39 and 40 - Pelvis I and II Flashcards
(226 cards)
1
Q
What bones make up the belvis?
A
- Os coxa (“hip bone”
- Sacrum
- Coccyx
2
Q
What are the three bones that make up the os coxa or “hip bone” or “innominate?
A
1 - Ilium
2 - Ishium
3 - Pubis
3
Q
What are the three regions of the articulated pelvis?
A
1 - Pelvic brim or pelvic inlet
2 - Greater pelvis or false pelvis
3 - Lesser pelvis or true pelvis
4
Q
What makes up the pelvic brim )or pelvic inlet)?
A
- Pectineal line of pubis
- Arcuate line of ilium
- Sacral promontory
5
Q
What is the greater pelvis (of flase pelvis)?
A
Located in the lower part of the abdominal cavity - superior to the pelvic inlet
6
Q
What is the lesser pelvis (or true pelvis)?
A
The actual pelvis
- Inferior to the pelvic inlet
- Superior to the pelvic outlet
- Space is closed by the pelvic diaphragm
7
Q
What four bony points are found on the ilium?
A
- Anterior superior iliac spine (ASIS)
- Anterior inferior iliac spine (AIIS)
- Posterior superior iliac spine (PSIS)
- Posterior inferior iliac spine (PIIS)
8
Q
There are four joints of the pelvis. What are they?
A
1 - Sacroiliac
2 - Lumbosacral
3 - Sacrococcygeal
4 - Pubic symphysis
9
Q
What type of joint is the sacroiliac joint? What is it important for?
A
- Synovial joint
- Binds the sacrum to the ilium
- Transfers weight from the torso to the lower limb
10
Q
What type of joint is the lumbosacral joint? Where is it located?
A
- A secondary cartilaginous (fibrocartilaginous) joint with an IV disc
- Lumbosacral joint is the juncture between L5 and S1
11
Q
What type of joint is the sacrococcygeal joint? Is it a moveable joint?
A
- Same as the lumbosacral joint - a secondary cartilaginous (fibrocartilaginous) joint with an IV disc
- A partially moveable joint
- Relaxin given during parturition increases mobility
12
Q
What type of joint is the pubic symphysis?
A
A secondary cartilaginous (fibrocartilaginous) joint
13
Q
What are the two ligaments of the pelvis?
A
1 - Sacrospinous ligament
2 - Sacrotuberous ligament
14
Q
What does the sacrospinous ligament connect?
A
The sacrum to the ischial spine
15
Q
What does the sacrotuberous ligament connect?
A
The sacrum to the ischial tuberosity
16
Q
What are the functions of the two pelvic ligaments?
A
- Help to prevent anteroinferior displacement of the superior sacrum
- Convert the greater and lesser sciatic notches into greater and lesser sciatic foramina
17
Q
How is the pelvic inlet different in males and females?
A
Males - heart shaped pelvic inlet
Females - round/oval shaped pelvic inlet
18
Q
How is the pelvic canal different in males and females?
A
Males - long and funnel-shaped
Females - Short with parallel walls
19
Q
How are the ishcial tuberosities and spines different in males and females?
A
Males - not everted
Females - everted
20
Q
How are the greater sciatic notches different in males and females?
A
Males - narrower
Females - broader
21
Q
How are the pubic arch and subpubic angle different in males and females?
A
Males - narrower (70 degrees)
Females - broader (90 degrees)
22
Q
How is the sacrum different in males and females?
A
Males - long and narrow
Females - short and broad
23
Q
What side of the ilium is the iliac fossa located on?
A
The anteromedial surface
24
Q
What is the purpose of the arcuate line that is located on the anteromedial surface of the ilium?
A
Muscle attachment
25
What is the acetabulum?
A point of convergence of all three bony components - where the head of the femur meets the pelvis
26
Where is the ischium located?
The most posterior part of the pelvis "ishium = ashium"
27
What components make up the ishium?
The ishium is composed of a body and a ramus (column)
28
What foramen does the ramus of the ishium contribute to?
The obturator foramen - it extends from the body toward the inferior pubic ramus
29
What is the obturator foramen lined by?
Membrane and muscle that forms a portion of the lateral pelvic wall
30
What is the ischial spine important for?
Muscle attachment - especially those on the pelvic floor
31
What is the pubis bone composed of?
