Flashcards in Pelvis and Perineum Deck (135):
Boundaries of pelvic inlet
Superior margin of the pubic symphysis, posterior border of pubic crest, ileopectineal line (arcuate line and pectineal line), anterior border of the ala of the sacrum, and sacral promontory
Boundaries of pelvic outlet
inferior margin of the pubic symphysis, inferior rami of the pubis and ischial tuberosities, sacrotuberous ligaments, tip of coccyx
sacral promontory to top of pubic symphysis
sacral promontory to thickest part of pubic bone
sacral promontory to inferior border of pubic sympysis
What is the most commonly assessed conjugate?
What is the ligament that is the primary structure involved in transferring the weight of the upper body from the axial skeleton to the two ilia and then to the femurs during standing and the ischial tuberosities when sitting?
Interosseous sacro-iliac ligament
What resist the sacrum from moving superiorly?
Sacrotuberous and sacrospinous
Between Sacrotuberous and sacrospinous which is more anterior?
What makes up the pelvic diaphragm?
Levator ani + coccygeus
What makes up levator ani?
puborectalis, puboccygeous, iliococcygeus
What is the name for an organ touching peritoneum?
What is the name for an organ below/not touching peritoneum?
What is the peritoneal category for ureters?
What are the three boundaries on one side of UG triangle?
IT, ischiopubic ramus, pubic symphysis
What are the three boundaries on one side of anal triangle?
IT, sacrotuberous ligament, coccyx
Perineal body consists of:
bulbospongiosus, external anal sphincter, superficial and deep transverse perineal
What are the three layers of the anal triangle?
Pelvic diaphragm (roof), fatty layer of the superficial perineal fascia (fat in ischioanal fossa), skin
What are the layers of the urogenital triangle?
Pelvic diaphragm (roof), superior fascia of UG diaphragm, deep perineal mm, perineal membrane (inferior fascia of UG diaphragm), superficial perineal mm, deep perineal fascia, colle's fascia (membranous layer), fatty layer of superficial fascia, skin
What makes up the urogenital diaphragm?
superior fascia of UG diaphragm, deep perineal mm, perineal membrane (inferior fascia of UG diaphragm)
What makes up superficial perineal fascia?
Deep perineal fascia and colle's fascia
What are the deep perineal mm?
deep transverse perineal and sphincter urethrae m
What are the superficial perineal mm?
bulbospongiosus, ischiocavernosus, superficial transverse perineal
What pouch are the bulbourethral glands located?
deep perineal space/pouch
What pouch are the greater vestibular glands located?
Superficial perineal space/pouch
What passes through both the deep and superficial pouch?
Bulbospongiosus sits over?
bulb of penis
Ischiocavernosus sits over?
Pudendal nerve levels?
Where does inferior rectal n come off of?
How does the pudendal n travel?
Pelvic cavity to perineum (via greater and lesser sciatic foramen
What passes through pudendal canal?
internal pudendal a/v, pudendal n
Pudendal canal is within what fascia?
fascia of obturator internus
What is the general innervation pattern for sympathetics in pelvis?
least thoracic/lumbar splanchnic/sacral splanchnic to hypogastric plexus/ganglia to pelvic plexus to pelvic organ
What is the general innervation pattern for parasympathetics in pelvis?
pelvic splanchnics to inferior hypogastric plexus to pelvic plexus to intramural ganglia to pelvic organs
Name pathway of male urethra:
pre-prostatic, prostatic, membranous, bulbar, penile
The subcutaenous tissue (camper's fascia/scarpa's fascia) in the abdominal wall becomes what in the scrotum?
Dartos fascia and dartos muscle
The external oblique muscle in the abdominal wall becomes what in the scrotum?
external spermatic fascia
The internal oblique muscle in the abdominal wall becomes what in the scrotum?
the fascia of internal oblique muscle in the abdominal wall becomes what in the scrotum?
The transverse abdominal muscle in the abdominal wall becomes what in the scrotum?
The transversalis fasica in the abdominal wall becomes what in the scrotum?
internal spermatic fascia
The peritoneum in the abdominal wall becomes what in the scrotum?
The external spermatic fascia continues on as what in the penis?
deep penile fascia (buck's fascia)
Scarpa fascia becomes what in perineum? in penis?
Colles fascia in perineum, dartos in penis
Campers fascia becomes what in perineum?
Superficial fascia--fatty layer
Where will the extravasation pool be if there is a tear in the tunica albuginea only?
Bulbar urethra injury can be caused by?
straddle injury or difficult urethral catheterization
Where will the extravasation pool be if there is a tear in buck's fascia?
Superficial perineal space
What is the posterior limit of colles' fascia?
posterior margin of perineal membrane
What is the inferior limit of colles' fascia?
What causes a perforation of the membranous urethra?
pelvic fracture, because prostatic urethra is fixed in position by prostate, shearing force.
Where will the extravasation pool be if there is a tear in the membranous urethra?
Pelvic cavity (superior to perineal membrane/deep perineal pouch/extraperitoneal space superior to pelvic diaphragm)
Average urine output
Normal bladder capcity
Urgency to urinate felt at:
What n stimulates external urethral sphincter m in bladder filling phase?
pudendal n and n to levator ani
Distension of lower bladder follows what innervation?
