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Anatomy 2nd Semester > ANA 212 > Flashcards

ANA 212 Flashcards

1
Q

What is the pelvis?

A

The pelvis is the region of the trunk that lies below the abdomen

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2
Q

The area of transition between the trunk and lower limb is the

A

Pelvis

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3
Q

What are regions of the pelvis?

A

False pelvis/ greater
True pelvis/ lesser

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4
Q

Describe the false pelvis (greater pelvis)

A

is the superior region related to upper parts of the pelvic bones and lower lumbar vertebrae
• it is generally considered part of the abdomen.

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5
Q

Describe the true pelvis (lesser pelvis

A

is related to the inferior parts of the pelvic bones, sacrum, and coccyx,
➢it has an inlet and an outlet

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6
Q

What is the Pelvis cavity? What does it contain?

A

The pelvis has a cavity which is roughly funnel shaped called the pelvis cavity

• This cavity is continuous superiorly with the abdominal cavity
• This cavity contains the urinary bladder, terminal parts of the ureters, pelvic genital organs, rectum, blood vessels, lymphatics, and nerves

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7
Q

List the abnormalities of the pelvis

A

Spina bifida occulta
•Unilateral lumbarisation
•Unilateral sacralisation
•Stress fractures of the sacrum, pubic arch and neck of femur may be first signs of osteoporosis

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8
Q

Boundaries of the false pelvis

A

It is of little clinical importance.

It is bounded behind by the lumbar vertebrae
•laterally by the iliac fossae and the iliacus muscles,
• in front by the lower part of the anterior abdominal wall.

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9
Q

Boundaries of the pelvic inlet

A

*The pelvic inlet, or pelvic brim is bounded:
posteriorly by the sacral promontory, laterally by the iliopectineal lines, and anteriorly by the symphysis pubis

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10
Q

Classification based on shape of pelvic inlet

A

•Gynaecoid pelvis: the inlet is round
•Anthropoid pelvis: inlet is long, narrow and oval in shape (usually seen in tall women)
•Android pelvis: the inlet is pear-shaped/heart shaped (shape is due to prominent sacrum)
•Platypelloid: inlet is oval with the long axis lying transversely

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11
Q

Boundaries of the pelvic outlet

A

The diamond-shaped pelvic outlet is bounded
posteriorly by the coccyx,
laterally by the ischial tuberosities, and anteriorly by the pubic symphysis

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12
Q

What are the inlets of the pelvic cavities?

A

Pelvic inlet (superior pelvic aperture)
•Pelvic outlet (inferior pelvic aperture)

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13
Q

Parts of the Levator Ani

A
  1. pubococcygeus
  2. the puborectalis
  3. the iliococcygeus.
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14
Q

Origin of Levator Ani

A

posterior surface of bodies of pubic bones (puborectalis and pubococcygeus); tendinous arch of internal obturator fascia, ischial spine (iliococcygeus)

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15
Q

Insertion of Levator Ani

A

puborectal sling (puborectalis); anococcygeal ligament, coccyx (pubococcygeus, iliococcygeus)

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16
Q

Innervation of Levator ani

A

Nerve to levator ani (S2-S4)

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17
Q

Function of Levator ani

A

supports pelvic viscera, increases intraabdominal pressure, assists with fecal and urinary continence

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18
Q

Origin of coccygeal muscle

A

ischial spine

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19
Q

Insertion of coccygeal muscle

A

inferior end of sacrum, coccyx

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20
Q

Innervation of coccygeal muscle

A

anterior rami of spinal nerves S4-S5

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21
Q

Function of coccygeal muscle

A

supports pelvic viscera, flexes coccyx

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22
Q

Describe viscera

A

•Urinary organs in the pelvis
•Ureters – muscular (smooth) tubes running from kidneys to bladder 25 to 30 cm long
•Bladder – a hollow container surrounded by a strong smooth muscular wall
•Temporary reservoir for urine
•Apex, Body, Fundus, Neck, Uvula

