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Gross Anatomy > Abdomen: Pelvis > Flashcards

Abdomen: Pelvis Flashcards

1
Q

Pelvic girdle

A
  • Coxal bones

- Articulate posteriorly with the sacrum (forms the pelvic skeleton/pelvic ring)

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2
Q

Coxal bones

A
  • Ilium
  • Ishium
  • Pubis
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3
Q

Coccyx is often included as

A
  • Part of the pelvic skeleton
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4
Q

Pelvic girdle function

A
  • Strong and rigid
  • Connects vertebral column to lower extremity
  • Weight transfer
  • Muscle attachment
  • Protect and support pelvic/abdominal viscera
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5
Q

Pelvis subdivisions

A
  • Greater pelvis

- Lesser pelvis

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6
Q

Greater pelivis

A
  • Superior to pelvic inlet
  • Surrounded by superior pelvic girdle
  • Abdominal viscera
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7
Q

Lesser pelvis

A
  • Inferior to pelvic inlet, superior to pelvic outlet
  • Pelvic cavity
  • Surrounded by inferior pelvic girdle
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8
Q

Perineum

A
  • Inferior to pelvic floor
  • Between coccyx to pubic symphysis
  • External genitalia, anus
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9
Q

Coxal bone

A
  • os coxae, hip bone
  • 3 separate bones
  • Multiple secondary centers
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10
Q

Coxal bones are separated by

A
  • Triradiate cartilage
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11
Q

Coxal bone development

A
  • Begins to fuse around puberty

- Completely fused by early 20s

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12
Q

Coxal bone articulates with

A
  • Sacrum posteriorly (sacroiliac joint)
  • Contralateral coxal bone anteriorly (pubic symphysis)
  • Femur laterally (acetabofemoral joint, hip joint)
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13
Q

Function of the Pelvis

A
  • Weight transfer
  • Muscle and ligament attachment
  • Protect abdominopelvic viscera
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14
Q

Pelvic inlet (superior pelvic aperture)

A
  • Passageway between greater and lesser pelvis

- Pelvic brim: edge of the pelvic inlet

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15
Q

Pelvic inlet is formed by

A
  • Linea terminalis

- Pubic crest and symphysis

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16
Q

Linea terminalis

A
  • Sacral promontory
  • Sacral ala
  • Arcuate line
  • Pectineal line
  • Pubic crest and symphysis
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17
Q

Arcuate line

A
  • Rounded inner border of ilium

- Inferior to iliac fossa

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18
Q

Pectineal line

A
  • Ridge on superior pubic ramus
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19
Q

The arcuate and pectineal lines are called

A
  • iliopectinal lines
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20
Q

Pelvic outlet (inferior pelvic aperture) boundaires

A
  • Anterior: Pubic arch (formed by ischiopubic rami)
  • Lateral: ischial tuberosities
  • Posterolateral: sacrotuberous ligament
  • Posterior: coccyx
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21
Q

Pelvic outlet (inferior pelvic aperture) POSTERIOR boundary

A
  • Coccyx
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22
Q

Pelvic outlet (inferior pelvic aperture) ANTERIOR boundary

A
  • Pubic arch (formed by ischiopubic rami)
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23
Q

Pelvic outlet (inferior pelvic aperture) LATERAL boundary

A
  • Ischial tuberosities
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24
Q

Pelvic outlet (inferior pelvic aperture) POSTEROLATERAL boundary

A
  • Sacrotuberous ligament
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25
Q

ASIS and superior edge of pubic symphysis are

A
  • In the same vertical plane
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26
Q

Inlet angle

A
  • 50-60 degrees above horizontal plane
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27
Q

Pelvic cavity projects

A
  • Posteriorly
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28
Q

Other passageways in/out of the pelvis

A
  • Greater sciatic foramen
  • Lesser sciatic foramen
  • Obturator foramen
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29
Q

Greater sciatic foramen

A
  • Passageway to gluteal region
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30
Q

Greater sciatic foramen Boundaries

A
  • Greater sciatic notch (ilium) is anterior (anterolateral)
  • Anterior sacroiliac ligaments are superior
  • Ischial spine and sacrospinous ligament are inferior
  • Sacrotuberous ligament is posterior (posteromedial)
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31
Q

