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Flashcards in Pelvis Deck (29):
1

PELVIS
Four bones: 2 hip bones, sacrum, coccyx
Pelvic brim/inlet
- anterior: ______________
- _________: ileopectineal line
- _________: sacral promontory
________ the pelvic brim/inlet: False/greater pelvis or pelvis major
________ the pelvic brim/inlet: True/lesser pelvis or pelvis minor

PELVIS
Four bones: 2 hip bones, sacrum, coccyx
Pelvic brim/inlet
- anterior: symphysis pubis
- lateral: ileopectineal line
- posterior: sacral promontory
Above the pelvic brim/inlet: False/greater pelvis or pelvis major
Below the pelvic brim/inlet: True/lesser pelvis or pelvis minor

2

_______ Pelvis
- forms part of the abdominal cavity
- bounded by the ________ vertebra, laterally by the _______ fossa and ________ muscle, and anteriorly by the anterior abdominal wall

False Pelvis
- forms part of the abdominal cavity
- bounded by the lumbar vertebra, laterally by the iliac fossa and iliacus muscle, and anteriorly by the anterior abdominal wall

3

Pelvic outlet
- ant: pubic arch
- lat: _____________
- post: tip of coccyx

Pelvic outlet
- ant: pubic arch
- lat: ischial tuberosities
- post: tip of coccyx

4

Female or male pelvis?
1) shallow false pelvis
2) oval pelvic inlet
3) bigger pelvic cavity
4) shorter, wider, flatter sacrum
5) rounded and wider pubic arch

1-5) female

5

MEASUREMENTS OF THE PELVIC INLET
________ conjugate diameter - from sacral promontory to the inferior margin of the pubic symphysis; measure during obstetric examination; adequate: greater than _____ cm
________ conjugate diameter - from sacral promontory to the superior margin of the pubic symphysis; adequate: greater than _____ cm
Obstetric conjugate diameter - adequate: greater than _____ cm

MEASUREMENTS OF THE PELVIC INLET
Diagonal conjugate diameter - from sacral promontory to the inferior margin of the pubic symphysis; measure during obstetric examination; adequate: greater than 11.5 cm
True conjugate diameter - from sacral promontory to the superior margin of the pubic symphysis; adequate: greater than 11 cm
Obstetric conjugate diameter - adequate: greater than 10 cm

6

MEASUREMENTS of the PELVIC OUTLET
______________ diameter
- distance between ischial tuberosities
Interspinous diameter
- distance between _______ spines
- if less than ____ cm, may present as barrier to the fetus during childbirth

MEASUREMENTS of the PELVIC OUTLET
Transverse diameter
- distance between ischial Tuberosities
Interspinous diameter
- distance between ischial spines
- if less than 9.5 cm, may present as barrier to the fetus during childbirth

7

TYPES OF PELVIS
___________ - typical
___________ - male or funnel-shaped pelvis, heart-shaped inlet, contracted outlet
___________ - long narrow oval-shaped
___________ - wide pelvis flattened at the brim with the promontory of the sacrum pushed forward

TYPES OF PELVIS
Gynecoid - typical
Android - male or funnel-shaped pelvis, heart-shaped inlet, contracted outlet
Anthropoid - long narrow oval-shaped
Platypelloid - wide pelvis flattened at the brim with the promontory of the sacrum pushed forward

8

Contents of PELVIC CAVITY common to both females and males: (4)

Contents of PELVIC CAVITY common to both females and males:
Urinary bladder
Ureters
Sigmoid colon
Rectum

9

The ________________ and ________________ ligaments divide the sciatic notch into:
- ________ sciatic foramen - more superior
- ________ sciatic foramen

The sacrotuberous and sacrospinous ligaments divide the sciatic notch to:
- greater sciatic foramen - more superior
- lesser sciatic foramen

10

Which stuctures pass both through the greater sciatic foramen and lesser sciatic foramen? (3) must-know

What other structure passes through the lesser sciatic foramen (but not the greater sciatic foramen)?

Pudendal nerve
Nerve to obturator internus
Internal pudendal vessels

Tendon of obturator internus

11

What nerve enters the greater sciatic foramen and goes superior to the piriformis muscle?

Superior gluteal nerve (along with superior gluteal vessels)

12

PELVIC OUTLET
- closed except where it transmits the urethra and anal canal and (in females) vagina

The _________________ is a superficial muscular sheet that spans the outlet of the pelvis. It fills the space within the pubic arch.

The __________________ is composed of muscle fibers of the levator ani, the coccygeus muscle, and associated connective tissue which span the area underneath the pelvis.

PELVIC OUTLET
- closed except where it transmits the urethra and anal canal and (in females) vagina

The urogenital diaphragm is a superficial muscular sheet that spans the outlet of the pelvis. The urogenital diaphragm fills the space within the pubic arch.

