Anatomy - Pelvis Flashcards Preview

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Flashcards in Anatomy - Pelvis Deck (79)
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1
Q

What type of joint is the sacro-iliac joint?

A

Synovial joint with no rotation

2
Q

What type of joint is the symphysis pubis?

A

Secondary cartilagenous joint with no rotation

3
Q

List the three bones that make up the hip bone

A
  • Ilium
  • Ischium
  • Pubis
4
Q

What makes up the pelvic wall?

A
  • Sacrum, coccyx and pelvic bones

- Sacrospinous and sacrotuberous ligaments

5
Q

What lines the pelvic outlet?

A
  • Pubic arch
  • Iscial tuberosity
  • Sacrotuberous ligament
  • Coccyx
6
Q

What is contained by the iliac fossa?

A

Lower abdominal viscera

7
Q

Describe the axis of the pelvic cavity

A
  • Antero-inferiorly inclined

- Conical or cylindrical

8
Q

What muscle covers the pelvic bone facing the pelvic cavity?

A

The obturator internus muscle and its fascia

9
Q

Which two muscles are attached to the medial surface of the greater trochanter of the femur?

A
  • Piriformis muscle

- Obturator internus muscle

10
Q

List the muscles of the pelvic diaphragm

A

Levator ani muscle (iliococcygeus, pubococcygeus, puborectalis)

11
Q

List the two ligaments in the medial aspect of the pelvic wall

A
  • Anococcygeal ligament (where the two levator ani muscles join)
  • Tendinus arch (or obturator internus)
12
Q

What is the function of the levator ani?

A

Supports the pelvic organs (bladder, cervix, uretus and rectum)

13
Q

What nerve supplies the levator ani?

A

Pudenal (S2-4) and directly by S4

14
Q

List the openings in the levator ani

A
  • Urethra
  • Anal canal
  • Vagina (in females)
15
Q

What is the perineal membrane?

A

The inferior layer of fascia of the urogenital part of the pelvic diaphragm

16
Q

What is below the pelvic diaphragm?

A

The perineum, containing voluntary sphincters and external genitalia

17
Q

Describe the shape of the urinary bladder.

A
  • Tetrahedral
  • Ureters make 2 borders
  • Median umbilical ligament at the apex
  • Urethra at the neck
18
Q

Describe how the ureters enter and the urethras exit the urinary bladder

A
  • Ureters supero-posterior angles

- Urethra inferior angle

19
Q

Where are the two sphincters of the urinary bladder located?

A
  • Smooth muscle at the neck (sphincter visicae)

- Skeletal muscle in the perineum (sphincter urethrae)

20
Q

Name the three rectal folds and their location

A
  • Superior and inferior rectal folds are on the left

- Middle rectal fold is inbetween these on the right

21
Q

List the rectal arteries

A
  • Superior rectal artery
  • Middle rectal artery
  • Inferior rectal artery
22
Q

Where are the anorectal flexure and anorectal junciton?

A

Between the rectum and the anal canal

23
Q

List the three components of the external anal sphincter

A
  • Deep
  • Superficial
  • Subcutaneous
24
Q

Name the skeletal muscle surrounding the anal canal

A
  • Sphincter ani

- Less important than the puborectalis levator ani, which puts a sharp angle in the recto-anal junction

25
Q

What does the internal iliac artery supply?

A
  • Pelvic walls
  • Pelvic viscera
  • External genitalia
  • Peineum
  • Buttock
  • Medial part of the thigh
26
Q

What does the external iliac artery supply?

A
  • The legs
  • Has two branches (inferior epigastric artery and deep circumflex artery) which supply the skin in the lower abdominal wall
27
Q

State the differences between the male and female pelves

A
  • Males have a narrow/heart shaped pelvic inlet
  • Females have a oval/round pelvic inlet
  • Females have a much larger pubic angle of over 80 degrees, males only 50-60 degrees
28
Q

Describe the characteristics of an orientated pelvic girdle

A
  • ASIS and pubic tubercles in the same plane

- Greater and lesser pelves are continuous

29
Q

Distinguish between the true pelvis and false pelvis (or greater and lesser pelvis)

A
  • True pelvis contains the pelvic inlet

- False pelvis is above the pelvic inlet, in the abdomen

30
Q

What is contained within the space between the pelvic wall and peritoneum?

A
  • Pelvic fascia

- Pelvic fascia form ligaments supporting the cervix, vagina and prostate

31
Q

List the contents of the male pelvic cavity

A
  • Ureter, bladder and urethra
  • Prostate, ductus deferens, sminal vesicles, bulbourethral glands
  • Caecum, appendix, ileum and parts of the sigmoid colon
  • Vessel, nerves and lymphatics
32
Q

Which structures in the male pelvis can be felt on a digital rectal examination of a healthy man?

