L39-40: Pelvis I-II Flashcards
(56 cards)
1
Q
What landmarks delineate the pelvic inlet/brim? Outlet?
A
- Pectineal line of pubis, arcuate line of ilium, sacral promonotory
- Outlet = space inferior that is closed by pelvic diaphragm
2
Q
Difference between the greater (false) and lesser (true) pelvis?
A
- Greater (false) = lower part of abdominal cavity, superior to pelvic inlet
- Lesser (true) = actual pelvis, inferior to pelvic inlet and sup to outlet
3
Q
Joints of pelvis – what type of joint is each?
A
- ) Sacroiliac (SI): synovial joint
- ) Lumbosacral (LS): secondary cartilaginous (fibro-) joint with IV disc
- ) Sacrococcygeal: secondary cartilaginous (fibro-) joint with IV disc
- ) Pubic symphysis: secondary cartilaginous (fibro-) joint
4
Q
Functions of sacrotuberous and sacrospinous ligaments
A
- Prevents anteroinferior displacement of superior sacrum
- Converts greater and lesser sciatic notches into foramina
5
Q
Attachments of sacrotuberous and sacrospinous ligaments
A
- Sacrotuberous: sacrum to ischial tuberosity
- Sacrospinous: sacrum to ischial spine
6
Q
Review bony landmarks of pelvis
A
Review bony landmarks of pelvis
7
Q
What bony landmarks form obturator foramen
A
- superior and inferior rami of pubic and ischial bones
8
Q
Sex differences regarding pelvis: pelvic inlet, canal, ischial tuberosities and spines, greater sciatic notch, subpubic angle, sacrum?
A
- Pelvic inlet: females = oval/rounded, males = heart-shaped
- Canal: females = short with parallel walls, males = long, funnel-shaped
- Ischial tuberosities and spine: females = everted, males = not everted
- Greater sciatic notch: females = broader, males = narrower
- Subpubic angle: females = >_ 90 deg, males = <_ 70 deg
- Sacrum: females = short/broad, males = long/narrow
9
Q
Pelvic wall and floor muscles
A
- Lateral wall = obturator internus
- Posteror wall = piriformis
- Pelvis floor = pelvic diaphragm = levator ani + coccygeus
10
Q
Attachments of obturator internus
A
- Lesser pelvis through lesser sciatic foramen and attaches to greater trochanter of femur
11
Q
What is the tendinous arch of the pelvis?
A
- Obturator membrane lines the obturator internus muscle
- Medial aspect of this membrane = tendinous arch
12
Q
Attachments of piriformis muscle
A
- Sacrum within lesser pelvis through greater sciatic foramen and attaches to greater trochanter of femur
13
Q
Nervous tissue associated with piriformis
A
- Sacral nerve plexus sits on piriformis muscle, acts as bed for it
14
Q
What muscles serve as the pelvic floor (aka diaphragm)?
A
- Levator ani (puborectalis, pubococcygeus, iliococcygeus – medial to lateral)
- Coccygeus (aka ischiococcygeus)
15
Q
Function of pelvic diaphragm?
A
- Supports pelvic viscera during increased intraabdominal pressure and aids with voluntary control of urination and fecal continence
16
Q
Name muscles of levator ani – attachments (name from medial to lateral)
A
- ) Puborectalis – muscular sling attaching to pubis (sometimes part of pubococcygeus)
- ) Pubococcygeus – arises from pubis and tendinous arch, attaches to coccyx
- ) Iliococcygeus – arises from tendinous arch and ischial spine, blends to pubococcygeus
17
Q
Attachments of ischiococcygeus (aka coccygeus) muscle
A
- Ischial spine to coccyx/sacrum
18
Q
What are the components of the pelvic viscera?
A
- Urinary bladder, parts of ureters, rectum and in….
- Males: ductus deferens, seminal vesicles, ejaculatory ducts, prostate and bulbourethral glands
- Females: ovaries, uterine tubes, uterus, vagina
19
Q
Describe associated structures with male and female ureters that a surgeon ought to be cautious of
A
- Males: ductus deferens passes between ureters and peritoneum close to bladder
- Females: ureters pass medial to uterine arteries’ origins
20
Q
What prevents reflux of urine into ureters from bladder?
A
- Flap valves where ureters enter bladder. Muscular contractions of bladder act as sphincters preventing reflux
21
Q
Arterial supply and innervation of ureters?
A
- Innervation: via autonomic plexuses nearby (renal, aortic, superior and inferior hypogastric)
- Male blood supply = inferior vesicular
- Female blood supply = uterine
22
Q
Position of bladder in adults / children
A
- Adults: empty it rests in lesser pelvis, full extends to umbilicus
- Children: empty it may rest in abdomen
23
Q
Anatomical regions of the urinary bladder
A
- Apex: anterosuperior
- Fundus: posterior wall
- Body: area bw apex and fundus
- Neck: constriction area
- Trigone: triangle between ureteric and urethral openings
24
Q
Differences between bladder/urethral sphincters in males/females
A
- Females and males both have external sphincter (voluntary)
- Males also have internal sphincter (involuntary): prevents reflux of semen into bladder – muscle from bladder continuous with prostate’s fibromuscular tissue
25
T/F. Urethra is in pelvis (is pelvic viscera).
- False.
- Females: descends anterior to vagina and is partly pelvic, partly perineal
- Males: only preprostatic and prostatic urethra is pelvic, membranous and spongy are perineal
26
4 parts of male urethra
1. ) Preprostatic: from neck of bladder to prostate
2. ) Prostatic: within prostate
3. ) Membranous: through external urethral sphincter
4. ) Spongy: longest and runs through penis
27
Of the 4 parts of the male urethra, which is least distensible?
