Repro Anatomy 1 Flashcards by Robbie Pollock

On the below diagram locate the following bony landmarks that make up the superior pelvic aperture (pelvic inlet/pelvic brim)

Sacral Promontory

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On the below diagram locate the following bony landmarks that make up the superior pelvic aperture (pelvic inlet/pelvic brim)

Ala of Sacrum

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On the below diagram locate the following bony landmarks that make up the superior pelvic aperture (pelvic inlet/pelvic brim)

Pubic Tubercle

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On the below diagram locate the following bony landmarks that make up the superior pelvic aperture (pelvic inlet/pelvic brim)

Pubis Symphysis

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On the below diagram locate the following bony landmarks that make up the superior pelvic aperture (pelvic inlet/pelvic brim)

Arcuate Line of Ilium

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On the below diagram locate the following bony landmarks that make up the superior pelvic aperture (pelvic inlet/pelvic brim)

Pecten Pubis

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On the below diagram locate the following bony landmarks that make up the superior pelvic aperture (pelvic inlet/pelvic brim)

Pubic Crest

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The pelvic outlet is the inferior opening of the pelvis and is formed by bony features and ligaments

Inferior Margin of Pubic Symphysis

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The pelvic outlet is the inferior opening of the pelvis and is formed by bony features and ligaments

Sacro-tuberous Ligaments

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The pelvic outlet is the inferior opening of the pelvis and is formed by bony features and ligaments

Inferior Rami of Pubis

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The pelvic outlet is the inferior opening of the pelvis and is formed by bony features and ligaments

Tip of Coccyx

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what is the true pelvis?

(lesser pelvis)

below the pelvic brim between the pelvic inlet and the pelvic floor

located superiorly, it provides support of the lower abdominal viscera (such as the ileum and sigmoid colon). It has little obstetric relevance.

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what is the false pelvis?

(greater pelvis)

above and in front the pelvis brim

located inferiorly. Within the lesser pelvis reside the pelvic cavity and pelvic viscera

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what type of joint is the Sacroiliac joint?

Synovial

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what type of joint is the Pubic Symphysis?

Secondary Cartilaginous

a secondary cartilaginous joint (a joint made of hyaline cartilage and fibrocartilage) located between the left and right pubic bones near the midline of the body

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which is the male pelvis and which is the female pelvis?

left is male pelvis and right is female pelvis

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Lesser pelvis (pelvis minor)

what is it like in males and females?

female - wide and shallow

male - narrow and deep

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Pelvic inlet

what is it like in males and females?

female - oval shaped + rounded

male - heart shaped

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Pelvic outlet

what is it like in males and females?

female - comparatively larger for child birth

male - Comparatively smaller

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Subpubic angle

what is it like in males and females?

female - Obtuse: Greater than 90^o

male - Acute: Less than 90^o

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Acetabulum:

what is it like in males and females?

female - small

male - large

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Obturator foramen:

what is it like in males and females?

female - oval

male - round

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With regards to the female pelvis and normal vaginal delivery:

What is the narrowest diameter of the pelvic inlet?

What is the narrowest diameter of the pelvic outlet?

13cm

11cm

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The pelvic cavity has an antero-inferior wall, two lateral walls and a posterior wall.

The anterior-inferior wall is formed by the bodies and rami of the pubic bones and the pubic symphysis.

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Which muscle is present in the posterior wall of the pelvis?

Piriformis and coccygeus

what is labelled?

sciatic nerve

what are the nerve roots of the sciatic nerve?

A combination of 5 nerve roots that exit from inside the lower lumbar and upper sacral spine - L4, L5, S1, S2, and S3

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

sacral plexus

Levator ani – pubococcygeus

Levator ani – iliococcygeus

Puborectalis

Anococcygeal ligament

Perineal body (female)

what is the perineal body?

fibromuscular node lying in the midline of the perineum. It is pyramidal in shape and provides an anchor point for several of the muscles within the perineum

anococcygeal body?

**the ligament runs in the midline between the inferior two segments of the coccyx and the posterior aspect of the rectum**

2 muscles make up the majority of the pelvic floor – one of these has 3 separate paired muscles what are the 2 muscles?

coccygeus muscle levator ani muscles (3 paired seperate muscles)

Give two functions of the pelvic diaphragm/floor

1) Support of abdominopelvic viscera 2) Resistance to increases in intra-pelvic/abdominal pressure 3) urinary and faecal continence

What is the innervation of the pelvic diaphragm/floor?

anterior ramus of S4 and branches of pudendal nerve (roots S2, S3 and S4)

what is a cystocele?

prolapsed, herniated, dropped or fallen bladder – ligaments that hold up bladder and muscles between a women’s vagina and bladder stretches or weakens, allowing bladder to sag into the vagina

what is a rectocele?

herniation of the front wall of the rectum into the back wall of the vagina

**Clinical** – **Pelvic Floor Injury** Injury to pelvic floor during childbirth is common and potentially damaging. Why?

Can lead to incontinence (stress incontinence)

Why may an episiotomy minimise long-term damage?

