Lec7/8/9Pelvis&Perineum Flashcards
The pelvic cavity is divided into what to pelvis’s?
False (greater) pelvis-superior portion
True (lesser) pelvis= inferior portion
What is the bony support for the pelvic cavity of the pelvis?
- ilium, ischium, pubis
- sacrum
—-Promontory=connects sacrum to lumbar spine
—–Ant + Post sacral foramen=house sacral nerves - coccyx
What are the pelvic ligaments within the pelvic cavity?
(names tell you where they go)
- Anterior SI ligament:
sacrum to ilum - Lumbosacral ligament: lumar spine to sacrum
- Iliolumbar ligament: ilium to lumbar spine
What does the pelvic inlet separate?
The false pelvis from the true pelvis
What is the pelvic inlet comprised of?
“People Always Love Pumpkin Season” or PALPS
Promontory (connects sacrum to lumbar spine)
Ala
Linea terminalis (arcuate line)
Pecten pubis (pectineal line)
Symphysis Pubis
What are three key characteristics of the male pelvis?
-heart shaped pelvis inlet
-decreased angle of pubis: 50-60 (smaller)
-more prominent promontory + ischial spine
What are three key characteristics of the female pelvis?
-circular pelivc inlet
-increased angle of pubis: 80-85 (bigger)
-less prominent promontory+ ischial spine
While performing a pelvic exenteration, the surgical oncologist notices a fracture in the boundary of the pelvic inlet. Which of the following structures is most likely damaged?
A. sacrotuberous ligament
B. sacropspinous ligament
C. greater sciatic foramen
D. promontory
D
What bones make up the pelvic wall?
ischium, pubis, sacrum, coccyx
What are the ligaments contained in the pelvic wall?
Sacrospinous: sacrum to ischial spine
Sacrotuberous: sacrum to ischial tuberosity
If you had a patient that damaged a nerve that exited superiorly to the piriformis muscle which nerve would be affected?
sup. gluteal nerve
What the muscles contained in the pelvic wall?
piriformis-goes through GSF
Obturator internus- goes through LSF
What are the apertures of the pelvic wall?
- GSF
-above piriformis: sup, gluteal art. and nerve
-below piriformis: inf. gluteal art and nerve - LSF: pudendal + internal pudendal vessels
- Obturar canal: obturator artery + nerve
What does the pelvis floor support?
Pelvic viscera (ex. uterus)
What three structures make up the pelvic floor?
Pelvic diaphragm: muscle
Deep perineal pouch: muscle
Perineal membrane: fascia (CT)
What does the pelvic diaphragm include?
Coccygenous m
Levator Ani
-iliococcygeus m: ilium to coccys
-pubococcygeus m: pubis to coccyx
-puborectalis m: pubis to rectum
What does the deep perineal pouch include?
External urethral sphincter
Sphincter urethrovaginalis (female)
Compressor urethrae (female)
Deep transverse perineal muscle
1st three listed wraps around urethra
What does the perineal membrane include?
opening for urethra
attaches to external genitalia (ex: root of the penis)
Exam question last year: If you had a patient and she tore her pelvic diaphragm during childbirth and had paralysis of one of her pelvic diaphragm muscles, which of the following muscles would be affected?
A. Sphincter urethrovaginalis
B. Levator Ani
C. Piriformis
D. Obturator internus
B
The main blood supply to the pelvic region comes from the
internal iliac artery
What arteries come off the anterior trunk of the internal iliac artery?
Internal pudendal a
Umbilical a
Middle rectal a
Obturator a
Vaginal a
Uterine a (crosses OVER (superior to) the ureters
Inferior gluteal a
What arteries come off the posterior trunk of the internal iliac artery?
PILS
Iliolumbar a
Lateral sacral a
Superior gluteal a
What are the minor arteries that branch off the abdominal aorta?( not impt for exam but you can still know)
Gonadal a: ovarian or testicular
Superior rectal a
Median sacra a
As the uterine arteries pass from the internal iliac arteries to the uterus it crosses superiorly to which of the following structures that sometimes is mistakingly ligated during surgery?
ureters
What is the innervation for the pelvis?
