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Flashcards in Pelvic Contents Deck (27)
1

Label

2

Label

3

Label Sacrum

5x vertebrae fused
4x paired foramen (nerve passage)

4

Label posterior sacrum

5

What makes up the pelvic inlet. What is this the boundary of?

  • Sacral promontory
  • Alae of sacrum
  • Arcuate line
  • Pectineal line
  • Pubic tubercle
  • Pubic Crest
  • Pubic symphysis

Above this= false pelvis
Below this= true pelvis

6

Describe the 'Pelvic Tilt'

~60 degree tilt anteriorly.

ASIS in line with Pubic tubercle

(sacrum also tilted)

7

What are the pelvic boundaries?

Ant, Post and Lat = bone

Floor = muscular (pelvic diaphragm)

8

Male/female variation of the pelvis

9

What forms the greater and lesser sciatic foramen?

Sacrospinous and sacrotuberous ligaments

10

Other ligaments of the pelvis?

Posterior sacroiliac ligament: fibrous (for strength)

Anterior sacroiliac ligament: synovial

Pubic symphysis

11

Muscles of the pelvic wall

Piriformus and Obturator Internus 

OI: fills entire obturator foramen except obturator canal, has 90 degree bend

12

Draw out the vessel passages through the greater and lesser sciatic foramen.

13

Journey of Pudendal Nerve and vessel

Leave through Greater sciatic foramen, loop under and around sacrospinous ligament and re-enter below pelvic floor into perineum

14

Label nerves. Why do we need to know where these are?

Superior Gluteal Nerve: at risk during lateral approach to surgery

Sciatic Nerve: at risk during intramuscular injection

15

Draw the branching of the anterior division!

Don't learn the pattern!!

16

Male/female differences of the anterior division of the internal iliac

Male: inferior vesical + middle rectal supply prostatem seminal vesicles and ductus deferens.
Testicular arteries from abdo aorta @L2

 

Female: uterine artery gives off vaginal artery (supplies femal genitalia)

17

Draw branches of the posterior division

To superior gluteal → GSF above piriformis

18

Venous drainage of the pelvis (EASY)

ALL draining to the Internal Iliac Veins

 

Exception: Deep dorsal vein of the penis/clitoris, drsins through deficiency in perineal membrane → vesical/prostatic plexuses

19

The sacral plexus

S1-4 is joined by L4-5 (lumbrosacral trunk), although it's mostly going to structures external of the pelvis, some are important!

  • Gluteal Nerves
  • Sciatic Nerves
  • Nerves to Levator Ani and Coccygeus
  • Pudendal Nerves

20

Gluteal Nerves

Superior Gluteal (L4,L5,S1): to gluteus medius and minimus

Inferior Gluteal (L5,S1,S2): to gluteus maximus

Passing above and below piriformis

21

Sciatic Nerves

L4-S3

Tibial always leaves below piriformis

Common peroneal can be above, below or thorugh

22

Nerves to Levator Ani (direct S3-4) and Coccygeus

 

 

  • Direct branches of sacral plexus
  • Lie atop muscle → risk of damage → risk of prolapse

23

Pudendal Nerve

"S2,3,4 keeps the penis off the floor

  • Supplies everything in perineum (M and S)

24

Branches of the Pudendal Nerve

  • Inferior rectal
  • Perineal
  • DOrsal nere to clitoris/penis
  • Scrotal/labial

25

2 Plexuses of the ANS to the pelvic Viscera

  1. Superior Hypogastric : Sits on anterior body of L5 and sacral 
  2. Inferior Hypogastric: on pelvic Floor (compression risk!)

 

26

Sympathetic supply to pelvic viscera

L1/2 fibres descends into pelvis via Sup. hypogastric and sacral splanchnic. Splits to form two big right and left hypogastric nerves

  • Contract int urethral and anal sphincters (continence)
  • Ejaculation
  • Moves secretions along epididymis

27

Parasympathetic supply via pelvic viscera

S2-4, ascend via HG nerves → sup. hypogastric plexus → abdomen

Direct into Inf. HG

  • Vasodilation (for erection)
  • Bladder contraction