Can help to prevent a severe tear of the perineum or speed up delivery

Why is a mediolateral episiotomy preferable to a midline episiotomy?

Lower risk of third and fourth degree laceration. Can lead to faecal incontinence

what is A and B?

bladder

what is C and D?

prostate uterus, ovaries

what is E and F?

Rectum

**Clinical – Digital Rectal Examination** As part of the clinical examination of the abdomen, a digital rectal examination (DRE) forms an important aspect of formulation of a diagnosis. What structures can be palpated when performing a DRE (in males and in females)

Male: Prostate(, seminal vesicles, bladder) Female: Cervix

Branches of [the right and left internal iliac artery](https://teachmeanatomy.info/pelvis/vasculature/arterial-supply/) distribute blood to most of the pelvic organs, perineum and gluteal region except the testis, ovary and upper part of rectum. Label the main branches of internal iliac artery on the image below A

Common iliac artery

Internal iliac a.

Umbilical artery

Superior vesical arteries

Posterior division of the internal iliac artery

Anterior division of internal iliac

Inferior gluteal

Internal pudendal

the terminal branches of the internal iliac artery: Arteries of pelvis - [Superior](https://www.anatomy.tv/anatomytv/html5ui_2018/#/product/har_pelvis_2014/type/Text%20articles/id/42800/layer/16/angle/0/structureID/1346600) and [inferior](https://www.anatomy.tv/anatomytv/html5ui_2018/#/product/har_pelvis_2014/type/Text%20articles/id/42805/layer/9/angle/0/structureID/1346596) vesical What is its distrubution/organ and what is its origin/branch of?

Bladder, seminal gland and prostate in males (and ureter) anterior division of the internal iliac artery

the terminal branches of the internal iliac artery: Arteries of pelvis - uterine artery What is its distrubution/organ and what is its origin/branch of?

branches to the cervix and the vagina, small vessels to the uterine tube and the round ligament of the uterus only in female, anterior division of internal iliac

the terminal branches of the internal iliac artery: Arteries of pelvis - Gonadal ([testicular](https://www.anatomy.tv/anatomytv/html5ui_2018/#/product/har_pelvis_2014/type/Text%20articles/id/42801/layer/8/angle/1/structureID/1346588) or [ovarian](https://www.anatomy.tv/anatomytv/html5ui_2018/#/product/har_pelvis_2014/type/Text%20articles/id/42812/layer/24/angle/34/structureID/1345548)) What is its distrubution/organ and what is its origin/branch of?

testicular = testes, within abdomen they supply the perirenal fat, ureter and iliac lymph nodes, within the spermatic cord, they supply the cremaster muscles Ovarian = uterus, ovary, ureter, skin of labia and inguinal region, receives lymph form the lumbar lymph nodes aorta

sigmoid colon, rectum and anal canal terminal branch of the inferior mesenteric artery

the terminal branches of the internal iliac artery: Arteries of pelvis - Middle and inferior rectal What is its distrubution/organ and what is its origin/branch of?

middle = lower rectum, inferior = anal skin and musculature, skin of the buttock internal iliac

the terminal branches of the internal iliac artery: Arteries of pelvis - Vaginal What is its distrubution/organ and what is its origin/branch of?

vagina, bulb of the vestibule, fundus of the bladder, contiguous part of the rectum uterine artery

the terminal branches of the internal iliac artery: Arteries of pelvis - Internal pudendal What is its distrubution/organ and what is its origin/branch of?

