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Clinical Anatomy Course > 14. Abdominal and Pelvic Walls > Flashcards

14. Abdominal and Pelvic Walls Flashcards

1
Q

What is the pelvic girdle?

A
  • The pelvic (hip) girdle is formed from two hip bones, known as the os coxae.
  • At birth, each hipbone is composed of three separate bones which fuse together, called the ilium, ischium and pubis.
  • The pelvic girdle directly articulates with the vertebral column at the sacroiliac joints.
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2
Q
A
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3
Q

What bones make up the hip bone? What is the position of each?

A
  • Ilium -> Top
  • Ischium -> Bottom, Back
  • Pubis -> Bottom, Front
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4
Q

What are the main landmarks of the hip bone?

A

Ilium:

  • Iliac crest (palpable)
  • Anterior superior iliac spine (ASIS) (palpable)
  • Posterior superior iliac spine (PSIS) (palpable)
  • Anterior inferior iliac spine (AIIS)
  • Greater sciatic notch

Ischium:

  • Ischial spine
  • Ischial tuberosity (palpable)

Pubis:

  • Pubic tubercle (palpable)

All 3:

  • Acetabulum -> Articulates with head of femur
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5
Q

What does the pelvic girdle articulate with?

A
  • Medially -> With sacrum at sacroiliac joint
  • Laterally -> With femur at acetabulum
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6
Q

Give a summary of the ligaments at the sacroiliac joint.

A
  • Sacroiliac ligament
    • Anterior sacroiliac ligament -> From the ala of the ilium to pelvic surface of
    • Posterior sacroiliac ligament -> Similar to anterior counterpart, except on the posterior side
  • Sacrotuberous ligament -> From inferior sacrum to iliac tuberosities
  • Sacrospinous ligament -> From lateral sacrum to ischial spine
  • Intrinsic ligaments
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7
Q

Draw the position of the anterior sacroiliac ligament.

A
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8
Q

Draw the position of the posterior sacroiliac ligament, sacrospinous ligament and sacrotuberous ligament.

A
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9
Q

What ligaments at the sacroiliac joint do you need to know about?

A
  • Intrinsic
  • Sacrotuberous
  • Sacroiliac
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10
Q

What are the greater and lesser sciatic foramina?

A
  • Greater sciatic foramen -> Formed by the ilium, sacrotuberous ligament and sacrospinous ligaments
  • Lesser sciatic foramen -> Formed by the ischium, sacrotuberous ligament and sacrospinous ligaments
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11
Q

What are the pelvic inlet and outlet, and what bones border each?

A
  • Pelvic inlet
    • This is the superior opening to the pelvis
    • Formed by the pubic symphysis anteriorly, and the pectineal line of the pubis, the arcuate line of the ilium, and the sacral promontory
  • Pelvic outlet
    • This is the inferior opening to the pelvis
    • Formed by the inferior margin of the pubic symphysis anteriorly, and the ischiopubic ramus, the ischial tuberosity, the sacrotuberous ligament, and the inferior tip of the coccyx posteriorly
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12
Q

What is the importance of the pelvic inlet?

A

Forms the boundary between the abdominal and pelvic cavities.

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13
Q

What is the pelvic brim?

A

The edge of the pelvic inlet.

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14
Q

What is the true pelvis?

A

The region between the pelvic inlet and outlet.

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15
Q

What is shown in red here?

A

Pelvic brim

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16
Q

What is shown in blue here?

A

Pelvic outlet

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17
Q

Describe the orientation of the pelvis.

A
  • When standing up, the pelvis is tilted in such a way that the anterior superior iliac spines are in the same coronal plane as the pubic symphysis and pubic tubercles.
  • This means that the pelvic inlet inclines anteriorly at 50-60° to the horizontal, whilst the pelvic outlet inclines anteriorly by around 10-15
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18
Q

Compare the male and female pelvis.

A
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19
Q

Is this the male or female pelvis?

A

Male

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20
Q

Is this the male or female pelvis?

A

Female

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21
Q

What’s the difference between the perineum and pelvic floor?