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23
Q

Classification based in shape of pelvic inlet

A

Gynecoid pelvis: the inlet is round
Anthropoid pelvis: inlet is long, narrow and oval shaped
Android pelvis: pear-shaped
Platypelloid pelvis: inlet is oval with the long axis lying transversely

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24
Q

Characteristic of android shape

A

Women with android pelvic may have babies whose backs lie against the mothers back causing a long labour

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25
Q

Characteristics of anthropoid shape

A

Common in taller woman and results in less labor complications

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26
Q

Characteristics of platypelloid shape

A

Associated with obstructed labor

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27
Q

What are the bones of the pelvis

A

Right and let hip bone
Sacrum
Coccyx

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28
Q

Describe the pelvic floor

A

•Formed by the funnel shaped pelvic diaphragm – consists of the levator ani and coccygeus muscles and their fascia

•Stretches between the pubis anteriorly and the coccyx posteriorly and from one lateral pelvic wall to the other

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29
Q

What is the primary function of the pelvic floor?

A

To separate the pelvic cavity from the perineum

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30
Q

Function of the urogenital hiatus

A

Allows urogenital apparatus to pass through the pelvic floor into the perenium
Male: passage of the urethra
Female: passage of the urethra and vagina

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31
Q

What is the urinary bladder?

A

it is a hollow musculomembranous sac which acts as a reservoir for the urine
urine enters the bladder via ureters and exits the bladder via the urethra

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32
Q

Anatomical location of the bladder

A

When “Empty” , the adult urinary bladder is located in the “Lesser pelvis”
While in the lesser pelvis it lies behind the pubic bones.
As the bladder fills it enters the “Greater Pelvis”
In some individuals, a full bladder may ascend to the level of the “Umbilicus”.
In infants and young children, the urinary bladder is in the abdomen even when empty.
The Bladder usually enters the Greater Pelvis by 6 Years of age.
it is not located entirely within the lesser pelvis until after puberty
At the end of micturition (urination) the bladder of a normal adult contains virtually no urine
When empty, the bladder is somewhat tetrahedral

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33
Q

Anatomical parts of the bladder

A

Apex
Body
Fundus/ base
Neck

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34
Q

What are the muscles of the bladder?

A
  1. detrusor muscle: The chief/main muscle of the bladder
  2. internal urethral sphincter : found in the neck of the bladder leading into the urethra and contracts the internal urethra orifice during ejaculation to prevent retrograde ejaculation (ejaculatory reflux) of semen into the bladder
    regulates involuntary control of urine flow from the bladder to the urethra
  3. External urethral sphincter
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35
Q

Describe the trigone of the urinary bladder

A

This TRIGONE is formed by three openings
2 of these openings are from the ureters and form the base of the trigone
Small flaps of mucosa cover these openings and act as valves that allow urine to enter the bladder but prevent it from backing up from the bladder into the ureters
The 3rd opening, at the apex of the trigone, is the opening into the urethra
A band of the detrusor muscle encircles this opening to form the internal urethral sphincter.

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36
Q

What epithelium lines the bladder?

A

The interior of the bladder is lined with transitional epithelium which is thrown into folds in the empty bladder, except for the smooth triangular area of the base called trigone

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37
Q

Arterial supply of the bladder

A

Branches of internal iliac arteries
Superior vesical arteries supply anterosuperior parts of the bladder.
In males, inferior vesical arteries supply the fundus and neck of the bladder.
In females, vaginal arteries replace the inferior vesical arteries and send small branches to posteroinferior parts of the bladder
Obturator and inferior gluteal arteries also supply small branches to the bladder

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38
Q

Venous drainage of the bladder

A

Venous drainage
The veins draining from the bladder correspond to the arteries and are tributaries of internal iliac veins
Veins from the Vesical venous plexus drain into the internal iliac veins

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39
Q

Describe the Lymphatic drainage of the bladder

A

In both sexes lymphatic vessels leave:
the superior surface of the bladder drains into the External iliac lymph nodes
Those from fundus drains into the Internal iliac lymph nodes
neck of bladder drain into the “Sacral” or “Common iliac lymph nodes”.

