Pelvis Flashcards Preview

Anatomy > Pelvis > Flashcards

Flashcards in Pelvis Deck (93):
1

Label these bony parts of the hip bone.

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2

Label these parts of the ilium.

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3

Label these parts of the ischium.

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4

Label these parts of the pubis.

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5

Label the ligaments of the pelvis.

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6

What is the purpose of the sacrospinous and scarotuberous ligaments?

They ensure the inferior part of the sacrum is not pushed superiorly when weight is suddenly transferred vertically through the vertebral column (e.g. when jumping or during late pregnancy)

7

Which foraminae does the presence of the sacrospinous and sacrotuberous ligaments create in the pelvis?

The greater and the lesser sciatic foramen

8

What bones make up the pelvic inlet?

-sacral promontory

-ilium

-superior pubic ramus

-pubic symphysis

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9

What structures make up the pelvic outlet?

-pubic symphysis

-ischiopubic ramus

-ischial tuberosities

-sacrotuberous ligaments

-coccyx

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10

What organs of the female reproductive system lie within the pelvic cavity?

-Ovaries

-Uterine tubes

-Uterus

-Superior part of vagina

11

What organs of the female reproductive system are found in the perineum?

-Inferior part of vagina

-Perineal muscles

-Bartholin's glands

-Clitoris

-Labia

12

Label these structures.

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13

What is the broad ligament and where is it found?

A double layer of peritoneum that extends between the uterus and the lateral walls and floor of the pelvis

14

What structures are contained within the broad ligament?

Uterine tubes

Proximal part of the round ligament

15

Decribe the bony attachments of the sacrospinous ligament.

Sacrum to ischeal spine

16

Describe the bony attachments of the sacrotuberous ligament.

Sacrum to ischeal tuberosity

17

How does the male pelvis differ from the female pelvis?

More prominent sacral promontory

More curved coccyx

Narrower, taller pelvic cavity

Narrower pelvic inlet and outlet

Thicker, more robust bones

 

 

18

When may it be necessary to palpate bony landmarks of the pelvis?

Ischeal spines (internally) - landmark to guide pudendal nerve block (S2,3,4)

Pubic symphysis - to measure symphysis fundal height

19

Describe the relationship between the ischial spine and the pudendal nerve.

Travels from the sacrum through the greater sciatic formen, and loops around the sacrospinous ligament before reentering the pelvis through the lesser sciatic foramen

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20

Which structures does the pudendal nerve innervate and which spinal cord levels does the nerve originate from?

S2, 3, 4

Supplies: clitoris and other perineal structures

21

How can fluid collection in the pouch of Douglas be drained?

Via needle aspiration passed through the posterior fornix of the vagina

22

What are the attachments of the round ligament?

Attaches to the lateral aspect of the uterus, and then passes through the deep inguinal ring to attach to the superficial tissue of the female perineum

23

What are the three layers of the uterus?

perimetrium

myometrium

endometrium

24

What are the three layers of support that hold the uterus in place?

- ligaments (e.g. uterosacral ligaments)

- endopelvic fascia

- muscles of the pelvic floor (e.g. levator ani)

 

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25

What is the most common position of the uterus?

Anteverted and anteflexed

26

What does anteverted mean?

 Uterus tipped anteriorly relative to the axis of the vagina

27

What does anteflexed mean?

Uterus tipped anteriorly relative to the axis of the cervix (the mass of the uterus lies over the bladder)

28

Where do the ovaries develop and what structure moves them to their final position?

Develop on the posterior abdominal wall and move onto the lateral wall of the pelvis

Round ligament of the uterus

29

What is the nerve supply of the levator ani?

Nerve to levator ani, S3, 4, 5 sacral plexus

30

What is the perineal body?

A bundle of collagenous and elastic tissue into which the perineal muscles attach

31

What is this structure?

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Bartholins gland

32

What are the muscles labelled?

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33

What is the rectus sheath?

A strong fibrous layer immediately deep to the superficial fascia, consisting of the combined aponeuroses of anterolateral abdominal wall muscles

34

What muscles does the rectus sheath surround?

Rectus abdominis muscles

35

What is the difference in the rectus sheath above and below the umbilicus?

Above the umbilicus there is an anterior and posterior rectus sheath

Below the umbilicus there is only anterior

36

Which level do the iliohypogastric and ilioinguinal nerve come from and in which direction do they travel?

L1

Travel in plane between internal oblique and transversus abdominis

37

Which artery is the suprior epigastric artery a continuation of and where can it be found?

Internal thoracic artery

Lies posterior to rectus abdominus

38

Which artery is the inferior epigastric artery a branch of?

External iliac artery

39

What layers must be opened to perform a lower section cesarean section (LSCS)?

-Skin and fascia

-(anterior) Rectus sheath

-Rectus abdominis – separate the muscles laterally

-Fascia and peritoneum

-Retract bladder (a urinary catheter is usually already inserted)

-Uterine wall

-Amniotic sac

40

What layers must be stitched closed following an LSCS?

-Uterine wall with visceral peritoneum

-Rectus sheath

-(Fascial layer if increased BMI)

-Skin

41

What artery must be avoided when inserting a lateral port during laparoscopy?

Inferior epigastric artery

42

How can the inferior epigastric artery be avoided during laparoscopy?

 Artery emerges just medial to the deep inguinal ring (located half way between ASIS and pubic tubercle)

Insert port laterally to this

43

What kind of nerve supply does the pelvis have?

Sympathetic, parasympathetic and visceral afferent

44

What kind of nerve supply does the perineum have?

Somatic motor and somatic sensory

45

What is the sensory supply to the superior part of the pelvis, and what defines this?

