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Neuromuscular/Anatomy > Anatomy of the female pelvis > Flashcards

Anatomy of the female pelvis Flashcards

1
Q

What is the pelvic inlet?

A

The pelvic brim, the entrance into the true pelvis - bound by the pubis, the iliopectineal lines, the ala and the promontory of the sacrum

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2
Q

What is the pelvic outlet?

A

The pelvic outlet extends from lower border of pubic symphysis to the tip of the cocyx- bound by the pubic arch, sacrotuberous ligaments, ischial tuberosities and the tip of the coccyx

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3
Q

What type of joint is the pubic symphysis?

A

secondary cartilaginous joint

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4
Q

What are the three muscles that make up the levator ani muscle?

A

Iliococcygeus

pubococcygeus

puborectalis muscle

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5
Q

What is the purpose of the levator ani muscle?

A

supports mid vagina, urethra and rectum

helps to fix the perineal body in place

assists anal and vaginal sphincters

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6
Q

What are the four muscles making up the pelvic floor?

A

(first three make up levator ani)

iliococcygeus

pubococcygeus

puborectalis

and

coccygeus muscle

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7
Q

Where is the perineal membrane in the pelvis?

A

the perineal membrane sits just below the deep perineal pouch

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8
Q

What does the deep perineal pouch contian?

A

the external urethral sphincter (very important) the compressor urethrae, the opening for the vagina, and the deep transverse perineal muscles

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9
Q

What is the most superficial layer of the pelvic floor?

A

the perineal muscles- these sit below the perineal membrane

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10
Q

what are the perineal muscles?

A

The ischiocavernosus

bulbospongiosus muscle

and the

superficial transverse perineal muscle

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11
Q

What is the perineal body (aka perineum) and why is it important?

A

The perineal body is the ‘zipper ‘ for the muscles of the pelvic floor

it has attachments to 8 muslces

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12
Q

What could potentially cause damage to the perineal body?

A

may be damaged due to trauma, repeated stretching from births, accidents or inaccurate episiotomy

  • damage to this area may result in incontinence of the anus, urethral incontinence, or prolapse of pelvic organs (uterus and bladder)
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13
Q

What is an episiotomy? What are the arguments for/against it?

A

An episiotomy is an incision in the perineal body at the time of delivery

  • the argument for episiotomy is that it prevents a perineal tear or excess strechign of the muscle. It may protect the fetus if the delivery is slow or the child is in distress - it may also prevent damage if abnormal presentation
  • argument against is that natural ‘tearing’ may be better during childbirth
  • there is no real indication about which method is better- the cut is ALWAYS MADE POSTEROLATERALLY
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14
Q

What is the superficial perineal pouch?

A

This is the most superficial pouch of the pelvis and it contains the tissues that form the clitoris, and three muscles – the ischiocavernosus, bulbospongiosus and superficial transverse perineal muscles. The greater vestibular glands (Bartholin’s glands) are also located in the superficial perineal pouch.

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15
Q

How long is the vagina? What are its relations to other organs? what cell type is it lined with?

A

The vagina is 7-10 cm long, it is lined with squamous epithelium.

anterior to the vagina is the bladder, posterior is the rectum, laterally is the ovarian artery and ureters

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16
Q

What are the vaginal fornices?

A

They are the gutters surrounding the cervis - anteror, 2xlateral, posterior

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17
Q

What can we palpate from the lateral fornices?

if you go through the posterior fornix, where would you be?

A

lateral fornices you can palpate the ureter and the uterine artery through (uterine artery more anterior)

just behind the posterior fornix is the pouch of douglas

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18
Q

during inproper abortions, what is a real risk associated with the posterior fornix?

A

one may rupture the posterior fornix and enter the pouch of douglas which is intraperitoneal - therefore a person may develop peritonitis

19
Q

What is the pouch anterior to the uterus? What is the pouch posterior to the uterus?

A

anterior = uterovesica pouch

posterior = pouch of douglas

20
Q

does the peritoneum wrap around the uterus?

A

no, the peritoneum passes over the uterus and the bladder - which is why you can give catheters suprapubically

21
Q

What is the round ligament of the uterus a remnant of?

A

The round ligament of the uterus is a remnant of the gubernaculum and passes through the inguinal canal

22
Q

Where is the bulbospongiosus muscle?