A
  • The pelvic floor is just above the perineum, separating it from the rest of the pelvic cavity.
  • The perineal body serves as an attachment for many of the pelvic floor muscles.
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22
Q

What is the pelvic floor?

A
  • A funnel-shaped diaphragm that separates the perineum from the rest of the pelvic cavity.
  • It is formed of muscle and connective tissue that functions to support the overlying pelvic viscera, including the bladder, intestines and uterus.
  • The pelvic floor also plays a role in urinary and faecal continence.
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23
Q

What are the components of the pelvic floor?

A

Muscles:

  • Levator ani -> Formed from three separate muscle components, called the puborectalis, pubococcygeus and iliococcygeus. Fibres insert into the central perineal body. Puborectalis forms a sling around the lower part of the rectum, creating a sphincter-like structure. Relaxation of the sling allows defaecation if combined with relaxation of the internal and external anal sphincters.
  • Coccygeus -> Posterior part of the pelvic floor.
  • Anococcygeal raphe (body) -> Musculotendinous structure passing between the anterior coccyx and the posterior aspect of the anus.

Non-muscular:

  • Pelvic fascia -> Contributes to the floor of the pelvis by enveloping the superior and inferior aspects of the pelvic diaphragm.
  • Perineal body -> A fibromuscular structure into which many muscles of the perineum, as well as the levator ani, insert. The structure lies just deep to the skin, between the urogenital and anal triangles of the perineum.

Note that the diagram is a superior view with the pubic symphysis at the bottom.

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24
Q
A
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25
Q

What is this?

A

Levator ani

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26
Q

What is the puborectal sling?

A
  • Puborectalis (part of levator ani) forms a sling around the lower part of the rectum, creating a sphincter-like structure.
  • Relaxation of the sling allows defaecation if combined with relaxation of the internal and external anal sphincters.
27
Q

What is the anococcygeal raphe?

A
  • A fibrous median raphe in the floor of the pelvis, which extends between the coccyx and the margin of the anus.
  • It is composed of fibers of the levator ani muscle that unite with the muscle of the opposite side, muscle fibres from external anal sphincter, and fibrous connective tissue.
28
Q

What is the pelvic diaphragm?

A

The pelvic diaphragm is part of the pelvic floor. It is a muscular partition formed by the levatores ani and coccygei.

29
Q

What is the fascia of the pelvic floor?

A

The fascia that covers the components of the pelvic floor.

30
Q

What muscles attach to the perineal body?

A
  • Levator ani
  • Muscles of the perineum
31
Q

What are the lateral (cardinal) ligaments of uterine cervix?

A
  • The ligaments that pass from the cervix to the lateral pelvic walls.
  • This supports the cervix.
32
Q

What vessels pass in the lateral (cardinal) ligaments of uterine cervix?

A

Uterine arteries

33
Q

Summarise the arterial supply of the pelvis.

A
  • Internal iliac artery -> To rectum, bladder and internal genitalia except gonads.

Internal iliac artery gives off:

  • Superior/inferior gluteal arteries and obturator artery -> To lower limb
  • Internal pudendal artery -> To external genitalia and perineum
34
Q

Summarise very concisely the arterial supply to the pelvis and perineum.

A
  • Pelvis -> Supplied by internal iliac artery
  • Perineum -> Supplied by internal pudendal artery (branch of internal iliac artery)
35
Q

What is the venous drainage of the pelvis by?

A

Internal iliac vein

36
Q

What nerve plexuses are involved in supplying the pelvis and perineum?

A
  • Sacral, pelvic and coccygeal plexuses
  • These form a number of nerves that innervate the pelvis
37
Q

Summarise the innervation of the pelvis.

A
  • Pudendal nerve (S2-S4) -> Supplies perineum (sensory, motor and sympathetic)
  • Pelvic splanchnic nerves (S2-S4) from the pelvic plexus -> Parasympathetic supply to pelvic organs
38
Q

Is the pudendal nerve sympathetic, parasympathetic or somatic?

A

Sensory, motor and sympathetic

39
Q

What is the pelvic plexus and what is its function?

