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OSPE MSK > Pelvis and Male Reproductive Structures > Flashcards

Pelvis and Male Reproductive Structures Flashcards

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1
Q

Name 5 structures that form the boundary of inferior pelvic aperture/pelvic outlet

A

superior: inferior rami of pubis
lateral boundary: ischial tuberosities
sacrotuberous ligament
posterior: tip of coccyx

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2
Q

True/lesser pelvis defined by…

A

enclosed by pelvic girdle
below the pelvic brim
between pelvic inlet and the pelvic floor

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3
Q

False/greater pelvis defined by…

A

above and in front of the pelvic brim

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4
Q

Female subpubic angle is obtuse/acute

A

obtuse

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5
Q

Male subpubic angle is obtuse/acute

A

acute

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6
Q

What type of joint is the SI joint

A

synovial plane joint

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7
Q

What type of joint is the pubic symphysis

A

secondary cartilaginous joint

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8
Q

Which muscle/structures occupy the lateral pelvic wall
Which muscle is present in the posterior wall of the pelvis
What are their origins and insertions

A

Obturator internus
Origin - obturator membrane
Piriformis
Origin - sacrum

Both insert into the greater trochanter of the femur

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9
Q

Where is the perineal body

Where is the anococcygeal body

A

Perineal body is the junction between the urogenital and anal triangle
Anococcygeal body is between coccyx and anus

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10
Q

Which nerve network lies on the muscle forming the posterior wall of the pelvis

A

Sacral plexus

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11
Q

/What are the 2 major parts of the pelvic diaphragm/floor

A

Coccygeus and levator ani

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12
Q

What are the 2 functions of the pelvic floor?

A

Maintains mostly fecal continence

Maintains intra-abdominal pressure supporting pelvic viscera > prevents prolapse of organs

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13
Q

What is the innervation of the pelvic diaphragm/floor?

A

Nerve to levator ani

2 muscles of the levator ani are also innervated by inferior rectal nerve

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14
Q

What is a cystocoele?

A

Anterior prolapse - wall between bladder and vagina weakens and allows bladder to droop into vagina

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15
Q

What is a rectocele?

A

Bulging of front wall of rectum in back wall of vagina

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16
Q

Why is injury to pelvic floor during childbirth common and potentially damaging?

A

Leads to urinary incontinence, sexual dysfunction, potential prolapse
When the pubococcygeus and puborectalis are torn, decrease in support for vagina, bladder. uterus and rectum > urinary stress incontinence also develops

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17
Q

Why may an episiotomy minimise long term damage

A

Heals faster, lessens damage to perineal body, lessens perineal trauma

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18
Q

Why is a mediolateral episiotomy preferable to a midline episiotomy?

A

Avoids trauma to the perineal body which is essential to the integrity of the pelvic floor only cuts through vagina epithelium, skin and transversalis and bulbospongiosus

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19
Q

What are the main pelvic viscera in the female pelvis

A

Bladder and urethra
Uterus, vagina, cervix, fallopian tubes, ovaries
Rectum and anus

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20
Q

What are the main pelvic viscera in the male pelvis

A

Bladder and urethra
VD, SV, prostate, bulbourethral gland
Rectum and anus

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21
Q

Supply of bladder

A

superior vesical artery > internal iliac artery (anterior division)

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22
Q

Supply of seminal gland and prostate

A

inferior vesicle artery > internal iliac artery (anterior division)

