ANATOMY - PELVIS Flashcards
1
Q
Prior to pubity, what separates the 3 parts of the hip bone?
A
Triradiate cartilage
2
Q
At what age do the hip bones fuse?
A
15-17 y/o
3
Q
Which bone of the hip bone is the largest?
A
ilium
4
Q
wing/ala of ilium - what attaches on the inner surface
A
iliacus muscle (iliac fossa)
5
Q
wing/ala of ilium - what attaches on the outer surface
A
gluteal muscles
6
Q
Mid-inguinal point + significance
A
half way between ASIS and PS
Palpate femoral artery here
7
Q
Mid point inguinan ligament
A
half way between ASIS + PT
8
Q
‘True leg length’
A
ASIS to medial malleolus
9
Q
Which hip bone is the most anterior?
A
Pubis
10
Q
what are the 3 parts of the pubis
A
pubic body (sup pubic crest –> PT)
superior pubic ramus
inferior pubic ramus
11
Q
What foramen do the pubic rami enclose and what travels through it
A
obturator foramen
obturator aa, vv, nn
12
Q
position of ischium in hip bone
A
posteroinferior
13
Q
inf ischial ramus + inf pubic ramus –>
A
ischiopubic ramus
14
Q
What are the 2 important ligaments related to the ischium?
A
Sacrospinous ligament (sacrum to IS) - GSF
Sacrotuberous ligament (sacrum to IT) - LSF
15
Q
Pelvic girdle - what are the 4 articulations
A
2 x sacroiliac joints
sacrococcygeal symphysis
pubic symphysis
16
Q
role of greater pelvis (false pelvis)
A
provides support for lower abdominal viscera
17
Q
role of lesser pelvis (true pelvis)
A
pelvic cavity and pelvic viscera
18
Q
pelvic inlet - anterior border
A
Pubic symphysis
19
Q
pelvic inlet - posterior border
A
Sacral promontry + sacral wings
20
Q
pelvic inlet - lateral border
A
arcuate line ilium, pectineal line, sup pubic ramus AKA iliopectineal line
21
Q
pelvic outlet - anterior border
A
pubic arch
22
Q
pelvic outlet - posterior border
A
tip of coccyx
23
Q
pelvic outlet - lateral border
A
ischial tuberosity + sacrotuberous ligament
24
Q
How many sacral vertebra
A
5
25
what does base of sacrum articulate with?
L5 Intervertebral disc
26
What does apex of sacrum articulate with?
coccyx
27
what does lateral sacrum articulate with
ilium
28
what are the 2 surfaces of the sacrum and the fundamental difference between them
posterosuperior dorsal surface = coarse
anteroinferior pelvic surface = smooth
29
what surface of sacrum is median sacral crest on
dorsal surface
30
what attaches to median sacral crest?
Supraspinatous ligament
31
what attaches to intermediate sacral crest?
posterior sacroiliac ligament
32
what attaches to lateral sacral crest?
posterior sacroiliac ligaments
sacrotuberous ligaments
33
which sacral articular processes arent fused>
S1 + S5
34
how many transverse lines on pelvic sacral surface?
4
35
what are the sacral transverse lines remenants of and when does this process begin?
fused sacral intervertebral discs
from age 20
36
3 muscles attaching to anterior sacral surface
piriformis (--> GT)
coccygeus (-->coccyx)
iliacus (-->LT)
37
2 muscles attaches to posterior sacral surface
multifidus lumbrorum
erector spinae
38
what is carried in the central canal of the sacrum
sacral fibres, cauda equinal
39
at what level does the dural sac terminate in the sacrum
S2
40
how many ganglia of the sympathetic trunks in the sacrum
4
41
what is the medial sacral artery a branch of
abdominal aorta posteriorly
42
what does medial sacral aa supply (before anastomoses w/ lateral sacral aa) (2)
posterior rectum
coccygeal gland
43
what is the lateral sacral artery a branch of?
internal iliac aa
44
what does the anastomoses of the sacral arteries supply
meninges
sacrum
45
how many vertebra fuse to form coccyx
4
46
embryological origin coccyx
caudate eminence
4-8w gestation
47
what do the coccygeal cornua articulate with?
sacral cornua via intraarticular ligaments
48
action of sacrococcygeal symphysis
minor passive flexion and extension
49
what are the 5 ligaments associated with the coccyx?
anterior sacrococcygeal ligament
deep posterior sacrococcygeal ligament
superficial posterior sacrococcygeal ligament
lateral sacrococcygeal ligament
intraarticular ligaments
50
anterior sacrococcygeal ligament
connects anterior aspects vertebral bodies
51
deep posterior sacrococcygeal ligament
post 5th VB sacrum --> dorsal coccyx
52
superficial posterior sacrococcygeal ligament
med sacral crest --> dorsal coccyx
53
lateral sacrococcygeal ligament
lateral sacrum --> TP Co1
54
what 3 mm attach to coccyx
gluteus maximus
levator ani
anococcygeal raphe
55
role anococcygeal raphe
help support position of anus
56
what is coccydynia
discomfort around coccyx
57
what is the most common presenting tumour in newborns?