A body and TWO rami
32
What do the two rami of the pubis bone contribute to?
The obturator foramen
- Superior ramus extends from body towards acetabulum
- Inferior ramus extends from body towards ischial ramus
33
The pectineal line is continuous with the ________________.
Arcuate line o the ilium
34
What is the difference in the pelvic floor muscles between a bipedal human and our quadrapedal ancestors?
- Muscle fibers now run in a different direction than if we were on four legs
- Boney attachments are the same, but muscles have changed structure/function to adapt
35
What is the inferior border of the pelvis bounded by?
The pelvic floor muscles
36
What muscle lines the lateral wall of the pelvis?
The obturator internus
37
What is the path of the obturator internus muscle?
- Arises from the lesser pelvis
- Passes through the lesser sciatic foramen
- Attaches to the femur's greater trochanter
38
What else lines the lateral wall of the pelvis?
The obturator membrane
39
What does the obturator membrane do?
Lines the obturator internus muscle and forms the tendinous arch medially
40
What muscle lines the posterior wall of the pelvis?
Piriformis muscle
41
Describe the path of the piriformis muscle
- Attaches to the sacrum within the lesser pelvis
- Passes through the greater sciatic foramen
- Attaches to the femur's greater trochanter
42
What is the purpose of the piriformis muscle?
IT serves as a "bed" for the sacral nerve plexus
43
What is the muscle that lines the pelvic floor?
The pelvic diaphragm
44
What is the function of the pelvic diaphragm?
- Functions to support the viscera (especially when there is increased intraabdominal pressure)
- Aids in voluntary control of urination and fecal continence
45
What muscles make up the pelvic diaphragm?
The levator ani and the coccygeus
46
The levator ani is composed of three muscles. What are they?
1 - Puborectalis (most medial)
2 - Pubococcygeus (middle)
3 - Iliococcygeus (most lateral)
47
Describe the puborectalis muscle (origin, function)
It is a muscular sling that arises from the pubis and maintains fecal continence
(NOTE: this muscle is sometimes treated as part of the pucococccygeus)
48
Describe the pubococcygeus muscle (origin, insertion)
- Arises from the pubis and tendinous arch
| - Attaches to the coccyx
49
Describe the iliococcygeus muscle (origin, insertion)
- Arises form the tendinous arch and ischial spine
| - Blends into the pubococcygeus
50
What is the coccygeus muscle?
The second muscle that makes up the pelvic diaphragm
51
What is the origin and insertion of the coccygeus muscle?
AKA ischiococcygeus muscle
- Origin: ischial spine
- Insertion: coccygeus/sacrum
52
What is included in the "pelvic viscera"?
- Urinary bladder
- Parts of the ureters
- Parts of the reproductive system
- Rectum
- Urinary system
53
What is the function of the urinary system?
- Transport urine from kidneys to bladder
- Store urine
- Transfer urine to outside world
54
Are kidneys considered abdominal or pelvic organs?
Abdominal, however they were embryologically located in the pelvis
55
What are ureters?
Retroperitoneal muscular tubes that transport urine from the kidneys to the posterosuperior bladder
56
Describe the ureters entering the bladder
The ureters enter the bladder obliquely, forming flap valves so muscular contractions of the bladder can act as spincters which prevents urinary reflux into the ureters
57
In females, the ureters pass ________ to the uterine artery's origin
Medial
58
In males, the ductus deferens rests between the ____________ and ______________.
Ureters and peritoneum
59
What is the arterial supply to the ureters?
Nearby arteries
- Uterine artery in females
- Inferior vesicular artery in males
60
What is the innervation of the ureters?
Nearby autonomic plexuses
- Renal
- Aortic
- Superior hypogastric
- Inferior hypogastric
61
What is the function of the bladder?
A temporary reservoir for urine
62
What is the position of the bladder?
Variable - it depends on the age and the individual's state
63
What is the general location of an adult bladder?
- Empty bladder - rests in the lesser pelvis
| - Full bladder - may extend to the umbilicus
64
What is the general location of a child's bladder?
An empty bladder may rest in the abdomen, even when it is empty
65
What are the five parts of the bladder?
```
1 - Apex
2 - Fundus
3 - Body
4 - Neck
5 - Trigone
```
66
Where is the apex of the bladder located?
