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Z MD1 Reproductive Block > Anatomy of the pelvis > Flashcards

Anatomy of the pelvis Flashcards

1
Q

which bones make up the bony pelvis

A
  • pair of hip bones laterally
  • sacrum midline posteriorly
  • coccyx midline posteriorly
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2
Q

which bones make up the hip bone

A

ischium
ilium
pubis

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3
Q

explain the 3 surfaces of the ilium

A
  • iliac fossa (anteriorly)
  • gluteal surface (posteriorly)
  • sacral surface (articulation at sacroiliac joint)
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4
Q

what attaches to the pubic tubercle

A

inguinal ligament

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5
Q

the pair of pubic bones articulate in the midline at the

A

pubic symphysis

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6
Q

which two bones make up the obturator foramen

A

inferior pubic ramus

ischial ramus

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7
Q

the ischial spine delineates the

A

greater and lesser sciatic notch

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8
Q

how many vertebra make up the sacrum

A

5

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9
Q

what are the lateral masses made of in the sacrum

A

the fused original transverse processes of the 5 vertebra

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10
Q

what is the promotary

A

the superior surface of the sacrum

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11
Q

what is the sacral alar

A

the superior surface of the lateral masses of the sacrum

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12
Q

what are the articulations of the sacrum

A

L5 joint

coccyx

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13
Q

what delineates the lesser/true and greater/false pelvis

A

the iliopectineal line (posterior extension of the pectineal line)

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14
Q

function of the greater/false pelvis

A

protection for the abdominal contents

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15
Q

what bounds the lesser/true pelvis

A

from anterior to posterior:

  • pubic symphysis
  • pubic crest
  • pectineal line of the pubis
  • arcuate line of the ilium
  • sacroiliac joint (anterior margin of the alar and sacral promontary)
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16
Q

what are the four basic pelvic types (based on shape of inlet)

A

gynaecoid
anthropoid
android
platypelloid

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17
Q

what are the typical pelvic shapes of males and females

A

males - android and anthropoid

females - gynaecoid

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18
Q

explain the general structure of the pelvis in males and females

A

males - thick and heavy

female - thin and light

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19
Q

explain the shape of the pelvic inlet in males and females

A

males - heart shaped

females - transverse oval

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20
Q

explain the greater sciatic notch in males and females

A

males - narrow inverted v

females - almost 90 degrees

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21
Q

explain the subpubic arch in males and females

A

males - acute angle

females - obtuse angle

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22
Q

explain the acetabulum in males and females

A

males - large

females - small

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23
Q

explain the obturator foramen of the pelvis in males and females

A

male - round

female - oval

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24
Q

what is the easiest thing to look at pelvic bones and tell whether it is a female or male

A

females - the distance from the acetabulum to the pubic symphysis is greater than the width of the acetabulum
males - distance is about the same

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25
Q

what structures make up the pelvic outlet

A
  • inferior margin of the pubic symphysis
  • tip of the coccyx posteriorly
  • ischial tuberosities either side
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26
Q

what is the shape of the pelvic inlet and outlet

A

inlet - heart (male) or oval (female)

outlet - diamond

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27
Q

where is the plane of least dimensions of the pelvis

A

extends from S4 behind, through the ischial spine to the pubic symphysis

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28
Q

what is the advantage of the shape of the pelvic floor during childbirth

A

it helps the babies head rotate and flex during childbirth so it only presents the smallest diameter to the smallest proportional part of which ever part of the pelvis it is going through

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29
Q

what are the 2 joints of the pelvis

A
  • pair of synovial sacroiliac joints laterally

- secondary cartilagenous pubic symphysis in the midline

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30
Q

which ligaments help reinforce the sacroiliac joints

A

anterior SI ligament
posterior SI ligament
interosseous SI ligament

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31
Q

what extra function does the interosseous SI ligament play

A

tightens as the sacrum rotates forwards - locking the sacroiliac joint

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32
Q

what are the 3 accessory ligaments of the sacroiliac joint

A

iliolumbar ligament
sacrotuberous ligament
sacrospinous ligament

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33
Q

what is the combined function of the accessory ligaments of the sacroiliac joint

A

resist tendency of the sacrum to rotate

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34
Q

where does the iliolumbar ligament extend from/to

A

from the iliac crest to the transverse process of L5

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35
Q

where do the sacrotuberous and sacrospinous ligaments extend from/to

A

ST - from ischial tuberosity to sacrum

SS - from ischial spine to sacrum

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36
Q

what is nutation and counternutation of the pelvis

A

nutation - top of the sacrum goes forwards (closing the pelvic entry and opening the pelvic outlet) –> “nodding”
counternutation - top of the sacrum moves out and the tip of the coccyx movs in (opens the pelvic inlet and closes the pelvic outlet)