(S 2/3/4 keeps shit off the floor)
sacral plexus —-pudendal nerve
What does the pudendal nerve supply and what structure does it travel through?
Supplies external genitalia, external urethral sphincter (deep perineal pouch), external anal sphincter
Travels though LSF
The sympathetic innervation of the pelvis comes from where
PARAvertebral sympathetic chain (sympathetic trunk)—-sacral splanchnic nerves with preganglionic fibers
What is the sympathetic innervation response for the pelvis
“Point and Shoot”
“fight or flight” response– contraction and ejaculation
“Shoot penis, ejaculation, sympathetic”
The parasympathtic innervation to the pelvis comes from where?
PREvertebral plexus (aka sacral plexus)—-pelvic splanchnic nerves with preganglionic fibers
What is the parasympathetic innervation response for the pelvis
“Point and Shoot”
“rest and digest” response—dilation and erection
“Point penis, erection, Parasympathetic”
Sympathetic and Parasympathetic innervation contributes to which plexuses?
superior and inferior hypogastric plexus
The rectum is the most anterior or posterior pelvic organ
posterior
What pulls the anorectal junction forward to prevent flow of stool
puborectalis of levator ani
The rectum contains 3 lateral curvatures, what are they?
upper curves to right
middle curves to left
lower curves to right
What is the blood supply for the rectum?
anterior trunk of internal iliac artery
superior rectal artery
middle rectal artery
inferior rectal artery
What is the innervation of the rectum?
sacral plexus
The bladder receives urine from ____ via the _____
kidneys, ureters
How is the bladder organized?
APEX= directed towards the top of the pubic symphysis
BASE: trigone (ureters + urethral sphincter are @ the corners of trigone)
NECK: most fixed part (anchored by pubovesical (F)/puboprostatic (M) ligaments
What muscle is contained within the bladder and what is its fxn?
detrusor muscle and its a smooth muscle that contracts to push urine into the urethra
What is the blood supply to the bladder?
anterior trunk of internal iliac artery
umbilical artery–superior vesical artery
inferior vesical artery
What is the innervation of the bladder?
inferior hypogastric plexus
parasymp: contracts detrusor muslcle- empties bladder
symp: relaxes detrusor muscle—stops bladder from emptying
The bladder is the most anterior or posterior pelvic organ?
anterior
What are the muscles wrapped around the female urethra?
external urethral sphincter
sphincter urethrovaginalis
compressor urethrae
What are the muscles wrapped around the male urethra?
external urethral sphincter
What are the 4 segments of the male urethra?
preprostatic=before the prostate
prostatic=in the prostate
membranous=after the prostate—perineal membrane
spongy= in external genitalia
–surrounded by corpus spongiosum (penile tissue)
– forms navicular fossa @ tip of penis
You have a patient with prostate cancer, you need to remove the tumor, but you don’t want to harm the neighboring structures within the prostate. You are worried about damaging the prostatic duct which drains into which of the following?
A. navicular fossa
B. midline of male prostatic urethra
C. prostatic sinus
D. remnant of mullerian duct (in colliculus)
c
What structures are the prostate relations?
- urethral crest=midline of male prostatic urethra
- prostatic ducts–drain into prostatic sinus
- prostatic utricle= remnant of Mullerian duct (in colliculus)
The root of the penis is
A. middle (free) part
B. proximal (fixed) part
C. distal part
proximal (fixed) part
The root of the penis is composed of erectile tissue. What is this tissue comprised of?
Right and Left Crura—give rise to corpora cavernosum (surround the bulb of the penis)
Bulb of penis–gives rise to corpus spongiosum
What muscles are within the root of the penis?
