The Pelvis And Perineum

Question 1

The Pelvis can be divided into 2 parts. Name and explain them

Answer 1

The false pelvis and the true pelvis. The false pelvis is the inferior part of the abdomen and it lies on the upper pelvic bone and the sacrum and the body of L5. The true pelvis includes the pelvic inlet, the pelvic walls and the pelvic outlet

Question 2

The pelvic bone can be divided into three parts which are

Answer 2

The ilium and pubis and ischium

Question 3

Name the components of the ilium when seen anterior-medial

Answer 3

Iliac fossa, anterior superior iliac spine, posterior superior iliac spine, body of the ilium, arcuate line, iliac tuberosity, articular surface for sacrum attachment

Question 4

Name the components of the pubis when anterior-medial

Answer 4

Obturator groove, superior pubic ramus, pubic tubercle, pubic crest, body of the pubis, inferior pubic ramus

Question 5

Name the components of the ischium when seen anterior and medially

Answer 5

Body of ischium, ischial spine, lesser sciatic notch, ischial tuberosity, ramus of the ischium

Question 6

Name the components of the ilium when seen posterior

Answer 6

Iliac creat, posterior superior iliac spine, posterior inferior iliac spine, tuberculum of iliac crest, gluteal surface, anterior inferior iliac spine

Question 7

Name the components of the pubis when seen posterior

Answer 7

Superior pubic rami and inferior pubic rami

Question 8

Name the components of the ischium when seen posterior

Answer 8

Body, ischial spine, lesser sciatic notch, ischial tuberosity, ramus

Question 9

Linea terminalis separates the? It is composed of?

Answer 9

Abdominal part of the pelvic bone from the pelvic part of the pelvic bone. It is made of the pubic crest, the pectin pubis and the arcuate line

Question 10

Where are the greater and lesser sciatic notches, what ligament divides them

Answer 10

Above and below the ischimus spine, the sacro-iliac ligament

Question 11

What is in the obturator foramen and where is it. What is its function

Answer 11

It is below the ilium and between the ischium and pubis bone. It contains the obturator canal and membrane. It allows the passage of nerves from the pelvis to the medial thigh

Question 12

What is the acetabulum

Answer 12

It is the socket of the hip bone, into which the head of the femur fits

Question 13

What is the important function of the ischial tuberosity

Answer 13

While sitting it transfers the forces of the trunk to the lower limbs

Question 14

What is the location of the lumbo-sacral joints of the false pelvis

Answer 14

Between the inferior part of L5 and the superior part of L1,

Question 15

How many zygoapophysial joints are present in the false pelvis area

Answer 15

Two (between the articular processes of L5 and S1)

Question 16

What’s important about the length of the intervertebral disk between L5 and S1

Answer 16

It has a longer height in the anterior part than the posterior part. This is to help the forces on the body, because the lumbar column angles on the sacrum

Question 17

Name the lumbo-sacral ligaments and their locations. The function of these is

Answer 17

The lumbo-sacral ligament : between transverse process of the L5 onto the superior part of iliac fossa of the ilium
The ilio-lumbar ligament : between the transverse processes of L5 onto the iliac spine superior.
They squeeze the sacrum in between the two pelvic bones and this helps stability

Question 18

Name the sacro-iliac ligaments and their locations

Answer 18

The anterior sacro-iliac ligament (from the ala of the sacrum onto the iliac fossa)
The posterior sacro-iliac ligament (from the transverse ridges of the sacrum onto the posterior superior iliac spine)

Question 19

The joint between the sacrum and the ilium is what kind of joint

Answer 19

It is a synovial joint

Question 20

Explain the joints around the pubic symphysis. What happens to it during pregnancy

Answer 20

Superior pubic ligament and the inferior pubic ligament. During pregnancy it widens due to water saturation and thus there is the widening of the hips

Question 21

Name the region’s where a pelvic fracture is very likely to occur

Answer 21

The wings of the ilium, the superior ramus of the pubis, the ischial ramus

Question 22

Explain the orientation of the true pelvis

Answer 22

It(the pelvis inlet) is in an oblique plane, this protects the organs of the urogenital system. Note that the anterior superior iliac spine is at the same vertical plane as the pubic symphysis

