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Anatomy Exam 4 > L39-40: Pelvis I-II > Flashcards

L39-40: Pelvis I-II Flashcards

1
Q

What landmarks delineate the pelvic inlet/brim? Outlet?

A
  • Pectineal line of pubis, arcuate line of ilium, sacral promonotory
  • Outlet = space inferior that is closed by pelvic diaphragm
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2
Q

Difference between the greater (false) and lesser (true) pelvis?

A
  • Greater (false) = lower part of abdominal cavity, superior to pelvic inlet
  • Lesser (true) = actual pelvis, inferior to pelvic inlet and sup to outlet
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3
Q

Joints of pelvis – what type of joint is each?

A
  1. ) Sacroiliac (SI): synovial joint
  2. ) Lumbosacral (LS): secondary cartilaginous (fibro-) joint with IV disc
  3. ) Sacrococcygeal: secondary cartilaginous (fibro-) joint with IV disc
  4. ) Pubic symphysis: secondary cartilaginous (fibro-) joint
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4
Q

Functions of sacrotuberous and sacrospinous ligaments

A
  • Prevents anteroinferior displacement of superior sacrum

- Converts greater and lesser sciatic notches into foramina

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5
Q

Attachments of sacrotuberous and sacrospinous ligaments

A
  • Sacrotuberous: sacrum to ischial tuberosity

- Sacrospinous: sacrum to ischial spine

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6
Q

Review bony landmarks of pelvis

A

Review bony landmarks of pelvis

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7
Q

What bony landmarks form obturator foramen

A
  • superior and inferior rami of pubic and ischial bones
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8
Q

Sex differences regarding pelvis: pelvic inlet, canal, ischial tuberosities and spines, greater sciatic notch, subpubic angle, sacrum?

A
  • Pelvic inlet: females = oval/rounded, males = heart-shaped
  • Canal: females = short with parallel walls, males = long, funnel-shaped
  • Ischial tuberosities and spine: females = everted, males = not everted
  • Greater sciatic notch: females = broader, males = narrower
  • Subpubic angle: females = >_ 90 deg, males = <_ 70 deg
  • Sacrum: females = short/broad, males = long/narrow
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9
Q

Pelvic wall and floor muscles

A
  • Lateral wall = obturator internus
  • Posteror wall = piriformis
  • Pelvis floor = pelvic diaphragm = levator ani + coccygeus
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10
Q

Attachments of obturator internus

A
  • Lesser pelvis through lesser sciatic foramen and attaches to greater trochanter of femur
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11
Q

What is the tendinous arch of the pelvis?

A
  • Obturator membrane lines the obturator internus muscle

- Medial aspect of this membrane = tendinous arch

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12
Q

Attachments of piriformis muscle

A
  • Sacrum within lesser pelvis through greater sciatic foramen and attaches to greater trochanter of femur
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13
Q

Nervous tissue associated with piriformis

A
  • Sacral nerve plexus sits on piriformis muscle, acts as bed for it
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14
Q

What muscles serve as the pelvic floor (aka diaphragm)?

A
  • Levator ani (puborectalis, pubococcygeus, iliococcygeus – medial to lateral)
  • Coccygeus (aka ischiococcygeus)
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15
Q

Function of pelvic diaphragm?

A
  • Supports pelvic viscera during increased intraabdominal pressure and aids with voluntary control of urination and fecal continence
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16
Q

Name muscles of levator ani – attachments (name from medial to lateral)

A
  1. ) Puborectalis – muscular sling attaching to pubis (sometimes part of pubococcygeus)
  2. ) Pubococcygeus – arises from pubis and tendinous arch, attaches to coccyx
  3. ) Iliococcygeus – arises from tendinous arch and ischial spine, blends to pubococcygeus
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17
Q

Attachments of ischiococcygeus (aka coccygeus) muscle

A
  • Ischial spine to coccyx/sacrum
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18
Q

What are the components of the pelvic viscera?

