pelvis A Flashcards
(151 cards)
1
Q
What are the 4 portals for portal hyerptension
A
Left/right gastric vv , superior mesenteric v, inferior mesenteric v, paraumbilical v
2
Q
Where does the left/right gastric vv drain back to? and what organ does it effect if there is portal hypertension? (verices)
A
Esophageal v, to the Azygos to the SVC. Esophagus
3
Q
Where does the superior mesenteric v drain back to? and what organ does it effect in portal hypertension (verices)
A
Colic vv, tp the ascending lumbar v to the SVC. colon
4
Q
Where does the inferior mesenteric v drain back to? and what organ does it effect in portal hypertension? (verices)
A
Superior rectal v, middle/inferior rectal vv, IVC. rectum
5
Q
Where does the paraumbilical v drain back to? and what organ does it effect in portal hypertension? (verices)
A
periumbilical vv, inferior epigastric v, IVC. umbilicus
6
Q
Differences in male and female pelvis. MALE
A
Heavy bones, heart shaped pelvic inlet conical pelvic cavity ant/post oval pelvic outlet narrow (90 degrees) infrapubic angle narrow and deep iliac fossa
7
Q
Differences in male and female pelvis. FEMALE
A
Light bones oval pelvic inlet cylindrical pelvic cavity circular pelvic outlet wide (120 degrees) indrapubic angle wide and shallow iliac fossa
8
Q
what is Levator Ani muscle
A
puborectalis, m puboococcygeus m iliococcygeus m. floor of the pelvis with pelvic diaphram. same in both sexes except females with have another hiatus for vagina
9
Q
what is pelvic diaphragm?
A
levator ani mm + coccygeus m. floor of the pelvis.
10
Q
what is the pelvic outlet? what perineum triangles are in the pelvic outlet
A
the inferior hole of the pelvis. urogenital triangle and anal triangle
11
Q
what is in the urogenital, and anal triangle? which one is more superior?
A
Perineum. urogenital is more superior.
12
Q
what makes up the anal triangle?
A
sacrotuberous ligaments, sacrum, and imaginary line between the two triangles
13
Q
what makes up the urogenital triangle?
A
ischiopubic rami and imaginary line
14
Q
which anal sphincter is voluntary?
A
external
15
Q
which anal schinter is controled by autonomics?
A
Internal anal sphincter
16
Q
which autonomics is the internal anal sphincter innervated by?
A
pelvic and sacral sphlanchnic
17
Q
what nerve is the external anal sphincter innervated by?
A
pudendal nerves. somatic
18
Q
how many transverse folds do we have in the rectum? what do they do?
A
2 on the left 1 on the right
gives rise to the curvature of the pelvis
19
Q
ischioanal fossa is filled with what?
A
it is a fat filled space
20
Q
what muscle is the internal pudendal vasculature and pudendal nerve closely associated with?
A
obturator internus muscle
21
Q
what is the round ligament anaolgous to in males?
A
inferior scrotal ligament. a remnant of the gubernaculum. it is a content of the inguinal canal in females but is usally obliterated.
22
Q
bladder, uterine and rectum… which ones are anterior middle and posterior?
A
anterior: bladder
posterior: rectum
middle: uterus
23
Q
Deep pouch is surounded by?
A
superior UG fascia. and inferior UG fascia aka perineal membrane.
24
Q
what is the superfical pouch surounded by?
A
a fascia of perineum and the perineum membrane
25
what is the the crus of the clitoris or the penis covered by? point out the crus of the clitoris in the picture
ischiocavernosus muscle
26
what is the bulb of the clitoris covered by? and point out bulb of clitoris in the picture.
bulbospongius muscle
27
is the rectum intra, secondarily retro, or retro peritoneal?
retroperitoneal?
28
which side of the uterus are the eggs dispersed or emmineated
lateral side out towards the fimbrae
29
what is the path of a sperm trying to get to an egg?
up the uterine tube towards the ampulaie
30
what is the path of an egg trying to get fertilized?
ampulae isthmus and then the body of the uterus
31
usually the female pelvis is... retroverted or anteverted, anteflexed or retroflexed?
anteverted and anteflexed. anterior trajectory covering up the bladder
32
if someone tries a coathanger abortion what is one of the worst things that can happen?
puncture of the posterior fornix, because of the pouch of douglas,(the piercing of the peritenal cavity.
33
what does the ovarian ligament do?
teathers the internal pole of the ovary to the uterus
34
what does the suspensory ligament do?
teathers the external pole of the uterus to the pelvis. really helps suport the uterus superior to the vagina.
35
what makes up the broad ligament?