sacrococcygeal teratoma
58
embryological origin sacrococcygeal teratoma
primitive streak
59
which structure separates the greater and lesser sicatic foramen?
sacrospinous ligament
60
GSF - superior border
anterior sacroiliac ligament
61
GSF - anterolateral border
greater sciatic notch (ilium)(
62
GSF - posteromedial border
sacrotuberous ligament
63
GSF - inferior border
sacrospinous ligament + ischial spine
64
which muscle divides the greater sciatic foramen into 2 sections?
piriformis muscle
65
suprapiriform GSF - contents (3)
superior gluteal aa, v, nn
66
infrapiriform GSF - contents (8)
inferior gluteal aa, vv, nn
nn obturator internus
nn to quadratus femoris
sciatic nn
pudendal nn
post femoral cutaneous nn
67
superior border LSF
sacrospinous ligament + ischial spine
68
anterior border LSF
ischial spine, lesser sciatic notch
69
posterior border LSF
sacrotuberous ligament
70
contents lesser sciatic foramen (5)
internal pudendal aa + vv
pudendal nn
nn to obturator internus
obturator internus tendon
71
significance of sciatic foramina + pudendal nn
pudendal nn leaves pelvis via GSF and then re-enters pelvis via LSF
72
what 2 muscle groups make up the pelvic floor>
levator ani
coccygeus
73
shape of pelvic floor
funnel shaped
74
what does pelvic floor separate?
pelvic cavity from perineum
75
2 holes in pelvic floor of significance
urogenital hiatus
rectal hiatus
76
what fibrous structure is between the urogenital and rectal hiatus?
perineal body
77
functions of pelvic floor (3)
support abdominopelvic viscera
resist increases in intra abdominal pressure
urinary and faecal continence with mm fibres --> sphincter action around urethra and rectum
78
inn levator ani mm
ant ramus S4
Pudendal nn S2-4
79
what 3 muscles constitute the levator ani
pubococcygeus
puborectalis
iliococcygeus
80
anterior attachment levator ani
pubic bodies
81
lateral attachment levator ani
tendinous arch obturator internus
82
posterior attachment levator ani
ischial spines
83
pre-rectal fibres
u shaped sling around urethra + vagina important in urinary continence
84
role puborectalis
bends anal canal anteriorly, maintaining faecal continence
85
role iliococcygeus
elevates pelvic floor + anorectal canal
86
which muscle is the main constituent of the levator ani?
pubococcygeus
87
coccygeus origin/insertion
ischial spines --> lateral sacrum + coccyx
88
innervation coccygeus
anterior rami S4/5
89
what is the most inferior part of the pelvic outlet
perineum
90
shape of perineum
diamond shaped
91
anterior anatomical border perineum
Pubic symphysis
92
posterior anatomical border perineum
tip of coccyx
93
lateral anatomical border perineum
inferior pubic rami
inferior ischial rami
sacrotuberous ligament
94
anatomical base of perineum
skin/fascia
95
anterior surface border perineum
mon pubs (f)
base of penis (m)
96
lateral surface border perineum
medial surface thigh
97
posterior surface border perineum
superior gluteal cleft
98
what structure divides the perineum into the anterior and posterior triangles?
ischial tuberosities
99
contents of anal triangle of the perineum (4)
anal aperture
ext anal sphincter
ischioanal fossa
pudendal nn
100
role of ischioanal fossa
allows for expansion of the anal canal during defacation
101
layers of the urogenital triangle of perineum (deep --> superficial) (5)
deep perineal pouch
perineal membrane
superficial perineal pouch
deep perineal fascia
superficial perineal fascia
102
contents deep perineal pouch (5)
urethra
external urethral sphincter
vagina
bulbourethral glands
deep transverse perineal muscles
103
what 2 structures perforate the perineal membrane?
