Lecture 20 - The Pelvis and Pelvic Viscera Flashcards

1
Q

What is the pelvis?

A
  • Bowl shaped
  • Bounded by hip bones, sacrum, and coccyx
  • Divided into two regions
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2
Q

What are the two pelvic openings?

A
  1. Pelvic inlet/brim
  2. Pelvic outlet
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3
Q

What are the 2 regions of the pelvis?

A
  1. False (greater)
  2. True (lesser)
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4
Q

What is the false pelvis?

A
  • Superior to the pelvic brim
  • Contains abdominal viscera
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5
Q

What abdominal viscera are located in the false pelvis?

A
  1. Cecum/appendix
  2. Sigmoid colon
  3. Loops of jejunum/ileum
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6
Q

What is the true pelvis?

A
  • Inferior to the pelvic brim
  • Between pelvic inlet and outlet
  • Funnel shaped
  • Contains pelvic viscera
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7
Q

Which pelvic viscera are located in the true pelvis?

A
  1. Rectum/anal canal
  2. Bladder
  3. Sex-specific viscera
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8
Q

What is the true pelvis a framework for?

A

The pelvic cavity and perineum

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9
Q

What are the two types of pelvic shapes?

A
  1. Gynaecoid
  2. Android
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10
Q

What characterizes a gynaecoid pelvis?

A
  • Wide and shallow
  • Wide oval-shaped inlet
  • Larger round outlet
  • Subpubic angle (~90-100 degree)
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11
Q

What characterizes an android pelvis?

A
  • Narrow and deep
  • Heart-shaped inlet
  • Narrow, oblong outlet
  • Subpubic angle (~70 degrees)
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12
Q

What are the 3 parts of the hip bones?

A
  1. Ilium
  2. ischium
  3. Pubis
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13
Q

What are the structures on the wing of the ilium?

A
  1. Iliac crest
  2. Iliac fossa
  3. Anterior superior iliac spine (ASIS)
  4. Sacral articular surface
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14
Q

What are the structures on the body of the ilium?

A
  1. Anterior inferior iliac spine (AIIS)
  2. Greater sciatic notch
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15
Q

What are the structures on the ischium?

A
  1. Ischial spine
  2. Lesser sciatic notch
  3. Ischial tubersosity
  4. Ischial ramus
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16
Q

What are the structures on the pubis?

A
  1. Superior pubic ramus
  2. Pubic tubercle
  3. Inferior pubic ramus
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17
Q

What bones of the hip form the obturator foramen?

A

Ischium and pubis

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18
Q

What is the acetabulum?

A

Hip joint socket

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19
Q

What are the number of vertebrae of the sacrum?

A

5 vertebrae (S1-S5)

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20
Q

What are the number of vertebrae of the coccyx?

A

3-5 vertebrae

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21
Q

What are the structures on the anterior side of the sacrum?

A
  1. Base
  2. Sacral promontory
  3. Ala (wing)
  4. Anterior sacral foramina
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22
Q

What are the structures on the posterior side of the sacrum?

A
  1. Sacral canal
  2. Posterior sacral foramina
  3. Sacral hiatus
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23
Q

What are the crests on the posterior sacrum?

A
  1. Lateral sacral crest
  2. Median sacral crest
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24
Q

What is the articular surface on the posterior sacrum?

A

Articulation with the ilium at the sacroiliac joint

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25
Q

What is the tip of the coccyx called?

A

The apex

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26
Q

What is the superior border of the pelvic inlet?

A

Sacral promontory (S1)

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27
Q

What is the superior-medial border of the pelvic inlet?

A

Anterior edge of the sacral ala (sacrum)

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28
Q

What is the lateral border of the pelvic inlet?

A

Arcuate line (ilium)

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29
Q

What is the inferior-medial border of the pelvic inlet?

A

Pectineal line (pubis)

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30
Q

What is the inferior border of the pelvic inlet?

A

Superior edge of the symphysis pubis

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31
Q

What structures are in the same vertical plane?

A

ASIS and pubic tubercles

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32
Q

What structures are in the same horizontal plane?

A

Coccyx and upper margin of the pubic symphysis

33
Q

What is the angle of the pelvic inlet?

A

50-60 degrees (relative to horizontal plane)

34
Q

What are the ligaments of the pelvis?

A
  1. Sacrospinous ligament (SSL)
  2. Sacrotuberous ligament (STL)
  3. Inguinal ligament
35
Q

Where does the sacrospinous ligament run?

A

Sacrum to ischial spine

36
Q

What foramina is formed by the sacrospinous ligament?

A

The greater sciatic foramina

37
Q

Where does the sacrotuberous ligament run?

A

Sacrum to ischial tuberosity

38
Q

What foramina is formed by the sacrotuberous ligament?

A

The lesser sciatic foramina

39
Q

What is the function of the SSL and the STL?

