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Anatomy - Block 2 > L7 - Pelvis & Perineum > Flashcards

L7 - Pelvis & Perineum Flashcards

1
Q

The pelvic cavity is continuous with the abdominal cavity and divided into two regions

Name them and their contents:

A

False [greater] pelvis

  • superior region related to upper parts of the pelvic bones
  • generally considered part of the abdominal cavity

True [lesser] pelvis

  • inferior parts of the pelvic bones, sacrum, and coccyx
  • has an inlet and an outlet
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2
Q

What is the area inferior to the pelvic inlet?

A. True Pelvis

B. False Pelvis

A

A. True Pelvis

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3
Q

The Pelvis

A
  • Pelvic inlet
  • Pelvic walls (2 muscles)
  • Pelvic floor (diaphragm)
  • Pelvic Outlet (orfices coming out of pelvic diaphragm)

Contain Elements of the:

  • urinary
  • gastrointestinal
  • reproductive systems
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4
Q

Name the Pelvic Bones

A
  • Ilium
  • Ischium
  • Pubis

Converge into acetabulum (femur articulates there)

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5
Q

Name the purple starred structures

A

ASIS

Ischial Spine

Ischial Tuberosity

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6
Q

What is the sacral promontory?

A

In between the 5th lumbar and 1st sacral vertebrae

  • More prominent in males
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7
Q

Where do the spinal nerves of the sacrum come out of?

A

Anterior sacral foramina

Posterior sacral foramina

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8
Q

What connects the sacrum to the L5?

A

zygapophysial joints

  • connects adjacent vertebrae
  • specifically between the L5 and the sacrum

Joints

  • zygapophysial joints
  • Sacro-iliac joints
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9
Q

Name the main ligaments of the pelvis

A

Main ligaments:

  • Anterior Sacro Illiac ligament
  • Lumbosacral ligament
  • Iliolumbar ligament
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10
Q

What is the common site of fractures,

also known as

the weakest point in the pelvis

A

Superior/Inferior Pubic Ramus

Superior/Inferior Ischial Ramus

= Ishiopubic Ramus

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11
Q

Name the differences between women and men

pelvis size, shape, and projections

A

Female:

  • Pelvic inlet is more circular
  • Wider infrapubic angle (80-85 degrees)
  • Less prominent Ischial Spine
  • Less prominent Promontory

Male:

  • Pelvic inlet is narrower and heart-shaped
  • Narrower infrapubic angle (50-60 degrees)
  • More prominent Ischial Spine
  • Prominent Promontory (sacral promontory)
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12
Q

The pelvic inlet contains 5 structures, name them

A

PAAPP

  • Promontory of sacrum
  • Ala of sacrum
  • Linea terminalis [Arcuate line]
  • Pecten pubis/pectineal line
  • Symphysis pubis
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13
Q

All of the following are a part of the linea terminalis EXCEPT:

A. Pubic Crest

B. Arcuate Line

C. Pectin Pubis

D. Ala of sacrum

A

D. Ala of sacrum

Linea terminalis = Arcuate line, Pecten pubis, Pubis crest

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14
Q

What are the contents of the Pelvic Wall?

A
  • Sacrum (bone)
  • Coccyx (bone)
  • Piriformis (muscle)
  • Obturator Internus (muscle)
  • Sacrospinous Ligament & Sacrotuberous Ligament
  • Pelvic bones inferior to linea terminalis
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15
Q

What are the ligaments that form the pelvic wall?

A

Sacrospinous Ligament:

  • Sacrum to the ischial spine

Sacrotuberous Ligament:

  • Sacrum to the ischial tuberosity

These ligaments stabilize the sacrum on the pelvic bones by resisting the upward tilting of the inferior aspect of the sacrum

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16
Q

What are the muscles that make up the pelvic wall?