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40
Q

Clinical correlates of the bladder include:

A

Cystocele (Hernia of the Bladder)
Rupture of the Bladder

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41
Q

Describe Cystocele

A

Cystocele (Hernia of the Bladder)
Loss of bladder support in females by damage to the perineal muscles or their associated fascia/pelvic floor can result in herniation of the bladder into the vaginal wall
A cystocele may also result from prolapse of pelvic viscera secondary to injury to the pelvic floor during childbirth

42
Q

Describe rupture of the bladder

A

Because of the superior position of the distended bladder, it may be ruptured by injuries to the inferior part of the anterior abdominal wall or by fractures of the pelvis.
The rupture may result in the escape of urine extraperitoneally or intraperitoneally.
Rupture of the superior part of the bladder frequently tears the peritoneum, resulting in extravasation (passage) of urine into the peritoneal cavity.
Posterior rupture of the bladder usually results in passage of urine extraperitoneally into the perineum

43
Q

Describe the female urethra

A

The female urethra The urethra extends from the neck of the bladder to the vulva
approx 3-5 cm long and 6 mm in diameter
It is exclusively urinary
Urethral glands are present, particularly in its superior part; the paraurethral glands are homologues to the prostate.
Enters deep pouch where it is surrounded by sphincter urethra, also called external sphincter of the bladder
Urethra is supported by the fascia of the pelvic floor including pubovesical and pubocervical ligaments
If this support is insufficient, the urethra can move downwards

44
Q

Clinical correlates of the female urethra

A

In times of increased abdominal pressure resulting in stress urinary incontinence (SUI)
The physical changes that can occur during pregnancy, delivery and menopause can predispose to SUI

45
Q

Contents of the pelvic cavity

A
  1. Loops of the small intestine.
  2. Sigmoid colon, rectum, and anal canal.
  3. Urinary bladder, lower part of the ureters, and urethra
  4. Reproductive organs:
    (a) Prostate gland, seminal vesicles, vas deferens, and ejaculatory ducts in male.
    (b) Uterus, uterine tubes, ovaries, and vagina in female
    Walls and floor of the pelvic cavity
46
Q

What are the walls of the pelvic cavity?

A

An antero-inferior wall,
two lateral walls,
a posterior wall
a floor

47
Q

Describe the antero-inferior wall of the pelvic cavity

A

is formed primarily by the bodies and rami of the pubic bones and the pubic symphysis
participates in bearing the weight of the urinary bladder

48
Q

Describe the lateral pelvic wall

A

Lateral Pelvic Walls
are formed by the right and left hip bones,
each of these hip bones has an obturator foramen closed by an obturator membrane
The fleshy attachments of the obturator internus muscles cover and thus pad most of the lateral pelvic walls

49
Q

Describe the posterior pelvic wall

A

The posterior pelvic wall consists of:
a bony wall (ilium)
roof in the midline (formed by the sacrum and coccyx)
ligaments associated with the sacroiliac joints and piriformis muscles
The ligaments include the
anterior sacro-iliac ligament
Sacrospinous ligament
sacrotuberous ligament

50
Q

What is micturition?

A

Micturition or urination is the process of expelling urine from the bladder. This act is also known as voiding of the bladder

51
Q

How much urine can the bladder hold

A

500ml in women
700ml in men
But we feel the urge to go at about 200-300ml

52
Q

What are the stages of Micturition?

A

The urinary bladder has two distinct stages or phases:
Resting or filling stage
Voiding stage

53
Q

Describe the first stage of micturition

A

Resting/filling stage

It is in this phase of the bladder that the urine is transported from the kidneys via the ureters into the bladder
The oblique nature of opening prevents the urine from re-entering the ureters. At the same time, the main muscle of the urinary bladder, the detrusor muscle, is relaxing allowing the bladder to distend and accommodate more urine.

54
Q

Describe the second stage of micturition

A

Voiding stage
The detrusor muscle of the urinary bladder which was relaxing so far starts to contract once the bladder’s storage capacity is reached.