Mesosalpinx + Mesovarium + Mesometrium
36
what does the suspensory ligament carry with it?
the ovarian artery and vein
37
where do the ovarian arteries emerge from the aorta?
L2
38
what part of the broad ligament is in closest association to the ovary?
mesovarium
39
what part of the broad ligament is just inferior to the uterine tube?
mesosalpinx
40
what is the part of the broad ligament that is not in closes association to the ovary or the uterine tube but every thing else?
mesometrium
41
what is the majority of the broad ligament made up of?
mesometrium
42
what is in the superficial pouch in males?
crus of penis and bulb of penis
43
what is the crus of the penis directly adhered to?
ischiopubic rami
44
what is the bulb of the penis associated with?
the urethrea
45
what is the crus of the penis covered by?
ischiocavernosis muscle
46
what is the bulb of the penis covered by?
bulbospongiosis muscle
47
what is the supericial layer of the pelvis called in males?
Colle's fascia important in extravigation of urine
48
what weeks in the womb are sexes undifferential?
4-7. can see the genital tubercle and urogenital folds
49
what weeks in the womb are sexes can be distinguishable
9th week
50
what week in the womb is there complete differentiation?
week 12
51
what is the sequence of name changes the pudendal nerve has once it re enters the lesser sciatic foramen? point them out on the picture
inferior rectal nerve, perineal nerve, posterior labial/scrotal nerve, and dorsal clitoral/penial nerve
52
the pudendal nerve exits the _______ and re enters the \_\_\_\_\_\_
exits greater sciatic foramen
re enters the lesser sciatic foramen
53
what vertebrae does the pudendal nerve get contribution from?
S2-S4
54
label the arteries and veins.
Pudendal nerve
internal pudendal A/V
inferior rectal VAN
Perineal VAN
Posterior Labial/scrotal VAN
Dorsal Clitoral/penial VAN
answers on pelvis A slide 25
55
label corpus spongiosum and corpus cavernosium
56
what was corpus cavernosum dervived from? and what was corpus spongiosum dervied from?
corpus cavernosum- crus of the penis/clitoris
corpus spongiosum- bulb of the penis/clitoris
57
what is the spongy part of the urethra covered by?
corpus spongiosum and then tunica albuginea of corpus spongiosum
58
deep penile fascia is also known as what?
Bucks fascia
59
label this diagram
label it
60
what does the ejaculatory duct receive secretions from?
seminal vesicle (its own fluid) and ampulla of ductus deferens (sperm)
61
label
62
what is in the deep pouch of the perineum?
bulboeurethral glands, sphincter muscles, deep perineal nerves (dorsal nerve of the penis/clitoris, posterior labial or scrotal branches)
63
label
64
what brings sympathetic innervation to the hindgut? and which plexus and ganglia do they go to?
lumbar splanchnic nerves. inferior mesenteric plexus and ganglia
65
the postganglionic fibers of the lumbar splanchnics innervates what?
descending colon to rectum
66
what do sacral splanchnics do?
sympathetic innervation to pelvic visceral
67
what do pelvic splanchnics do?
**parasympathetic** innervation to eveything in pelvis
68
what innervates the gonads?
postganglionic fibers eminating from the superior mesenteric plexus
69
what innervates the kidneys and the suprarenal glands
aorticorenal ganglia
70
what spinal nerves does superior gluteal nerve derive from?
L4-S1
71
What spinal nerves do these nerves derive from?
inferior gluteal
piriformis
pudendal
obturator internus
quadratus femoris
inferior gluteal- L4-S1
Piriformis - S1-S3
Pudendal - S2-S4
Obturator internus -L5-S1
Quadratus Femoris L4-S1
72
what are the 3 fetal shunts?
1. Foramen Ovale
2. Ductus Arteriosus
**3. Ductus Venosus**
73
what is the retrouterine space and its clinical significance?
most inferior respect of perineal cavity. when you pierce through the posterior fornix and enter pariteal perineaum of the vagina doing a coat hanger abortion you are in this space. aka puch of douglas
74
what space is right between the sacrum and the rectum?
retrorectum space or pre sacral space
75
what space is right behind the uterus?
retrouterine space or prerectal sapce
76
what is synonymus with campers fascia?
telasubcutanea
77
what erectile tissue is associated with ischopubic rami?
crus of the penis/clitoris
78
what is in the superficial pouch?
eriectile tissue: crus and bulb of the penis of clitoris
79
what is in the deep pouch?
Superior UG fascia and Inferior UG fascia (or perineal membrane- just the inferior-) urethral sphincters.
80
what is the ductus venosus
fetal shunt that bypasses the liver. oxygenated blood from maternal circulation to fetal circulation. direct pathway from umbilical vein to the IVC.