A

Piriformis

  • Piriformis goes through the GSF

Obturator internus

- Obturator Internus goes through the LSF

Both:

  • External Rotators
  • medial surface of greater trochanter of femur
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17
Q

How many Apertures are in the pelvic wall and what are they?

A

Three major apertures:

- the obturator canal

  • Greater sciatic foramen
  • Lesser sciatic foramen

Obturator canal –> obtrurator vessels

GSF –> Piriformis

LSF –> Obturator internus

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18
Q

What is the name of the following structure in green?

A. Promontory of Sacrum

B. Pubic Crest

C. Pectin Pubis

D. Arcuate Line

E. Margin of Ala

A

D. Arcuate Line

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19
Q

True or False

The superior gluteal nerve and vessels are inferior to the piriformis

A

False

The superior gluteal nerve and vessels are superior to the piriformis

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20
Q

Structures in relation to the Piriformis

A

Superior:

Superior Gluteal Nerve, Artery & Vein

Inferior:

Sciatic Nerve, Inferior Gluteal Nerve & Internal Pudendal Vessels

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21
Q

True or False

Obturator Vessels run through the obturator canal

A

True

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22
Q

Name the structure in green

A. Ischial Tuberosity

B. Ischial Spine

C. AIIS

D. PIIS

A

B. Ischial Spine

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23
Q

What is the Pelvic floor formed by?

A
  • Pelvic diaphragm
  • Perineal membrane
  • Deep perineal pouch

The pelvic floor separates the pelvic cavity, above, from the perineum, below.

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24
Q

The pelvic diaphragm

A

Formed by funned shape muscles

Levator anni

  • Contributes to the formation of the pelvic floor

which supports the pelvic viscera

  • Maintains _90-degre_e angle between the rectum and anal canal
  • Reinforces the external anal sphincter and, in women, functions as a vaginal sphincter

Coccygeus muscle

(not in levator anni)

  • supports the pelvic viscera
  • pulls coccyx forward after defecation
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25
Q

Name the levator anni muscles in the Pelvic Diaphragm

A

Levator Ani Muscles

  • Puborectalis
  • Pubococcygeus
  • Iliococcygeus

Coccygeus Muscle

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26
Q

Where is the tendinous arch found?

A

Tendinous Arch:

Fascia of Obturator Internus and Levator Ani

(Specifically Iliococcygeus)

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27
Q

Which of the following muscles are within the pelvic wall?

A. Piriformis

B. Coccygeus

C. Obturator Internus

D. A and C

E. All of the above

A

D. A and C

Piriformis & Obturator Internus –> muscles within the pelvic wall

Coccygeus –> part of the pelvic diaphragm

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28
Q

Perineal membrane and Deep perineal pouch

A

Perineal membrane

  • a thick fascial structure attached to the bony framework of the pubic arch

Deep perineal pouch

  • contains a layer of skeletal muscle and various neurovascular elements
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29
Q

What does the perineal membrane and adjacent pubic arch

do for the roots of the external genitalia and the muscles associated with them?

A

The perineal membrane and adjacent pubic arch

provides attachment for the roots of the external genitalia and the muscles associated with them

30
Q

True or False

The urethra penetrates vertically through a circular hiatus in the perineal membrane

A

True

31
Q

skeletal muscle functions as a sphincter

A

Anteriorly

  • muscle fibers surround the urethra and collectively form the

external urethral sphincter

(important in voluntary urinating)

1. Sphincter Urethrovaginalis

2. Compressor Urethrae

(found only in female)

= facilitate the closing of the urethra

deep transverse perineal muscle

32
Q

The perineal body is on the side of the perineal membrane

A

The perineal body is on the posterior side of the perineal membrane

33
Q

What are the muscles within the Deep Perineal Pouch?

Does the female and male have the same muscles within the deep perineal pouch?

A

Males:

Deep Transverse Perineal Muscle

External Urethral Sphincter

Females:

Deep Transverse Perineal Muscle

External Urethral Sphincter

Compressor Urethrae

Sphincter Urethrovaginalis

34
Q

What structure is this?