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37
Q

what are the ligaments that reinforce the pubic symphysis

A

superior pubic ligament

inferior arcuate ligament

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38
Q

what separates the two bones of pubic symphysis

A

fibrocartilagenous disc

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39
Q

what other than ligaments help support the pubic symphysis

A

the criss-crossing muscles of:

  • oblique abdominal muscles (and aponeurosis)
  • rectus sheath
  • adductor longus
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40
Q

what are the muscles of the walls of the pelvis and what are their positioning

A
  • obturator internus - lateral wall
  • piriformis - posterior wall
  • pelvic floor
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41
Q

origin of obturator internus

A

arises from the internal surface of the obturator membrane, the adjacent margins of the obturator foramen, and extends up onto the posterosuperior aspect of the hip bone

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42
Q

route and insertion of obturator internus

A

goes through lesser sciatic foramen (collecting the lesser and greater gemeli) and appears into the gluteal region –> greater trochanter

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43
Q

origin of piriformis

A

arises from the middle 3 pieces of the sacrum and the adjacent parts of the lateral mass

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44
Q

route and insertion of piriformis

A

the fibres converge as they exit the greater sciatic foramen into the gluteal region

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45
Q

origin of the pelvic floor

A

one continuous lateral origin around the side wall of the pelvis (the internal aspect of the body of the pubic bone, along the side wall of the pubis, across the obturator membrane, halfway along obturator internus, and ending at the ischial spine)

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46
Q

insertion of the pelvic floor

A

central line of insertion into a midline raphe that extends from the tip of the coccyx to the anorectal junction (anococcygeal raphe)

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47
Q

what are the 3 muscles that make up the pelvic floor and which muscles make up the levator ani

A

pubococcygeus
iliococcygeus
ischiococcygeus
(pubo and ilio = levator ani)

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48
Q

what are the three parts of pubococcygeus

A

pubovaginalis/prostaticus - most medial/anterior
puborectalis - more lateral
most lateral fibres - most lateral

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49
Q

does iliococcygeus overlye or underlies pubococcygeus

A

underlaps

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50
Q

where does the ischiococcygeus muscle extend from/to

A

extends from the ischial spine towards the side of the coccyx (internal aspect of the sacrospinous ligament)

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51
Q

function of ischiococcygeus

A

nothing

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52
Q

what is the anorectal angle

A

80 degrees

53
Q

explain the pelvic fascia

A

dense fascia overlies fascia over structures that dont move

loose fascia on structures that need to expand or move

54
Q

what is endopelvic fascia

A

loose CT that fills the spaces in the pelvis

55
Q

what is special about the endopelvic fascia

A

condenses around the NV structures that help them go from the lateral wall into the viscera

56
Q

where is the sacral plexus

A

on the surface of piriformis

57
Q

which branch of the internal iliac artery supplies the pelvic viscera

A

anterior

posterior gives only parietal branches

58
Q

explain the peritoneum of the pelvis

A
  • anterior pelvic peritoneum leaves the anterior abdominal wall and then drapes over pelvic viscera and invests them in part with a serous coat before onto the posterior abdominal wall
  • between viscera it hangs in dependent folds or pouches
59
Q

what structures cross the ureter in the male and female

A

male - vas deferens

female - uterine artery

60
Q

what are the 2 ligaments that stabilise the bladder

A
  • pubovesical ligament

- fascial condensation = lateral pelvic ligament

61
Q

explain the orientation of the bladder

A

tipped forwards so that the apex points towards the pubic bone
- base is posterior

62
Q

explain the orientation of the structures entering the bladder

A
  • ureters entering at the base of the triangle

- urethra exits at the apex of the triangle

63
Q

explain the internal surface of the bladder

A
  • have mucosal ridges overlying the detrusor muscle

- bladder base (most posterior) is smooth (trigone)

