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Flashcards in Pelvis Deck (27):
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Fusion of S1-5

Sacrum

1

Has 2 coxal (hip) bones

3 parts: Ischium, ileum & pubis that join at the acetabulum of the hip joint

Bony pelvis

2

Transmit the dorsal primary rami of the sacral spinal nerves

Dorsal sacral foramina

3

Transmit the ventral primary rami of sacral spinal nerves

Ventral sacral foramina

4

Formed when laminae of S5 vertebra do not fuse

Sacral hiatus

5

Formed by pedicles

Landmarks in locating sacral hiatus for administration of caudal anesthesia

Sacral cornua

6

Fusion of vertebrae Co1-4

Coccyx (tailbone)

7

From sacrum to ischial tuberosity

Sacrotuberous ligament

8

From sacrum to ischial spine

Sacrospinous ligament

9

Divided by the PIRIFORMIS muscle into suprapiriformis recess & infrapiriformis recess

Structures transmitted:
- superior gluteal vein, artery & nerve
- Piriformis muscle
- inferior gluteal vein, artery & nerve
- sciatic nerve
- internal pudendal vein & artery
- pudendal nerve

Greater sciatic foramina

10

Structures transmitted:
- internal pudendal vein & artery
- pudendal nerve

The structures exit the pelvic cavity through greater sciatic foramen --> reenter the pelvic cavity through the lesser sciatic foramen --> proceed to the perineum

Lesser sciatic foramina

11

Defined by:
- Sacral promontory (S1)
- Linea terminalis - includes the pubic crest, iliopectineal line & arcuate line

Divides the pelvic cavity into 2 parts:
- major (false) pelvis - above the pelvic inlet between the iliac crests, part of abdominal cavity
- minor (true) pelvis - below the pelvic inlet & extends to the pelvic outlet

Measurements:
- true conjugate diameter - from sacral promontory to superior margin of pubic symphysis
- diagonal conjugate diameter - from sacral promontory to inferior margin of pubic symphysis

Pelvic inlet

12

Defined by coccyx, ischial tuberosities, inferior pubic ramus & pubic symphysis

Closed by the pelvic diaphragm & urogenital diaphragm

Measurements:
- Transverse diameter - distance between the ischial tuberosities
- Interspinous diameter - between ischial spines, contracted if

Pelvic outlet

13

Support of the pelvic organs

- Pelvic diaphragm (floor)
- Urogenital diaphragm muscle
- transverse cervical ligament (Cardinal ligament of MACKENRODT)
- uterosacral ligament
- pubocervical ligament

14

Coccygeus muscle & levator ani muscles (iliococcygeus, pubococcygeus & puborectalis)

Pelvic diaphragm

15

Forms as a U-shaped sling around the anorectal junction, causing a 90* perineal flexure; important for fecal continence

Puborectalis

16

Deep transverse perineal muscle

Sphincter urethra muscle

Urogenital diaphragm muscle

17

Thickening of the endopelvic fascia

Laterally from cervix to the sidewall of the pelvis

Transverse cervical ligament (Cardinal ligament of MACKENRODT)

18

From cervix to the sacrum

Uterosacral ligament

19

From cervix to pubic symphysis

Pubocervical ligament

20

Weakening of support of pelvic organs

- cystocele
- Rectocele
- uterine prolapse
- risk factors: multiparity, birth trauma, ⬆️ intraabdominal pressure from obesity, heavy lifting, chronic cough, menopausal loss of muscle tone
- SSX: heavy sensation in the lower abdomen, aggravated by heavy lifting, prolonged standing; urinary frequency/stress incontinence (leakage with coughing or sneezing)

Pelvic relaxation

21

1% lidocaine solution injected transvaginally or just lateral to the labia majora around the tip of ischial spine & through the sacrospinous ligament

Pain of Childbirth is transmitted by pudendal nerve via spinal nerves S2-5

Pudendal nerve block

22

Course of pudendal nerve

Exits the pelvic cavity through greater sciatic foramen

Travel around the posterior surface of ischial spine

Renters pelvic cavity through lesser sciatic foramen

Travels within the fascia of obturator internus muscle (pudendal nerve of Alcock) & divides into:
- perineal nerve
- posterior labial nerve
- inferior rectal nerve
- dorsal nerve of the clitoris

23

To obtain complete anesthesia of perineal region, the ff nerves must also be anesthesized:

Ilioinguinal nerve

Genitofemoral nerve

Perineal branch of posterior femoral cutaneous nerve

24

Basin and is more correctly applied to the skeleton of the region

Region of the trunk below the abdomen and meets the lower extremity

PELVIS

25

Surface landmarks

Iliac crest

Anterior superior iliac spine

Pubic tubercle - bony projection at the superior lateral border of the body of pubic bone

Symphysis pubis

Posterior superior iliac crest

26

MUST KNOW:
1. Brim
Ant - symphysis pubis
Lat - iliopectineal line
Post - sacral promontory

2. Above
False pelvis
Greater pelvis
Pelvis major

3. Below
True pelvis
Lesser oelvis
Pelvis minor

4. Pelvic inlet
Ant - symphysis pubis
Lat - iliopectineal line
Post - sacral promontory

5. Pelvic outlet
Ant - pubic arch
Lat - ischial tuberosities
Post - tip of coccyx

Must know!!