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Anatomy - Surgical soc > General Features of the Pelvis and Perineum > Flashcards

General Features of the Pelvis and Perineum Flashcards

1
Q

where do the bones of the pelvis join?

A

acetabulum

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2
Q

what is the sacrum made of?

what do the sacral formamina do?

where does the sacrm articulte with ilieum?

A

5 fused sacral vertbrae

Sacrial foremina allows the passage of sacral nerves

articulats ith the iliem at the sacroiliac joint

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3
Q

what is the sacral promontary?

A

anterior projection of bone which forms the posteror margin of the pelvic inlet.

Less prominant in female

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4
Q

WIT coccyx?

A

Inf to the sacrum

attaches the sacrum via the sacrococcygal symphysis - via the fibronocartilaginous joint

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5
Q

comaprison of male and female pelvis

A

Pelvic inlet - m: narrow/heart shaped. f: oval and round

sub pubic angle - m: acute f: around >80degrees

ischial spines - m: projects madially f: not project medially

greater pelvis - m: deep f: shallow

lesser pelvis - m: narrow, deep and tapering f: wide, shallow and cylinderical

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6
Q

what is the false pelvis?

A

upper part of the pelvis and the lumbar vertebrae

true pelvis - lower part of the pelvis below the sacral promontary and the sacrum and coccyx.

they are separated by the pelvc inlet

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7
Q

what is teh perineum?

A

inf t the pelvic floor. it’s boundaris form the pelvic outlet

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8
Q

what is meant by pelvimetry?

A

measurement of female pelvic inlet to check if the baby can fit through the canal

measure from the acral promontory to the sup margin of pubic bone AND the distance // the ischial spines

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9
Q

WATtwo main ligaments of the pelvis?

A

Sacrotuberous = scaral to ischial tuberosity

sacrospinous = sacral to ischial spine

THEY form the GREATER and the LESSER sciatic foramenia

On top the sacrospinous lig = greater. // the two lig = Lesser

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10
Q

which nerves pass trough the lesser sciatic foramen?

A

Pudendal (into the pelvis)

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11
Q

which nerve passes trhough the greater foramen of sciatic?

A

sciatic nerve

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12
Q

what forms the wall of the pelvis?

A

BONES: Sacrum, coccyx and inferior half of the pelvic bone

LIGAMENTS - connecting the pelvic bone to the sacrum and the coccyx

MUSCLES - Piriformis and Obturator internus

^^ these stabilise the hip joint

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13
Q

where does the pedundal arise?

Where does it pudendal nerve leave and enter?

what is the trajectory of the nerve?

A

S2 - S4

LEAVES via the GREATER sciatic foramen inferior to the periformis.

It crosses teh sacrispinous lig and re-enters the pelvic cavity throigh the lesser sciatic foramen

it passes through the pedundal canal formed by the fascia of the obtruatr internus

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14
Q

what are the branches ofthe pudendal?

A 
Inferior rectal nerve
Perineal nerve (superficial and deep)
The dorsal nerve of the penis and clitoris
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15
Q

what kind of innervation does the pedendal nerve have?

A

Sensory, motor and autonomic

External genitalia and skin sensation

Levator ani, external urethral and anal sphincters, bulbospongiousus and ischiocavernosus

Sympathetic fibres to the S2-4

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16
Q

what is meant by a pudendal block?

A

Used for prain during childbirth/chornic pelvic pain. Local anesthetia is given where the nerve crosses. - lateral aspect of sacrispinous lig and near its attachement on the ischial spine.

17
Q

What does the pelvic floor separate?

A

PELVIC CAVITY AND PERINEUM (region containing the genitalia and anus)

18
Q

What are the two parts of the pelvic diaphragm?

A

Coccygeus (sacrum+coccyx -> ischial spine) - correspoding the sacrospinous ligament

Levator Ani (formed of 3 muscles) (pubic bone -> ischial spine) LOOK @ DIAGRAM

19
Q

What is the levator ani formed off?

WAT two gaps allowing passage of structures?

A

iliococcygeal
puboccocygeal
puborectal

muscles

there are two gaps allowing the passage of structures.