Anterosuperior aspect
67
Where is the fundus of the bladder located?
Posterior wall of the bladder
68
Where is the body of the bladder located?
Area between the apex and fundus
69
What is the purpose of the neck of the bladder?
Constriction
70
What is the trigone of the bladder?
The triangle between the ureteric and urethral openings of the bladder
71
What is the uvula of the bladder?
A projection of the trigone that is visible in older men
72
What are the walls of the bladder composed of?
Primarily detrusor muscle
73
In females, what is the muscle of the bladder continuous with?
The muscle of the bladder's neck is continuous with the urethra muscle
74
In males, what is the muscle of the bladder continuous with?
The muscle of the bladder's neck is continuous with the prostate's fibromuscular tissue - Muscle fibers from the involuntary internal urethral spincter
75
What is the function of the male's internal urethral spincter?
Prevent semen from entering the bladder
76
What is the urethra?
A muscular tube that conveys urine from the bladder to the outside world
77
Describe the path of the urethra in females
The urethra descends anterior to the vagina (partially pelvic, partially perineal)
78
What does the urine exit through in females?
The external urethral orifice
79
Where do glands exist in females?
Adjacent to the urethra - we will discuss this in the perineum)
80
How is the male urethra different from the female urethra?
It is much longer and more complex than the female urethra
81
How many curves will you find in the urethra of a male?
- When penis is flaccid, 2 urethral curves
| - When penis is erect, 1 urethral curve
82
There are four parts of the male urethra. What are they?
- Preprostatic
- Prostatic
- Intermediate/membranous
- Spongy
83
Where is the preprostatic region located?
From the neck of the bladder to the prostate
84
Where is the prostatic region located?
Within the prostate - it has a gentle curvature
85
Where is the intermediate/membranous region located?
It passes through the external urethral sphincter
- Short
- Narrow
- Least distensible
Note: located in perineum, NOT pelvis
86
Where is the spongy region located?
It ends at the external urethral orifice of the penis - longest portion of the urethra
Note: located in perineum, NOT pelvis
87
The prostatic urethra has some specialization/structures/features that aid in function. What are these specializations?
- Urethral crest
- Seminal collicus
- Prostatic uricle
- Opening of the ejaculatory ducts
- Opening of the prostatic ducts
88
What is the urethral crest of the urethra?
- Found in male urethra - prostatic region
| - It is the median ridge
89
What is the seminal colliculus of the urethra?
- Found in male urethra - prostatic region
| - It is a rounded eminence
90
What is the prostatic utricle of the urethra?
- Found in male urethra - prostatic region
| - It is a cul-de-sac remnant of a uterovaginal canal in the seminal colliculus
91
Where is the opening of the ejaculatory duct in the urethra?
- Found in male urethra - prostatic region
| - It is in the seminal colliculus which is located inferior to the prostatic urticle
92
Where is the opening of the prostatic duct?
- Found in male urethra - prostatic region
| - Lateral to the seminal colliculus
93
What are the organs of the female reproductive system?
- Ovaries
- Uterine tubes
- Uterus
- Vagina
94
What are ovaries?
Female glands that house and release ova
95
There are four parts of the female uterine tubes. What are they?
1 - Infundibulum
2 - Ampulla
3 - Isthmus
4 - Uterine part
96
What is the infundibulum?
The funnel-shaped part of the female uterine tube that has fimbrae at the opening
97
What is the ampulla?
The widest and longest part of the female uterine tube
98
What is the isthmus?
The part of the female uterine tube that enters the uterine horns
99
What is the uterine part?
The short segment of the female uterine tube that inserts into the uterine wall
100
There are two parts of the uterus. What are they?
- Body
| - Cervix
101
What makes up the body of the uterus?
- Upper 2/3
102
The body of the uterus has three regions. What are they?
1 - Fundus
2 - Uterine horns
4 - Isthmus
103
What is the fundus of the uterine body?
The area superior to the uterine tubes
104
What are the uterine horns?
The entrance of the uterine tubes into the uterus (can see this in radiographs)
105
What is the isthmus of the uterine body?
The constricted region found just superior to the cervix
106
What is the cervix?
The neck of the uterus
107
What two structures make up the cervix?
- Internal Os
| - External Os
108
What is the internal O?
The opening to the uterus
109
What is the external O?
