20. The Pelvis Flashcards
Identify the various parts and bones of the hip and pelvis.
- Blue: Hip bones: ileum, ischium, pubis
- green: sacrum
- orange: coccyx
- arrow: pubic symphysis
- in anterior view: circle = pelvis inlet = pelvis brim (enters pelvis)
- in posterior view circle: pelvis outlet
What divisions do the pelvis inlet and outlet create?
- everything above the pelvis inlet is the false greater pelvis that holds abdominal organs
- everything between the inlet and outlet is the true lesse pelvis that holds pelvic organs
Identify the various parts of the hips
PICTURE ON LEFT: 3 bones of the hip
- in beinge: ilium
- in red: ischium
- in blue: pubis
they form the acetabulum which holds the femur
2 OTHER PICTURES
- red: greater sciatic notch (the bigger one) and the lesser sciatic notch (smaller one)
- light blue: in between the greater and lesser sciatic notch = ischial spine
- pink: ischial tuberosity (sitting bone)
- purple: pubic tubercle
- light green: anterior superior iliac spine (ASIS)
- white: from ASIS to pubic tubercle = inguinal ligament
- orange: obturator foramen
- arrow: ischiopubic ramus (2 of them create the pelvis angle used to determine wheter its female or male)
PIC ON RIGHT:
- green line: arcuate line which becomes
- blue line: pectinate line
What creates the pelvic brim
arcuate line, pectinate line and sacral promontory
Identify the pelvic ligaments.
- pink: inguinal ligament: from asis to pubic tubercle
- green: obturator membrane
- purple: sacrotuberous ligament: sacrum to ischial tuberosity
- orange: sacrospinous ligament: sacrum to ischial spine (more horizontal)
What do the sacrotuberous and sacrospinous ligament create?
greater sciatic foramen (blue) and the lesser sciatic forament (red)
Identify the muscles part of the pelvis wall. Identify their origins and attachments.
PELVIS WALL:
- blue: PIRIFORMIS M: from anterior aspect of sacrum through the greater sciatic foramen to the femur: laterally rotates hip
- green: ISCHIOCOCCYGEUS (aka coccygeus m): from ischial spine to coccyx: covers the sacrospinous ligament
- orange: OBTURATOR INTERNUS M: on the obturator membrane, from ischium and pubis through the lesser sciatic forament to the femur
Identify the muscles of the pelvic floor seen in this picture
purple: LEVATOR ANI: supports pelvic organs and rectums
white: tendinous arch: many muscles of the pelvic floor do not attach to bone but to this tendinous arch
Identify the various pelvic floor muscles.
LEVATOR ANI MUSCLES: medial to lateral
- blue: PUBORECTALIS M (r/l) : from pubis and wraps around the rectum : sling like
- green: PUBOCOCCYGEUS m: pubis to coccyz
- orange: ILIOCOCCYGEUS M: (from tendinous arch that follows the obturator internus m) coccyx
Why do people say pooping in a squatting position is beneficial?
in seated position, the puborectalis m (sling) closes off the rectum this qhen squatting the muscle doesnt and feces can pass through more easily
Why is the pelvic floor also known as the pelvic diaphragm?
during breathing, the pelvis flood muscles aid in respiration
- during inspiration, the abdominal organs pushs down onto the pelvis, the pelvic floor relaxes to allow abdominal organ to further push down
- during expiration: the pelvic floor contracts to push abdominal organs back up
Draw the pelvic floor muscles and the pelvic wall muscles.
What are the functions of the pelvic floor muscles (3)?
- support pelvic organs
- urinary continence
- (for females) support babies during pregnancy and for child birth
Identify the various parts of the bladder.
a. ureters: enters in posterior aspect of bladder
b. urethra
c. bladder
d. urachus: closing off of passageway of waste of fetus go to the placenta during fetal devepment to umbilicus (if doesn’t close off properly, fluid can come out of umbilicus)
e. detrusor m: contract voluntarily to excrete urine
f. rugae: allows for stretching of bladder to allow for more urine
g. trigone (smooth muscle): involuntary (controlled by ans), the feeling of wanting to pee (pressure)
- in blue: ureteric orifices: urine enters bladder from ureter through these (posterior aspect of bladder)
- in green: urethral orifice: allows for urine to leave bladder to urethra
Is the bladder retroperitoneal or intraperitoneal?
retroperitoneal
Where does the rectum sit in the pelvis?
the most posterior pelvic organ, sits on the sacrum
Idenitfy the various parts of the rectum and anus.
(following order of passage of feces)
a. rectal folds (inferior, middle, superior): relieves P on anus and sphincter
b. rectal ampulla = base right before anus
- blue: anorectal junction
c. internal anal sphincter: (thickening in muscle) involuntary
d. external anal sphincter: in perineum, voluntary
- green: anal columns: extension of tissue
- purple: at bottom and between anal columns = anal valves which stops flow
e. anal sinuses (space between anal columns)
Describe the position of the male and female pelvic viscera: what do they have in common? What are the differences?