64
Q

what are the bilateral reproductive structures of male

A
  • testis
  • epididymus
  • ejaculatory duct
65
Q

what are the midline reproductive structures of the male

A

urethra

penis

66
Q

what are the accessory glands of the male

A

prostate
seminal vesicles
bulbourethral glands

67
Q

what structures comes together to form the ejactulatory duct

A

vas deferens

seminal vesicle

68
Q

where is the prostate located

A

between the neck of the bladder and levator ani (above) and the perineal membrane (below)

69
Q

what part of the prostate is palpable on PR exam

A

the posterior surface of the prostate

70
Q

what things can you feel about the prostate gland on PR exam

A

size
hardness
contour

71
Q

which part of the prostate gland is transversed by the ureter

A

median/medial lobe

72
Q

what does an antiverted uterus mean

A

uterus bent forward over the vagina that is bent backwards

73
Q

what are and where are the parts of the uterus

A
  • above the uterine tubes = fundus
  • below the entrance of the uterine tubes = body of the uterus
  • cervix
74
Q

which part of the cervix is visible on a speculum examination

A

external os

75
Q

which part of the uterus is stabilised by ligaments

A

cervix

76
Q

what are the 3 ligaments that attach to the cervix

A
  • lateral cervical ligaments
  • utero-sacral ligaments/recto-uterine ligaments
  • pubocervical ligament
77
Q

what is the most substantial ligament

A

lateral cervical ligaments

78
Q

where are the ligaments that attach to the cervix

A
  • lateral cervical - from side wall to the cervix (endofascial condensation surrounding NV structures)
  • uterosacral ligament (backwards to the sacrum)
  • pubocervical ligament (forwards to the pubic bone)
79
Q

what is the cause of a prolapsed uterus

A

the ligaments supporting the cervix and vagina slacken (due to childbirth or advancing age)

80
Q

how long are the uterine tubes

A

10-14cm

81
Q

what is the broad ligament

A

the peritoneum that covers most of the anterior surface of the uterus, the uterine tubes and the posterior part of the uterus

82
Q

where do the ovaries lie in relation to the broad ligament

A

on the posterior side

83
Q

what are the 4 parts of the uterine tubes

A

intramural
isthmus
ampulla
fimbriae

84
Q

which direction do the fimbriae of the uterine tube point

A

posteriorly towards the ovary

85
Q

how and where are the ovaries connected to the uterus

A

connected by the ovarian ligament to the upper angle of the uterus

86
Q

what are the three structures that attach to the upper angle of the uterus

A

fallopian tubes
ovarian ligaments
round ligaments

87
Q

where does the ovary sit in relation to NV structures

A

sits between the bifurcation of the iliac vessels

88
Q

which direction does the vagina sit

A

sits with an angulation backwards

89
Q

which wall of the vagina is longer (ant or post)

A

posterior

90
Q

where can you palpate the pouch of douglas

A

via vaginal examination - the posterior wall of the vagina at the superior asepct

91
Q

what is the vaginal fornix

A

the expanded upper part of the vagina that surrounds the external os

92
Q

what do the ant, post and lateral parts of the vaginal fornices relate to

A

ant - bladder
post - pouch of douglas
lateral - lateral structures

93
Q

at what anatomical landmark does the rectum begin

A

at S3 - where the taenia change back to a longitudinal muscle coat

94
Q

which part of the rectum stores the faeces

A

ampulla

95
Q

what are the 2 arteries that enter the pelvis from above and what do they themselves branch from

A 
ovarian arteries (abdominal aorta)
superior rectal artery (continuation of the inferior mesenteric artery)
96
Q

what are the common (both male and female) visceral arterial branches for the pelvis and which structures do they relate to

A

superior vesical artery = bladder

superior rectal artery

97
Q

what are the visceral arterial branches of the plevis that are extra in the male

A

inferior vesical artery - reinforces the prostate, seminal vesicles etc

98
Q

what are the visceral arterial branches of the pelvis that are extra in the female

A

uterine artery - uterus

vaginal artery - vagina

99
Q

where is the the nerve supply to the pelvic viscera derived from

A

the inferior hypogastric plexus (contains both SNS and PNS)

100
Q

where is the PNS component of the inferior hypogastric plexus derived from

A

pelvic nerves S2-4 (part of sacral plexus)