The opening to the vagina
110
What four structures of the pelvis would be considered "supporting structures" to the uterus?
1 - Ovarian ligament
2 - Round ligament
3 - Broad ligament
4 - Pelvic diaphragm
111
What does the ovarian ligament connect?
Connects the ovary to the uterus
| posteroinferior to uterotubal junction
112
What does the round ligament connect?
Uterus (posteroinferior to uterotubular junction) to labia majora
113
What is another name for the round ligament?
Ligamentum teres
114
What is the broad ligament? What are the four subdivisions of the broad ligament?
```
The broad ligament is the mesentery of the uterus
1 - Suspensory ligament
2 - Mesovarium
3 - Mesosalpinx
4 - Mesometrium
```
115
What does the suspensory ligament do?
Conveys the ovarian vessels, lymphatics and nerves
116
What does the mesovarium do?
Suspends the ovary
117
What does the mesosalpinx do?
Suspends the uterine tue
118
What does the mesometrium do?
Suspends most of the uterus
119
What is the general position of the uterus?
- Anteverted
| - Anteflexed
120
What is the vagina?
A musculomembranous tue that runs from the cervix to the vestibule
121
Is the vagina in the pelvic region or the perineum?
Both - partly in the pelvic region, partly in the perineum
122
Where is the vagina located?
- Posterior to the urethra and bladder
| - Anterior to the rectum
123
What muscles compress the vagina?
Several muscles compress the vagina, including...
- External urethral spincter
- Bulbospongious muscle
124
The superior most part of the vagina surrounds the ___________.
Cervix
125
What is a fornix? What do they do?
A fornix is a projection of vaginal tissue that connects to the cervix of the uterus - the vagina has four fornices
- Anterior
- Posterior
- Lateral (2)
126
What innervates the vagina?
- Lower 1/4: somatic (deep perineal branch of pudendal)
| - Upper 3/4: autonomic
127
What are the seven components of the male reproductive system?
```
1 - Testes
2 - Epididymis
3 - Ductus deferentes
4 - Seminal vesicles
5 - Ejaculatory ducts
6 - Prostate
7 - Bulbourethral glands
```
128
What is the ductus deferens?
(ductus deferens = singular)
The ductus deferens is a continuation of the duct of the epididymis
129
What is the ampulla of the ductus deferens
An expansion of the ductus deferens
130
The ductus deferens joins the ___________ to form the ____________.
Seminal vesicle, Ejaculatory duct
131
What are the seminal vesicles?
Paired glands that secrete a thick fluid into the ejaculatory ducts
132
What are the ejaculatory ducts?
- Two ducts that are formed by the joining of the seminal vesicle ducts and the ductus deferens
- The ducts converge at the seminal colliculus of the prostatic urethra
133
What is the course of the ejaculatory duct?
It descends through the posterior prostate
134
What is the prostate?
An accessory gland for male reproduction which contains the prostatic urethra
135
How is the prostate divided?
Into lobes - anterior, posterior, middle, lateral
136
What are the prostatic ducts?
There are 20-30 prostatic ducts in the prostate gland which empty into the prostatic sinuses on either side of the seminal colliculus
137
What are the bulbourethral glands?
- Small glands which secrete their secretions during sexual arousal
138
What is semen?
A mixture of secretions by the testes, seminal vesicles, prostate and bulbourethral glands which usually contains sperm
139
Where are the bulbourethral glands located?
Posterolateral to the intermediate/membranous urethra
140
Where do the ducts of the bulbourethral glands open into?
The spongy urethra in the bulb of the penis
141
What is a retroverted uterus?
- A uterus that is tilted posteriorly
- This is in contrast to the slightly "anteverted" uterus that most women have, which is tipped forward toward the bladder, with the anterior end slightly concave
142
How common is a retroverted uterus?
Between 1 in 3 and 1 in 5 women has a retroverted uterus, which is tipped backwards towards the spine.
143
What is benign prostatic hyperplasia?
- Aging males face a problem known as benign prostatic hyperplasia (also sometimes called benign prostatic hypertrophy)
- One or more lobes of the prostate are affected
- Middle and lateral lobes of the prostate exist
- When a lobe is enlarged, it can impinge the urethra
- Affects the sphincter urethrae
- Complications include urgency to urinate and difficulty urinating
144
What is the surgical intervention used in patients with benign prostatic hyperplasia?