A
  • The pelvic plexuses are around the rectum and base of the bladder
  • They are autonomic plexuses that provides both sympathetic and parasympathetic innervation to the viscera of the pelvic cavity.
  • The plexus is formed by contributions from the superior hypogastric plexus (sympathetic), sacral splanchnic nerves (sympathetic) and pelvic splanchnic nerves (S2-S4, parasympathetic).
40
Q

Does the pelvis only have efferent fibres?

A

No, it also has sensory fibres from the pelvic viscera.

41
Q

What is the sacral plexus and what is its function?

A
  • A nerve plexus which provides motor and sensory nerves for the posterior thigh, most of the lower leg and foot, and part of the pelvis.
  • It gives rise to the pudendal nerve.
42
Q

What innervates the pelvic floor muscles?

A

Pudendal nerve

43
Q

What is the coccygeal plexus and what is its function?

A
  • A nerve plexus near the coccyx bone.
  • It gives rise to the anococcygeal nerve so it contributes slightly to the innervation of the pelvic floor.
44
Q

What are the main layers of the anterior abdominal wall?

A
  • Skin
  • Superficial fascia
  • Muscles
  • Parietal peritoneum
45
Q

What are the two layers of superficial fascia in the anterior abdominal wall?

A
  • Fatty (superficial Camper) type
  • Membranous (deeper Scarpa) type
46
Q

What are the layers of muscle in the anterolateral abdominal wall?

A
  • External oblique
  • Internal oblique
  • Transversus abdominis

The rectus abdominis muscles also form the “6 pack” muscles.

47
Q

What are the external oblique muscles?

A
  • Pass from the external surfaces of ribs 5-12 to the linea alba (mid-line connective tissue of the abdomen), pubic tubercle and iliac crest.
  • Fibres run in a inferomedial direction.
48
Q

What are the internal oblique muscles?

A
  • Passes from the anterior part of the iliac crest and thoracolumbar fascia to the linea alba, pectineal line of the pubis via the conjoint tendon (shared with transversus abdominis) and inferior borders of ribs 10-12.
  • Fibres run in a superomedial direction.
49
Q

What are the transversus abdominis muscles?

A
  • Pass from the internal surfaces of 7th-12th costal cartilages, iliac crest and thoracolumbar fascia to the linea alba and pectineal line via the conjoint tendon.
  • Fibres run transversely.
50
Q

What is the rectus abdominis muscle?

A
  • Forms the “six-pack” muscles along the mid-line of the anterior abdominal wall.
  • Rectus abdominis passes from the xiphoid process and 5th-7th costal cartilage to the pubic symphysis and crest.
  • The tendinous intersections of the muscle create the bulging, segmented appearance of the muscle.
51
Q

What forms the rectus sheath?

A

Towards the mid-line, the other abdominal wall muscles form aponeuroses to create the rectus sheath that surrounds the rectus abdominis muscle

52
Q

What is the conjoint tendon?

A
  • A sheath of connective tissue formed from the lower part of the common aponeurosis of the abdominal internal oblique muscle and the transversus abdominis muscle, joining the muscle to the pelvis.
  • It forms the medial part of the posterior wall of the inguinal canal.
53
Q

Summarise the direction of the abdominal muscle fibres.

A

Fibre direction of the abdominal wall muscles follows a similar pattern to the intercostal muscles. The outermost external oblique has fibres that run in the direction of the fingers if placing your hands in your pockets (inferomedially). The next layer, the internal oblique, has fibres that run in a direction perpendicular to the external fibres (superomedially). Lastly, as the name suggests, transversus abdominis fibres run transversely.

54
Q

Describe the blood supply and innervation of the anterior abdominal wall.

A

Blood supply:

  • Superior epigastric artery -> From internal thoracic artery
  • Inferior epigastric artery -> From external iliac arteries

The superior and inferior epigastric arteries form an anastomosis within the rectus sheath at the umbilicus.

Innervation:

  • Intercostal nerves (T6-T12)
55
Q

Where do the nerves that innervate the anterior abdominal wall pass?