A
  • Urinary bladder, parts of ureters, rectum and in….
  • Males: ductus deferens, seminal vesicles, ejaculatory ducts, prostate and bulbourethral glands
  • Females: ovaries, uterine tubes, uterus, vagina
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19
Q

Describe associated structures with male and female ureters that a surgeon ought to be cautious of

A
  • Males: ductus deferens passes between ureters and peritoneum close to bladder
  • Females: ureters pass medial to uterine arteries’ origins
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20
Q

What prevents reflux of urine into ureters from bladder?

A
  • Flap valves where ureters enter bladder. Muscular contractions of bladder act as sphincters preventing reflux
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21
Q

Arterial supply and innervation of ureters?

A
  • Innervation: via autonomic plexuses nearby (renal, aortic, superior and inferior hypogastric)
  • Male blood supply = inferior vesicular
  • Female blood supply = uterine
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22
Q

Position of bladder in adults / children

A
  • Adults: empty it rests in lesser pelvis, full extends to umbilicus
  • Children: empty it may rest in abdomen
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23
Q

Anatomical regions of the urinary bladder

A
  • Apex: anterosuperior
  • Fundus: posterior wall
  • Body: area bw apex and fundus
  • Neck: constriction area
  • Trigone: triangle between ureteric and urethral openings
24
Q

Differences between bladder/urethral sphincters in males/females

A
  • Females and males both have external sphincter (voluntary)
  • Males also have internal sphincter (involuntary): prevents reflux of semen into bladder – muscle from bladder continuous with prostate’s fibromuscular tissue
25
Q

T/F. Urethra is in pelvis (is pelvic viscera).

A
  • False.
  • Females: descends anterior to vagina and is partly pelvic, partly perineal
  • Males: only preprostatic and prostatic urethra is pelvic, membranous and spongy are perineal
26
Q

4 parts of male urethra

A
  1. ) Preprostatic: from neck of bladder to prostate
  2. ) Prostatic: within prostate
  3. ) Membranous: through external urethral sphincter
  4. ) Spongy: longest and runs through penis
27
Q

Of the 4 parts of the male urethra, which is least distensible?

A
  • The membranous urethra. Likely and area for kidney stone
28
Q

Describe the specializations/anatomical features of the prostatic urethra

A
  1. ) Urethral crest = median ridge
  2. ) Seminal colliculus = rounded eminence
  3. ) Prostatic utricle = remnant of uterovaginal canal in seminal colliculus
  4. ) Openings of ejaculatory ducts into seminal colliculus inferior to utricle
  5. ) Openings of prostatic ducts lateral to seminal colliculus
29
Q

4 parts to the uterine tube

A
  1. ) infundibulum: funnel-shaped with fimbrae
  2. ) ampulla: widest and longest part
  3. ) isthmus: enters uterine horns
  4. ) uterine part: short segment in uterine wall
30
Q

Anatomical regions of uterus

A
  1. ) Fundus (superior to uterine tubes)
  2. ) Uterine horns
  3. ) Isthmus: constricted region superior to cervix
  4. ) Cervix: internal os (opening to uterus) and external os (opening to vagina)
31
Q

What structures support the uterus?

A
  • Ovarian ligament: from ovary to uterus
  • Round ligament: uterus to labia majora
  • Broad ligament = mesentery of uterus with subdivisions
    a. ) Suspensory ligament = ovarian vessels, lymphatics and nerves conveyed to uterus
    b. ) Mesovarium: suspends ovaries
    c. ) Mesosalpinx: suspends uterine tube
    d. ) Mesometrium: suspends most of uterus
  • Pelvic diaphragm
32
Q

What structures support the uterus? List the mesentery that suspends the female reproductive organs.