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23
Q

Supply of uterus, ovary, vagina, cervix

A

Uterine artery > internal iliac artery

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24
Q

Supply of testis, ovaries

A

Gonadal arteries

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25
What is the origin of the gonadal arteries
Abdominal aorta
26
What supplies the upper third of the rectum?
superior rectal artery
27
What supplies the lower 2/3 of the rectum
middle and inferior rectal artery > internal iliac artery
28
What is the origin of the superior rectal artery
inferior mesenteric artery
29
What 3 structures does the vaginal artery supply
vagina cervix bladder
30
What is the origin of the vaginal artery
uterine artery
31
What does the internal pudendal artery supply?
Main artery to perineum
32
What does the obturator artery supply?
obturator externes medial compartment of the thigh femur
33
Which part of the rectum drains into portal circulation?
upper third of rectum drains into portal vein | superior rectal vein > inferior mesenteric vein > splenic vein > portal vein
34
Where does the lower 2/3 of the rectum drain into
internal iliac vein > IVC
35
Why might haemorrhoids be associated with cirrhosis of the liver
Anorectal varices in portal HTN - shunting of blood from portal system to portosystemic anastomoses
36
Which venous plexus does the prostatic/Santorini's venous plexus communicate with on posterior side of prostate
internal vertebral venous plexus
37
Which venous plexus does the prostatic/Santorini's venous plexus communicate with on anterior side of prostate
vesical venous plexus
38
Where does the internal vertebral venous plexus and vesicle venous plexus drain into
Internal iliac veins
39
Which is thought to be the route of bone mets of prostate cancer?
Posterior side - internal vertebral venous plexus
40
Ilioinguinal nerve origin and where does it enter
L1 - enters inguinal canal at the superficial inguinal ring
41
Genitofemoral nerve origin and where does it enter
L1-2 and deep inguinal ring
42
What does the ilioinguinal nerve supply
skin at root of penis in male | labia in female
43
What does the genitofemoral nerve supply
Cremaster muscle
44
Pudendal nerve: state its origin (which segmental level), course and innervation
originates from the sacral plexus at S2, S3, S4 follows the course of the pudendal artery innervates skin and muscle of perineum
45
What bony landmarks do you think are used when performing a pudendal nerve block during labour?
ischial spine
46
What are the 3 nerves of reproductive organs
ilioinguinal nerve genitofemoral nerve pudendal nerve
47
Which autonomic component of the nerve supply of male reproductive organs is responsible for ejaculation
sympathetic fibres originating from L1-2
48
Which autonomic component of the nerve supply of male reproductive organs is responsible for erection
parasympathetic fibres originating from S2-4
49
What LN groups drain the prostate
internal iliac | sacral
50
What LN groups drain the seminal vesicles
internal iliac | external iliac
51
What LN groups drain the scrotum
superficial inguinal
52
What LN groups drain the penis
skin: superficial inguinal | glans - superficial inguinal, deep inguinal, external iliac
53
What LN groups drain the rectum
upper, lower para-rectal LN | Internal iliac LN
54
What are the 3 components of the spermatic cord
Vas deferens Nerves: cremaster nerve, testicular nerve, genital branch of genitofemoral nerve Vessels: lymphatic vessels, arteries, pampiniform plexus
55
What are the arterial vessels in the spermatic cord
testicular artery, deferential artery, cremaster artery,
56
What is the tough outer fibrous layer of the testis
Tunica albuginea
57
What are the two layers of the tunica vaginalis
Parietal and visceral lamina
58
What material is present between the 2 layers of the tunica vaginalis
Serous fluid
59
What is a hydrocele
Accumulation of fluid within vaginalis cavity
60
What is a hematocele
accumulation of blood within vaginalis cavity
61
What is the blood supply of the testis
Testicular arteries
62
At what vertebral level do the testicular arteries arise from the abdominal aorta
L1-2 | Just below the level of the renal arteries
63
What structures do the testicular arteries cross in their anatomical course near the pelvic brim before they go through the inguinal canal?
Ureter and genitofemoral nerve
64
What is the term used for the 8-12 anastomosing veins associated with the testis
pampiniform plexus
65
What is the function of the pampiniform plexus
To cool arterial blood before it reaches the testis
66
Into which vein does the right testicular vein drain?
IVC
67
Into which vein does the left testicular vein drain
Left renal vein
68
What is a varicocele
an abnormal enlargement of the pampiniform plexus in the scrotum
69
What LN group drains the testes
Lateral aortic group of para-aortic LN at L2 | Lumbar lymph nodes
70
What secretions are produced by the seminal vesicles
seminal fluid
71
What secretions are produced by the prostate gland
prostatic fluid - PSA, zinc, enzymes, citric acid
72
What secretions are produced by the bulbourethral glands
alkaline mucus-like fluid
73
Muscles of the perineum (6)
``` external anal sphincter external urethral sphincter superficial transverse perineal muscle deep transverse perineal muscle bulbospongiosus ischiocavernosus ```
74
What are the 3 parts of male urethra
Prostatic, membranous, spongy/penile
75
Narrowest portion of male urethra
membranous
76
Most dilatable portion of male urethra
prostatic
77
What is the major content of the ischia-anal fossa
Fat
78
Alcock's canal contents (3)
internal pudendal artery internal pudendal vein pudendal nerve
79
Where does the neuromuscular bundle that enters the sischioanal fossa enter through
lesser sciatic foramen
80
What structures do the contents of the alcock's canal supply?
external genitalia perineal muscles parts of the levator ani
81
Where are the bulbourethral glands | Where do they empty into?
Located in the urogenital diaphragm | Empty into the spongy urethra
82
Function of testes, epididymis, ductus deferens
Testes - production of sperm Epididymis - storage of sperm Ductus deferens- transport of sperm

OSPE MSK (8 decks)

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