Pelvis is divided into 2 parts by the
Pelvic brim
Pelvic brim is formed by (3)
1) Sacral promontory
2) Iliopectineal line
3) Symphysis pubis
Above the pelvic brim
False pelvis
Below the pelvic brim
True pelvis
4 bones of bony pelvis
1) 2 hip bones
2) Sacrum
3) Coccyx
Pelvic inlet is aka
Pelvic brim
Boundaries of pelvic outlet (3)
1) Coccyx
2) Ischial tuberosities
3) Pubic arch
Main function of SI joint
Transmit weight of body from vertebral column to bony pelvis
SI joint: Type of joint
Synovial
Symphysis pubis: Type of joint
Cartilaginous
T/F Great deal of movement is possible at the sacrococcygeal joint
T
Imaginary line joining the central points of the AP diameters of the inlet and outlet
Axis of pelvis
Curved course taken by the baby’s head as it descends through the pelvis during childbirth
Axis of pelvis
Distance between lower margin of symphysis pubis and sacral promontory
Diagonal conjugate
Normal length of diagonal conjugate
13 cm
Normal distance between 2 ischial tuberosities
10cm
Shallowest wall of pelvis
Anterior
Anterior pelvic wall is formed by (2)
1) Pubic bones
2) Symphysis pubis
Posterior pelvic wall is formed by
1) Sacrum
2) Coccyx
3) Piriformis
Lateral pelvic wall is composed of (4)
1) Hip bone below inlet
2) Obturator membrane
3) Obturator internus
4) Sacrospinous and sacrotuberous ligament
Structure that almost completely closes the obturator foramen
Obturator membrane
Small gap in the obturator membrane
Obturator canal
Obturator canal transmits
Obturator nerve and vessels
Triangular pelvic ligament
Sacrospinous ligament
Prevent lower end of sacrum and coccyx from being rotated at the SI joint
Sacrospinous and sacrotuberous ligaments
Pelvic diaphragm is formed by (2)
1) Levator ani muscles
2) Coccygeus
Pelvic diaphragm is incomplete at what portion
Anterior
Anterior defect in the pelvic diaphragm transmits (2)
1) Urethra
2) Vagina in females
Widest diameter of the pelvic inlet
Transverse
Visceral pelvic fascia around the cervix is called
Parametrium
Nerve supply: Coccygeus
S4-5
Lumbar sympathetic trunk and pelvic sympathetic trunk come together where
In front of coccyx
Constitute the PSY part of ANS in the pelvis
Pelvic splanchnic nerves
Pelvic splanchnic nerves: Arise from
S2,3,4
Pelvic splanchnic nerves: Preganglionic fibers synapse in ganglia of
Hypogastric plexus
Musculofascial structure that fills the gap of the pubic arch
Urogenital diaphragm
Urogenital diaphragm: Formed by
1) Sphincter urethrae
2) Deep transverse perineal muscles
Urogenital diaphragm: Fascial layers
1) Superior fascial layer
2) Inferior fascial layer
Urogenital diaphragm: Inferior fascial layer is aka
Perineal membrane
Small mass of fibrous tissue attached to the center of the posterior margin of the urogenital diaphragm
Perineal body
Perineal body: Male vs female, larger
Female
Perineal body: Attachement for
Muscles in the perineum
Perineal body: Supports what other structure in females
Posterior vaginal wall
Pelvic diaphragm: Levator ani muscles
1) Iliococcygeus
2) Pubococcygeus
3) Puborectalis
Pelvic muscles
1) Piriformis
2) Obturator internus
3) Coccygeus
4) Levator ani
Pelvic muscle that covers the lateral wall of the pelvic cavity
Obturator internus
Pelvic muscles: Insert to the greater trochanter of femur
1) Obturator internus
2) Piriformis
Pelvic muscle: Originates from ischial spine
Coccygeus
Coccygeus: Nerve supply
Sacral nerve
Coccygeus: Degenerates forming
Sacrospinous ligament
Pelvic muscle: Constricts the rectum and pulls it forward
Levator ani
Pelvic muscle: Forms a sling around the anorectal junction, kinking it anteriorly
Puborectalis
The membranous layer of the superficial fascia of the abdomen continues down the perineum to form the
Colles fascia
The Colles fascia is attached to the
Margins of the pubic arch on each side
Rupture of penile urethra may be followed by extravasation of urine into
1) Scrotum
2) Perineum
3) Penis
4) Anterior abdominal wall, deep to the membranous layer of the superficial fascia
Urine from rupture of penile urethra is excluded from the thigh because of
Attachment of superficial abdominal fascia to the deep fascia of the thigh
