Trans - Pelvis Flashcards by UPCM 2018

What separates the major and minor pelvis?

Superior pelvic aperture / pelvic brim

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Major route of communication between pelvic cavity and lower limb

Greater sciatic foramen

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Prior to puberty, the ilium, ischium, and pubis are three separate bones connected by:

Triradiate cartilage

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T/F: The greater sciatic foramen serves as the entry point of neurovascular structures to the abdominal cavity

F. It serves as the exit. The lesser sciatic foramen is the entry point

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In obstetrics, the most important pelvic diameter measured is:

Anteroposterior, because it is the shortest diameter

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Most adequate diagonal conjugate for childbirth

Greater than or equal to 11.5 cm

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Boundaries of the pelvic outlet

Anterior: pubic symphysis
Posterior: sacrum, coccyx
Lateral: ischial tuberosity

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The normal female pelvic type is termed:

Gynecoid – pelvic inlet is rounded, oval shape, transverse diameter is wide

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What muscle makes up most of the lateral pelvic wall?

Obturator internus

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Largest muscle in the pelvic floor

Levator ani

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Part of the levator ani that forms a muscular sling around the anorectal junction

Puborectalis

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During childbirth, what is the most likely muscle to be injured? Why?

Pubococcygeus, because of its proximity to the uterus

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In females, what are the two potential spaces in the pelvic area?

Vesicouterine: between bladder and uterus

Retrouterine / pouch of Douglas: between rectum and uterus

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Serves as a bed for the sacral and coccygeal plexuses

Piriformis

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Main nerve of perineum and chief sensory nerve of external genitalia

Pudendal nerve

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T/F: The inferior gluteal nerve supplies both the gluteus maximus and the gluteus minimus

F. The superior gluteal nerve innervates both muscles. The inferior gluteal nerve only innervates gluteus maximus

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T/F: The superior gluteal artery arises from the posterior division of the internal iliac artery

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The artery supplying the ductus deferens and prostate originates from where?

inferior vesicular artery

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The pelvic girdle is composed of:

Innominate bones – ilium, ischium, pubis

2. Sacrum and coccyx

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Dimples at buttocks are at the level of:

PSIS

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When in a sitting position, a person is resting on his/her ________

Ischial tuberosity

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Attachment of the inguinal ligament in the pelvis

Pubic tubercle

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Sharp oblique ridge at the lateral part of the superior pubic ramus

Pectineal line / pecten pubis

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The pubic arch is formed by:

Ischiopubic rami of both sides of the pelvis

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How many longitudinal crests are on the dorsal part of the sacrum

Median sacral crest is formed from:

Fused spinous processes

Intermediate sacral crest is formed from:

Fused articular processes

Lateral sacral crest is formed from:

Fused transverse processes

`The coccyx is formed from the fusion of how many rudimentary vertebrae

Strongest ligament in the body

Sacroiliac ligament

Thickenings on the superior and inferior aspect of the pubic symphysis

Superior: superior pubic ligament Inferior: arcuate ligament

Narrowest diameter which a baby has to pass through during childbirth

Obstetric conjugate

T/F: The obstetric conjugate is directly measurable

F, because the bladder is in the way

The diagonal conjugate is measured from:

Inferior end/base of the pubic bone to sacral promontory

The pelvic midplane is at the level of the:

Ischial spine

Common pelvic types in males

Android | Anthropoid

Exit of the urethra and vagina through the pelvic diaphragm

Urogenital hiatus

Sacral plexus: components

Lumbosacral trunk (L4, L5), ventral rami of S1-S4

Branches of the sacral plexus

1. Sciatic nerve – lower limb 2. Pudendal nerve – external genitalia 3. Superior gluteal nerve – gluteus medius and minimus 4. Inferior gluteal nerve – gluteus maximus

Obturator nerve arises from what plexus

Lumbar plexus

Superior gluteal nerve innervates:

gluteus medius | gluteus minimus

Inferior gluteal nerve innervates:

gluteus maximus

Obturator nerve innervates:

Medial thigh muscles

Coccygeal plexus: components

Ventral rami of S4, S5 | Coccygeal nerves

The pudendal nerve splits the fascia of the obturator internus to form _________

Pudendal canal / Alock’s canal

The anterior division of the internal iliac artery mainly supplies ________

Organs and viscera

The posterior division of the internal iliac artery mainly supplies ___________

Muscles

Males: inferior vesical artery :: females:_______________

Vaginal artery

The superior vesical artery originates from ___________

Umbilical artery

Terminal branch of the internal pudendal artery

Dorsal artery of penis or clitoris

Females: uterine artery :: Males: ___________

Artery to the ductus deferens

The uterine artery passes directly ________ to the ureter

Superior

Iliolumbar artery supplies __________

Posterior abdominal muscles (iliacus, psoas major, quadratus lumborum)

Lateral sacral artery supplies __________

Spinal meninges and spinal nerves

In females, what vessels enter the true pelvis

2 Internal iliac 2 ovarian 1 median sacral 1 superior rectal

In males, what vessels enter the true pelvis

2 internal iliac 1 median sacral 1 superior rectal

Main venous drainage of the pelvis

Internal iliac vein

Pelvic venous plexuses are formed by which veins

Rectal Vesical Uterine Prostatic

Obturator foramen is formed by:

ramus of ischium | anterior ramus of pubis

The sacral promontory is the:

body of S1

Inferior borders of pubic arch define the:

subpubic angle

Structure covering the obturator canal

obturator membrane

Anterior sacrococcygeal joint is held together by:

anterior longitudinal ligament

Posterior sacrococcygeal joint is held together by:

posterior longitudinal ligament

the sacroilac ligament is supported by which other ligaments?