Main artery to perineum internal iliac

the terminal branches of the internal iliac artery: Arteries of pelvis - Obturator What is its distrubution/organ and what is its origin/branch of?

pelvic muscles and hip joint internal iliac

The venous drainage of the pelvic structures is complex and involves interplay between the portal and systemic circulations. This has clinical significance especially in some pathologies e.g. liver cirrhosis, pelvic cancers There are many venous plexuses formed in relation to pelvic organs (for example: rectal, prostatic) – some of these have clinical significance (e.g. [prostatic venous plexus](https://www.anatomy.tv/anatomytv/html5ui_2018/#/product/har_pelvis_2014/type/Text%20articles/id/42809/layer/12/angle/30/structureID/1350764)) Which part(s) of the [rectum](https://www.anatomy.tv/anatomytv/html5ui_2018/#/product/har_pelvis_2014/type/Text%20articles/id/42821/layer/3/angle/12/structureID/1327160) drain(s) into the portal circulation? Which part(s) of the rectum drain(s) into the systemic circulation?

superior middle and inferior

What is the significance of understanding the venous drainage of the rectum?

may cause haemorrhoids in liver cirrhosis portal systemic anastomosis is there

Why might [haemorrhoids](https://www.anatomy.tv/anatomytv/html5ui_2018/#/product/har_pelvis_2014/type/Text%20articles/id/42821/layer/0/angle/12/structureID/1327160) be associated with cirrhosis of the liver?

due increased to increased portal pressure

The veins along the sides and base of the prostate join to form the prostatic venous plexus. This makes the prostate a very vascular organ – important to consider the risks of bleeding associated with operations in the area. With which venous plexus does the prostatic venous plexus communicate with on its posterior side? Why is this important – think of how prostate cancer spreads...?

internal vertebral venous plexus it can spread to bones easy, spreads to spinal cord

**_Nerve Supply to the Reproductive Organs_** **_Somatic Nerves_** The **\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_** originates from L1 and enters the inguinal canal at the **\_\_\_\_\_\_\_\_\_ inguinal ring** to supply skin at the root of the penis in the male and the labia in the female. The **\_\_\_\_\_\_\_\_\_\_** nerve originates at L1-2 and enters at the **\_\_\_\_ inguinal ring**.

**ilioinguinal nerve** **superficial** **genitofemoral** **deep**

What structure(s) in the male are supplied by the genital branch of the genitofemoral nerve?

cremaster muscle and anterior scrotal skin

The **pudendal** nerve arises from the **_\_\_\_\_\_ plexus_** and follows the course of the pudendal artery to innervate the skin and the muscles of the perineum.

**_sacral_**

From which segmental level(s) does the pudendal nerve arise?

S2-4

note how the pudendal nerve travels from pelvis to perineum, via the gluteal region. This arrangement is essential to understand in bilateral pudendal nerve block for pain relief during childbirth, particularly for an instrumental (e.g. forceps) assisted vaginal birth What bony landmarks are used when performing a pudendal nerve block during labour?

ischial spine

The autonomic nerve supply to the pelvis originates from the where?

**pelvic plexus** (or inferior hypogastric) **The sympathetic fibres** originate from L1 and L2 via the **hypogastric nerve and terminal aspect of the sympathetic trunk**. These fibres hitchhike on the arterial supply to reach their target organs. They provide sympathetic supply to all internal pelvic organs. In a male they supply the vas deferens, seminal vesicles, prostate and epididymis. In a female they supply the ovaries, uterus, fallopian tubes and vagina. **Parasympathetic fibres** in the pelvis originate from the _pelvic splanchnic nerves_ (S2 to S4). In addition to providing parasympathetic supply to all the internal pelvic organs, they innervate erectile tissues in both male and female.

**_Confusing Splanchnics..._** It is very easy to get confused when describing “splanchnic” nerves, as both parasympathetic and sympathetic nerves can be described as such In the thorax the greater, lesser and least splanchnic nerves are **\_\_\_\_\_\_\_\_\_\_\_\_** In the pelvis the **pelvic splanchnic nerves** are **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**sympathetic** **parasympathetic**

**Applied clinical question:** After rectal surgery, why are some men unable to ejaculate? Which part of the autonomic nervous system has been affected?

damage to sympathetic fibres sympathetic, L1 and 2 sympathetic fibres

**_Lymphatics of the Pelvis_** There are four primary nodes present in the pelvis receiving the lymphatic drainage of the pelvic organs. They are variable in number, size and location. Remember that the lymphatic drainage of the pelvis tends to follow the arterial supply Lymph node group in the pelvis - what pelvic area do the extenral iliac lymph nodes drain?

directly from pelvic structures, inguinal lymph nodes

Lymph node group in the pelvis - what pelvic area do the internal iliac lymph nodes drain?

Gluteal region, deep perineum and inferior pelvic viscera

Lymph node group in the pelvis - what pelvic area do the sacral lymph nodes drain?

posteroinferior pelvic viscera

Lymph node group in the pelvis - what pelvic area do the common iliac lymph nodes drain?

Drainage from the three main groups: external, internal and sacral lymph nodes

Repro Anatomy 1 Flashcards

(79 cards)