Abdomen Lecture Notes Pt. 3 Flashcards
1
Q
Common in women after they give birth
A
Pelvic organ prolapse
2
Q
Transmits the force of body weight to lower limbs and helps to protect pelvic visceral structures
A
Pelvis
3
Q
What are the three pelvic ligaments
A
- ) Sacroiliac
- ) Sacrospinous
- ) Sacrotuberus
4
Q
Prevent sacrum and coccyx from rocking posteriorly and superiorly as we stand and move
A
Sacrospinous and sacrotuberous ligaments
5
Q
Bony line where the pelvis communicates with the abdomen
A
Pelvic brim
6
Q
Above the pelvic brim is the
A
Abdomen
7
Q
Below the pelvic brim is the
A
Pelvis
8
Q
Space between the pelvic brim is the
A
Pelvic inlet
9
Q
Located below the pubic bone
A
Pelvic outlet
10
Q
Separates the false pelvis (pelvic fossa) from the true pelvis (pelvic cavity)
A
Pelvic Brim
11
Q
Located from the pelvic brim up to the iliac crest
A
Fase pelvis
12
Q
Suspended by the side walls of the bony pelvis
A
Pelvic Floor
13
Q
Extends from the pelvic floor to the pelvic brim
A
True pelvis
14
Q
Below the pelvic floor is the
A
Perineum
15
Q
What are the three pelvic foramen?
A
- ) Greater sciatic foramen
- ) Lesser scietic foramen
- ) Obturator foramen
16
Q
Connects the true pelvis with the gluteal region
A
Greater sciatic foramen
17
Q
What passes through the greater sciatic foramen?
A
- ) Sciatic nerve
2. ) Piriformis
18
Q
Connects the gluteal region with the perineum
A
Lesser sciatic foramen
19
Q
What passes through the lesser sciatic foramen?
A
Pudendal nerve and internal pudendal vessels
20
Q
Connects the pelvis to the medial thigh
-Obturator nerve passes through
A
Obturator canal
21
Q
Which three things pass from the pelvis to the perineum by going directly through the pelvic floor?
A
Urethra, vagina, and anal canal
22
Q
Has a wider pelvic inlet and outlet, and the subpubic (infrapubic) angle is 90 degrees
-transverse dimension exceeds anteroposterior dimension
A
Female pelvis
23
Q
What is the subpubic (infrapubic) angle in males?
A
60 degrees
24
Q
Feeling the ischial spines allows us to measure the transverse diameter of the
A
Pelvic outlet
25
The musculature of the pelvic floor is suspended like a
Hammock
26
Forms the lateral side walls of the pelvic floor
Obturator internus muscle
27
The extraperitoneal layer is continuous with the
Subperitoneal space
28
Continues down into the pelvis and becomes the endopelvic fascia
Transversalis fascia
29
Skeletal muscle floor that supports the pelvic viscera (bladder, rectum, uterus)
Pelvic diaphragm (pelvic floor)
30
Provides sphincter control over the urethra, vagina, and anal canal
Pelvic diaphragm (floor)
31
Increasing intraabdominal pressure increases
Intrapelvic pressure
32
Separates the true pelvis from the perineum
Pelvic diaphragm
33
During inspiration, the diaphragm descends which increases pressure on the
Pelvic floor
34
As the diaphragm descends, the pelvic floor
-contracts around urethra and anal canal
Ascends
35
Goes from body of pubis all the way back to the ischial spine
Tendinous arch of levator ani (Muscular white line)
36
The attachmentsite of the pelvic floor to the side walls
Muscular white line
37
Main muscle of the pelvic floor
covered with fascia called the pelvic diaphragm
Levator Ani
38
Forms lateral muscular walls of pelvis and ischioanal fossa
- superior part in pelvis
- inferior part in perineum
- LATERAL rotator of hip
Obturator internus
39
Layered on top of the sacrospinous ligament
Coccygeus muscle
40
Thickening of obturator internus fascia that serves as the attachment site for the levator ani muscle
Muscular white line (Arcus tendineus levator ani)
41
Innermost layer of the levator ani, which creates the anorectal angle at the anorectal junction
Puborectalis
42
Contraction of the puborectalis maintins
Fecal continence
43
Second layer of the pelvic floor and also the largest portion of the muscular pelvic floor
Pubococcygeus
44
The pubococcygeus sends muscle slips around the
Urethra and vagina
45
Contraction of the pubococcygeus helps to:
1. ) Maintain?
