HD SM notes Flashcards
what are the borders of the pelvic inlet? [1]
what are the borders of the pelvic outlet? [1]
Pelvic inlet = from sacral promontry to the anterior part of pubic symphysis
Pelvic outlet = Inferior part of pubic symphysis to posterior coccyx, following the ischium bone round
Difference in the true pelvis and false pelvis?
True pelvis = contains all the pelvic organs (vagina, uterus, rectum, bladder, etc)
False pelvis = Despite the ilium being present, it just contains abdominal organs as they are continuous
Differences in the male and female pelvis
Male = Smaller sub-pubic angle, heart shaped pelvic inlet
Female = Much wider sub-pubic angle, more circular pelvic inlet
What is the narrowest part of the pelvis in:
- anterior-posterior view?
- transverse view?
Are they immobile?
Ant-Post: Between sacral promontry + pubic symphysis. This is fairly immobile
Transverse: Between ischial spines, but moves 10-15% in pregnancy as pelvic ligaments between more laxed to allow more room for baby to pass through
name for female shaped pelvis?
gynecoid
What covers almost the entirety of the obturator foramen? What passes through the small gap present?
Obturator membrane
Obturator nerve, artery, vein passes through small gap present
What passes through the greater sciatic foramen? [5]
Sciatic nerve, Superior and inferior gluteal nerve, artery, vein
Pudendal nerve
What passes through the lesser sciatic foramen?
Pudendal nerve to innervate the perineum
What muscle do the superior and inferior gluteal neurovasculature exit either side of?
Piriformis
What spinal roots are the pudendal nerve from
What does it innervate
S2-S4
Motor and sensory innervation to perineum
What are the 4 branches from the internal iliac artery that LEAVE the pelvis?
Superior Gluteal
Inferior Gluteal
Obturator
Internal pudendal
What are the branches of internal iliac artery that STAY in the pelvis? [4]
Superior vesicular (supply bladder)
Inferior vesicular (in men only, to prostate)
Middle rectal (to rectum)
Uterine artery (females only and supplies uterus, leads to another branch called vaginal artery to supply vagina)
Where does the piriformis muscle attach proximally and distally, and what movement does it allow?
Attaches proximally to the sacrum, moves through greater sciatic foramen and distally on the greater trochanter
Allows lateral rotation of thigh
Where does obturator internus attach both proximally and distally, and what movement does it allow?
Attached to the ischium/obturator membrane proximally and the posterior aspect of femur distally
Allows lateral rotation of the thigh
What two muscles make up the pelvic floor?
Coccygeus and Levator Ani
What are the 3 divisions of levator ani and where do they run from/to?
Puborectalis- from pubis to rectum
Pubococygenous- from pubis to coccyx
Iliococcygeus - From ilium to coccyx
Describe features of the puborectalis portion of levator ani that is specialised for function
This muscle gives a kink to the rectum, adding a right angle between anal canal and rectum which is important for continence
Relaxation of puborectus allows defecation
Where is the perineal membrane in respect to the pelvic floor, and what is attached to the perineal membrane?
Perineal membrane is inferior to the muscles of the pelvic floor, and the external genitalia are attached to this perineal membrane
Where do all muscles of the perineum insert onto?
perineal body
What is the name of the procedure of cutting the perineal body to prevent further damage from tearing in childbirth, and also to widen the vagina?
Episiotomy
What passes through the posterior sacral foramina?
Posterior rami which form the sacral plexus
What 3 structures does the genitofemoral nerve innervate (1 in male, 1 in femlae, 1 both)
- *Skin of scrotum** in males
- *Labia majora** in females (outside bit of vagina)
- *Cremaster muscle (**muscle of spermatic cord, can raise the testicles)
What nerve supplies the parasympathetic fibres to the pelvic viscera? What are their roots?
pelvic splanchnic nerves
S2,3,4
What does sympathetic innervation to the perineum take part in? [2]
Filling of the bladder via contraction of internal urethral sphincter and relaxation of detrusor muscle
Stimulates contraction of vas deferens and seminal vesicles
What artery does the inferior epigastric branch from, and is it before or after this artery has passed under the inguinal ligament
Inferior epigastric branches from external iliac artery just after it has passed under the inguinal ligament
What nerve, other than the pudendal, passes through the lesser sciatic foramen?
