Pelvis I Flashcards

(106 cards)

1
Q

What is the pelvic girdle held together posteriorly?

A

the sacroiliac joints

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2
Q

What two spaces are separated by the linea terminalis?

A

False (greater pelvis)

True (lesser pelvis)

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3
Q

What does the linea terminalis circumscribe?

A

Sacral Promontory (S1)
arcuate lines of the ilium
pectinal lines of the pubis
pubic symphysis

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4
Q

What marks the inlet of the true pelvis/pelvic brim/superior pelvic aperture?

A

Linea Terminalis

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5
Q

What makes up the pelvic outlet?

A

inferior margin of the pubic symphysis
inferior pubic rami
sacrotuberous ligaments
tip of coccyx

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6
Q

What marks the lateral boundaries of the false pelvis?

A

Iliac fossa

Note: this is really part of the abdominal cavity proper

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7
Q

What gender has a pelvis with the following features:

  • Circular pelvic inlet
  • angle of pubic arch wider than 80-85º
  • Ischial spines that don’t project as far into the pelvic cavity
  • Thinner, less massive bones of pelvic girdle
A

Female

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8
Q

What are some features of the male pelvis?

A
  • Heart shaped pelvic inlet

- angle of pubic arch less than 50-60º

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9
Q

What is the smallest anterior to posterior space the babies head must pass through when giving birth?
- How is this space measured?

A
  • True (obstetrical) conjugate

- Sacral Promontory to Pubic Symphysis

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10
Q

What prevents the true (obstetrical) conjugate from being measured in a pelvic exam?

A
  • The urinary bladder
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11
Q

A palpates the sacral promontory with the tip of her middle finger and usd the other hand to mark the inferior margin of the pubic symphysis, what is the measuring?

A

Diagonal Conjugate

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12
Q

What size of true conjugate ensure safe delivery?

A

11cm

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13
Q

How is true conjugate found if it can’t be directly measured?

A
  • After finding the distance of the diagonal conjugate using the middle finger, the true conjugate is estimated as the distance from the inferior pubic symphysis to the INDEX finger
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14
Q

Why would you measure the interspinous distance on a woman?

A
  • its the narrowest part of the pelvic canal from side to side
  • Measured between L and R ischial spines
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15
Q

How wide should the interspinous distance be for safe delivery?

A

should be able to stick in 3 fingers side by side

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16
Q

T or F: obstetric distance and interspinous distance may change in response to hormones during pregnancy.

A

True

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17
Q

What bones form the walls of the true pelvis?

A
  1. Sacrum
  2. Coccyx
  3. Pubis
  4. Inferior aspect of the ischium
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18
Q

What structures make up the anterior wall of the true pelvis?

A
  • pubic symphysis
  • body of pubic bone
  • superior ramus of the pubic bone
  • ischiopubic ramus

(mostly pubis w/ a little ischium)

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19
Q

What is the bony framework of the posterior wall of the true pelvis?

A
  • Sacrum

- coccyx

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20
Q

What is the framework of the lateral walls of the true pelvis?

A
  • pubis
  • ischium
  • Greater Sciatic Foramen
  • Lesser Sciatic Foramen
  • Obturator Foramina
  • *Think about nn. and vessels going through here
  • obturator membrane
  • sacrotuberous
  • sacrospinous ligaments
  • Piriformis
  • obturator internus
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21
Q

Pirifomis

  • origin
  • insertion
  • innervation
  • action
A

Origin - Pelvic surface of sacrum

Insertion - Greater trochanter or femur

action - lateral rotation

Innervation - n. to piriformis

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22
Q

Obturator internus

  • origin
  • insertion
  • innervation
  • action
A

Origin - Internal aspect of the obturator foramen and membrane

Insertion - Greater trochanter of the femur

Action - lateral rotation

Innervation - n. to the obturator int.

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23
Q

What forms the funnel-like pelvic floor?