Greater sciatic foramen ANTERIOR boundary

A
  • Greater sciatic notch/ilium (anterolateral)
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32
Q

Greater sciatic foramen SUPERIOR boundary

A
  • Anterior sacroiliac ligaments
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33
Q

Greater sciatic foramen INFERIOR boundary

A
  • Ischial spine and sacrospinous ligament
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34
Q

Greater sciatic foramen POSTERIOR boundary

A
  • Sacrotuberous ligament (posteromedial)
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35
Q

Lesser sciatic foramen

A
  • Passageway to gluteal region/perineum
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36
Q

Lesser sciatic foramen boundaries

A
  • Lesser sciatic notch (ischium) is anterior
  • Ischial tuberosity is anterior, inferior
  • Ischial spine is anterior, superior
  • Sacrospinous ligament is superior
  • Sacrotuberous ligament is posterior
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37
Q

Obturator foramen

A
  • Mostly covered by obturator membrane

- Passageway to medial thigh

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38
Q

Obturator canal (in obturator foramen)

A
  • Superior opening between obturator membrane and superior pubic ramus
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39
Q

Sacroiliac joint (SI)

A
  • Sturdy, designed for weightbearing
  • Interlocking bony auricular surfaces of ilium and sacrum
  • 2 parts
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40
Q

2 parts of sacroiliac joint

A
  • Anterior synovial joint (limited motion)

- Posterior syndesmosis, fibrous join

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41
Q

Ligaments of the sacroiliac joint

A
  • Anterior sacroiliac
  • Interosseous sacroiliac
  • Posterior sacroiliac
  • Iliolumbar
  • Sacrotuberous & sacrospinous ligaments
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42
Q

Interosseous sacroiliac ligament

A
  • Connect tuberosities of sacrum/ilium

- Weight transfer

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43
Q

Sacrotuberous & sacrospinous ligaments

A
  • Resist anterior/inferior motion of sacrum

- Superior rotation of pelvis (weight-bearing)

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44
Q

Pubic symphysis

A
  • Fibrocartilaginous joint (Symphysis joint)

- Superior and inferior pubic ligaments

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45
Q

Lumbosacral joint

A
  • L5/S1
  • Synovial joint between articular facets
  • Symphysis joint between L5 body and sacral base
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46
Q

Male vs. Female pelvis

A
  • Differences due to body size/muscle mass

- Adaptation for childbearing and birth

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47
Q

Male pelvis

A
  • Larger/heavier
  • Narrow and deep lesser pelvis
  • Comparatively smaller pelvic inlet/outlet
  • Narrower subpubic angle and greater sciatic notch
  • Round obturator foramen
  • Longer sacrum
  • Mostly android shaped pelvis
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48
Q

Female pelvis

A
  • Lighter
  • Shallower/wider greater and lesser pelvis
  • Inlet/outlet are comparatively wider
  • Inlet more oval
  • Obturator foramen is smaller and triangular shaped
  • Acetabulum faces more anteriorly
  • Wider subpubic angle and greater sciatic notch
  • Mostly gynecoid shaped pelvic inlet
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49
Q

Subpubic angle

A
  • Reflects distance between ischial tuberosities

- Narrower in males (< 90 degrees) than females (> 90 degrees)

50
Q

Peritoneum in the pelvis

A
  • Reflects onto viscera and pelvic fascia
  • Does not reach pelvic floor
  • Most pelvic viscera are below the peritoneum
51
Q

Uterine tubes

A
  • Intraperitoneal
52
Q

Ovaries

A
  • Suspended by peritoneum
53
Q

Female peritoneum

A
  • Recto-uterine pouch (pouch of Douglas)

- Most inferior extent of peritoneal cavity

54
Q

Male peritoneum

A
  • Rectovesical pouch is most inferior extent
55
Q

Supravesical fossa

A
  • Between bladder and anterior abdominal wall
56
Q

Pararectal and paravesical fossae

A
  • Separated by broad ligament (females) and uteric fold (males)
57
Q

Broad ligament (females)