Superior part defined as 'touching the peritoneum'

Visceral afferents run alongside sympathetic fibres

 

46

What level of the spinal cord do the visceral afferents from the superior pelvis enter?

T11-L2

47

What is the sensory nerve supply of the inferior aspect of the pelvic organs?

Visceral afferents running alongside parasympathetic fibres

48

Which level of the spinal cord do the visceral afferents supplying the inferior part of the pelvic organs enter?

S2, S3 and S4

49

At what level does the subarachnoid space end?

S2

50

At what level does the spinal cord become the cauda equina?

L2

51

What level is the anaesthetic injected in a spinal/epidural procedure?

Subarachnoid space of L3-L5

52

What structures does the needle pass through to administer a spinal anaesthetic??

-supraspinous ligament

-interspinous ligament

-ligamentum flavum

-epidural space (fat and veins)

-dura mater

-arachnoid mater

 

53

How may a mediolateral episiotomy reduce the risk of faecal incontinence developing after a difficult vaginal delivery?

Tear can be directed away from the anus

54

What is the mahjor structure incised during a median episiotomy and what potential issues are faced if further tearing occurs?

Perineal body

Urgence, flatulence, faecal incontinence

55

Which nerve block could be performed to abolish sensation from the anterior aspect of the perineum?

Ilioinguinal

Posterior cutaneous femoral nerve

56

How does a spinal anaesthetic differ from an epidural anaesthetic?

Epidural injected into epidural space and acts on the rootlets passing through rather than the cord itself

Spinal anaesthetic injected into the subarachnoid space

57

What are the potential side effects of a spinal or epidural anaesthetic?

Temporary paralysis/immobility

Dural headache

Hypotension

58

What is the pudendal canal?

A passageway within the obturator fascia

Contains the pudendal nerve, internal pudenal artery and vein and the nerve to obturator internus

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59

Into which structure is an episiotomy incision made?

Ischioanal fossa

60

What are the three layers of the pelvic floor?

pelvic diaphragm

muscles of perineal pouches

perineal membrane

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61

What muscles make up the levator ani?

Puborectalis

Pubococcygeus

Iliococcygeus

62

Label these muscles.

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63

What nerves innervate the levator ani?

Pudendal nerve

Nerve to levator ani

64

What is this structure?

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Tendinous arch of levator ani

65

What muscle forms the tendinous arch of levator ani?

Obturator internus

66

What is the origin and insertion of the piriformis muscle?

Origin: pelvic surface of sacrum

Insertion: superior aspect of greater trochanter

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67

What is the origin and insertion of the obturator internus muscle?

Origin: ischiopubic ramus & obturator membrane

Insertion: medial aspect of the greater trochanter

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68

What is the obturator membrane?

The obturator membrane is a thin fibrous sheet, which almost completely closes the obturator foramen

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69

Label these structures.

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70

Where is the deep perineal pouch located?

Lies below the fascia covering the inferior aspect of the pelvic diaphragm

Lies above the perineal membrane

 

71

What is contained in the deep perineal pouch?

Contains part of the urethra and vagina in females

 Bulbourethral glands in male

Neurovascular bundle for penis/clitoris

Extensions of the ischioanal fat pads and muscles

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72

What is the difference between the deep transverse perineal muscle in males and females?

In females this is smooth muscle

In males this is skeletal muscle

73

Label these structures.

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74

What structures are the last passive support for the pelvic organs?

Perineal body

Perineal membrane

75

What is the perineal membrane?

Thin sheet of touch, deep fascia located superficially to the deep perineal pouch

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76

Where does the perineal membrane attach laterally?

Pubic arch

77

What structures are contained in the superficial perineal pouch of the male?

Root of penis:

Bulb – corpus spongiosum

Crura – corpus cavernosum

Associated muscles – bulbospongiosus and ischiocavernosus

Proximal spongy (penile) urethra

Superficial transverse perineal muscle

Branches of internal pudendal vessels and pudendal nerve

78

Label these structures.

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79

Label these structures.

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80

Label these structures.

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81

Label these arteries.

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82

The majority of arteries of the pelvis and perineum arise from the internal iliac, with the exception of which two arteries?

Gonadal

Superior rectal

83

What arteries arise from the posterior division of the internal iliac artery?

Gluteal

84

What arteries arise from the anterior divison of the internal iliac artery?

Obturator artery

Superior vesical arterie

Inferior vesical artery/vaginal artery

Internal pudendal artery

85

Most arteries in the male perineum arise from the internal pudendal artery, with the exception of which artery?

Anterior scrotal artery - comes from external iliac

86

What is the significant anastamosis in the female pelvis and why?

Anastamosis between uterine and ovarian artery

Uterine artery comes from internal iliac

Ovarian artery comes from abdominal aorta

87

Why might prostate cancers spread to the cranial cavity?

Venous drainage of prostate occurs through lateral sacral veins, which have no valves

88

Describe the venous drainage of the pelvis.

Drain mainly to internal iliac vein:

 - some will drain via superior rectal into hepatic portal system

 - some will drain via lateral sacral veins into internal vertebral venous plexus

89

What is the drainage of the gonadal veins?

Right - drains directly into IVC

Left - into left renal vein

90

Why does ureter damage in females during surgery more commonly occur on the left than the right?

The right usually crosses the external iliac, the left is more medial and crosses common iliac

91

Where does lymph from the superior pelvic viscera drain?

- external iliac nodes

  - common iliac, aortic, thoracic duct

-,venous system

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92

Where does lymph from the inferior pelvic viscera drain?

- deep inguinal

  - internal iliac nodes

  - common iliac, aortic, thoracic duct, venous system

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93

Where does lymph from the superficial perineum drain??

Superficial inguinal nodes