GUT Women's Health Anatomy & Radiology Part 1 (& Commentary) Flashcards
Normally the pelvic inlet is tilted 50-60 degress ___ and the Ischiopubic arch is ___
Normally the pelvic inlet is tilted 50-60 degress forward and the Ischiopubic arch is horizontal
What are the dermatomes of the sacral segments of the pelvis?
S3-S5
Dermatomes of skeletal mm in Perineum and Pelvic Floor including urethral and anal sphincters?
S2-S4
Much of the somatic motor and sensory innervation of the Perineum and Pelvic Floor is via what nerve?
Pudendal Nerve (S2-S4)
What is the major nerve of the Perineum?
Pudendal N
Where do you place the Pudendal nerve block?
Aims to block the nerve as it enters the lesser sciatic foramen, 1 cm inside (inferior and medial) relative to the ischial tuberosity
The arterial supply to the pelvis is basically from the ___ ___, anterior and posterior branches
Internal Iliac A
Extending across the Ischiopubic arch is a thick triangular fascial structure that has transverse muscles within and is called?
The Urogenital Diaphragm/Perineal Membrane & Deep Perineal Pouch
The Perineum includes what structure anteriorly and what structure posteriorly?
- Urogenital triangle (anterior)
- Anal triangle (posterior)
- Note its diamond shape & the anterior triangle is perforated anteriorly by a gap transmitting the dorsal vein of the penis & clitoris
The Urogenital Diaphragm/Perineal Membrane & Deep Perineal Pouch is innervated by? Arterial supply?
- Innervation via Pudendal N
- Internal Pudendal A
What membrane is a thick fibrous sheet with a free posterior border?
perineal membrane
The Deep Perineal pouch contains muscles and ___ structures
neurovascular
The Pelvic Diaphragm is composed of?
-Levator Ani
- Iliococcygeus
- Pubococcygeus
- Puborectalis
-Coccygeus m
The ___ ___ arises from the walls of the true pelvis, from the posterior pubic bone, from a ligament on the Obturator internus muscle, from the Ischial tuberosity
Levator Ani (Levator Sling)
What muscle arises from the ischial spine and Sacrospinous ligament and inserts on the sacrum & coccyx?
Coccygeus
The Levator Ani is comprised of what 3 muscles?
- Iliococcygeus
- Pubococcygeus
- Puborectalis
What muscle of the Levator Ani pulls the anorectal junction forward to help keep the GI system closed at the rectal area, helping the anal sphincters?
Puborectalis muscle
What muscle of the Levator Ani arises from the ilium and the tendonous arch on the obturator internus muscle?
Iliococcygeus muscle
What is the space between the muscles of the Levator Ani that allows the Urethra and Vagina to pass through the Pelvic Diaphragm/Sling?
Urogenital Hiatus (anteriorly) - look at bottom of photo
The Ischiorectal (ischioanal) fossa is also called?
The Deep Perineal Space (abscesses can form here)
The Levator Ani and Perineal Membrane come together at what structure?
Perineal Body
The Inferior Hypogastric Plexus is what type of plexus?
Visceral (PSNS, SNS, and visceral afferents)
The Internal Anal Sphincter is smooth muscle and therefore controlled by what nervous system?
Autonomic (PSNS)
The External Anal Sphincter is skeletal muscle and has what 3 components?
- deep
- superficial
- subcutaneous
What is the External Anal Sphincter innervated by?
Inferior rectal branches of the Pudendal nerve (Somatic nerve)
In the perianal area there is a transition zone between rectal mucosa and nonkeratinized squamous epithelium called the?
Anal Pecten
*After the Anal Pecten = the Anocutaneous Line (true skin = keratinized squamous epithelium)
Hemorrhoidal Veins: the Superior rectal veins enter the ___ system
Portal
Hemorrhoaidal Veins: The Middle and Inferior rectal vein enter the ___ system
Caval
What ligamentous structures of the Uterus play a substantial role in supporting the uterus?
- Pelvic Diaphragm (Levator Ani, Coccygeus, & assoc. fascia)
- Urogenital Diaphragm/Perineal membrane
- Uterosacral ligaments
- Cardinal (Transverse servical, Mackenrodt)
- Anterior Pubocervical ligament
*UCA are the main ones
Which major ligament of the uterus is a fibromuscular fascia that goes from either side of the cervix to the pelvic walls?
Cardinal (Transverse cervical, Mackenrodt)
What major ligament of the uterus goes from the posterior cervix to the sacrum?
Uterosacral ligaments
What major ligament of the uterus is comprised of the Recto-uterine folds - comprised of fibrous tissue & muscular fibers attached to the front of the sacrum?
Uterosacral ligaments
What major ligament of the uterus goes from the uterus to the pubic symphysis?
Anterior Pubocervical ligament
What ligaments are associated with the uterus but are not considered to be true uterine support structures?
- Broad Ligament
- Round Ligament
- Suspensory ligment of the ovary
- Peritoneal folds
What structures are associated with the uterus, broad ligament, mesovarium, mesosalpinx and are not supportive?
Peritoneal folds
The Cardinal Ligament = what ligament?
Transverse Cervical Ligament
The ureters are very close to what female structure?
Uterine cervix
The Broad ligament has what artery within it?
Ovarian
The Ovarian artery within the Broad ligament originates in the Aorta and thus creates what type of pressure system?
High pressure - a problem with hemorrhage 2/2 to Ectopic pregnancy
The Uterine artery arises from?
Internal Iliac artery
What other peritoneal folds are in the Pelvis that form pouches?
- Vesicouterine Pouch
- Rectouterine Pouch (Pouch of Douglas) - deep pouch posterior to uterus and anterior to rectum where blood, fluid, pus, & tumors can lodge
T/F: You can actually palpate tumor or fluid collections in the Pouch of Douglas and drain the space with a needle via the rectum
True
The Urachus and Umbilical Folds are associated with what structure?
The bladder
What are the “supporting” structures (not true support) of the ovary?
- Mesocarium
- Suspensory Ligament of Ovary
- Ligament of Ovary
What is the Mesovarium?
A fold of peritoneum off of the Broad Ligament
What “supporting” ligament of the ovary is a fold of peritoneum from the superiolateral pelvis wall and contains arteries, veins, & lymphatics?
Superior Ligament of Ovary
What “supporting” ligament of the ovary is continuous with the Round LIgament of the Uterus and is attached to the lower pole?
Ligament of Ovary
The Deep Pelvic Structures drain into what part of the lymphatic system?
Internal and External Iliac chains
Lymph: The Deep Perineal structures drain into the?
Internal Iliac chain
Lymph: Some Superificial Perineal structures (Penis & Scrotum, Clitoris and Labia majora) drain into the?
Superficial Inguinal nodes
Lymph: Other Superficial Perineal structures (Glans penis, Glans clitoris, Labia minora, and inferior end of vagina) drain into the?
Deep Inguinal nodes & External Iliac chain
Lymph: The Ovaries, related Uterine structures, and the Testes drain into the?
Lateral and Pre-Aortic nodes
A key takeaway of the lymph system is that the deep parts of the Perineum are drained by the?
Internal Pudendal Chain > Internal Iliac nodes > Aortic nodes
Another key takeaway of the lymphatic system is that the superficial Perineum & external genetalia are drained by the?
Superficial Inguinal Nodes, Deep Inguinal nodes, & External Iliac nodes
What are important considerations when catheterizing the bladder?
Orientation/angulation of the urethra and relation/location of the bladder