A

Pelvic diaphragm

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24
Q

Levator Ani

  • origin
  • insertion
  • innervation
A

Origin - Pubis, tendinous arch of the levator ani, ischial spine

Insertion - midline connective tissue raphe

Innervation - inferior rectal n. and branches from S4

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25
Coccygeus - origin - insertion - innervation
Origin - Ischial Spine Insertion - Sacrum and coccyx Innervation - Direct braches from s3 and s4
26
What are the two functions of the pelvic diaphragm?
1. Support of Pelvic Viscera | 2. Keeping the rectum and vagina closed
27
T or F: both men and women have structures that pass through the pelvic diaphragm.
True, these are the urethra and anal canal
28
What structure passes through the pelvic diaphragm in females?
Urethra Anal Canal Vagina (clearly nothing comparable to this in males)
29
How do structures pass through the diaphragm to enter the deep perineum?
Urogenital Hiatus | Anal Hiatus
30
What is the extremely important relationship between obturator internus the levator ani?
Obturator internus is BISECTED by the origin of Levator Ani from the Tendinous arch
31
What muscle has fibers both in the pelvis and perineum?
Obturator internus - its bisected by the structure that divides the two cavities (levator ani)
32
What spaces does the true pelvis communicate with?
Superiorly - abdomen Laterally (and dorsally) - Lower limb and gluteal region via Greater sciatic foramen and obturator canal Anteriorly - communicates with the perineum via a gap in the perineal membrane just posterior to the pubic symphysis and urogenital hiatus
33
What communicates via obturator canal, and what is contained in it?
- Pelvis to medial compartment of the thigh | - Passageway for obturator nn. and vessels
34
What allows communication of the pelvis with the gluteal region?
Greater sciatic foramen
35
What two areas communicate via the lesser sciatic foramen?
Gluteal region to PERINEUM
36
What is the relationship between the pelvic diagphragm and the lesser sciatic foramen.
The lesser sciatic foramen is below
37
What passes through the anterior gap in the gap in the perineal membrane?
Dorsal vein of the Penis
38
What is the only direct communication between perineum and pelvis?
Anterior gap in perineal membrane
39
What is the boundary between the abdominal cavity and pelvic cavity?
Inferior Parietal Peritoneum
40
Can parietal peritoneum be found on the pelvic floor?
No
41
The bladder lies anterioly and the rectum lies posterioly to what structure?
The uterus in the femal
42
What is the draping of peritoneum spanning between rectum and bladder called?
Rectovesical Pouch
43
Where is the vesicouterine pouch located?
Between the bladder and uterus *This is made by parietal peritoneum
44
Where is the rectouterine pouch (POUCH OF DOUGLAS) located?
Between the rectum and uterus *This is made by parietal peritoneum
45
What is the importance of the POUCH OF DOUGLAS?
1. Collection site for fluids and infection 2. Risk of perforation in cystoscopic procedures using the vaginal approach 3. Most common site for ectopic pregnancy
46
What is the mesentery of the uterus?
Broad ligament
47
Where does the rectum begin?
-Begins at S3
48
When does the rectum become the anal canal?
As it pierces the pelvic floor
49
If you put your fingers in the rectum and press posteriorly, what would you be feeling?
sacrum
50
What is formed by the expansion of the lower part of the rectum?
Rectal Ampulla
51
What is the function of the rectal ampulla?
- Serves as a reservoir for fecal matter, allowing us to maintain fecal continence
52
What is the perineal flexure and what maintains it?
- At 90º flexure of the rectum - The levator ani (puborectalis) of the pelvic floor *Note: this muscle must be relaxed for defecation
53
What 3 muscles allow for rectal continence?
- puborectalis (of levator ani) to maintain the 90º flexure | - internal and external anal sphincters
54
What do the anal columns overlie?
The terminal branches of the superior rectal VIENS
55
What do the anal valves overlie?
Communicating veins
56
How is the ano-rectal junction demarcated?
by the upper border of the anal columns
57
How is the pectinate junction demarcated?
by the imaginary lines connecting anal valves
58
What embryological feature was positioned at the pectinate line?
Anal membrane
59
What is the anal pecten?
- Transition zone inferior to pectinate line | - Stratified squamous epithelium
60
What two zones are separated by the white line?
- Separates cutaneous and transitional zones
61
Describe the following features above the pectinate line: - Mucosa - Innervation - Blood Supply - Lymph Drainage
Mucosa: endoderm Innervation: Autonomic - HYPOGASTRIC PLEXUS Sympathetic - Lumbar Splanchnics L1-L2 Parasympathetic - Pelvic Splanchanics S2-S4 Blood Supply: Superior Rectal branches of IMA - PORTAL Lymph Drainage: Internal Iliac nodes
62
Describe the following features below the pectinate line: - Mucosa - Innervation - Blood Supply - Lymph Drainage
Mucosa: ectoderm Innervation: Somatic - inf. rectal n. via pudendal n. Blood Supply: Middle and Inferior rectal - CAVAL Lymph Drainage: Superficial inguinal nodes
63
What is the difference between hemorrhoids above and below the pectinate line?
- Above is not painful and below is | - above is related to INTERNAL venous plexus, below is EXTERNAL venous plexus
64
What extends anterioly from the bladder?