The urethra is controlled by two sets of muscles: The internal and external urethral sphincters. The internal sphincter is a smooth muscle whereas the external one is skeletal. Both these sphincters are in a contracted state during the filling stage.

55
Q

What is the pubovesicle ligament?

A

The pubovesical ligament is the continuation of the detrusor muscle and the adventitia surrounding the urinary bladder.

It connects the urinary bladder to the pubis and to the tendinous arch of the pelvic fascia.It may also integrate fibres from the proximal side of the prostate in men.

56
Q

What is the vagina?

A

A fibromuscular tube that extends from the cervix to the vulva and is between 8-10cm

57
Q

Functions of the vagina

A

Serves as a canal for menstrual fluid.
Forms the inferior part of the pelvic (birth) canal.
Receives the penis and ejaculate during sexual intercourse.
Communicates superiorly with the cervical canal, and inferiorly with the vestibule
The cervical canal extends from the isthmus of the uterus to the external os (opening) of the uterus

58
Q

4 muscles compress the vagina and act like sphincters

A

pubovaginalis
external urethral sphincter
urethrovaginal sphincter
bulbospongiosus

59
Q

Describe the tissue of the vagina

A

Lined by stratified squamous non-keratinized epithelium. The vagina service being kept moist

60
Q

What is the pudendal canal?

A

The pudendal canal (also called Alcock’s canal) is an anatomical structure in the pelvis through which the internal pudendal artery, internal pudendal veins, and the pudendal nerve pass.

61
Q

Contents of the pudendal canal

A

Internal pudendal artery.
Internal pudendal veins.
Pudendal nerve
Perineal nerve
Labial nerve
Dorsal nerve of the clitoris
Inferior rectal nerve

62
Q

Clinical significance of the pudendal canal

A

Pudendal nerve entrapment can occur when the pudendal nerve is compressed while it passes through the pudendal canal whcih causes chronic pain and results in genito-anal numbness, fecal and/or urinary incontinence, burning pain in the perineal or genital area
AKA Alcock’s syndrome

63
Q

Blood supply of pudendal canal

A

Uterine arteries
Vaginal arteries
Internal pudendal arteries

Vagina venous drainage
Internal pudendal veins

64
Q

Location of the pudendal canal

A

Found in the lower lateral wall of the ischiorectal fossa
Formed by the obturator fascia

65
Q

Describe the perineum and it’s boundaries

A

Lies inferior to the pelvic outlet and is separated from the pelvic cavity by the pelvic diaphragm (Levator ani and coccygeus muscles)
●Bounded by Pubic symphysis anteriorly; inferior pubic rami and ischial rami anterolaterally; ischial tuberosity laterally; sacrotuberous ligament posterolaterally; inferiorly by sacrum and coccyx

66
Q

Describe the perineum, perineal body, membrane and triangles

A

Two Triangles
•Anal triangle (posterior) contains the anal canal and 2 ischiorectal fossae
•Urogenital triangle (anterior) contains the root of the scrotum and penis in males or the external genitalia in females
●The perineal membrane stretches between the two sides of the pubic arch and covers the anterior part of the outlet
●The perineal body is an irregular fibromuscular mass located between the anal canal and the perineal membrane

67
Q

Bulbospongiosus

A

F O: central tendon of perineum, M O: central tendon of perineum and bulb of penis; F I: dorsum of clitoris, urogenital diaphragm, M I: root of penis; A: compress vagina orifice or compress urethra, N: perineal nerve, pudenal nerve

68
Q

Ischiocavernosus

A

Ischiocavernosus – O: ramus of ischium, I: near pubic symphysis, maintains erection of penis or clitoris

69
Q

Internal and External sphincter muscles

A

External anal sphincter (skeletal muscle) – O: skin an fascia surrounding anus and coccyx, I: perineal body, A: closes anal canal, N: Inferior Anal Nerve (Somatic nerve from S2-S4) – inhibits voiding
●Internal Anal Sphincter – smooth muscle innervated by sympathetic NS (S2,S3,S4) – inhibits voiding

70
Q

Superficial Transverse Perineal

A

●O: Ischial tuberosity
●I: Perineal body
●A: Support perineal body
●N: Pudenal nerve