A
  • Lateral extension of peritoneum from uterus
58
Q

Pelvic fascia (2 components)

A
  • Between peritoneum and pelvic wall/floor
  • Fills potential spaces (retropubic and rectrorectal)
  • Allows for passage of vessels/nerves
  • Supports pelvic viscera
59
Q

2 components of pelvic fascia

A
  • Parietal pelvic fascia

Visceral

60
Q

Parietal pelvic fascia

A
  • Covers muscles forming the pelvic floor and wall
61
Q

Visceral pelvic fascia

A
  • Ensheaths pelvic organs

- Allows for movement and volume changes

62
Q

Pelvic viscera support

A
  • Organ prolapse and incontinence can result if damaged/lax
63
Q

Antero-inferior wall of pelvic cavity

A
  • Pubic bone

- Pubic symphysis

64
Q

Anterolateral wall of pelvic cavity

A
  • Obturator internus muscle/fascia
65
Q

Posterolateral wall of pelvis

A
  • Sacrum and coccyx
  • Sacroilial, sacrotuberous, and sacrospinous ligaments
  • Piriformis muscle and fascia
66
Q

Floor of pelvic cavity

A
  • Pelvic diaphragm (coccygeus and levator ani muscles)

- Pelvic fascia

67
Q

Obturator internus attaches to

A
  • Ischiopubic rami/obturator membrane
68
Q

Obturator internus exits pelvis through

A
  • Lesser sciatic foramen
69
Q

Piriformis attaches to

A
  • Anterior sacrum (S2-4)

- Sacrotuberous ligament

70
Q

Piriformis exits pelvis through

A
  • Greater sciatic foramen
71
Q

Pelvic diaphragm

A
  • Spans pelvic outlet
  • Gaps allow for the passage of organs
  • Tonic and dynamic contraction
  • Supports viscera
72
Q

Gap allowing for the passage of organs in the pelvic diaphragm

A
  • Urogenital hiatus
73
Q

If viscera of pelvic diaphragm is weak it may result in

A
  • Urinary and fecal incontinence
  • Organ prolapse
  • Rectocele, cystocele, enterocele, uterus prolapse
74
Q

Pelvic diaphragm can be damaged

A
  • During childbirth (muscle tearing, nerve trauma)
75
Q

Muscles of the Pelvic diaphragm

A
  • Coccygeus

- Levator ani

76
Q

Coccygeus attachments

A
  • ischial spine

- inferior sacrum/coccyx

77
Q

Coccygeus innervation

A
  • S4,5
78
Q

Levator ani consists of

A
  • Puborectalis
  • Pubococcygeus
  • Iliococcygeus
79
Q

Puborectalis

A
  • Major role in fecal continence
80
Q

Levator ani attachments

A
  • Pubic bone, tendinous arch of obturator fascia, ischial spine
  • Perineal body, coccyx, anococcygeal ligament, raphe
  • Walls of pelvic viscera
81
Q

Levator ani innervation

A
  • Nerve to levator ani (S4)

- Pudendal nerve

82
Q

Perineum

A
  • Area between thighs
  • Anterior to gluteal fold
  • Posterior to mons pubis and penis base
83
Q

Perineum boundaries

A
  • Superior: pelvic floor
  • Inferior: skin
  • Anterior: pubic symphysis
  • Anterolateral: ischiopubic ramus
  • Lateral: ischial tuberosities
  • Posterolateral: sacrotuberous ligament
  • Posterior: coccyx
84
Q

Perineum SUPERIOR boundary

A
  • Pelvic floor
85
Q

Perineum INFERIOR boundary

A
  • Skin
86
Q

Perineum ANTERIOR boundary

A
  • Pubic symphysis
87
Q

Perineum ANTEROLATERAL boundary

A
  • Ischiopubic ramus
88
Q

Perineum LATERAL boundary

A
  • Ischial tuberosities
89
Q

Perineum POSTEROLATERAL boundary

A
  • Sacrotuberous ligament
90
Q

Perineum POSTERIOR boundary

A
  • Coccyx
91
Q

Line passing through ischial tuberosities divides into

A
  • Urogenital triangle

- Anal triangle

92
Q

Urogenital triangle content

A
  • External genitalia
  • Urethra
  • Erectile tissue of penis and clitoris
  • Muscles
  • Nerves, vessels, glands
93
Q