101
Q

where is the SNS component of the inferior hypogastric plexus derived from

A

the thoracolumbar nerves

102
Q

where is the perineum and what are its borders

A

beneath the pelvic floor and the skin

- diamond - from symphysis pubis to tip of the coccyx behind and ischial tuberosities either side

103
Q

how is the perineum divided up

A

into 2 triangles by a line that joins the ischial tuberosities horizontally

  • uritogenital triangle
  • anal triangle
104
Q

what further divides the uritogenital triangle of the perineum and what are the divisions called

A

the peroneal membrane

  • superficial peroneal pouch
  • deep peroneal pouch
105
Q

what is and where is the peroneal membrane

A

it is a fibrous membrane that extends from one ischial pubic ramus to the other with a free posterior edge

106
Q

what is important about the free posterior edge of the peroneal membrane

A

has a thickening in the midline of its posterior margin (peroneal body)

107
Q

the free posterior edge of the peroneal membrane is reinforced by…

A

pair of superficial transverse peroneal muscles and a pair of transverse peroneal muscles

108
Q

what is the ischiorectal fossi

A

the space on either side of the anal canal that is filled with fat in real life

109
Q

what forms the pudendal canal

A

a split in the fascia overlying obturator internus (lateral wall of the anal triangle)

110
Q

explain the lining of the anal canal

A

upper 2/3 lined by mucosa

lower 1/3 lined by skin

111
Q

explain the differences in arterial supply of the upper 2/3 and lower 1/3 of the anal canal

A

upper 2/3 = superior rectal artery

lower 1/3 = rectal artery

112
Q

explain the differences in portal drainage of the upper 2/3 and lower 1/3 of the anal canal

A

upper 2/3 - drains to portal system

lower 1/3 - drains to system system (site of porto-systemic anastomoses)

113
Q

explain the differences in nerve supply of the upper 2/3 and lower 1/3 of the anal canal

A

upper 2/3 = autonomic nerves

lower 1/3 = somatic nerve supply

114
Q

what are where are the 3 parts of the external anal sphincter

A

deep - directly related to the pelvic floor
superficial - part that is fixed anteriorly and posteriorly
subcutaneous - immediately deep to the skin

115
Q

what are the anterior and posterior anchor points of the superficial part of the external anal sphincter

A

anterior - to the perineal body

posterior - tip of the coccyx

116
Q

where are the external sphincters involved with the urethra

A

in the deep perineal pouch on the deep surface of the membrane

117
Q

what structures are associated with the superficial peroneal pouch and the superficial surface of the peroneal membrane

A

the anchor points for the external genitalia

118
Q

what are the 4 parts of the male urethra

A
  • pre-prostatic (associated with the internal urethral sphincter)
  • prostatic
  • membranous - tranverses the deep perineal pouch and deep surface of perineal membrane)
  • spongy part
119
Q

explain the tissue of the penis

A

pair of corpora cavernosa

single corpora spongiosum

120
Q

anchor points for corpora cavernosa

A

laterally to the pair of ischial pubic rami - come together in the midline and join spongiosum

121
Q

what are the muscles that cover the tissues of the penis

A

ischiocavernosus

bulbospongiosus

122
Q

what is the major nerve of the perineum

A

pudendal nerve

123
Q

explain the composition of the pudendal nerve

A

sensory, sympathetic and somatic (not PNS) - branch of sacral plexus (S2-4)

124
Q

route of the pudendal nerve

A
  • starts in sacral plexus on piriformis
  • exits with piriformis via GSF
  • winds around the back of the ischial spine and leaves through the LSF beneath the pelvic floor
  • goes into the pudendal canal and lands on obturator internus
125
Q

what are the 3 branches of the pudendal nerve

A

inferior rectal nerve
perineal nerve
dorsal nerve of the clitoris/penis

126
Q

route of inferior rectal nerve and what does it supply

A

through ischiorectal fossa and supplies the anal canal

127
Q

route of perineal nerve and what does it supply

A

splits into motor and cutaneous branches to all the structures associated with the urogenital triangle

128
Q

which nerves could potentially be damaged with a fracture of the pelvis

A

sciatic
femoral
lateral femoral cutaneous

129
Q

what structures might be injured if the sacrum is fractured or there is a disruption of the SI joint

A

internal iliac
nerves in sacral foramen
hip flexors

Z MD1 Reproductive Block (12 decks)

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