71
Q

External Urethral Sphincter

A

●O: Ischial tuberosity
●I: surround urethra
●A: compress urethra to maintain urine continence
●N: Pudenal (S2-S4)

72
Q

Deep Transverse Perineal

A

●O: Medial Aspect of Ischial Ramus
●I: Pineal Body
●A: Stabilizes position of the perineal body
●N: Pudenal N (S2-S4)

73
Q

Contents of the deep perineal pouch

A

deep transverse perineal muscles (in males)
External urethral sphincters

74
Q

Contents of the superficial perineal pouch

A

Bulbospongiosus
Ischiocarvernosus
Superficial transverse perineal muscle

75
Q

Describe the ischioanal fossa

A

It’s occupies the space between the deep pouch and pelvic floor muscles

76
Q

What is the perineal membrane?

A

The perineal membrane is a tough fascia sheet which attaches to the sides of this triangle and is penetrated by the urethra and by the vagina in the female.

77
Q

Female external genitalia consists includes

A

mons pubis
labia majora
labia minora
clitoris
bulbs of the vestibule
greater and lesser vestibular glands

78
Q

Which muscles hold up the diaphragm

A

Piriformis and obturator internus

79
Q

What is suprapubic aspiration of the bladder

A

Suprapubic aspiration (SPA) is a sterile procedure that allows for the sampling of uncontaminated urine in patients. It is considered the gold standard for collecting urine for urinalysis in children.

80
Q

What are the ligaments associated with the sacroiliac joint and piriformis muscle?

A

Anterior sacroiliac ligament
sacrospinous ligament
sacrotuberous ligament

81
Q

Female external genitalia include

A

Mons pubis
labia majora
labia minora
clitoris
bulbs of the vestibule
greater less and vestibular glands

82
Q

What are the ligaments associated with the sacroiliac joints and piriformis

A

Anterior sacroiliac ligament
sacrospinous ligament
sacrotuberous ligament

83
Q

Lymphatic drainage of the pudendal canal

A

Superior: to the internal and external iliac lymph nodes

Middle part: to the internal iliac lymph nodes

Inferior part: to the sacral and common iliac nodes

External orifice: to the superficial inguinal lymph nodes

84
Q

Nerve supply of the pudendal canal

A

Predominantly from the autonomic nervous system
parasympathetic and sympathetic nerves arise from the uterine vagina nerve plexus
deep perineal nerves

85
Q

What is the superficial perineal pouch?

A

A space between the perineal membrane (superiorly) and the superficial perineal fascia (inferiorly)

It’s contains the erectile tissue that forms the penis and clitoris and 3 muscles the ischiocavernosus, bulbospongiosis and superficial transverse perineal muscles

86
Q

What is a deep perineal pouch?

A

A partially enclosed space in the perineum located superiorly to the perineum membrane
Lacks a superior border

87
Q

Function of the testes

A

Produces spermatozoa
synthesizes testosterone
participates with the hypothalamus-pituitary unit in regulating reproductive function

88
Q

Function of the clitoris

A

Sensitive part of the vulva and enables the feeling of sexual pleasure ( erectile tissue)

89
Q

What is the Perineal body?

A

An irregular fibromuscular mass located between the anal canal and a perineal membrane

90
Q

Layers of the urogenital triangle from deep to superficial

A
  1. Deep peroneal pouch
  2. perineal membrane : Perforated by the urethra ( and vagina in females)
  3. superficial perineal pouch
  4. Perineal fascia - Consists of
    deep fascia (collie’s fascia) : continuous with scarpa’s fascia of the anterior abdominal wall
    and superficial fascia: continuous with the camper’s fascia of the anterior abdominal wall
  5. skin
91
Q

Describe the rectum

A

The rectum is the last part of the large intestine and connects the sigmoid colon to the anal canal. The rectum begins at the height of S2-S3 and ends at the perineum. It is about 12 to 16 cm long

92
Q

Parts of the rectum in relation to the peritoneal layer

A

The upper third lies intraperitoneally
The middle third retroperitoneally
The lower third under the pelvic diaphragm and therefore extraperitoneally.