Ovary: Attached to the back of the broad ligament by
Mesovarium
Suspensory ligament of the ovary: Contents
Ovarian vessels and nerves
Ovarian capsule
Tunica albuginea
Ovary: Outermost epithelium
Germinal epithelium
Ovarian follicles: Medulla vs cortex of ovary
Cortex
Ovarian fossa: Bounded by
External and internal iliac arteries
Connects the mesovarium to the lateral pelvic wall
Suspensory ligament of the ovary
Ovarian ligaments: Extends from the medial margin of the ovary to the lateral wall of the uterus
Round ligament of the ovary
The round ligament of the ovary is the adult derivative of
Upper gubernaculum
The round ligament of the uterus is the adult derivative of
Lower gubernaculum
The ovarian vein drains into the ___ on the right
IVC
The ovarian vein drains into the ___ on the left
Left renal vein
Ovary: Lymphatic drainage
Paraaortic nodes at L1
Ovary: Kept in position by
Mesovarium
Time in which the broad ligament is lax hence ovaries may prolapse into the pouch of Douglas causing pain during sexual intercourse
After pregnancy
Fallopian tube: Most common site of fertilization
Ampulla
Fallopian tube: Blood supply
Uterine and ovarian arteries
Fallopian tube: Drainage
Uterine and ovarian veins
Fallopian tube: Lymphatic drainage
Internal iliac and paraortic nodes
Anterior vs posterior wall of vagina: Cervix pierces the vagina at
Anterior wall
Attaches the cervix and upper end of vagina to the lateral pelvic walls
Transverse cervical/cardinal ligaments
Broad ligament: Contents
1) Uterine tubes
2) Round ligaments of ovaries and uterus
3) Uterine and ovarian vessels, nerves, and lymphatics
T/F The broad ligament provide little support to the uterus
T
Extends from the superolateral angle of the uterus through the inguinal canal, to the subcutaneous tissue of the labia majora
Round ligament of the uterus
Assists in keeping the uterus anteroflexed
Round ligament of the uterus
Uterus: Blood supply
1) Uterine artery from internal iliac
2) Ovarian artery
Uterus: Lymphatic drainage
1) Fundus: Paraaortic nodes
2) Body and cervix: Internal and external iliac nodes
3) Superficial inguinal nodes
External os: Nulliparous
Circular
External os: Parous
Fishmouth
Important structures that may be damaged in childbirth causing prolapse of uterus
1) Levator ani muscles
2) Transverse cervical ligament
3) Pubocervical ligament
4) Sacrocervical ligament
Superficial perineal pouch, boundaries: Inferior
Colles fascia
Superficial perineal pouch, boundaries: Superior
Urogenital diaphragm
Superficial perineal pouch, boundaries: Posterior
Attachment of Colles fascia to the posterior border of urogenital diaphragm
Superficial perineal pouch, boundaries: Lateral
Attachment of Colles fascia and urogenital diaphragm to the pubic arch
Superficial perineal pouch, boundaries: Anterior
Communicates freely with potential space between Scarpa fascia and anterior abdominal muscles
Contents of superficial perineal pouch, males
1) Root of penis
2) Superficial perineal muscle
3) Bulbospongiosus
4) Ischiocavernosus
5) Perineal body
6) Perineal branch of the pudendal nerve
T/F Deep perineal pouch is a closed space
T
Deep perineal pouch: Lies within
Urogenital diaphragm
Deep perineal pouch: Contents in males
1) The membranous part of the urethra.
2) The sphincter urethrae.
3) The bulbourethral glands.
4) The deep transverse perineal muscles.
5) The internal pudendal vessels.
6) The dorsal nerve of the penis.
Deep perineal pouch: Contents in females
1) Part of the urethra
2) Part of the vagina
3) Sphincter urethrae
4) Deep transverse perineal muscles
5) Internal pudendal vessels
6) Dorsal nerve of the clitoris
Delineates deep from superficial perineal pouch
Perineal membrane
Contents of superficial perineal pouch, females
1) Root of clitoris
2) Superficial perineal muscle
3) Bulbospongiosus
4) Ischiocavernosus
5) Perineal body
6) Perineal branch of pudendal nerve
7) Greater vestibular glands
Greater vestibular glands are aka
Bartholin gland
Most important ligement that prevents uterine prolapse
Uterosacral ligament
SOURCE: Boundless.com