2. ) Compress?
1. ) Urinary continence
| 2. ) Pelvic portion of vagina
46
Forms the 3rd wall of the levator ani
Illeococcygeus
47
The levator ani is made up of which three levels?
1. ) Puborectalis
2. ) Pubococcygeus
3. ) Illeococcygeus
48
The length from the body of the pubis to the ischial spine are important landmarks because this is the length of the
Vagina
49
Provides static support of the pelvic viscera
-connects bilaterally to fascial white lines
Endopelvic fascia
50
There is a thickening of endopelvic fascia covering the levator ani. This is where we see the fascial support structures on the
Vagina and cervix
51
Thickening of levator ani fascia that serves as the attachment to the transverse cervical (cardinal) ligament and uterosacral ligaments
Fascial white line (Arcus tendineous fascia pelvis; ATFP)
52
Help provide support around the cervix
Uterosacral ligaments
53
The fascial white line serves as an important attachment site for which two fascia sheets?
1. ) Pubocervical fascia (Anterior sheet)
| 2. ) Rectovaginal fascia (Posterior sheet)
54
Located between the urethra and anterior vaginal wall, back of the bladder, and anterior vaginal wall
Pubocervical fascia
55
Helps to reinforce the anterior vaginal wall, preventing posterior movement of the urethra or bladder (preventing prolapse)
Pubocervical fascia
56
Part of ururectal septum between the posterior vaginal wall and anterior rectal wall
Rectovaginal fascia
57
Supports the posterior vaginal wall
Rectovaginal fascia
58
Help to hold up the cervix
Uterosacral and cardinal ligaments
59
Attaches one muscular white line to another
Levator ani
60
Runs in the transverse cervical (cardinal) ligament on its way to supply the uterus
Uterine artery
61
The place where 2 ligaments and 2 fascia come together to provide support to the cervix, uterus, and apex of vagina
Pericervical ring
62
For the pericervical ring, what is the
1. ) Anterior part?
2. ) Posterior part?
1. ) Pubocervical fascia
| 2. ) Rectovaginal fascia
63
The lateral support of the pericervical ring is from the
Cardinal ligaments
64
The posterior ligament support of the pericervical ring is from the
Uterosacral ligaments
65
Tearing or stretching of this fascia allows the bladder to push into the anterior vaginal wall, causing it to protrude outside of the body
Pubocervical fascia
66
LAteral detachment from the ATFP, resulting in an anterior vaginal wall prolapse
Cystocele
67
Cycstocele will occur when the patient increases
Intraabdominal pressure
68
Defect in rectovaginal fascia that allows the colon to push into the posterior vaginal wall and cause prolapse
Rectocele
69
Caused by lateral detachment from ATFP or tear in the pelvic diaphragm
Rectocele
70
Commonly seen in cystocele and rectocele
-Coughing results in patient peeing
Stress urinary incontinence (SUI)
71
In SUI, there is no support to stop the urethra from moving posteriorly and straightening out, and when this happens the urethra
Opens
72
How can we fix SUI?