IN COMMON: both male and female have the bladder as the pelvic organ that is most anterior and the rectum is the most posterior pelvic organ that sits on the sacrum
MALES: (from anterior to posterior)
- bladder,
- prostate with seminal vesicles that extend out of the back: prostate used: meeting place of ducts and tubes for both reproductive and urinary system
- rectum
FEMALES: (from anterior to posterior)
- bladder
- uterus: sits on top of the bladder (pregnant woman has an expanded uterus that puts pressure on the bladder thus they have a smaller bladder tolerance)
- extending at side of the uterus = fallopian tubes (intraperitoneal) that take eggs from ovaries
- vagina
- rectus
What covers the testis? What is the function of the testis?
tunica albuginea
-produces sperm
Explain the trajectory of the sperm.
- produced in the testis
- stored in the epididymis
- sperm is pushed out from epididymis to ductus deferens = vas deferens
- vas deferens goes through the inguinal canal (goes up into the canal whilst the testicular a and v go down)
- vas deferens goes to posterior aspect of bladder (crosses and goes under ureters)
- vas deferens and seminal vesicles (creates semen thus combines sperm at back of prostate and at ejaculatory ducts) join in at ejaculatory ducts
- ejaculotory duct and prostatic urtricule join in at urethra (in both reproductive and urinary system)
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What is the problem with the urinary system and reproductive system sharing the urethra in males?
dont want sperm to mix with urine bc urine is acidic and can kill sperm
What travels through the inguinal canal in males?
vas deferens
testicular a
pampiniform venous plexus (plexus of veins in testis)
What is a vasectomy?
cutting of the vas deferens to stop sperm from leaving testes
What is the function of the bulborethral glands?
bulborethral glands secrete into the urethra and clean the urethra (make it not acidic) before ejaculation
What is found between the ejaculatory ducts when they enter into the urethra?
= prostatic utricule = vagina and uterus that never form: contract during orgamsn to open ducts wider
Explain the different naming of the urethra.
Bladder
internal urethral sphincter
PRE-PROSTATIC URETHRA
PROSTATIC URETHRA (in prostate)
external urethral sphincter
MEMBRANOUS URETHRA (in perineum: between prostate and penis)
SPONGY URETHRA (longest urethra)
Why are females more prone to urinary infection?
their urethra is shorter thus infection can enter system quicker and they only have one urinary sphincter: external urenal sphincter in perineum
Identify the various parts of the female pelvic viscera.
e. ovaries
- orange: fallopian tubes
- a: fimbrae (projections of fallopian tubes)
- b: infundibulum
- c:ampulla
- d: isthmus (narrowing)
- blue: uterus
- f: fundus
- g: body
- h: isthmus (narrowing)
green: cervix
- i: canal
- j: internal and external ora (os singular)
- yellow: left, right, posterior, anterior fornices (cervix pushes into vagina adn creates one fornix) = continous circle
- k: rugae of vagina: allow for expansion of vagina
- L: vagina
How do you examine the cervix?
using a speculum: looking at external os
Identify these two ligaments.
upper: suspensory ligament (holds the ovarian a and v)
lower: round ligament
Identify these 2 female pelvic ligaments.
A. Broad ligament formed by the folding of the Parietal peritoneum
B. Round ligament: comes out of uterus and goes to deep inguinal ring (similar to the vas deferens)
Identify the 2 female pelvic ligaments.
A. Suspensory ligament: holds the ovarian artery and ligament (reflection of peritoneum that encases the artery and vein)
B. Round ligament: from the ovary to the deep inguinal ring (in blue)
Identify these female pelvic ligaments.
- in green: gubernaculum (goes through the round ligament)
a. round ligament: has 2 ends: 1 goes to the labia majora and the other goes to the gonad
the round ligament gets stuck at the uterus and gives off 2 ligaments: one being the ligament of the ovary
b. ligament of ovary: anchors ovary to the side of the uterus
c. ovarian a and v
d. broad ligament
e. suspensary ligament
Identify the blood flow structures.
A. bifurcation of abdominal aorta: L4/L5 into:
B. Right/Left Common iliac A into:
C. R/L: external iliac A
D. R/L internal iliac A
E. external iliac a becomes the femoral A after crossing the inguinal ligament
Describe the various branches of the internal iliac artey in males. (11)
Describe the various branches of the internal iliac artery in women. (11)
Draw the internal iliac artery and its branches.
Describe the pelvic somatic nerves.
Somatic Pelvic Nerves: from L4-S4
- superior gluteal n (L4-S1): goes above the piriformis
- inferior gluteal n (L5-S2): goes below the piriformis
- Sciatic n (L4-S3): travels inferior to piriformis
- Pudendal n (S2-S4): travels with the internal pudendal a: exits through the greater sciatic foramen inferior to the piriformis m, travels around the ischial spine (ischiococcygeus m), enters through the lesser sciatic foramen to go to the perineum
Explain and describe the autonomic pelvic nerves.
the superior hypogastric plexus gives off the
- L/R hypogastric n that goes into inferior hypogastric plexuses (L/R)
- joined by the sacral splanchnic n (from sympathetic trunk) that joins into inferior hypogastric plexuses (L/R)
- joined by pelvic splanchnic n (comes off ramus = parasymplathetic) that joins into inferior hypogastric plexuses (L/R)
Explain the sympathetic and parasympathetic innervation of the pelvis.
Parasympathetic n: from the pelvic splanchnic n (S2-S4)
Sympathetic n: sacral splanchnic n from the sympathetitc trunk
