagina drain into what?

Answer 21

Drain into the deep inguinal nodes and the external iliac chain.

Question 22

The ovaries and related uterine structures and the testes (the lymphatic accompany the gonadal arteries) drain into what NODES?

Answer 22

Drain into the lateral and pre-aortic nodes.

Question 23

Gluteal nodes drain into what?

Answer 23

Drain into the internal iliac chain

Question 24

Drainage from the lower extremities drains into what nodes?

Answer 24

Superficial and deep inguinal nodes.

Question 25

Lower abdominal wall, gluteal and superficial areas of the lower limb drain into what?

Answer 25

The superficial inguinal nodes

Question 26

What nodes receive drainage from the femoral lymphatic and the perineal areas?

Answer 26

Deep inguinal nodes.

Question 27

The key to lymph drainage is that the deep parts of the perineum are drained by the?

Answer 27

Internal pudendal chain —> internal iliac nodes —> aortic nodes.

Question 28

The key part to the drainage of the superficial perineum and external genitalia are drained by what nodes?

Answer 28

Superficial inguinal nodes —> deep inguinal nodes —> external iliac nodes

Question 29

Extending across the ischiopubic arch is a thick triangular fascia structure that has transverse muscles within is called the?

Answer 29

Urogenital diaphragm/perineal membrane and the deep perineal pouch.

Question 30

What are the perforations in the urogenital diaphragm?

Answer 30

Male - the urethra Female - the urethra and the vagina

Question 31

What are the boundaries of the perineum? innervation and blood supply?

Answer 31

Includes the urogenital triangle (anterior) and the anal triangle (posterior) Innervation is the pudendal n and artery is the internal pudendal artery.

Question 32

The perineal membrane is composed of what?

Answer 32

Composed of a thick fibrous sheet with a free posterior border.

Question 33

The deep perineal pouch consists of?

Answer 33

Contains muscles and neuro-vascular structures within the perineal membrane.

Question 34

The pelvic diaphragm is composed of what muscles?

Answer 34

Levator Ani and the Coccygeus muscle Levator Ani - composed of iliococcygeus muscle, pubococcygeus muscle, and puborectalis muscle.

Question 35

The levator Ani is called the levator sling. It arises from the walls of what?

Answer 35

It arises from the walls of the true pelvis, from the posterior pubic bone, from a ligament on the Obturator internist muscle, from the ischial tuberosity.

Question 36

The coccygeus arises from what? Where does it insert?

Answer 36

From the ischial spine and sarcospinous ligament and inserts on the sacrum and the coccyx.

Question 37

What are the three muscles that the levator Ani is composed of?

Answer 37

Pubococcygeus muscle Puborectalis muscle - pulls anorectal junction forward to help keep the GI system closed at rectal area (called perineal flexure), helping the anal sphincter muscles. “Muscle of civilization” Iliococcygeus muscle - which arises from the ilium and the tendonous arch on the obturator internus muscle.

Question 38

What places in the perineal space can abscess form?

Answer 38

The ischiorectal (ischialanal) fossa - is called the deep perineal space - abscesses can form here.

Question 39

What two structures come together at the perineal body?

Answer 39

The Levator Ani and Perineal Membrane come together at the perineal body.

Question 40

If you have a tear through the perineal body and through the anal sphincter you get what?

Answer 40

You get a “cloaca” - a common cavity at the end of the digestive tract for the release of both excretory and genital products in vertebrates

Question 41

The perianal area, - smooth muscle of the internal anal sphincter - is innervated by?

Answer 41

Autonomic nervous system (contracts) and PSNS (relaxes).

Question 42

The perianal area - the external anal sphincter - skeletal muscle - is innervated by?

Answer 42

Three components - innervated by the inferior rectal branches of the pudendal nerve - a somatic nerve.

Question 43

The transition zone between the rectal mucosa and nonkeratinized squamous epithelium is called what?

Answer 43

The anal pecten. Then the anocutaneous line (true skin)

Question 44

The external hemorrhoidal veins go to what?

Answer 44

The systemic circulation

Question 45

The internal hemorrhoidal veins go to what?

Answer 45

The portal system.

Question 46

As the bladder begins to fill, it lifts what?

Answer 46

Lifts the peritoneum up and away from the abdominal wall.

Question 47

What 3 structures support the uterus?

Answer 47

Pelvic diaphragm (pelvic floor) - levator ani, coccygeus muscle, and associated fascia Urogenital diaphragm/perineal membrane Perineal body Note: the broad ligament, round ligament, and suspensory ligament of the ovary, and the perineal folds associated with the uterus are not considered to be true uterine support structures. - Just folds of peritoneum, not true support structures.

Question 48

What are the 3 “ligamentous supporting” structures of the uterus?

Answer 48

Cardinal ligament - (transverse cervical, Mackenrodt) - fibromuscular fascia from either side of the cervix Uterosacral ligaments - from the posterior cervix to the sacrum — comprised of the recto-uterine folds - comprised of fibrous tissues and muscular fibers attached to the front of the sacrum. Anterior pubocervical ligament - from the uterus to the pubic symphysis.

Question 49

T/F the peritoneal folds associated with the uterus are supporting structures?

Answer 49

False, - broad ligament, mesovarium, mesosalpinx, round ligament are not true support structures.

Question 50

What are the 3 pouches are associated with folds of the peritoneum in the perineum.

Answer 50

Urachus, umbilical folds Vesicouterine pouch Rectouterine pouch (douglas)

Question 51

What pouch is a deep pouch posterior to the uterus and anterior to the rectum.

Answer 51

Pouch of Douglas. Rectouterine or rectovaginal pouch