1. sacrotuberous ligament | 2. sacrospinous ligament

3 planes through which the head of the baby must exit in childbirth

1. Superior pelvic aperture 2. Pelvic midplane 3. Inferior pelvic aperture

the pelvic brim is formed by:

1, promontory and ala of sacrum | 2. right and left linea terminalis - arcuate line, pecten pubis, pubic crest

continuation of pecten pubis in ilium

arcuate line

elevations and depressions on surfaces of ilium and sacrum produce:

interlocking of bones, giving the sacroiliac joint more strength and stability

Sacroiliac joint: type of joint

synovial

most uncommon pelvic type

platypelloid

Components of lateral pelvic wall

1. ilium and ramus of ischium | 2. obturator internus muscle

Components of posterior pelvic wall

1. sacrum 2. ilium 3. sacroiliac joint 4. piriformis muscle

The piriformis exits at the

greater sciatic foramen

The obturator internus exits at the

lesser sciatic foramen

Piriformis: action

laterally rotate thigh

Components of the pelvic floor

1. levator ani | 2. coccygeus

Membrane that closes the urogenital hiatus

perineal membrane

Shape of pelvic diaphragm

hammock-shaped - deeper at the central part, shallower at the end

T/F: the pelvic diaphragm is relaxed during forced expiration, coughing, and strong movements of the upper limbs

F, the pelvic diaphragm contracts/tightens during these actions to increase support to the viscera and increase abdominal pressure

Major consequence of denervation of levator ani

Fecal and urinary incontinence

Likely consequences of pubococcygeal injury

1. uterine prolapse 2. cystocoele 3. rectocoele

Cystocoele: definition

bladder wall prolapse

Rectocoele: definition

rectal wall prolapse

T/F: the entire rectum is covered by peritoneum

F, the inferior third of the rectum does not have a peritoneal covering

T/F: the Fallopian tube is not entirely covered by the peritoneum on its posterior aspect

F, the Fallopian tube is entirely enclosed by peritoneum

The pelvic peritoneum covers what surfaces of the pelvic viscera?

Superior and lateral surfaces

The space between the peritoneum and the pelvic muscles/pelvic floor is covered by

Pelvic fascia

Pelvic fascia is a continuation of:

endoabdominal fascia

T/F: the entire uterus is mobile to allow for enlargement during pregnancy

F, the cervix of the uterus is an immobile structure

Visceral pelvic fascia: type of connective tissue

Loose connective tissue

The parietal pelvic fascia covers what structures

Obturator internus Levator ani Coccygeus Piriformis

T/F: neurovascular structures in the pelvis lie intraperitoneally

T/F: in the pelvis, nerves are generally more lateral to the vessels

T/F: in the pelvis, the veins are generally more medial to the arteries

T/F: all branches of the sacral plexus exit through the greater sciatic foramen

F, the nerve to the piriformis does not exit the greater sciatic foramen

T/F: the pudendal nerve returns to the pelvis via the lesser sciatic foramen

T. It leaves the greater sciatic foramen, hooks around the ischial tuberosity, and reenters the pelvis through the lesser sciatic foramen

Obturator nerve exits the pelvis via:

obturator foramen

The coccygeal plexus innervates:

coccygeus

The birfurcation of the common iliac arteries into the internal and external iliac arteries occurs at what level

L5-S1

Main artery of pelvis

Internal iliac artery

The internal iliac artery divides into anterior and posterior divisions near the __________

obturator foramen

T/F: the inferior vesicular artery may be found in both sexes

F, it is only found in males. its counterpart in females is the vaginal artery

The artery to the ductus deferens and the artery to the prostate are branches of:

inferior vesicular artery

Inferior vesicular artery: structures supplied

bladder, seminal vesicle, prostate

At the junction of the uterus and the vagina, the uterine artery passes over what structure

Ureter

junction of vagina and uterus

vaginal fornix

Critical areas of possible ureter ligation

1. When ligating the uterine arteries near the lateral vaginal fornix 2. When ligating ovarian vessels near the pelvic brim

Only branch in the anterior division of the internal iliac that supplies muscles

Inferior gluteal artery

Unpaired artery arising from the posterior surface of aorta near the pelvis

Median sacral artery

T/F: the ovarian artery lies anterior to the ureter as it enters the pelvic brim

F. The artery lies adjacent to the ureter as it enters the pelvic brim

The ovarian artery runs within what structure

suspensory ligament of ovary

Largest tributary of internal iliac vein

Superior gluteal vein

Lateral sacral veins drain into

internal vertebral venous plexus

Trans - Pelvis Flashcards

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