Nerve to obturator internus [1]
which of the following is the pubococcygeus
A
B
C
D
which of the following is the pubococcygeus
A
B
C
D
which of the following is the coccygeus
A
B
C
D
which of the following is the coccygeus
A
B
C
D
which of the following is the puborectalis
A
B
C
D
which of the following is the puborectalis
A
B
C
D
which of the following is the iliococcygeus
A
B
C
D
which of the following is the iliococcygeus
A
B
C
D
which of the following is most anterior
puborectalis
pubococcygeus
coccygeus
iliococcygeus
which of the following is most anterior
puborectalis
pubococcygeus
coccygeus
iliococcygeus
which of the following is most posterior levator ani muscle?
puborectalis
pubococcygeus
coccygeus
iliococcygeus
which of the following is most posterior levator ani muscle?
puborectalis
pubococcygeus
coccygeus
iliococcygeus
which of the following is most posterior ?
puborectalis
pubococcygeus
coccygeus
iliococcygeus
which of the following is most posterior ?
puborectalis
pubococcygeus
coccygeus
iliococcygeus
Action of piriformis?
lateral rotation
State the 3 layers of the uterus from the inside –> outwards
Endometrium
Myometrium
Perimetrium
label A-C
A: **endometrium
B: myometrium
C: perimetrium**
label this xx
label this
Define the internal and external os of the cervix respectively
Internal os = Opening into the uterus
External os = Opening into the vagina
What does the ovarian ligament connect?
Ovary to wall of uterus
What important structure is the uterine artery closely related to at the side of the cervix? When can this be clinically relevant?
Uterine artery close to ureter
Need to be careful in hysterectomy as ureter easily damaged
Where does the ureter lie in position to the uterine vessels [1]
Underneath the uterine vessels
’ Water under the bridge’ as the ureter lies underneath the uterine vessels
What vertebral region do the ovarian arteries branch from? [1]
from which artery? [1]
L2
abdominal aorta !!
Where does the suspensory ligament of the ovary run from-to?
From the ovary, and outwards to the lateral abdominal wall
What vessels does the suspensory ligament of the ovary carry? [4]
Ovarian artery, vein, nerve plexus and lymphatic vessels
What is the round ligament of the uterus?
originates at the uterine horns, runs through inguinal canal and then attaches to the labia majora
Define the
- rectouterine pouch
- vesicouterine pouch
60/111
Rectouterine = extension of peritoneum between posterior wall of uterus and rectum
Vesicouterine = extension of peritoneum from the bladder to anterior wall of uterus
Which wall of the vagina is longer: anterior or posterior?
posterior
Describe the route taken by sperm cells from seminiferous tubules -> outside world
Testes -> Epididymis -> Vas deferens -> Inguinal canal -> Seminal vesicles at post. bladder –> Ejaculatory duct through prostate –> Urethra
Why are females more susceptible to UTIs?
shorter uretha
What are the two functions of the urethra? [2]
Carry urine from the bladder to the outside world
Carry semen to ejaculate from penis
Where are the seminal vesicles located
Posterior aspect of bladder
Which part of the penis does the urethra run through?
Corpus spongiosum
State the borders of the perineum
Ant = pubic symphysis
Inf = coccyx
Lateral = Inferior ramus of pubis + sacrotuberous ligament
The perineum can be divided into 2 triangles by a line drawn between ______?
State the names of the 2 triangles
Line drawn between the two ischial tuberosities
Anterior triangle = Urogenital
Posterior triangle = Ana
label A [1]
what is its function? [1]
helps with expansion during defecation
What muscle makes up the lateral walls of the anal triangle? [1]
obturator internus
State the branches of the pudendal nerve [4]
Inferior anal/rectal
Dorsal nerve of penis/clitoris
Perineal
Posterior labial
For pudendal nerve block, what is the bony prominence that is the landmark for the nerve (i.e. where the anaesthetist would inject? [1]
ischael spine
What is the urogenital triangle bounded by?
Anteriorly = pubic arch
Laterally = ischial tuberosities
Imaginary line between ischial tuberosities also separates urogenital triangle from anal triangle
where is the urogenital diaphragm? [1]
what is the function of the urogenital diaphragm? [1]
Urogenital diaphragm - muscles directly above peroneal membrane within the deep peroneal pouch (sphincter urethrae and deep transverse perineal)
The urogenital diaphragm adds strength around the apertures, which are basically deficits in the pelvic floor.
what is the difference between the pelvic floor muscles and urogenital diaphragm?