A

Piriformis

  • goes through the GSF
35
Q

What structure is this?

A

Obturator Internus

  • Goes through the LSF
36
Q

What structure is this?

A

Coccygeus

37
Q

What structure is this?

A

Levator Ani

38
Q

What are the major arteries of the Pelvis: Internal Iliac

A

Anterior Trunk:

  • up to 8 arteries
  • differ in males and females

Supplies viscera: urinary bladder, internal and external genitalia, rectum, gluteal region

Posterior Trunk:

3 arteries

Supplies the parietal tissues: pelvic walls and gluteal region

39
Q

True or False

Most of the pelvic organs are supplied by the anterior trunk, not the posterior trunk

A

True

40
Q

What are the 3 arteries that come off of the Posterior Trunk?

A

P: Posterior Trunk

I: Iliolumbar Artery

L: Lateral Sacral Artery

S: Superior Gluteal Artery

Iliolumbar Artery

  • One common trunk with two branches:

Iliac and Lumbar

Supplies:

Iliacus, Psoas major, quadratus lumborum muscles, and cauda equina

Lateral Sacral Artery

Supplies:

the piriformis muscle and vertebral canal

Superior Gluteal Artery

Exits pelvis through Greater Sciatic Foramen, superior to the Piriformis muscle

Supplies Gluteal muscles and Tensor Fascia Latae

41
Q

What are the starred structures?

A

- Iliolumbar

- Lateral sacral

- Superior gluteal

Remember:

P: Posterior Trunk

I: Iliolumbar Artery

L: Lateral Sacral Artery

S: Superior Gluteal Artery

42
Q

What are the 8 arteries that come off of the anterior trunk?

A

Anterior Trunk

- Pudendal Artery (Internal)

- Umbilical Artery –> Superior Vesical Artery (Lower Yield)

- Middle Rectal Artery

- Vesical Artery (Inferior)

- Obturator Artery

- Vaginal Artery (Females)

- Uterine Artery (Females)

- Gluteal Artery (Inferior)

Me: “A Person Used My Van On Vegas’s Unstable Grounds”

43
Q

Anterior Trunk

A

Obturator artery

  • Travels through the obturator canal, accompanied by the obturator nerve and vein. It supplies the muscles of the thigh’s adductor region.

Umbilical artery

  • Gives rise to the superior vesical artery, which supplies the superior aspect of the urinary bladder.

Inferior vesical artery

  • Supplies the lower aspect of the bladder. In males, it also supplies the prostate gland and seminal vesicles.

Vaginal artery (female)

- Descends to the vagina, supplying additional branches to the inferior bladder and rectum

Uterine artery (female)

  • ascends along the lateral aspect of the uterus. At the fallopian tubes, it anastomoses with the ovarian artery.
  • During its course, it crosses the ureters superiorly.

Middle rectal artery

  • Travels medially to supply the distal part of the rectum. It also forms anastomoses with the superior rectal artery (derived from the inferior mesenteric) and the inferior rectal artery (derived from the internal pudendal)

Internal pudendal artery

  • exit the pelvis via the greater sciatic foramen
  • Accompanied by the pudendal nerve, it then enters the perineum via the lesser sciatic foramen
  • It is the main artery responsible for the blood supply to the perineum.

Inferior gluteal artery

  • The terminal branch of the anterior trunk.
  • It leaves the pelvic cavity via the greater sciatic foramen, emerging inferiorly to the piriformis muscle in the gluteal region.
  • It contributes to the blood supply of the gluteal muscles and hip joint.
44
Q

Minor arteries of the pelvis do NOT come from the internal iliac

A

Gonadal Arteries

  • The ovarian and Testicular.
  • They arise from the abdominal aorta, distal to the origin of the renal arteries

Superior Rectal Artery

  • terminal continuation of the inferior mesenteric artery.