A

The prostate gland is about 2.5 cm in length, with a medial sulcus, is firm and non-tender.

33
Q

Where is the prostate gland?

A

Surrounding the 1st (prostatic part) or the urethra

34
Q

Where is the ductus deferens?

A

Passes through the inguinal canal then over and behind the ureter to enter the urethra through the prostate

35
Q

Where are the seminal vesicles?

A

On the back of the bladder, they open into the ductus deferens between the ampulla and ejaculatory duct

36
Q

What needs to be considered when inserting a male catheter?

A
  • The catheter needs to negotiate the first bend of the urethra as it passes from the perineum to the pelvis
  • Can also be lodged in the prostatic utricle
  • The second bend can be flattened by lifting up the penis
37
Q

What percentage of secretions of the ductus deferens are from seminal vesicles and prostate?

A
  • 60% seminal vesicles

- 40% prostate

38
Q

Compare the organisation of the internal urethral sphincter in males and females

A
  • In males it is better organised

- This is because it needs to be closed in males during ejaculation to prevent reflux of the ejaculatory fluid

39
Q

List the parts of the male urethra

A
  • Preprostatic part (1.5cm)
  • Prostatic part (2.5cm)
  • Membranous part (2cm)
  • Spongy part (15cm)
40
Q

Describe the arterial supply of the male pelvis

A
  • Internal iliac artery splits into an anterior and a posterior branch
  • Inferior vesical artery supplies the prostate, bladder and ductus deferens
  • The prostatic branch of the inferior vesical artery goes to the prostate
  • Superior vesical arteries supplies the bladder and ductus deferens
  • Pensi supplied by internal pudendal artery from the internal iliac
41
Q

Describe the anatomy of the perineum

A
  • Diamond shaped area between the pubic symphysis, iscial tuberosities and coccyx
  • Split into an anterior (urogenital region) and posterior (anal triangle)
42
Q

Describe the structure of the posterior compartment

A
  • Ischio-anal fossae (fat filled spaces separating the anal canal and levator ani from pelvic muscles
43
Q

Describe the structure of the anterior triangle

A
  • Divided into superficial and deep parts by the perineal membrane
  • Perineal membrane attached to the pubic arch, with a small gap and a free posterior margin
  • Deep peritoneal space is above the perineal membrane, but below the fascia of the pelvic diagram
  • The superficial perineal space is below the perineal membrane and perineal fascia
  • Spaces are potential
44
Q

Describe the superficial perineal structures of the male

A
  • Glans of the penis
  • Body of the penis
  • Suspended from the falciform ligament
  • Two crus of the penis, either side, with two ischiocavernosus muscles (corpus cavernosum) attached to ischiopubic rami
  • Bulb of the penis in the middle, with the bulbospongiosus muscle/corpus spongiosum
  • Meet to form the shaft and head of the penis/clitoris
45
Q

List the deep perineal structures of males

A
  • External urethral sphincter (skeletal muscle)

- Two bulbourethral glands and ducts open into urethra below the perineal membrane

46
Q

List the arteries supplying the rectum and anal canal

A
  • Superior rectal artery, middle rectal artery and inferior rectal artery
  • One from inferior mesenteric, two from internal iliac artery
47
Q

What are the iscioanal fossae?

A
  • Fat filled spaces in the anal triangle which allow recto-anal and vaginal expansion
  • Lateral wall contains the pudendal neurovascular bundle
48
Q

List the contents of the spermatic cord

A
  • Testicular artery and pampiniform plexus of vein
  • External spermatic fascia (external oblique aponeurosis)
  • Internal spermatic fascia (transversalis fascia)
  • Cremasteric fascia (from internal oblique)
49
Q

Describe the nerve supply of the pelvis

A
  • Supplied by autonomic nerves only
  • Sympathetic nerves from lower thoracic and upper lumbar segments via hypogastric plexus (superior and inferior)
  • Parasympathetic from S2-4 outflow
  • Pain referred to the suprapubic region
50
Q

List the sensory and motor functions of the pudendal nerve

A
  • Sensory - dorsal nerve, sensory to the penile skin and flans, lower urethra, lower rectum and anal canal
  • Motor - to perineal muscles, bulbospongiosus and ischicavernosus causing ejaculation and external urethral sphincter
51
Q

List the functions of the parasympathetic nerves

A
  • Vasodilation of arterioles in erectile tissue

- Secretion in prostate and bulbourethral glands

52
Q

List the functions of the sympathetic nerves

A
  • Contraction of smooth muscles of epididymis, vas deferens, seminal vesicles and prostate cause emission
  • Contraction of internal urethral sphincter
53
Q

Where does the pudendal nerve arise?

A

From the lumbosacral plexus (S2-S4)

54
Q

List the female pelvic organs

A
  • Ovary, uterine tubes
  • Uterus and cervix
  • Vagina
  • Ureter bladder and urethra
  • Rectum, caecum and appendix, parts of sigmoid colon and ileum
  • Vessels nerves and lymphatics
55
Q

Why do females get UTIs more easily than males?