Anal triangle content

A
  • Anus

- Anal canal and associated structures

94
Q

Muscles of the perineum

A
  • EAS
  • Bulbospongiosus
  • Ischiocavernosus
  • Superficial and deep transverse perineal muscles
95
Q

Muscles of the perineum function

A
  • Support pelvic floor

- Help with maintaining erectile tissue turgor

96
Q

Perineal body

A
  • Fibromuscular structure between anus and vagina vestibule/bulb of penis
97
Q

Perineal body is important in

A
  • Pelvic floor support, especially during increased abdominal pressure
98
Q

Perineal body resists

A
  • Tearing between vagina and external anal sphincter during childbirth
99
Q

Damage to the perineal body can cause

A
  • Vaginal prolapse

- Pelvic viscera prolapse

100
Q

Muscles that attach to perineal body

A
  • levator ani
  • Bulbospongiosus muscle
  • Transverse perineal muscles
  • External anal sphincter
101
Q

Pudendal nerve (S2-4)

A
  • Branch of the sacral plexus
  • Sensation from external genitalia, urethra, anus, perineum
  • Passes through greater and lesser sciatic foramen
102
Q

Branches of the pudendal nerve (S2-4)

A
  • Inferior rectal
  • Perineal nerve
  • Deep perineal nerve
  • Superficial perineal nerve
  • Dorsal nerve of clitoris/penis
103
Q

Deep perineal nerve (branch of pudendal nerve) supplies

A
  • Muscles of the perineum
104
Q

Branches of superficial perineal nerve

A
  • Posterior scrotal/labial nerves
105
Q

Dorsal nerve of clitoris/penis supplies

A
  • Skin and glans of penis/clitoris
106
Q

Pudendal nerve block

A
  • Blocks the perineum for vaginal childbirth and minor surgeries of the perineum
  • Is local for the perineum, does not block higher structures
107
Q

Pudendal nerve block targets

A
  • Nerve trunk as it enters lesser sciatic foramen
108
Q

Pelvic visceral pain sensation follows

A
  • Sympathetics if above the pelvic pain line

- Parasympathetics (S2-4) if below the pelvic pain line

109
Q

Above the pelvic pain line means

A
  • In contact with peritoneum

- Superior bladder and uterus are above the pelvic pain line

110
Q

Pain afferents of intraperitoneal structures follows sympathetics

A
  • Distal half of sigmoid colon and rectum are the exception (follows parasympathetics)
111
Q

Anesthesia for parturition

A
  • Spinal anesthesia via lumbar puncture into subarachnoid space
112
Q

Spinal anesthesia via lumbar puncture into subarachnoid space produces

A
  • Complete anesthesia of uterus, cervix, vagina, perineum, lower extremities, and inferior abdominal wall
113
Q

Lumbar epidural

A
  • Most common type of anesthesia during labor
114
Q

Caudal epidural nerve block via injection through sacral hiatus and canal

A
  • Bathes S2-4 spinal nerve roots

- Anesthetizes the cervix, vagina, and perineum

115
Q

Caudal epidural nerve block does not affect

A
  • Sensation from structures above pelvic pain line (body and fundus of uterus)
116
Q

Pudendal nerve block

A
  • Local anesthesia of perineum only (S2-4 dermatomes)
117
Q

Blood Supply to the perineum

A
  • Internal pudendal artery
118
Q

Internal Pudendal Artery

A
  • Branch of the internal iliac artery

- Passes through greater and lesser sciatic foramen

119
Q

Branches of the internal pudendal artery

A
  • Inferior rectal
  • Perineal
  • Deep artery of clitoris/penis
  • Dorsal artery of clitoris/penis
120
Q

Perineal branch of internal pudendal artery supplies

A
  • Posterior scrotal/labial arteries

Gross Anatomy (50 decks)

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