A

in the superficial perineal pouch just around the bartholin’s glands

23
Q

Describe the histology of the Uterus

A

body and fundus composed of thick muscular walls = myometrium- this muscle is hormone sensitive and undergoes hypertrophy and hyperplasia during pregnancy - it can also develop fibroids

The endometrium = basal layer is composed of the spongiosum and compactum - these develop over the menstrual cycle and shed with a period

24
Q

Describe the cervix

A

lower 1/3 of the uterus

supravaginal and vaginal parts

during pregnancy it holds the fetus in the uterus - dilates during labor to allow delivery

provides alkaline secretion for sperm penetration

mainly fibroelastic tissue

in a non - pregnant woman, it is firm

in a pregnant woman it is soft in consistency

25
Q

Describe the cervix Os in a nulliparous woman vs. a parous woman

A

the external os is small and round before parturition

after a woman gives birth (parous) it becomes a transverse slit

26
Q

Describe the location and the conditions of the squamocolumnar junction

A

Occurs at the external os- vaginal portion is covered with non keratinized stratified epithelium, internal portion is columnar epithelium

this junction could be a region for metaplasia and ultimately dysplasia of cells

27
Q

What is anteflexion? What is anteversion?

A

Anteflexion refers to the body of the uterus bent forward on cervix at 170 degrees

anteversion refers to the body of the uterus bent forward on the vagina at 90 degrees

28
Q

What percent of women have a retroverted uterus?

A

20%

29
Q

What is the major blood supply to the uterus?

A

-uterine artery and the vaginal artery (or inferior vesicle artery in men)

30
Q

What are the anterior branches of the internal iliac artery?

A

3 parietal

  • obturator
  • inferior gluteal
  • internal pudendal

3 visceral

  • umbilical
  • inferior vesical/vaginal in women
  • middle rectal
  • uterine
31
Q

What are the regions of the uterus?

A

lateral cornu

cavity

fundus

body

isthmus

internal os

cervical canal

external os

32
Q

What are the ligaments of the uterus?

A

broad ligament - fold of peritoneum passing from the uterus to the side wall of the pelvis

Round and ovarian ligaments - sit inside of the broad ligament

33
Q

What does the broad ligament contain?

A

it contains the

1) fallopian tube
2) Round and ovarian ligaments
3) ovariouterine anastomosis
4) ureter (At base)

34
Q

what is the lymphatic drainage of the uterus and the vagina?

A

external iliac nodes

internal iliac nodes

sacral nodes

superficial inguinal nodes

para-aortic nodes

35
Q

What are the main supports of the uterus?

A

1) uterosacral ligament
2) transverse cervical ligaments
3) pubocervical ligament
4) levator ani

36
Q

What are the two main functions of the fallopian tubes?

A

1) convey ova from ovary to the uterus
2) site of fertilization of ovum = ampulla

37
Q

Describe the parts of the fallopian tube and ovary

A

the uterus opens to the fallopian tube in the isthmus, then the tube becomes the Ampulla (where fertilization normally occurs), then the tube opens into the infundibulum which presents the fimbriae that suck the little egg up into the tube

  • fimbriae
  • infundibulum
  • ampulla
  • isthmus of uterus
38
Q

Where does the ovary develop embryologically?

A

in the abdomen

39
Q

What blood vessels supply the ovary?

A

ovarian artery (off the aorta at L2)

left ovarian vein and left renal vein

*the right ovarian vein drains directly into the IVC but the left ovarian vein drains into the renal before going into the IVC*

40
Q

What is the ovarian fossa ?

A

lies between the bifurcation of the common iliac artery into external and internal branches, the ovary DOES NOT lie in the ovarian fossa. But it is close to the ovary and if the ovary develops cysts- we could see refered pain to their knee b/c the obturator nerve and artery pass through the ovarian fossa before entering the obturator canal

41
Q

What are the two main functions of the ovaries?

A

1) they are a source of mature ova
2) they are endocrine organs, producing the hormones that prepare the endometrium for conception and maintain pregnancy

42
Q

What are the branches from the pudendal nerve after it exits Alcock’s canal?

A

1) anal branch
2) labial branch

*also provides sensory function - which is why we give pudendal nerve blocks during labor *

43
Q

What are the layers (superficial to deep) of the pelvic floor?

A

perineal fascia (superficial)

superficial perineal pouch

perineal membrane

deep perineal pouch (contains perineal muscles)

pelvic diphragm (contains levator ani)- most deep

44
Q

name the perineal muscles

A

“BIT. P”

Bulbocavernosus

Ischiocavernosus

Transverse perineal

perineal body

*they all sit in the superficial perineal pouch and make up the most superficial layer of the pelvic floor *

Neuromuscular/Anatomy (37 decks)

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