Urachus - remnant of fetal allantois
65
What enters the bladder posteriorly?
Ureters
66
What muscles lie laterally to the bladder?
Obturator internus | Levator Ani
67
What part of the bladder is fixed? | - ligaments involved?
``` The neck Pubovesical ligaments (females) Puboprostatic ligaments (males) ```
68
Where is the prostate gland in relation to the bladder?
Immediately Inferior
69
What space exists between the pubic bones and the apex of the bladder?
retropubic space (of Retzius) - can be used to retrieve urine via cystoscope
70
What is the trigone of the bladder?
- Smooth mucosal layer of the bladder - At the top L and R corners ureters enter - at the bottom the urethra begins at INTERNAL URETHRAL SPINCTER
71
What muscle contracts to allow you pee?
Detrusor Muscle
72
Describe the nerve activity during the filling phase of the bladder.
Detrusor Relaxed Internal Urethral Sphincter Flexed **sympathetic fibers from lumbar splanchnics L1-L4 are active causing flexion of sphincter
73
Desribe the nerve activity of the emptying phase of the bladder.
Detrusor Flexed Internal Urethra Sphincter Relaxed **Paraympathetic pelvic splanchnics S2-S4 are active in Detusor contraction and sphincter relaxation
74
What crosses the ureter "water under the bridge" in males and females.
Males: Vas Deferens = bridge Females: Cardinal liagment containing uterine artery = bridge
75
What are 3 sites where a kidney stone might get lodged?
Superior --> Inferior - Passing over pelvic brim - piercing bladder - Junction of ureter and renal pelvis
76
Describe the course of the urethra in females.
From bladder to Vaginal Vestibule - Pelvic Diaphragm - UG Diaphragm - Superficial Space of Perineum
77
Describe the course of the urethra in males.
Bladder to External orifice - Prostate Gland (PROSTATIC PT) - UG diaphragm (MEMBRANOUS PT) - Bulb of Penis (SPONGY PT) - Corpus Spongiosum (SPONGY PT)
78
What are the two angles of the penis, which one is fixed?
1. Anterior bend after passing through UG into bulb (FIXED) | 2. inferior bend where unattached flacid penis is flopped over
79
What 3 things open into the prostatic urethra in males?
- Ejaculatory Ducts - Prostatic Ducts - Prostatic Utricle
80
What marks the lumen of the prostatic urethra?
Urethral Crest NOTE: there are depressions on either side = SINUSES
81
What is the seminal colliculus and what opens here and on either side?
- Circular elevation of the urethral crest - Prostatic Utricle opens on top (male vagina) - Ejaculatory ducts open on either side
82
Where are Cowper's glands located in relation to the prostate?
Below, inside the deep space of the UG triangle
83
T or F: the vulva is a collective term for the external female genitalia
True
84
What is the job of the broad ligament?
To keep the uterus properly positioned
85
What are the 3 parts of the broad ligament and what do they span?
Mesometrium - lateral pelvic wall and BODY OF THE UTERUS Mesovarium - Ovary and Mesometrium Mesosalpinx - Uterine tube to mesometrium
86
What is the superior extension of the mesovarium?
- suspensory ligament
87
T or F: the round ligament and ligament of the ovary are enclosed in the broad ligament.
True
88
What part of the uterus lies above the uterine tubes?
The fundus
89
What are the uterine and vaginal openings to the cervical canal?
internal os - uterine | external os - vaginal
90
What part of the cervix projects into the vaginal canal and what does this form?
- Infravaginal portion | - Forms the Fornices
91
What is the Lowest point of the abdominopelvic cavity in a supine patient?
Pouch of Douglas
92
During a procedure the physician accidentally pierces the area posterior to the posterior fornix, what area did he penetrate into?
Pouch of Douglas
93
What forms the angle of ANTEVERSION?
Axis of Vagina and Axis of Cervix (V for Vagina and anteVersion) Normally 100-110º
94
What forms the angle of ANTEFLEXION?
Axis of Uterine body to Axis of Cervix Normally 100-110º
95
What causes uterine prolapse?
Weakening of supporting structures in the Vagina
96
Which would be more detrimental, a cut infudibulopelivic ligament (IPL / suspensory ligament) or ovarian ligament and why?
- Cut IPL = BAD | - Contains ovarian a. and v. as well as nerve supply
97
What uterine ligaments are a remnants of the gubernaculum?
- ovarian ligament | - Round ligament
98
What are the boudaries of the ovarian fossa?
- Anteriolaterally by the external iliac vessels | - Posteriomedially by the ureter
99
A surgeon slips and cuts posteriomedially to the ovary, fluid starts coming out. What kind of fluid is this?
Urine, the ureter was cut
100
What is the most common site of conception in the uterine tube?
The ampulla
101
What is the most common site of ectopic pregnancy?
Uterine tube, specifically the ampulla
102
A Dr. sticks his fingers in a vagina and presses forward then back. What structures does she press on in the two different positions?
- Forward: Uterus | - Back; Rectum
103
A Dr. sticks his fingers in a rectum of a female and presses forward then back. What structures does she press on in the two different positions?
- Forward: Vagina | - Back: Sacrum
104
What ligament could be pierced by puncturing the posterior fornix?
Cardinal ligament **Note Water under the bridge occurs here at the base of the round ligament, you also risk puncturing a ureter
105
What is blood supply to the vagina?
- Vaginal Aa. --> internal iliac a.
106
Where is a culdoscopy typically done?
in the pouch of douglas