Median Sacral Artery

  • originates from the posterior aspect of abdominal aorta
45
Q

All of these are branches off the posterior trunk of the internal iliac artery EXCEPT:

A. Iliolumbar Artery

B. Superior Gluteal Artery

C. Lateral Sacral Artery

D. Inferior Gluteal Artery

A

D. Inferior Gluteal Artery

Inferior Gluteal Artery comes off the anterior trunk

46
Q

Somatic: Voluntary

Autonomic: Involuntary

A

Voluntary –> muscle

Involuntary –> heart rate

47
Q

Sacral Plexus

A

These nerves provide somatic innervation to pelvic and lower limb structures

Pink: Ventral Division

This will become the tibial part of the sciatic nerve

Yellow: Dorsal Division

This will become the common fibular part of the sciatic nerve

48
Q

What is the Pudendal Nerve of the Sacral Plexus formed by?

A
  • Formed by anterior rami of S2-S4
  • Innervates structures of the perineum
  • provides sensory and motor function to the:

external genitalia

external urethral sphincter

external anal sphincters

S2,S3,S4 Keeps POOP Off the Floor

49
Q

Pudendal Nerve

A

Dorsal Nerve of Penis:

Somatic ONLY

Deep Perineal Nerve:

Muscles

Superficial Perineal Nerve –>

Posterior Scrotal Nerve:

Mostly Sensory

50
Q

Visceral plexuses

A

Paravertebral sympathetic chain

Via ventral rami

  • lower limb and perineum

Via sacral splanchnic nerves

  • Pelvic organs and erectile tissue

Sympathetic:

Sympathetic Trunk → Gray Rami Communicantes → Ventral Rami → Lower Limb and Perineum

Sympathetic Trunk → Sacral Splanchnics → Inferior Hypogastric Plexus → Pelvic Organs & Erectile Tissue

Superior Hypogastric Plexus → Inferior Hypogastric Plexus

Parasympathetic:

Ventral Rami → Pelvic Splanchnics → Inferior Hypogastric Plexus

51
Q

Pelvic extensions of the prevertebral plexus

A
  • carry sympathetic, parasympathetic, and visceral afferent fibers

Superior hypogastric plexus

Hypogastric nerves

pelvic splanchnic nerves carrying preganglionic parasympathetic fibers from S2 to S4

Inferior hypogastric plexus

52
Q
  • rectal plexus
  • uterovaginal plexus
  • prostatic plexus
  • vesical plexus
A
53
Q

Sympathetic fibers

A
  • innervate blood vessels
  • cause contraction of smooth muscle in the internal urethral sphincter in men and the internal anal sphincters in both men and women
  • cause smooth muscle contraction associated with the reproductive tract and with the accessory glands of the reproductive system
  • important in moving secretions from the epididymis and associated glands into the urethra to form semen during ejaculation.

Sympathetic = ejaculation

54
Q

Parasympathetic fibers

A
  • are generally vasodilatory,
  • stimulate bladder contraction,
  • stimulate erection
  • modulate activity of the enteric nervous system of the colon distal to the left colic flexure (in addition to pelvic viscera, some of the fibers from the pelvic plexus course superiorly in the prevertebral plexus, or as separate nerves, and pass into the inferior mesenteric plexus of the abdomen).

Parasympathetic = erection

55
Q

True or False

Parasympathetic = ejaculation

Sympathetic = erection

A

False

Sympathetic = ejaculation

Parasympathetic = erection

56
Q

The inferior hypogastric plexus has sympathetic innervation coming from all EXCEPT:

A. Superior Hypogastric Plexus

B. Sacral Splanchnic Nerves

C. Pelvic Splanchnic Nerves

D. A and B

A

C. Pelvic Splanchnic Nerves

57
Q

Pelvic Viscera

A
  • Gastrointestinal
  • Genitourinary
  • Reproductive
58
Q

Rectum

A

- most posterior element of the pelvic viscera

  • anorectal junction is pulled forward (perineal flexure)

by the action of the puborectalis

59
Q

Rectum

A

Rectum has three lateral curvatures:

  • Upper and lower curvature to the right
  • Middle curvature to the left
  • Lower part of the rectum is expanded to form the rectal ampulla
60
Q

Urinary system

A

The pelvic parts of the urinary system consist of the

  • terminal parts of the ureters
  • bladder
  • Proximal part of the urethra
61
Q

Urinary Bladder

A

Empty bladder is shaped like a three-sided pyramid

It has:

Apex

  • directed toward the top of the pubic symphysis;
  • Median umbilical ligament [urachus]

Apex of Bladder → Median Umbilical Ligament (Urachus)

Base

Trigone

  • superior surface
  • two inferolateral surfaces.
  • Neck

Top corners of Trigone:

  • Openings of the ureter

Bottom Corner:

  • Internal Urethral Sphincter
62
Q

True or False

Detrusor muscle contracts and pushes urine from the bladder into the urethra

A

True

63
Q

Which of the following muscles are NOT a part of the Levator Ani Muscles?

A. Iliococcygeus

B. Pubococcygeus

C. Puborectalis

D. Coccygeus

A

D. Coccygeus

64
Q

Neck of bladder

A

most “fixed” part.

It is anchored into position by a pair of tough fibromuscular bands

Pubovesical → female

Puboprostatic → male

65
Q

Fascia of Denovilliers =

Rectoprostatic Fascia (Males)

Rectovaginal Fascia (Females)

A
66
Q

Blood supply, lymph drainage, and nerve supply of bladder

A

Arteries

  • Superior and inferior vesical arteries

Veins

  • Vesical veins

Lymph drainage

  • Internal and external iliac nodes

Superior Vesical Artery comes off

the Umbilical Artery

Sympathetic & Parasympathetic:

Inferior Hypogastric Nerves

67
Q

Autonomic innervation of bladder

A
  • The parasympathetic nerve (pelvic splanchnic nerve originating from S2–S4) stimulates to contract the musculature (detrusor) of the bladder wall, relaxes [inhibitory] to the internal urethral sphincter, and promotes emptying.
  • The sympathetic nerve relaxes the detrusor of the bladder wall and constricts the internal urethral sphincter.

Visceral afferents follow the pelvic splanchnic into the spinal cord

Parasympathetic (Pelvic Splanchnic)
→ Contract Detrusor → Relax Internal Urethral Sphincter

Sympathetic

→ Relax Detrusor → Contract Internal Urethral Sphincter

68
Q

Which curvature of the rectum is pointing to the LEFT?

A. Upper Curvature

B. Middle Curvature

C. Lower Curvature

D. A and C

A

B. Middle Curvature

69
Q

Urethra in Males vs Females

A

Females:

  • 4cm Long
  • Anterior to Vaginal Orifice
  • Surrounded by external urethral sphincter

Males:

  • 20cm Long

Preprostatic:

  • 1cm; Surrounded by Internal Urethral Sphincter
70
Q

Male Urethra

A

Prostatic:

4cm; Urethral Crest turns into → Seminal Colliculus

Prostatic ducts secrete into → Prostatic Sinuses

Ejaculatory Ducts (2) secrete into → Seminal Colliculus

Prostatic Utricle located in Seminal Colliculus

Membranous:

Passes through deep perineal pouch

Surrounded by external urethral sphincter

Spongy:

Surrounded by corpus spongiosum

Forms bulb @ base; forms the navicular fossa at the glans penis

71
Q

Which portion of the male urethra is surrounded by the internal urethral sphincter?

A. Preprostatic

B. Prostatic

C. Membranous

D. Spongy

A

A. Preprostatic

Membranous –> external urethtra

72
Q
A

Anatomy - Block 2 (8 decks)

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