TURP (transurethral resection of the prostate)
| - This allows both the external (voluntary) and internal (involuntary) sphincters to be free of obstruction
145
The pelvic fascia is a continuation of the ___________ fascia.
Endoabdominal fascia
146
The ________ lines the walls of the pelvic floor while the ________ lines the walls of the pelvic surfaces
Parietal
| Visceral
147
What are the three peritoneal reflections of the pelvic region?
- Extraperitoneal (or subperitoneal)
- Primarily retroperitoneal (PRP)
- Intraperitoneal (IP)
148
What does the extraperitoneal (or subperitoneal) reflection include?
Most of the pelvic viscera
Note that the extraperitoneal reflection is actually outside of the peritoneal cavity
149
What does the primarily retroperitoneal (PRP) reflection include?
PRP
- Kidneys
- Urethers
- Rectum
- Anal canal
- Prostate (male)
- Seminal vesicles (male)
- Vas deferens (male)
150
What does the intraperitoneal reflection include?
IP
- Uterus
- Ovaries
- Uterine tubes
151
The uterus could also be considered secondarily intraperitoneal. Why is that?
The uterus is complicated
152
What are the five spaces of the pelvis?
```
1 - Retropubic space
2 - Retrorectal space
3 - Rectovesical pouch
4 - Vesicouterine pouch
5 - Rectouterine pouch
```
153
What is the retropubic space also known as?
Space of Retzius
154
Where is the retropubic space located?
Behind the pubis
155
What is the purpose of having a retropubic space?
It accommodates for bladder distension
156
Where is the retrorectal space located?
Behind the rectum
157
What is the purpose of having a retrorectal space?
It accommodates for rectal expansion
158
Is the rectovesical pouch found in males, females or both?
Males only
159
Where is the rectovesical pouch located?
Between the male bladder/prostate and the rectum
160
Is the vesicouterine pouch found in males, females or both?
Females only
161
Where is the vesicouterine pouch located?
Between the female bladder and the uterus
162
What is the rectouterine pouch also known as?
The Pouch of Douglas
163
Is the rectouterine pouch found in males, females or both?
Females only
164
Where is the rectouterine pouch located?
Between the uterus and rectum
165
How can you access the rectouterine pouch for surgical/treatment purposes?
The rectouterine pouch may be easily accessed via posterior fornix (connection between vagina and cervix)
166
Where is the rectouterine pouch located in relation to the vesicouterine pouch?
The rectouterine pouch is located a little lower than the vesicouterin pouch
167
What does this mean for clinical purposes?
If fluid is accumulating in the pouches of the pelvis, there will be more fluid accumulation in the rectouterine pouch than in the vesicouterine pouch
168
What is the main arterial supply to the pelvic region?
The common iliac arteries
169
Each common iliac artery splits into an _________ artery and an _________ artery
Internal iliac artery
| External iliac artery
170
The internal iliac artery has two divisions. What are they?
- Anterior division
| - Posterior division
171
What are the seven branches off of the anterior division of the internal iliac artery?
```
1 - Umbilical artery
2 - Obturator artery
3 - Inferior vesicular
4 - Middle rectal artery
5 - Internal pudendal artery
6 - Inferior gluteal artery
5 - Uterine artery
```
172
What branch does the umbilical artery give off?
The superior vesicular artery that goes to the ductus deferens (variable)
173
What branch does the uterine artery give off?
The vaginal artery
174
What are the three branches of the posterior division of the internal iliac artery?
- Iliolumbar artery
- Lateral sacral artery
- Superior gluteal artery
175
What is the path of the lateral sacral artery?
It runs laterally across the sacrum
176
What is the path of the superior gluteal artery?
Runs between L5 and S1 nerves and is a KEY landmark
177
Which branch off of the posterior division of the internal iliac artery is the largest?
Superior gluteal artery
178
From the anterior division, where does the obturator artery run?
Through the obturator foramen
179
The umbilical artery has two parts. What are they?