93
Q

Role of the rectum

A

It is important for the water resorption as well as for the resorption of electrolyte from the stool and plays an important role in the defecation process.

94
Q

What are the ligaments of the rectum?

A

The lateral ligaments of rectum are which are formed by dense connective tissue of the condensation of pelvic fascia, between the posterolateral pelvic wall (near S3) and the rectum.

95
Q

Parts of the rectum

A

The rectum has a slight “S” shape, with two bends in it. The one near the top (sacral flexure) follows the curve of your spine, while the one near the bottom (anorectal flexure) marks the transition from rectum to anus. These bends help control continence (holding your poop in). The rectum also has segments, like a worm, which are separated by horizontal folds in the inner lining called the valves of Houston.

96
Q

Describe the muscles of the rectum

A

The muscles of the rectum include both smooth and skeletal muscle fibers.

The smooth muscle fibers of the rectum are arranged in two layers, an inner circular layer and an outer longitudinal layer. These muscles are responsible for the involuntary contractions that move fecal matter through the rectum and into the anal canal.

The skeletal muscles that surround the rectum are collectively called the pelvic floor muscles or the levator ani muscles. These muscles help to support the rectum, anus, and other pelvic organs, and are also involved in voluntary control of bowel movements.

97
Q

Lymphatic drainage of the rectum

A

Lymphatic drainage of the rectum is via the pararectal lymph nodes, which drain into the inferior mesenteric nodes.

Additionally, the lymph from the lower aspect of the rectum drains directly into the internal iliac lymph nodes.

98
Q

Nerve supply of rectum

A

The rectum receives sensory and autonomic innervation.

Sympathetic nervous supply to the rectum is from the lumbar splanchnic nerves and superior and inferior hypogastric plexuses. Parasympathetic supply is from S2-4 via the pelvic splanchnic nerves and inferior hypogastric plexuses. Visceral afferent (sensory) fibres follow the parasympathetic supply.

99
Q

Blood supply of the rectum

A

Superior rectal artery – terminal continuation of the inferior mesenteric artery.
Middle rectal artery – branch of the internal iliac artery.
Inferior rectal artery – branch of the internal pudendal artery.
Venous drainage is via the corresponding superior, middle and inferior rectal veins. The superior rectal vein empties into the portal venous system, whilst the middle and inferior rectal veins empty into the systemic venous system. Anastomoses between the portal and systemic veins are located in the wall of anal canal, making this a site of portocaval anastomosis.

100
Q

Clinical significance of the rectum

A

The anterior wall of the rectum has a number of close anatomical structures. These can therefore be palpated digitally via the rectum. Most significant are the prostate and seminal vesicles in males, and cervix in females. Bony structures, such as the sacrum and coccyx, may also be palpated in both sexes.

101
Q

Difference between the pelvic floor and pelvic diaphragm

A

The terms “pelvic floor” and “pelvic diaphragm” are often used interchangeably, but they are not exactly the same thing.

The pelvic diaphragm is a muscular sheet that forms the bottom of the pelvic cavity and separates the pelvic cavity from the perineum. It is made up of two muscles, the levator ani and coccygeus, and provides support for the pelvic organs such as the bladder, uterus, and rectum. The pelvic diaphragm also helps maintain continence by providing muscular support to the anal canal and urethra.

The pelvic floor, on the other hand, is a broader term that includes not only the pelvic diaphragm but also other muscles, ligaments, and connective tissue that support the pelvic organs and control urinary and fecal continence. In addition to the levator ani and coccygeus muscles, the pelvic floor also includes the deep transverse perineal muscles, external anal sphincter, and bulbospongiosus muscles.

In summary, the pelvic diaphragm is a specific component of the pelvic floor that forms the bottom of the pelvic cavity and provides support to the pelvic organs, while the pelvic floor is a larger structure that includes the pelvic diaphragm as well as other muscles and connective tissue that support the pelvic organs and control continence.

Anatomy 2nd Semester (12 decks)

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