81
what are hemroids?
venus vericees in rectal vasculature
82
what is the archistendidious?
tendinous ridge that is a tiebeam support for hysterectomy or pelvic surgery and reinforce the vagina upon removal of the uterus
83
does the bulbospongiosum muscle continues all the way down the penis?
no. it stops before the penis gives rise
84
label
85
label
86
label
87
label the numbers
88
label the numbers
89
what vasculature emerges superior to piriformis?
superior gluteal artery
90
what artery branches off of the umbilical artery? (even though umbilical artery is obliterated at the end)
superior vesicle artery which vasculatizes the bladder
91
what spinal nerves does sciatic nerve come from?
tibial division - L4-S3
common fibular - L4-S2
92
label
93
what is an alternative place for lumbar splanchnics to synapse? (very deep in the pelvis hindgut like to the anal canal)
inferior hypogastric plexus
94
label
95
label
96
what is the connection between the lumbar plexus and the sacral plexus/
lumbosacral trunk
97
pelvic splnachincs do what and to what structures?
where do they synapse?
what plexus does it go to?
parasympathetics to the hindgut and pelvic viscera.
–Left colic flexure to anal canal plus bladder, prostate, accessory reproductive glands (Male), uterus
–Synapse: Visceral wall
ventral rami (S2-S4) to inferior hypogastric plexus (mush)
98
what do lumbar splanchincs do and to what structures?
where do they synapse?
•Sympathetic nerves to hindgut
–Left colic flexure to anal canal
–Synapse: Inferior Mesenteric Ganglia or Inferior Hypogastric Ganglia (technically superior hypogastric ganglia too..)
99
what do sacral splanchnics do and to what structures?
where do they synapse?
what plexus does it synapse?
•Sympathetic nerves to pelvic viscera Bladder, prostate, seminal vesicles, uterus etc.
–Synapse: Inferior Hypogastric Ganglia
sympathetic trunk to inferior hypogastric plexus (mush)
100
label
101
where do the gray rami communicans of the pelvis go?
•sympathetic trunk to ventral rami (sacral plexus)
102
what kind of fibers are visceral afferent?
sensory fibers
103
what kind of fibers are visceral efferent?
motor fibers
104
label and explain what is going on
105
what are the visceral afferents a derivitive of?
where do they emminate?
pelvic splanchnics
detruser muscle
106
what is the first step in the urination process?
- Viseral afferents sense that detruser muscle is stretched and there is an increase in visicular pressure.
- sensory messages gets sent back to the spinal cord back to brain--- says we have to pee
107
what is the second step in the urination process?
Somatic Efferents (we felt something so now we do something motor) leaving the ventral rami through the ventral root to the mixed spinal nerve and out the ventral rami and go directly to levator ani and sphincter urethra within the deep pouch
-causes the sphincter and the levator ani to relax
108
what is the 3rd step of the urination process?
go back to the parasympathetic system. **Viseral Efferents**
the Detruser muscle contracts to expell the Urine now that the levator ani and sphincter muscles have relaxed.
109
is urination or defication sympatheric or parasympatheric?
parasympathetic
110
what is the 4th step in the urination process?
Go back to the somatic system. **Somatic Afferents **sense that our bladder has emptied and we close the sphincter
keeping the sphincter closed is considered a tonic activity.
111
all the somatic fibers going to the urinary system that control the levator ani, sphincter and detruser muscle are branches of what nerve?
pudendal nerve
-inferior rectal branch
112
what is the first step of the defecation process?
Viserceral Afferents
feel stretch of the rectum (meaning feces is present)
work their way back up to dorsal horn
113
what is the second step in the defecation process?
Somatic Efferents
Relax the external anal sphincter (located the anal triangle)
114
what is the 3rd step in the defectation process?
Visceral Efferents
increase paristalasis of the hindgut of the rectum and relax the internal sphincter (there is usually a constant contraction but visceral efferents relax the sphincter)
115
4th step of defecation
Somatic Afferents
lets you know the rectum is empty and you can close your sphincters back up (or resume tonic activity to their structures)
116
label
117
which nerves are involved in erection?
pelvic splanchnics
118
what nervous system is the erection a part of?
what nervous system is ejaculation a part of?
erection- Parasympathetic
ejaculation- sympathetic
"Point and Shoot"
119
Pelvic splanchnic nerves travel in the ventral rami of what spinal nerves?
how does they leave?
S2, S3, S4 spinal nerves
They leave the ventral rami as it exits the sacral foramina and pass in the presacral space to the inferior hypogastric plexus…
120
label
121
what plexus do the pelvic splanchnic nerves run INFERIOR to?
inferior hypogastric plexus. They DO NOT synapse here but continue to the plevic organ plexus
122
What is the name of the plexus the pelvic splanchnics fibers arrive at for erection?
prostatic plexus (in males) inferior vesicle plexus (in females)
and synapse intrinsically to give rise to cavernous nerves which directly act on the helicine arteries.