The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus muscle, and associated connective tissue which span the area underneath the pelvis.

13

PELVIC DIAPHRAGM
Levator ani - composed of: (3)
Coccygeus

PELVIC DIAPHRAGM
Levator ani - composed of:
-- puborectalis
-- pubococcygeus
-- iliococcygeus
Coccygeus

14

LEVATOR ANI Nerve Supply
- pelvic side - lower sacral nerve
- perineal side - inferior hemorrhoidal nerve

LEVATOR ANI Nerve Supply
- pelvic side - lower sacral nerve
- perineal side - inferior hemorrhoidal nerve

15

The line between the ischial ____________ divides the perineum into the genitourinary and anal triangles.

The line between the ischial tuberosities divides the perineum into the genitourinary and anal triangles.

16

PERINEUM
- inferior to the pelvic outlet
- separated from the pelvic cavity by the pelvic diaphragm
Boundaries:
-- anterior: __________
-- anterolateral: _______ rami and _______ rami
-- lateral: ________ tuberosities
-- inferior: sacrum and coccyx
Triangles:
-- urogenital triangle - contains:
----- in females: external genitalia and orifices of ________ and ________
----- in males: root of scrotum and penis, urogenital passages
-- anal triangle - contains:
----- anal canal
----- external anal sphincter
----- _________________ (fat-filled space located lateral to the anal canal and inferior to the pelvic diaphragm)
Perineal body (a.k.a. central perineal tendon): midpoint, site of convergence of _________________, ___________________, and superficial and deep transverse perineal muscles

PERINEUM
- inferior to the pelvic outlet
- separated from the pelvic cavity by the pelvic diaphragm
Boundaries:
-- anterior: symphysis pubis
-- anterolateral: pubic rami and ischial rami
-- lateral: ischial tuberosities
-- inferior: sacrum and coccyx
Triangles:
-- urogenital triangle - contains:
----- in females: external genitalia and orifices of urethra and vagina
----- in males: root of scrotum and penis, urogenital passages
-- anal triangle - contains:
----- anal canal
----- external anal sphincter
----- ischioanal fossae
Perineal body: midpoint, site of convergence of bulbospongiosus, external anal sphincter and superficial and deep transverse perineal muscles

17

EPISIOTOMY - incision of the posterior wall of the vagina
Median episiotomy - extends posteriorly in the midline through the _______ body
Mediolateral episiotomy - extends through the _______________ and __________________ muscles; less risk incising the fibers of the external anal sphincter

EPISIOTOMY - incision of the posterior wall of the vagina
Median episiotomy - extends posteriorly in the midline through the perineal body
Mediolateral episiotomy - extends through the bulbospongiosus and transverse perineal muscles; less risk incising the fibers of the external anal sphincter

18

ISCHIOANAL FOSSAE
- fat-filled wedge-shaped space located _______ to the anal canal and ________ to the pelvic diaphragm
Boundaries:
- base: skin overlying anal triangle
- lateral: ______________ muscle
- medial: levator ani
Contents:
- fats
- ________________ vein, artery, and nerve
- perineal branch of the _________________ nerve

ISCHIOANAL FOSSAE
- fat-filled wedge-shaped space located lateral to the anal canal and inferior to the pelvic diaphragm
Boundaries:
- base: skin overlying anal triangle
- lateral: obturator internus muscle
- medial: levator ani
Contents:
- fats
- inferior rectal vein, artery, and nerve
- perineal branch of the femoral cutaneous nerve

19

PERINEAL FASCIA - continuous anteriorly with the fascia of the abdomen
Superficial perineal fascia
-- superficial fatty layer (________ fascia) - makes the substance of the mons pubis and labia majora
-- deep membranous layer (_________ fascia)
Deep perineal fascia

PERINEAL FASCIA - continuous anteriorly with the fascia of the abdomen
Superficial perineal fascia
-- superficial fatty layer (Scarpa's fascia) - makes the substance of the mons pubis and labia majora
-- deep membranous layer (Colles' fascia)
Deep perineal fascia

20

SUPERFICIAL PERINEAL SPACE/POUCH (must-know)
- between ________ fascia and ________ fascia of the urogenital diaphragm

DEEP PERINEAL SPACE/POUCH (must-know)
- between _________ and _________ fascia of the urogenital diaphragm

SUPERFICIAL PERINEAL SPACE/POUCH (must-know)
- between Colles' fascia and inferior fascia of the urogenital diaphragm

DEEP PERINEAL SPACE/POUCH (must-know)
- between superior and inferior fascia of the urogenital diaphragm

21

Contents of deep perineal space common to both females and males: (3)

Internal pudendal vessels
Sphincter urethral muscle
Deep transverse perineal muscle

22

In the superficial or deep perineal space?
1) bulbourethral gland, membranous urethra, dorsal nerve of penis
2) part of urethra, part of vagina, dorsal nerve of clitoris

1-2) deep

23

The internal iliac artery branches can be divided into anterior and posterior divisions. What are the three branches found in the posterior division?