A
  • Ovarian ligament: from ovary to uterus
  • Round ligament: uterus to labia majora
  • Broad ligament = mesentery of uterus with subdivisions
    a. ) Suspensory ligament = ovarian vessels, lymphatics and nerves conveyed to uterus
    b. ) Mesovarium: suspends ovaries
    c. ) Mesosalpinx: suspends uterine tube
    d. ) Mesometrium: suspends most of uterus
  • Pelvic diaphragm
33
Q

Typical position of uterus

A
  • Anteverted (axis bw cervix and vagina), anteflexed (axis bw uterine body and cervix)
34
Q

Location of vagina in reference to bladder/urethra and rectum

A
  • Anterior to rectum, posterior to bladder/urethra
35
Q

Names of superiormost vagina as it surrounds cervix

A
  • Anterior, posterior and lateral fornices
36
Q

Which part of the vagina is somatically innervated? By what?

A
  • Lower 1/4th by deep perineal branch of pudendal
37
Q

What is the ejaculatory duct?

A
  • Seminal vesicle and ductus deferens unite and converge upon seminal colliculus of prostatic urethra
38
Q

Lobes of prostate. Clinical relevance

A
  • Ant/post/middle/lateral
  • Can hypertrophy in BPH (benign prostatic hyperplasia) and make ejaculation and urination difficult – requires TURP (transurethral resection of the prostate) procedure
39
Q

Glands that are posterolateral to membranous urethra. Where are the openings for this gland?

A
  • Bulbourethral glands

- Openings in spongy urethra in bulb of penis

40
Q

Contents of semen

A
  • Testes secretion, seminal vesicle secretion, prostate secretion, bulbourethral gland secretion
41
Q

Primarily retroperitoneal pelvic organs

A
  • Ureters, male prostate, seminal vesicles, vas deferens (ductus)
42
Q

What are intraperitoneal pelvic organs?

A
  • Uterus (can be considered secondarily intraperitoneal), ovaries, uterine tubes
43
Q

Space behind pubis that accommodates bladder distension?

A
  • Retropubic space (of Retzius)
44
Q

Space behind rectum that accommodates rectal expansion?

A
  • Retrorectal space
45
Q

Area in males between bladder/prostate and rectum

A
  • Rectovesical pouch
46
Q

Area in females between bladder and uterus

A
  • Vesicouterine pouch
47
Q

Area in females between uterus and rectum

A
  • Rectouterine pouch (of Douglas)
48
Q

How can the rectouterine pouch (of Douglas) be accessed by a surgeon?

A
  • Posterior fornix
49
Q

Branches of the common iliac artery

A
  1. ) Internal iliac (I Love Going Places In My Very Own Underwear)
    - Iliolumbar, lateral sacral, gluteal (sup and inferior), internal pudendal, inferior vesical, middle rectal, vaginal (off uterine), obturator, umbilical (gives off superior vesicular)
    - Posterior division is iliolumbar, lateral sacral and sup gluteal (sometimes off anterior division), rest are anterior division

2.) External iliac

50
Q

Lymphatic nodes of pelvis

A
  1. ) Inguinal nodes (superficial and deep)
  2. ) External and internal iliac nodes
  3. ) Common iliac nodes
  4. ) Lumbar nodes
51
Q

Nerve supply to lower limb

A
  • Sciatic nerve (L4-S3 ant / post division) exits greater sciatic foramen
52
Q

Nerve supply to skin and muscles of perineum/sensory for external genitalia

A
  • Pudendal nerve (S2-S4 ant division) exits via greater sciatic foramen, enters via lesser sciatic foramen
53
Q

What is the ganglion impar?

A
  • ends of bilateral sympathetic trunk that converge to this structure
54
Q

Arrangement of sympathetics in pelvis

A
  • Arise from T11-L2 through sympathetic chain through lumbar and sacral splanchnic nerves, synapse in inferior mesenteric ganglion
  • Postsynaptics through superior hypogastric, R/L hypogastric nerves and or inferior hypogastric plexus then with pelvic arteries to target organs
55
Q

Arrangement of parasympathetics in pelvis

A
  • Arise from S2-S4 ascending through inferior/superior hypogastric plexuses then follow arteries to target organs
  • Synapse in ganglia in organ/gut plexuses
56
Q

What is the perineum?

A
  • Everything beneath the pelvic diaphragm/floor

Anatomy Exam 4 (8 decks)

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