Question 23

Explain the differences between the male and female pelvices

Answer 23

The male pelvis has a heart shaped pelvic inlet, a smaller angle between the pubic tubercles, and a more prominent ischial spine.
Women have a circular pelvic inlet, a larger angle between the pubic tubercles and a less prominent ischial spine

Question 24

Name the ligaments of the wall of the true pelvis. Why are they important

Answer 24

Sacro-tuberous ligament (is posterior and it joins the sacrum, coccyx, and ischial tuberosity) and the sacro-spinal ligament (is inferior and it joins the sacrum, coccyx and ischial spine)
Note that the sacrum tuberous ligament attaches to almost the entire body of the sacrum and part of the coccyx, whole the sacro-spinal ligament joins the ischial spine with a bit of the sacrum and coccyx.
They prevent the sacrum bone being tilted upwards and anterior when a person stands

Question 25

Name the muscles present in the pelvic inlet

Answer 25

The coccygeus, the obturator internus, the levator ani (divides into the puborectalis, pubococcygeus, iliococcygeus), primiformis muscle

Question 26

What is the origin, insertion, innervation and function of the obturator internus

Answer 26

Origin: anterolatera wall of the true pelvis
Insertion: medial surface of greater trochanter of femur
Innervation: nerve to obturator internus
Function: lateral rotation of hip joint and abduction of flexed hip

Question 27

Explain how to perform the obturator sign

Answer 27

Have patient lie down, and lift right leg while it is flexed against the calf at a 90° angle, once in this position place your left hand on the patients hip and use your right hand to pull gently the calf towards you (away from the center of the patient) This will increase the contact between the obtrusor and the appendix and will cause pain if the appendix is imflammed

Question 28

What is the origin insertion and function of the piriformis

Answer 28

Origin is the anterior surface of the sacrum between the anterior sacral foramina
Insertion medial side of superior border of greater trochanter of femur
Innervation branches from S1 and S2
Function lateral rotation of extended hip joint and abduction of flexed hip

Question 29

What are the anterior and posterior borders of the pelvic outlet

Answer 29

Anterior: pubic symphysis, pubic arches, ischial tuberosity
Links to posterior by the sacro-tuberous ligament
Posteriorly: coccyx

Question 30

What are the muscles of the pelvic floor

Answer 30

There are 2 : the coccygeus (from the ischial spine till lateral border of coccyx) and the levator ani
the levator ani divides into a medial (puborectalis), intermediate (pubococcygeal), and lateral (iliococcygeal)

Question 31

What is the origin, insertion, innervation and function of the coccygeus

Answer 31

Origin ischial spine and pelvic surface of sacro-spinal ligament
Insertion lateral margin of coccyx and related margin of sacrum
Innervation anterior rami of S3 ad S4
Function formation of pelvic floor, pulls coccyx inwards after defecation

Question 32

What is the anococcygeal ligament

Answer 32

It helps the division of the urogenital hiatus from the anal aperture

Question 33

What is the perineum

Answer 33

In both males and females it is a diamond shaped membrane that is present for the attachment/resting for the genital area. It’s superior margin is the same as the margins of the pelvic outlet
It has the urethral and vaginal opening. Posterior to it we have the anal canal, anterior to it we have the urogenital triangle.

Question 34

Where are the deep and superficial perineal pouches

Answer 34

Inbetween the levator ani and the perineal membrane

Question 35

The superficial perineal pouch is made of ? The deep perineal pouch?

Answer 35

The colles fascia (membranes) it covers the inferior perineum and attaches on the inferior part of the perineal membrane. The investing fascia from the abdomen forms the deep perineal membrane which forms the deep perineal pouch

Question 36

Where is the external urethral sphincter? In this area what is the difference between men and women

Answer 36

It is in the deep perineal pouch, and it surrounds the urethra in both sexes. In females there is also the compressor urethra and the spinchter urethra vaginalis muscles.

Question 37

What is the perineal Body? How can it be damaged and what are the consequences of this damage

Answer 37

It is made of CT fibers of the levator ani, it is posterior to the perineal membrane, it’s damage during pregnancy leads to prolapse of uterus into vagina and of pelvic organs into the perineal region. It can be damages during childbirth and episiotomy.

Question 38

Stopped slide 61

Answer 38

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