Iliolumbar
Lateral sacral
Superior gluteal

24

A mass has compressed the common iliac artery. To which of the following structures will arterial supply be unaffected?
A. Detritus or muscle
B. Gluteus Maximus muscle
C. Testis
D. Rectus abdominis muscle
E. Corpus spongiosum

C. Testis - supplied by the gonadal artery from the abdominal aorta

25

The _______________ artery is one of the three pudendal arteries that branch off the internal iliac artery, providing blood to the external genitalia (penis, clitoris, etc). It gives rise to the perineal and inferior rectal arteries among others.

The superficial external pudendal artery arises from the medial side of the femoral artery. It supplies the male _________ and the female _________.

The internal pudendal artery is one of the three pudendal arteries that branch off the internal iliac artery, providing blood to the external genitalia (penis, clitoris). It gives rise to the perineal and inferior rectal arteries among others.

The superficial external pudendal artery arises from the medial side of the femoral artery. It supplies the male scrotum and the female labia majora.

26

PELVIC VEINS
All branches of the internal iliac arteries are accompanied by corresponding veins which drains into the internal iliac vein, except the __________ artery which has no accompanying vein.

PELVIC VEINS
All branches of the internal iliac arteries are accompanied by corresponding veins which drains into the internal iliac vein, except the umbilical artery which has no accompanying vein.

27

PUDENDAL NERVE (must-know)
- leaves the main pelvic cavity through the ________ sciatic notch and enters the perineum through the ________ sciatic foramen.
- branches:
---- ________ rectal nerve: mucous membrane of the lower anal canal, external anal sphincter, perianal skin
---- dorsal nerve of ___________
---- ________ nerve: perineal muscles and skin

PUDENDAL NERVE (must-know)
- leaves the main pelvic cavity through the greater sciatic notch and enters the perineum through the lesser sciatic foramen.
- branches:
---- inferior rectal nerve: mucous membrane of the lower anal canal, external anal sphincter, perianal skin
---- dorsal nerve of penis/clitoris
---- perineal nerve: perineal muscles and skin

28

PUDENDAL NERVE BLOCK
- may be performed to suppress labor pain by anesthetizing the _________ nerve as it crosses the _______ spine
- Pain of childbirth is transmitted through sensory fibers of S__-S__
- To abolish pain from the anterior part of the perineum, an __________ nerve (branch of the anterior rami of the L1 spinal nerve) block is performed.
- Transvaginal Approach:
--- Index finger is inserted through the vagina to palpate the ischial _________
--- Needle is passed through vaginal mucous membrane through the ischial _________
---- In passing through the ______________ ligament, the anesthetic solution is injected.
- Perineal procedure:
---- Bony landmark is the ischial __________
---- The tuberosity is palpated subcutaneously through the buttock and the needle is introduced into the pudendal canal along the _______ side of the _________
---- Canal lies about 1 _____ deep to the free surface of the tuberosity
---- Local anesthetic is then infiltrated around the pudendal nerve.

PUDENDAL NERVE BLOCK
- may be performed to suppress labor pain by anesthetizing the pudendal nerve as it crosses the ischial spine
- Pain of childbirth is transmitted through sensory fibers of S2-S5
- To abolish pain from the anterior part of the perineum, an ilioinguinal nerve (branch of the anterior rami of the L1 spinal nerve) block is performed.
- Transvaginal Approach:
--- Index finger is inserted through the vagina to palpate the ischial spine
--- Needle is passed through vaginal mucous membrane through the ischial spine
---- In passing through the sacrospinous ligament, the anesthetic solution is injected.
- Perineal procedure:
---- Bony landmark is the ischial tuberosity
---- The tuberosity is palpated subcutaneously through the buttock and the needle is introduced into the pudendal canal along the medial side of the tuberosity
---- Canal lies about 1 inch deep to the free surface of the tuberosity
---- Local anesthetic is then infiltrated around the pudendal nerve.

29

MOTOR FUNCTIONS of the PUDENDAL NERVE (S__-S__)
- maintains voluntary _______ continence
- maintains voluntary _______ continence
- supports pelvic viscera
- maintains erection
- facilitates expulsion of urine from the penile urethra during micturition, sperm and seminal fluid during ejaculation

MOTOR FUNCTIONS of the PUDENDAL NERVE (S2-S4)
- maintains voluntary urinary continence
- maintains voluntary fecal continence
- supports pelvic viscera
- maintains erection
- facilitates expulsion of urine from the penile urethra during micturition, sperm and seminal fluid during ejaculation