G25 Pelvis and Perineum Lecture

Question 1

pelvic peritoneal reflections

Answer 1

peritoneal cavity extends inferiorly into the pelvis and drapes the pelvic organs

rectouterine pouches

vesicouterine pouches

Question 2

Pelvic girdle

Answer 2

2 os coxae (three fused bones)
-ilieum, ischium, pubis (connected with triradiate cartilage

and
sacrum , coccyx

Ilium
ID: iliac crest, ala, body, psis, aiis, asis, arcuate line, articular surface -sacroiliac joint

pubis:
pubic tubercle, pubic sympysis (fibrocartilaginous joint with articular cartilage), artricular surface

ischium:
greater sciatic notch, lesser sciatic notch, ischial ramus, ischiopubic ramus, inferior pubic ramus
tuberosity, ischial spine

Obturator foramen

subpubic angle, distance between R and L ischial tuberosities

pubic archL inf border of 2 sichiopubic rami
-obturator membrane

Question 3

ligaments of pelvic girdle

Answer 3

posterior sacroiliac ligaments: attached to bumps on posterior sacrum, attach to medal, superior portion of ilium

iliolumbar ligament from lumbar TP, to superior iliac

anterior sacroiliac ligament: sacrum to medial ischium

sacrospinous ligament (most medial from the sacrum near coccix to ischial spine (above, greater sciatic foramen, below, lesser)

sacrotuberous ligament linger and more posterior/lateral to sacrospinous, from the sacrum to the ischial tuberosity??

interosseus sacroiliac lig, pull the ilia medially,
-body massL transmitted anterior to axis of rotation

joint capsul between sacrum and ilium

tendancy for increated weight to rotate sacrum anteriorly and inferiorly, resisted by sacrotuberus and sacrospinous lig

Question 4

Greater and Lesser sciatic foramina

obturator foramen

Answer 4

greater, borders sacrospinal and anterior sacroiliac

lesser, borders sacrotuberus and sacrospinous

obturator foramen, made by pubic arch, filled with obturator membrane, small obturator canal on top

greater sciatic foramen and obturator canal, carry neurovasculature to lower limp

lesser sciatic foramen carries pelvic neurovasculature to perineum

Question 5

pelvic brim

Answer 5

divides pelvis into greater (false, and lesser (true) pelves

-tilted from horizontal ~55 degrees

Question 6

inferior pelvic aperature

Answer 6

(lower opening of pelvis, closed by pelvic diaphragm

coccyx, sacrum, sacrotuberous lig, ischial tubs , pubic symphysis

lesser pelvis, bony canal traversed by fetus
slide 26 MDA 334-335

know diagonal conjugate, promontory to inf border of pub symp

true obstetrical conjugate
-promontory to sympysis, cant be measured

interspinous distance, lease transverse distance, hormones relax ligaments during birth

Question 7

male and femal differences

Answer 7

maleL narrower between pubic arches, heart shaped, more curved sacrum

female: wider shallower pubic arches, large oval shaped brim, wider ischial tuberosities and spine, straighter sacrum

Question 8

pelvic diaphragm muscles

Answer 8

piraformis: tracvels thorugh the greater sciatic foramen, attaches to sacrum anteriorly (S2-4), to greater trochanter of femur
I: twigs from an rami of S1S2
A: rotate thigh laterally
-sacral plexus on ANTERIOR surface of piriformis

obturator internus: forms part of lateral pelvic wall
-travels thourhg lesser sciatic formen and makes right turn
PA: pelvic surfaces of ilium and ischium; obturator fascia
DA: greater trochanter of femur
I: nerve to obturator internus
AL rotates thigg laterally

coccygeus m and levator ani
-pelvic floor, skeletal muscle
bowl, funnel shaped
midline raphe
viscera: pelvic above, peritoneum below,
contracts with increase abdominal pressure

coccygeus:
PA: ischial spine
DAL inferior end of sacrum and coccyx
I twigs from S4 and S5
ACt: flexes coccyx

levator ani: two or three musles form a muscular sheet from pubis to coccyx
male two openings: 
-anterior UG hiatus
-posterior anal aperature
-innervation: nerve to lev ani

puboccygeus

• post pubisL midline raphe
• anococcygeal ligament
  puborectalis: fibers around anus

pubovaginalis and puboprostaticus

missing info…look at slide 37 38 39

Question 9

clinical correlation of pelvic diaphragm

Answer 9

wekness of the pelvic diaphragm (levator ani and coccygeus) can result in urinary stress or incontinence, bowel incontinense and herniation of prolapse of pelvic viscera thoruhg the perineum