Transvaginal sling
73
Placing a peice of mesh from anterior vaginal wall to obturator internus
-We want to stay entirely below pelvic floor so as not to perforate the bladder
Transvaginal sling
74
Endopelvic fascia surround the prostate, and it is here that we see the nerves responsible for
Erection
75
The descending aorta bifurcates into L and R common iliac arteries at the level of
L4
76
The common iliac artery divides into internal and external branches at
L5
77
Does not go into the pelvis
-becomes femoral artery
External iliac artery
78
Main artery of the pelvis
-divided into anterior and posterior divisions
Internal iliac (hypogastric) artery
79
Sends branches to the gluteal region, sacrum, and posterior abdominal wall, thus it does not supply pelvic viscera structures
Posterior branch of internal iliac artery
80
The anterior branch of the internal iliac artery supplies the pelvic viscera. What are the 2 branches?
1. ) Umbilical
| 2. ) Obturator (runs with obturator nerve)
81
Takes fecal blood away from the fetus to the umbilicus and also will supply the bladder
Umbilical artery
82
After birth, the umbilical artery becomes fibrotic and is renamed the
Medial umbilical fold
83
There is TREMENDOUS collateral circulation between the
R and L internal iliac arteries
84
Will spread to the lateral aortic nodes, not the pelvic lymph nodes
Ovarian cancer
85
Will spread to the internal iliac lymph nodes
Cervical cancer
86
The vagus nerve does not innervate anything in the
Pelvis
87
In the pelvis, the parasympathetic fibers are all from the
Pelvic splanchnics
88
In the pelvic viscera, ONLY PREGANGLIONICS run through?
1. ) Thoracic splanchnics (sympathetic)
2. ) Lumbar splanchnics (sympathetic)
3. ) Pelvic splanchnics (parasympathetic)
89
In the pelvic viscera, ONLY POSTGANGLIONICS run through ?
Ovarian plexus (on ovarian artery)
90
In the pelvic viscera, PRE- and POSTGANGLIONICS run through?
1. ) Superior hypogastric plexus (sympathetic)
2. ) Hypogastric nerves (sympathetic)
3. ) Inferior hypogastric plexus (both)
91
Visceral pain is not typical burn or touch pain, rather it is
Distention and ischemic pain
92
ABOVE the pelvic pain line, pain will manifest as
Low back or suprapubic pain (sympathetic)
93
BELOW the pelvic pain line, pain will manifest as
Perineal pain (parasympathetic)
94
Uterine body and fundus pain will show up in dermatome segments of
T11-L1
95
Visceral afferents from structures below the pelvic pain line supply which 4 things?
1. ) Cervix
2. ) Pelvic portion of vagina
3. ) Bladder
4. ) Pelvic portion of urethra
96
Ovarian/tubal pain DOES NOT use the
Superior hypogastric plexus
97
Important surgical space located immediately behind the pubic bone and in front of the bladder
Retropubic space
98
Space between labia minora where the openings for the urethra and vagina are located
-has periurethral and greater vestibular glands
Vestibule of the vagina
99
There are two sources of blood supply to the vagina. What is the blood supply for the:
1. ) Pelvic vagina
2. ) Perineal vagina
1. ) Vaginal artery off internal iliac
| 2. ) Internal pudendal artery
100
There is dual innervation to the vagina. What is the innervation for the:
1. ) Pelvic vagina
2. ) Perineal vagina
1. ) Uterovaginal plexus (autonomic)
| 2. ) Pudendal nerve (sympathetic)
101
The pelvic vagina receives pain innervation from the
Pelvic splanchnic nerves
102
The perineal vagina receives pain innervation from the
Pudendal nerve
103
Fascial sheet covering the uterus, which is open on both sides (the reason an abdominal pregnancy is possible)
Broad ligament
104
The thinnest portion of the uterus and where C sections are performed
Lower uterine segment
105
The cervix begins at the cervouterine junction. From deep to superficial, what are the three openings called?
1. ) internal OS
2. ) Canal
3. ) External OS
106
When there is NO fusion of the paramesonephric ducts, we get a double uterus and double vagina. This is called
Didelphyc Uterus
107
If you have a retroverted and retroflexed uterus, you may have loops of bowel in the
Vesicouterine pouch
108
The uterus receives its blood supply from the
Uterine artery (branch of internal iliac)