Distension of lower bladder triggers?
tension and pain stimuli to spinal cord and brainstem, reflex control of bladder
Distension of bladder roof follows what innervation?
Distention of bladder roof results in?
transmit painful stimuli from bladder roof to spinal cord and cerebral cortex, conscious perception
Internal urethral sphincter is held closed by what innervation?
Describe Vescicoureteral Reflux (VUR)
Retrograde flow of urine from bladder into ureter during voiding due to deficient vesicoureteral sphincter, exposes kidneys to urinary infections
What is the boundary between the visceral and somatic innervation in the rectum/anus?
What pudendal n goes to rectum/anus?
Inferior rectal nn
Normal anorectal flexure angle:
Anorectal angle during defication
What lymph nodes would be palpable with a cancerous lymphadenopathy?
Superficial inguinal lymph nodes/ perinal nodes
Which fornix is associated with the rectouterine pouch?
Posterior vaginal fornix
What are the two ligaments that are related to the gubernaculum in the female?
Round ligament, ovarian ligament
What are the two types of membranous pelvic fascia?
What are the two types of endopelvic fascia?
Describe parietal fascia
Describe visceral fascia
Describe loose fascia
potential spaces, accomdate expansion
Describe condensed fascia
"pelvic ligaments" like hypogastric sheath
Describe endopelvic fascia?
lying between the parietal and visceral fascia
What are the three ligaments formed by thickened endopelvic fascia?
uterosacral, transverse cervical (cardinal) ligament, pubocervial ligament
Which muscle is extremely important in active support of the uterus?
Lesser vestibular glands are homologous to?
Greater vestibular glands aka
Greater vestibular glands are homologous to?
Caudal epidural anesthetizes what structure?
Peritoneal plus somatic areas via pudendal n
When doing a pudendal nerve block where is your landmark?
What nerves are anesthetized in caudal analgesia?
sacral and coccygeal nn.
What is the landmark for caudal analgesia?
What is the most common regional anesthesia for childbirth?
lumbar (epidural) block
What is the landmark for (lumbar) epidural block?
widest interspace below L3, commonly L3-L4.
What nerves are anesthetized in (lumbar) epidural block?
thoracolumbar and sacral nn.
Which type of regional anethesia goes to subarachnoid space?
What is the landmark for a spinal block?
L3/L4 vertebral level
"water under the bridge" applies to?
Uterine a, vas deferens in relation to ureter
What is the prostatic utricle homologous to?
What are the urethral lacunae?
small depressions or recesses on the surface of the mucous membrane of the urethra, location of urethral glands that protect epithelium against acid urine
Parasympathetics (GVE) for testes and ovaries?
Culdocentesis occurs via what fornix?
What are the "cruciate anastomosis"
medial circumflex femoral, lateral circumflex femoral, inferior gluteal, 1st perforating
What are the extracapsular ligaments?
patellar, fibular collateral, tibial collateral, oblique popliteal, arcuate
What are the intracapsular ligament?
cruciate, menisci, tendon of popliteus
Which is more superficial: fibrous or synovial membrane?
Which is stronger: tibial or fibular collateral ligament?
Fibular collateral ligament
What does the fibular collateral ligament split?
Splits biceps femoris tendon
What does tibial collateral ligament attach to?
Suprapatellar bursa is deep to?
Pes Anserinus is a tendinous expansion of?
gracilis, sartorius, semitendinosus
Oblique popliteal ligament is an expansion of?
posterior displacement of femur on tibia/ hyperextension of knee
What are the three ligaments of the ball and socket joint?
Iliofemoral, pubofemoral, ischiofemoral
hyperextension and lateral rotation
extension and medial rotation
What is the weakest hip joint ligament?
Ligament of head of femur houses?
artery of ligament of head of femur
How do you test tibial n?
achilles tendon reflex
What injury will result in a foot drop?
fracture at neck of fibula
What is injured with a fracture of the neck of the fibula?
common fibular n.
What two ligaments limit inversion?
anterior talofibular and calcaneofibular ligament
What is the strongest lateral ankle ligament?
What is the weakest lateral ankle ligament?
What is the role of the posterior talofibular ligament?
ensure fibula sits on top of the talus, especially in dorsiflexion
What makes up the deltoid ligament?
anterior tibiotalar, tibionavicular, tibiocalcaneal, and posterior tibiotalar
What is the strongest ligament in the foot?
What does the deltoid ligament do?
prevents over eversion, stablizes foot when you're doing external rotation and pronation of the foot
What is another name for Spring LIgament?
plantar calcaneonavicular ligament
What does the plantar calcaneonavicular ligament do?
helps maintain integrity of medial longitudinal arch
Ankle sprains occur with what type of motion?
What side ligaments likely tear during an ankle sprain?
What is plantar fascitis?
straining and inflammation of plantar aponeurosis with pain on sole and medial side of foot, especially heel
What ligament helps with medial arch?
plantar calcaneonavicular ligament
What ligament helps with lateral arch?
long plantar and short plantar ligament
What happens in flat feet?
Spring ligament fails