vagina
urethra
104
role perineal membrane
provide attachment for muscles in the external genetalia
105
contents superficial perineal pouch (4)
ischiocavernosus
bulbospongiosus
transverse perineal muscles
Bartholins glands
106
what are the 2 layers of the superficial perineal fascia and what are they continuous with respectively
superficial layer - continuous with Campers fascia
Deep layer - continuous with Scarpas = Colles
107
what material is the perineal body
fibromuscular - SKM, SM, collagen + elastic fibres
108
which mm attach to perineal body? (5)
levator ani
bulbospongiosus
sup + deep transverse perineal mm
ext anal sphincter mm
ext urethral sphincter mm
109
nn supply to perineum
pudendal nn S2-4
110
aa supply to perineum
internal pudendal aa
111
sensory supply by pudendal nn
external genitalia
skin around anus
anal canal
perineum
112
motor supply by pudendal nn (5)
bulbospongiosus
ischiocavernosus
levator ani
ext urethral sphincter
ext anal sphincter
113
pathway pudendal nn
sacral plexus ant ramus S2-4
descends between piriformis + ischiococcygeus mm
through greater sciatic foramen
crosses sacrospinous ligament
re-enters via lesser sciatic foramen
accompanies int pudendal aa/vv anterosuperiorly to Alcocks canal where it divides
114
3 main divisions of pudendal nn
1 - inf rectal nn
2- perineal nn
3 - dorsal nn penis/clitoris
115
action inferior rectal nn
inn perianal skin
lower 1/3 anal canal
116
action perineal nn
skin perineum, labia + post scrotum
117
action dorsal nn penis/clitoris
skin penis or clitoris
afferent aspect of erection
118
which muscle is the sacral plexus anterior to?
piriformis
119
which nn roots/ant rami make up sacral plexus
ant rami S1-4
L4 + L5 lumbar roots
120
what are the 5 major nn that are formed by sacral plexus
Sometimes Izzy Shits Poo Persistently
Sup gluteal L4-S1
Inf gluteal L5-S2
Sciatic L4-S3
Post femoral S1-3
Pudendal S2-4
121
route superior gluteal nn
leaves pelvis via GSF --> gluteal region superior to piriformis via sup gluteal aa + vv
122
motor function superior gluteal nn (3)
gluteus minimus
gluteus medius
TFL
123
route inferior gluteal nn
leaves pelvis via LSF --> gluteal region inferior to piriformis w/ inf gluteal aa + vv
124
motor fct inferior gluteal nn
gluteus maximus
125
tibial portion sciatic nn - motor fct
mm post compartment APART FROM BICEPS FEMORIDS
Hamstring adductor magnus
all mm posterior leg + sole foot
126
tibial portion sciatic nn - sensory fct
skin post lateral leg
lateral foot
sole of foot
127
common fibular portion sciatic nn - motor fct
short head biceps femoris
ant + lat leg
EDB
128
common fibular portion sciatic nn - sensory fct
skin lateral leg
skin dorsum foot
129
route posterior femoral cutaneous nn
leaves pelvis via GSF --> gluteal region inferior to piriformis --> descends deep to gluteus maxmus --> down back of thigh to knee
130
posterior femoral cutaneous nn - sensory fct
skin post thigh + leg + perineum
131
other nn from sacral plexus not mentioned (3)
nn to piriformis
nn to obturator internus
nn to quadratus femoris
132
which artery is the major artery to the pelvis?
internal iliac aa
133
anterior trunk branches internal iliac aa (7)
obturator aa
umbilical aa --> sup vesical aa
inf vesical aa
vaginal aa (F)
uterine aa (F)
Middle rectal aa
Inf gluteal aa
134
posterior trunk branches int iliac aa (3)
iliolumba raa
lateral sacral aa
sup gluteal aa (terminal branch)
135
obturator aa supplies
adductor thigh region via adductor canal
136
sup vesical aa supplies
sup bladder
137
inf vesical aa suppplies
lower bladder
prostate
seminal vesicles
138
vaginal aa supplies (3)
vagina
inf bladder
rectum
139
inf gluteal aa supples
gluteus max + hip joint
140
what does iliolumbar aa branch off into + what do the branches supply
iliac branches - mm + bone around iliac fossa
lumbar branches - psoas major, quadratus lumbrorum + post abdo wall
141
lateral sacral aa supplies
structures in sacral canal
skin + mm post to sacrum
142
superior gluteal aa supplies
skin + mm gluteus medius + minimus
143
level that median sacral aa posterior branches off from abdo aorta
L2
144
where does ext iliac vv receive blood from (3)
inf epigastric vv
deep circumflex iliac vv
femoral vv
145
where vv is responsible for the majority of pelvic drainage
int iliac vv
146
sup/inf gluteal vv - drain where
buttock + upper thigh
147
int pudendal vv drains where
reprodcutive organs + inf rectum via inf rectal vv
148
lateral sacral vv drains
part of sacrum
149
middle rectal vv drains where
bladder, prostate, mid rectum
150
vesical vv drains where
bladder via vesical venous plexus
151
uterine + vaginal vv drain where
female reproductive organs
via vaginal/uterine venous plexus
152
where does common iliac vv form
at pubic symphysis
153
what drains into common iliac vv
ext + iliac vv
ilioluumbar vv
middle sacral vv
154
what level does Common iliac become ivc
L5