- The membranous urethra. Likely and area for kidney stone
28
Describe the specializations/anatomical features of the prostatic urethra
1. ) Urethral crest = median ridge
2. ) Seminal colliculus = rounded eminence
3. ) Prostatic utricle = remnant of uterovaginal canal in seminal colliculus
4. ) Openings of ejaculatory ducts into seminal colliculus inferior to utricle
5. ) Openings of prostatic ducts lateral to seminal colliculus
29
4 parts to the uterine tube
1. ) infundibulum: funnel-shaped with fimbrae
2. ) ampulla: widest and longest part
3. ) isthmus: enters uterine horns
4. ) uterine part: short segment in uterine wall
30
Anatomical regions of uterus
1. ) Fundus (superior to uterine tubes)
2. ) Uterine horns
3. ) Isthmus: constricted region superior to cervix
4. ) Cervix: internal os (opening to uterus) and external os (opening to vagina)
31
What structures support the uterus?
- Ovarian ligament: from ovary to uterus
- Round ligament: uterus to labia majora
- Broad ligament = mesentery of uterus with subdivisions
a. ) Suspensory ligament = ovarian vessels, lymphatics and nerves conveyed to uterus
b. ) Mesovarium: suspends ovaries
c. ) Mesosalpinx: suspends uterine tube
d. ) Mesometrium: suspends most of uterus
- Pelvic diaphragm
32
What structures support the uterus? List the mesentery that suspends the female reproductive organs.
- Ovarian ligament: from ovary to uterus
- Round ligament: uterus to labia majora
- Broad ligament = mesentery of uterus with subdivisions
a. ) Suspensory ligament = ovarian vessels, lymphatics and nerves conveyed to uterus
b. ) Mesovarium: suspends ovaries
c. ) Mesosalpinx: suspends uterine tube
d. ) Mesometrium: suspends most of uterus
- Pelvic diaphragm
33
Typical position of uterus
- Anteverted (axis bw cervix and vagina), anteflexed (axis bw uterine body and cervix)
34
Location of vagina in reference to bladder/urethra and rectum
- Anterior to rectum, posterior to bladder/urethra
35
Names of superiormost vagina as it surrounds cervix
- Anterior, posterior and lateral fornices
36
Which part of the vagina is somatically innervated? By what?
- Lower 1/4th by deep perineal branch of pudendal
37
What is the ejaculatory duct?
- Seminal vesicle and ductus deferens unite and converge upon seminal colliculus of prostatic urethra
38
Lobes of prostate. Clinical relevance
- Ant/post/middle/lateral
- Can hypertrophy in BPH (benign prostatic hyperplasia) and make ejaculation and urination difficult – requires TURP (transurethral resection of the prostate) procedure
39
Glands that are posterolateral to membranous urethra. Where are the openings for this gland?
- Bulbourethral glands
| - Openings in spongy urethra in bulb of penis
40
Contents of semen
- Testes secretion, seminal vesicle secretion, prostate secretion, bulbourethral gland secretion
41
Primarily retroperitoneal pelvic organs
- Ureters, male prostate, seminal vesicles, vas deferens (ductus)
42
What are intraperitoneal pelvic organs?
- Uterus (can be considered secondarily intraperitoneal), ovaries, uterine tubes
43
Space behind pubis that accommodates bladder distension?
- Retropubic space (of Retzius)
44
Space behind rectum that accommodates rectal expansion?
- Retrorectal space
45
Area in males between bladder/prostate and rectum
- Rectovesical pouch
46
Area in females between bladder and uterus
- Vesicouterine pouch
47
Area in females between uterus and rectum
- Rectouterine pouch (of Douglas)
48
How can the rectouterine pouch (of Douglas) be accessed by a surgeon?
- Posterior fornix
49
Branches of the common iliac artery
1. ) Internal iliac (I Love Going Places In My Very Own Underwear)
- Iliolumbar, lateral sacral, gluteal (sup and inferior), internal pudendal, inferior vesical, middle rectal, vaginal (off uterine), obturator, umbilical (gives off superior vesicular)
- Posterior division is iliolumbar, lateral sacral and sup gluteal (sometimes off anterior division), rest are anterior division
2.) External iliac
50
Lymphatic nodes of pelvis
1. ) Inguinal nodes (superficial and deep)
2. ) External and internal iliac nodes
3. ) Common iliac nodes
4. ) Lumbar nodes
51
Nerve supply to lower limb
- Sciatic nerve (L4-S3 ant / post division) exits greater sciatic foramen
52
Nerve supply to skin and muscles of perineum/sensory for external genitalia
- Pudendal nerve (S2-S4 ant division) exits via greater sciatic foramen, enters via lesser sciatic foramen
53
What is the ganglion impar?
- ends of bilateral sympathetic trunk that converge to this structure
54
Arrangement of sympathetics in pelvis
- Arise from T11-L2 through sympathetic chain through lumbar and sacral splanchnic nerves, synapse in inferior mesenteric ganglion
- Postsynaptics through superior hypogastric, R/L hypogastric nerves and or inferior hypogastric plexus then with pelvic arteries to target organs
55
Arrangement of parasympathetics in pelvis
- Arise from S2-S4 ascending through inferior/superior hypogastric plexuses then follow arteries to target organs
- Synapse in ganglia in organ/gut plexuses
56
What is the perineum?
- Everything beneath the pelvic diaphragm/floor