  • > Urogential hiatus
  • > Rectal hiatus
20
Q

what is the perineal body?

A

ill defined, connectibe tissue structure

important structures attaach to the PB:-
Lavetor ani
Skeletal muscle sphincters (ext. urethral and anal) sphincter)

21
Q

when can a pelvic organ prolapse occur?

A

if the pelvic organ ike the blader or vagina undergoes trayma or poor muscle tone

or if the perineal body is torn during birth

Can be avoided by EPISIOTOMY (perineal body is disscted to allow the baby’s head to pass through the vagina. -> the clean incision is easier to suture than rough tear

22
Q

WIT ureter?

where does it cross in the pelvic cavity?

WAT the 3 points/junctions?

Imortantance of tehse Jx

A

smooth muscle tube formed at the hilum of kidney

around 30cm

enters at pelvic inlet and crosses DUCTUS DEFERNS in men and UTERINE ARTERY in women

Jx
Ureteropelvic junction (at the kidney pelvis)
Crossing the oelvic inlet
Entering the bladder

^ these are the sites which kidney stones ay be lodged

23
Q

what shape is the bladder?

What is the apex attached to and how?

How is the URETHRA achored ?

A

triangular pyramid

2 ureters

Apex is attached to the umbilius via MEDIAL UMBILICAL LIGAMENT

Urethra achored to the pubic bone by the pubovesicular (female) and puboprostatic ligament (male)

24
Q

How many walls does bladder have?

A

3

  • serous - outer layer
  • smooth muscle - detrusor muscle: PSNS supply.
  • transitional epi
25
Q

What are the sphincters of the bladder mae of?

what is the detrusor made of?

A

skeletal muscle

smooth muscle

26
Q

what does the SNS do to the detrusor?

A

relaxation and the internal urethral sphincter contraction.

27
Q

what happens when you pee?

A

detrusor contraction & internal urethral sphincter relaxation - involuntary control (Pelvic splanchnic nerves)

external urethral sphincter relaxation - voluntary control - this is done by inhibiting the motor signal voluntarily

28
Q

what implication does the pelvic floor have on the dunctionality of vol and invol sphincters?

A

divides the voluntary and involuntary sphincters

Urinary continence requires a balance between detrusor relaxation and external sphincter contraction

The pelvic floor muscles exert sphincter action on the urethra
As the bladder fills, bladder pressure is increased. But urethral sphincter pressure (maintained by the pelvic floor) exceeds this, maintaining continence.

Normally, when intrabdominal pressure is high (coughing or sneezing), the pressure in the bladder and urethra increases equally, maintaining continence.
Weakness/damage to the pelvic floor can lead to urinary stress incontinence
Damage to the muscles/pudendal nerve can occur during labour*
Pubococcygeusandpuborectalisare most medial and therefore the more prone to injury*
The pelvic floor can be repaired surgically or strengthened by pelvic floor exercises*

29
Q

describe the structure of the rectum

A

S-shaped distal part of GIT

has 3-4 transverse rectal fold which act as shelves for faecal material

Involuntary internal sphincter closes the upper and middle portion of the anal canal

30
Q

where is the anal canal located?

A

External to the pelvic floor

31
Q

What is PUBORECTALIS?

A

Muscle that forms a sling around the rectum. making a 90degree angle // rectum nal canal

-> The damage to this muscle leads to faecal incontincences?

32
Q

how is defecation aided by muscles?

A

The pelvic floor helps increase intrabdominal pressure during defecation
When intrabdominal pressure is high, puborectalis relaxes, straightening the anorectal angle

The internal anal sphincter relaxes
The circular muscles of the rectum undergo a wave of contraction to push faeces forwards
The longitudinal muscles of the rectum and lavator ani bring the anal canal upwards so the faeces are expelled.

33
Q

What is the ischio-anal fossa?

A

Lateral to the anal canal

Has adipose tissue and contains the pudendal canal (w/ internal pudendal vessels and nerve)

Boundaries:
Base: Skin over anal region
Medial wall: anal canal & levator ani
Lateral wall: obturator internis & ischial tuberosity

Anatomy - Surgical soc (9 decks)

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