A
  • These nerves lie between the internal oblique and transversus abdominis muscles (the neurovascular plane).
  • When they reach the mid-axillary line, produce perforating branches to innervate the lateral abdominal wall.
  • Within the muscle sheath of rectus abdominis, the nerves produce perforating branches to innervate the anteromedial wall.
56
Q

Name in detail the layers of the anterior abdominal wall.

A
  1. Skin
  2. Subcutanoues tissue
  3. Camper fascia
  4. Scarpa fascia
  5. External oblique
  6. Internal oblique
  7. Transversus abdominis
  8. Transversalis fascia
  9. Pre-peritoneal adipose
  10. Parietal peritoneum
57
Q

What is the neurovascular plane of the abdominal wall?

A

All of the neurovascular structures supplying the abdominal muscles run in the plane between the internal oblique and transversus abdominis muscles, except for the iliohypogastric and ilioinguinal nerves.

58
Q

What muscles contibute to the posterior abdominal wall? What is their innervation?

A
  • Psoas major (L1-L3 anterior rami)
  • Psoas minor (L1 anterior ramus)
  • Iliacus (femoral nerve)
  • Quadratus lumborum (T12-L4 anterior rami)
  • Diaphragm (phrenic nerve)
59
Q
A
60
Q

What are the para-vertebral gutters and what is found in them?

A
  • A deep, vertical recesses passing either side of the vertebral column
  • Quadratus lumborum passes within the para-vertebral gutters, just lateral to psoas.
61
Q

Describe the vasculature of the posterior abdominal wall.

A

The abdominal aorta and inferior vena cava are found passing along the posterior abdominal wall as retroperitoneal structures:

  • Aorta -> Arises at the level of T12, as the thoracic aorta passes through the diaphragm, and continues to the level of L4, where it bifurcates into the common iliac arteries.
  • IVC -> Forms at the level of L5 by the union of the common iliac veins, to the right of the mid-line. The IVC leaves the abdomen at the level of T8 through the central tendon of the diaphragm.

In addition, the dilated abdominal part of the thoracic duct, called the cisterna chyli, is found at the level of L1-L2, just to the right and posterior to the aorta.

62
Q

Describe the nerves of the posterior abdominal wall.

A
  • Lumbar plexus (within psoas major) gives rise to somatic branches:
    • Femoral nerve -> Supplies iliacus and the muscles of the anterior compartment of the thigh. Also provides cutaneous innervation to the thigh and leg.
    • Obturator nerve -> Passes through the obturator foramen to supply the adductor muscles of the thigh.
    • Subcostal, iliohypogastric and ilioinguinal nerves -> Equivalent of the intercostal nerves, passing around the abdominal wall within the neurovascular plane. The ilioinguinal nerve supplies the anterior part of the scrotum or labia.
    • Genitofemoral nerve -> Emerges on the anterior surface of psoas major. Supplies a small area of skin over the femoral triangle and the cremaster muscle.
  • Sacral plexus forms a number of large branches, including the superior and inferior gluteal nerves, sciatic nerve, nerve to quadratus lumborum and the posterior cutaneous nerve of the thigh.
  • Lumbar sympathetic chain -> Supplies the legs and pelvis
63
Q

What is the hiccoughing reflex?

A
  • Hiccoughs = Spontaneous, myotonic, repetitive contractions of the diaphragm and intercostal musculature, which may be triggered by a range of stimuli including a large oral intake, carbonated drinks, alcohol, excitement and over-breathing.
  • Afferent component -> Vagus nerve, phrenic nerve or sympathetic nerve fibres. Ultimately, these sensory fibres converge at the upper spinal cord, medulla, reticular formation and hypothalamus.
  • Efferent component -> Phrenic nerve
64
Q

What is the abdominal skin reflex?

A
  • This is a superficial reflex obtained by firmly stroking the skin of the abdomen around the umbilicus
  • Carried by the anterior primary rami of T7-T12 (intercostal nerves)
  • Normally results in a contraction of abdominal muscles, leading to the umbilicus moving toward the site of the stimulus.

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