A
  1. Prevent upward tilting of the distal sacrum
  2. Pull pelvis down
40
Q

What are the pelvic wall muscles?

A
  1. Piriformis
  2. Obturator internus
  3. Pelvic diaphragm
41
Q

What muscles makes up the pelvic diaphragm?

A
  1. Coccygeus
  2. Levator ani
42
Q

What is the function of the pelvic wall muscles?

A
  • Turn the pelvis into a “bowl”
  • Contain viscera
  • Seals off the lateral walls and floor
43
Q

What does the levator avi create?

A

The pelvic floor

44
Q

What are the muscles that make up the pelvic floor?

A
  1. Puborectalis
  2. Pubococcygeus
  3. Iliococcygeus
45
Q

Where does the puborectalis run?

A
  • Slings around rectum
  • From L to R superior pubic rami and OI fascia
46
Q

Where does the pubococcygeus run?

A
  • Superior pubic rami and OI fascia to coccyx
  • L/R meet at median fibrous ridge
47
Q

Where does the iliococcygeus run?

A

Ischium/OI fascia to coccyx and fibrous ridge (L/R)

48
Q

What are the functions of the levator ani and coccygeus muscles?

A
  1. Support abdominopelvic viscera
  2. Control urinary/fecal continence
  3. Increase intra-abdominal pressure
49
Q

What are the two hiatuses created by the left and right levator ani?

A
  1. Rectus hiatus
  2. Urogenital hiatus
50
Q

What is the rectal hiatus for?

A

Rectum/anal canal

51
Q

What is the urogenital hiatus for?

A

Urethra and vagina

52
Q

What type of organ is the upper 1/3 of the rectum?

A

Intraperitoneal

53
Q

What type of organ is the middle 1/3 of the rectum?

A

Retroperitoneal

54
Q

What type of organ is the lower 1/3 of the rectum?

A

Sub-peritoneal

55
Q

What are the sections of the rectum?

A
  1. Rectum
  2. Rectal ampulla
56
Q

What structures is present in the rectum?

A

Transverse folds

57
Q

What separates the rectum and the anal canal?

A

Anorectal junction

58
Q

What are the structures present in the anal canal?

A
  1. Anal columns
  2. Sinuses
  3. Valves
59
Q

What do the sinuses do?

A

Secrete mucus

60
Q

What do the valves do?

A

Mark the transition from mucosa to skin

61
Q

What are the muscles that play a role on the anal canal?

A
  1. Puborectalis
  2. External anal sphincter (voluntary)
  3. Internal anal sphincter (involuntary)
62
Q

What pulls the anorectal junction forward?

A

Tonic/constant contraction of the puborectalis

63
Q

What does the forward pull on the anorectal junction ensure?

A

Fecal continence

64
Q

How is fecal continence ensured?

A
  • Creating a ~90 degree angle at the anorectal junction
  • Seals off the anal canal
65
Q

What does relaxation of the puborectalis lead to?

A
  • Increase intra-abdominal pressure
  • Straightening of the anorectal junction (120-140 degrees)
  • Relaxation of internal and external anal sphincters
  • Voiding
66
Q

Where is the urinary bladder located?

A

Lies anterior to the rectum, sub-peritoneally

67
Q

Where is the urinary bladder located when empty?

A

Fully within the pelvic cavity (true pelvis)

68
Q

Where is the urinary bladder located when full?

A

Expands into the abdominal cavity (false pelvis)

69
Q

What is the shape of the urinary bladder?

A
  • 3-sided pyramid
  • Tipped over with apex pointed to the pubic symphysis
70
Q

What are the structures of the urinary bladder?

A
  1. Body (anterior)
  2. Base (posterior)
  3. Fundus
  4. Apex
  5. Median umbilical ligament
  6. Ureters
  7. Urethra
71
Q

What is the median umbilical ligament a remnant of?

A

Urachus: Fetal connection to umbilicus for urine removal

72
Q

For an assigned female at birth, what structures are present for the urinary bladder?

A
  1. Ureteric orifices
  2. Interuteric ridge
  3. Trigone
  4. Internal urethral orifice
  5. Urethra
  6. External urethral orifice
73
Q

What are the sphincters of the urinary bladder for an AFAB?

A
  1. Internal urethral sphincter (involuntary)
  2. External urethral sphincter (voluntary)
74
Q

What muscle lines the urinary bladder?

A

Detrusor muscle

75
Q

Where is the uterus located in an AFAB?

A

Between the bladder and rectum

76
Q

What structures are found in an assigned male at birth?

A
  1. Seminal vesicles
  2. Prostate glands
77
Q

What is the difference between an AFAB and an AMAB urethra?

A

Urethra longer in AMAB

78
Q

Where does the abdominal portion of the ureter pass?

A

Posterior to the gonadal vessels (at iliac crest)

79
Q

Where does the ureter enter the pelvis?

A

By crossing anterior to the bifurcation of the common iliac artery