The pelvic floor muscles and urogenital diaphragm are not the same thing.
Pelvic floor muscles create the floor (Levator ani and Coccygeus).
Above the perineal membrane is the urogenital diaphragm. The urogenital diaphragm are all the muscles imbedded within the deep perineal pouch.
what is the Deep perineal pouch is space above? [1]
what is the superior boundary of the deep perineal pouch? [1]
- Deep perineal pouch is space above perineal membrane the urogenital triangle
- State the superior boundary of the deep perineal pouch: levator ani
State the superior and inferior boundary of the superficial perineal pouch
Superior = Perineal membrane
Inferior = Colles’ fascia
State the superior and inferior boundary of the superficial perineal pouch [1]
Superior = Perineal membrane
Inferior = Colles’ fascia
What muscle surrounds:
corpus spongiosum tissue
corpora cavernosa tissue?
- Bulbospongiosus
= Ischicavernosus
What are the right and left crura or the penis? where are they located?
These are the two individual bases of the corpus cavernosum tissue, will be surrounded by ischiocavernosus
Located in superficial perineal pouch
What are the two muscles present in the scrotum and what does each one do? [4]
Dartos muscle = Causes the scrotum to wrinkle up, to increase S.A. and therefore regulate temperature of testes
Cremaster = Causes testes to elevate, occurs during erections
What are the 3 columns of erectile tissue in the penis?
2 dorsal corpus cavernosa
1 ventral corpus spongiosum
Where do the arteries of the penis branch from?
Pudendal artery
What is bucks fascia?
Fascia surrounding all 3 columns of erectile tissue in the penis
Where do the superficial and deep dorsal veins of the penis drain to? [2]
Superficial –> Saphenous
Deep –> Internal iliac
Function of bulbospongiosus in men
Compresses urethra to expel final drops of semen and urine
Define mons pubis [1]
Fatty region on top of the pubic symphysis in women
What is the vulva vestibule guarded by?
Labia minora
Define the hymen
This is a membrane that surrounds / partially surrounds the vaginal opening
Function of bulbospongiosus in women
Contraction of bulbospongiosus in women contracts the vagina
Function of ischiocavernosus in women
Assists clitoral erection
Function of ischiocavernosus muscle in men [1]
Erection
(Also flexes anus in both male and female)
Major blood supply to both urogenital and anal triangle?
Internal pudenal artery
what is the homologue of the scrotum in women
labia majora
what is the homologue of the glans penis in women
glans clitoris
Boundaries of anal triangle?
Post = Coccyx
Ant = imaginary line between ischial tuberosities
Lateral = Sacrotuberous ligament
Define tunica vaginalis
The closed sac of peritoneum that covers the sides and anterior aspect of the testis
What is the spermatic cord [1]
The vas deferens and surrounding connective tissue that runs from the deep inguinal ring to the testes
Define tunica albuginea
A layer of connective tissue that surrounds the testes, and also the corpora cavernosa
Define seminiferous tubules
Coiled-threadlike tubules that make up the bulk of the testis and are lined with a layer of epithelial cells from which spermatozoa are produced
The duct which conveys sperm from the testicles to the urethra is called WHAT?
vas deferens
what is this?
what is its function?
rete testis
A anastomosing network of delicate tubules that carry sperm from seminiferous tubules –> efferent ductules, which then pass to epididymis
what is the highly convoluted duct behind the testes which passes sperm to vas deferens? [1]
epididymis
Name the vein that drains the testes, and where this vein drains to in left and right testis [2] (theyre different !!)
Testicular vein
Right drains to IVC
Left drains to left renal vein
where does the following occur?
Sperm acquire the ability to move and fertilise an egg [1]
Stored here until ejaculation [1]
Sperm acquire the ability to move and fertilise an egg [1]
epididymus
Stored here until ejaculation [1]
epididymus
What does the ejaculatory duct consist of? [2]
Ductus deferens and duct of seminal vesicle [2]
State the coverings that the testis take as they descend from post. abdominal wall into scrotum, from most deep -> most superficial [3]
Deepest = Transversalis fascia Middle = Musculature of internal oblique Superficial = Aponeurosis of external oblique