- A living component that still conveys blood
| - A ligament known as the obliterated umbilical artery that runs on the anterior wall
180
Describe the path of the inferior gluteal artery
The inferior gluteal artery travels on the sacral plexus to the gluteal region between S2 and S3
181
Describe the path of the internal pudendal artery
It travels near the inferior gluteal but tranvels into the perineum
182
Where do the gonadal arteries branch from (the testicular or ovarian arteries)
Directly from the abdominal aorta
183
What four lymph nodes are found in the pelvic region?
1 - Inguinal nodes
2 - External and internal iliac nodes
3 - Common iliac nodes
4 - Lumbar nodes
184
Describe the inguinal nodes
- There are superficial and deep inguinal nodes
- They receive lymph from the lower limb and the lowest part of the body wall
- This includes the genetalia
185
Describe the external and internal iliac nodes
- Receive lymph from the pelvis and from the inguinal nodes
186
Describe the common iliac nodes
- They receive lymph from the external and internal iliac nodes
187
Describe the lumbar nodes
They receive lymph from the common iliac nodes
188
Describe the venous drainage in the pelvic region
Pelvic venous drainage generally follows the arterial pattern
189
What components are there of the venous plexus?
Pelvic venous plexuses...
- Rectal
- Vesical
- Prostatic
- Uterine
- Vaginal
190
What two nerves of the pelvic region are branches of the lumbar plexus?
- Lumbosacral trunk
| - Obturator nerve
191
What spinal levels does the lumbosacral trunk arise from?
L4-L5
192
What spinal levels does the obturator nerve arise from?
L2-L4
193
Is the accessory obturator always present?
No
194
When the accessory obturator is present, what does it arise from?
L3-L4
195
There are four components of the sacral plexus. What are they?
- Sciatic nerve
- Pudendal nerve
- Superior gluteal nerve
- Inferior gluteal nerve
196
What spinal levels does the sciatic nerve arise from?
L4-L5
197
What does the sciatic nerve divide into?
The anterior and posterior divisions
198
What does the sciatic nerve exit the pelvis through?
The greater sciatic foramen
199
What does the sciatic nerve supply?
The lower limb
200
What spinal levels does the pudendal nerve arise from?
S2-S4
201
What division does the pudendal nerve have?
An anterior division
202
What does the pudendal nerve exit the pelvis through?
The greater sciatic foramen
203
What does the pudendal nerve then enter the perineum through?
The lesser sciatic foramen
204
What does the pudendal nerve supply?
The skin and muscles of the perineum - it is the main sensory nerve for the external genetalia
205
What spinal levels does the superior gluteal nerve arise from?
L4-S1
206
What division does the superior gluteal nerve contribute to?
The posterior division
207
What does the superior gluteal nerve exit the pelvis through?
The greater sciatic foramen
208
What does the superior gluteal nerve supply?
- Gluteus medius
- Gluteus minimus
- Tensor fascia latae
209
What spinal levels does the inferior gluteal nerve arise from?
L5-S2
210
What does the inferior gluteal nerve exit the pelvis through?
The greater sciatic foamen
211
What does the inferior gluteal nerve supply?
The gluteus maximus
212
What is the coccygeal plexus/
A small plexus from the ventral rami of S4-S5 and the coccygeal nerves
213
What are the two branches of the autonomic nervous system?
Sympathetics and parasympathetics
214
How many sympathetic ganglia are typically found in the anterior sacrum?
Usually 4 on each side
215
Where do the sympathetic ganglia converge?
At the ganglion impar (the end of the sympathetic trunk)
216
Where do the sympathetics arise from?
T11-L2
217
What do the sympathetics pass through?
The sympathetic chain
218
What two nerves do the sympathetics pass through?
Lumbar and sacral splanchnic nerves
219
Where do the sympathetics synapse?
In the inferior mesenteric ganglion
220
Where do the postsynaptics travel?
- Through the superior hypogastric plexus
- Through the right and left hypogastric nerves
- (and/or) Through the inferior hypogastric (pelvic) plexus
221
What do the sympathetics follow to the target organs?
Pelvic arteries
222
What spinal levels do the parasympathetics arise from?
S2-S4
223
What nerves do the parasympathetics pass through?
They ascend mainly through the inferior and superior hypogastric plexuses
224
What do the parasympathetics follow to the target organs?
Arteries
225
Where do the parasympathetics synapse?
In the ganglia of the organs or the gut plexuses
226
How do parasympathetics read the target organs?
Via short postsynaptic fibers
| Para = long pre, short post