123
what is the initiation of the erection process?
•Initiation: pelvic splanchnics cause relaxation of the smooth muscle of the corpora cavernosa and vasodilation of the helicine arteries.
124
Pelvic splanchnic nerves are ________ to the smooth muscle of the descending colon, sigmoid colon, rectum, anus and bladder wall but _______ to the vesical sphincter.
Motor
Inhibitory
125
Sexual arrousal leads to rapid inflow of blood to what?
this inflow leads to what?
**Helicine arteries**
•This inflow of blood **fills the cavernous spaces leading to tumescence.**
126
Once tumescence occurs the penis distends and pressure on the ________ converts tumescence to an erection
subtunical veins
127
how does pressure on the subtunical veins keep the penis erect?
obstructing (or putting pressure on) these veins limits their ability to drain blood from the erectile tissue.
this is known as: Veno-occulsive mechanism- the holding of blood in the penis
128
what can cause ED?
fascial layers that aren't taught enough to obstruct the blood flow from leaving the penis
we can have veins that dont dilate enough as they should
faulty pelvic splanchnic nerves or no pelvic splanchnic nerves at all.
the first two are more common
129
is ejaculation a sympatheric release or a parasympathetic release?
sympathetic
130
what causes ejaculation?
sympathetic release... stimulation to all the accessory glands and the testis that allows for ejaculation
131
what does the the epiploic foramen connect?
the lesser sac to the greater sac. when are laying down and turn to the right contents of the greater sac can enter the lesser sac
132
what are the boundaries of the lesser sac?
Anterior: lesser momentum
Inferior: transverse mesocolon
Superior: Liver
Posterior: pancreas, aorta, celiac trunk, splenic a+v left kidney
133
describe the internal obliques aponeurosis in respect to the rectus abdominus muscle?
above the arcuate line it runs on both sides of it, and below the arcuate line it is in front of the rectus abdominus
134
where is the tunica vaginalis derived from?
processes vaginalis of the parietneum
135
why are structures retroperitneal?
because they were once intraperoneal (suspended by mesentary) but migrated posteriorly and only have their anterior surface touching peritoneum.
136
what are the major nerves of the lumbar plexus?
ilioinguinal
Iliohypogastric
Lateral femoral cutaneus
femoral (L2-L4)
obturator (L2-L4)
lumbosacral trunk (L4-L5)
genitofemoral (L1-L3
137
is everything in the abdominal cavity within the peritoneal cavity?
no, retroperitoneal structures are not in the peritoneal cavity
138
why does the aponeurosis of the IO and the TA come anterior to the rectus abdominus, inferior to the arcuate line?
To allow epigastric vessels to get into the rectus sheath on posterior aspect
139
what gives rise to the medial imbilical fold?
Umbilical artery. it should be obliterated. median fold contains the urachus
140
what is an Urachal Fistula?
connection between the bladder and the medial umbilicus. pee through your belly button
141
what is in the inguinal canal IN FEMALES
round ligament, ilioinguinal n, iliohypogastric n, genital branch of genitofemoral n
142
what is the lacunae ligament?
attaches to the inguinal and pectinal ligaments
143
what if the processus vaginalis does not completely obliterate within the inguinal canal?
inguinal canal would be more open and hernea's would occur for frequently
144
what artery serves as an anastamoses for the colon?
marginal arteries serve as an anastamoses of the mesenteric arteries
145
is the greater omentum in the abdominal cavity or th peritoneal cavity?
BOTH
146
describe the second section of the duodenum
the second section is the descending duodenum, it is responsible for glandular drainage.
main duodenal papilae- main pancreatic duct and bile duct
minor duodenal papilae- accessory pancreatic duct
147
what causes uterine prolapse?
when the pelvic floor muscles and ligaments stretch and weaken, which causes inadequte support for the uterus... it can then slip down into the vagina
148
describe the path of the sperm from the testes to the vagina
1. seminephrous tubules
2. straight tubules
3. rete testes
4. head of epi
5. body of epi
6. tail of epi
7. vas deferens
8. ampula of vas deferens
9. ejaclatory duct
10. seminal caliculus of prostate
11. prostatic urethrae
12. membranous urethrae
13. spongy urethrae
14. vagina
15. uterus
16. isthmus
17. ampulla
18. egg!!!
149
what two ligaments make up the lesser omentum
hepatoduodenal ligament
hepatogastric ligament
150
151