A

They have a shorter urethra

56
Q

Describe the peritoneum in females

A
  • Does not go to the pelvic floor
  • Uterine tubes enveloped by the broad ligament
  • Ovaries are suspended by mesovarium from posterior of broad ligament
  • Pelvic fascial condensations form ligaments supporting viscera (cervix and vagina)
57
Q

What are the important contents of the broad ligaments

A

Uterine tubes and uterine arteries

58
Q

What anchors the cervix in position?

A
  • The vervical ligaments
  • Prevent the uterus from prolapsing into the vagina
  • Pubocervical ligament
  • Transverse cervical ligament (very important, also called the cardinal ligament - it is the strongest)
  • Uterosacral ligament
59
Q

List the parts of the uterus and uterine tube

A
  • Uterus has fundus, body, lower part and cervix

- Uterine tubes have infundibulum, ampulla, isthmus and uterine parts

60
Q

What is the fornix?

A

The border between the cervix and the vaginal cavity, where the cervix curves into the vagina

61
Q

List the openings of the cervix and the cell types that line it

A
  • A fibromuscular cylinder with internal os and external ox (os meaning opening)
  • Canal is lined by simple columnar epithelium, with the vaginal surface covered in stratified squamous non-keratinised epithelium
62
Q

What does a smear test identify?

A

If the squamous cells of the vaginal part of the cervix has become keratinised

63
Q

What is the angle of anteversion?

A

Angle between the axis of the vagina and the axis of the cervix (90 degrees)

64
Q

What is the angle of anteflexion?

A

Angle between the axis of the cervix and the axis of the uterine body

65
Q

Where is the posterior fornix?

A
  • Between the vagina and the rectum

- From here a pelvic abscess can be drained and eggs can be collected

66
Q

Describe the relationship between the urethra and vaginal wall

A

They are fused - attached very tightly

67
Q

List the structures palpable from the vaginal wall

A
  • Cervix
  • Ischial spine
  • Sacral promontory
  • Uterine artery pulse
  • Ovary
68
Q

List the arteries supplying the female pelvis

A
  • Superior vesical, uterine and middle rectal
  • Walls of the pelvis supplied by sacral, gluteal and obturator branches
  • Pudendal arteries supplies the perineum and recto anal region via inferior rectal branch
  • The vaginal artery is the equvalent to the inferior vesiclal artery in males
69
Q

Where does the uterine artery supply?

A
  • Main blood supply to the uterus
  • Enlarges during pregnancy
  • Crosses the ureter 1cm from the cervix
  • Runs close to the uterus in the broad ligament, with ascending (body of uterus and tube) and descending branches (vagina)
70
Q

What supplies blood to the ovary?

A
  • Ovarian artery from the abdominal aorta

- Descending branch supplies the vagina

71
Q

What do you need to be wary of in hysterectomy?

A

When stopping the blood supply the ureters could accidentally be tied off

72
Q

What is the lithotomy position?

A

Lying supine with the knees flexed

73
Q

List the deep perineal structures in the female

A
  • Exit for urethra and external urethral sphincter (responsible for incontinence)
  • Sphincter urethrovaginalis (around vagina and urethra)
  • Opening for vagina
  • Anal opening
74
Q

Describe the formation of the clitoris

A
  • Median erectile mass (corpus spongiosum) divides to form vestibular bulbs which forms the glans of the clitotis)
  • Lateral erectile tissue (corpora cavernosa) paired cylinders attached to the ischiopubic rami, forming the body of the clitoris
  • Erectile tissues are surrounded by skeletal muscle
75
Q

List the contents of the superficial perineal pouch

A
  • Vulva
  • Labia majora
  • Mons pubis
  • Labia minora
  • Clitoris
  • Vestibule of vagina
  • Vestibular bulbs (under the labia majora)
  • Vestibular glands (lesser on either side of the urethra, greater either side of the vaginal opening)
76
Q

What is another name for the lesser vestibular glands?

A

Skenes glands

77
Q

What is another name for the greater vestibular glands?

A

Bartholins glands

78
Q

List the nerves supplying the female pelvis

A
  • Only autonomic
  • Sympothetic T10-L2 hypogastric plexus
  • Parasympathetic S2-4
  • Anterior labial nerve (from iliolingual)
  • Perineal branch of postcutaneous nerve of thigh
  • Pudendal nerve (clitoris, vagina, labia minora, rectum)
79
Q

Where does lymph drain in the pelvis?

A
  • Pelvic organs drain to external and internal iliac nodes
  • Ovary and testes drain to para-aortic nodes
  • Perineum and external genitalia drain to superficial inguinal nodes below the inguinal ligament