Ischiocavernosus (x2 right and left)—covers the crura
Bulbospongiosus (x2 right and left) —–covers the bulb
The body of the penis is
A. middle (free) part
B. proximal (fixed) part
C. distal part
middle (free) part
The body of the penis is composed of erectile tissue. What is this tissue comprised of?
Copora Cavernosa: formed by the crura
Corpus Spongiosum: gives rise to the glans (formed by the bulb and surrounds the male spongy urethra
The glans of the penis is
A. middle (free) part
B. proximal (fixed) part
C. distal part
distal part
What does the glans of the penis formed by and what does it contain?
Formed by corpus spongiosum (of penile body)
Contains male spongy urethra— navicular fossa
What are the structures (in order) contained within the testes?
Seminiferous tubules, rete testis, efferent duct, epididymis, vas deferens, seminal vesicle, ejaculatory duct, urethra
Spermatozoa (premature sperm) are produced in the
seminiferous tubules
What two structures join to form the ejaculatory duct?
vas deferens and seminal vesicle
Does the vas deferens travel over or under the ureter?
over
What is the blood supply to the testis?
testicular arteries (off abdominal aorta)
What is the venous drainage of the testes?
pampiniform plexus—drains into testicular veins
left testicular vein –drains into left renal vein—IVC
right testicular vein—IVC
What are three zones of the prostate?
peripheral zone, central zone, transitional zone
You had a patient come in and you perfomed a digital rectal exam. Which of the zones of the prostate will be felt during this exam?
peripheral zone
The prostate peripheral zone
major part
most posterior zone
area felt on DRE
The central zone
minor part
middle zone
surrounds the ejaculatory ducts
Transitional zone
minor part
most anterior zone
surrounds the urethra
indicated in BPH
What is the blood supply and innervation of the prostate?
blood supply: prostatic arteries
innervation: inferior hypogastric plexus
The uterus is comprised of what three segments?
Fundus: top—connects to uterine (fallopian) tubes
Body: middle—site of implantation
Cervix: bottom–connects to the vagina
The uterine (fallopian) tubes consist of
fimbraie, infundibulum, ampulla, isthmus
What are the ligaments of the uterus?
broad, suspensory, ovarian
What are the parts of the broad ligament of the uterus?
mesometrium–covers myometrium
mesosalpinx—covers uterine (fallopian) tubes
mesovarium—covers ovaries
What does the suspensory ligament connect and what does it contain?
connects the ovary to pelvis
contains the uterine vasculature
What does the ovarian ligament connect?
Ovary to uterus
What is the blood supply and venous drainage of the uterus?
blood supply: uterine arteries (off internal iliac artery)
venous drainage: uterine plexus
What is the normal position of the uterus 100% on exam?
anteverted and anteflexed
Which structure would play the most important role in supporting the uterus?
Levator ani or coccygeus
What is the uterine support for the uterus (very high yield)?
pelvic diaphragm=levator ani + coccygeus
Uterine ligaments=
(a) pubocervical attaches pubis to cervix
(b) transverse cervical (cardinal) attaches cervix to the lateral walls
(c)Uterosacral attaches uterus to sacrum
What are the cervical structures of the uterus?
endocervix: endocervical canal (contains Internal os (opening) that leads into uterus
Ectocervix: connects to vagina
(contains External os (opening) that leads into endocervix
What is the fxn of the cervix?
facilitate sperm passage + stop bacteria
What is the ovary covered by and attached to?
Covered by mesothelium=mesovarium (broad ligament)
attached to the uterus via ovarian ligament
What is the endocrine fxn of the ovary
produces hormones and oocytes
What is the blood supply and he venous drainage of the ovary?
Blood supply: ovarian arteries (off abdominal aorta)
travel in the suspensory ligament of the uterus
What is the venous drainage of the ovary?
Venous drainage: ovarian (gonadal) veins
right ovarian vein—IVC
left ovarian vein—Left renal vein–IVC
What is the vulva?
external female genitalia
What is the vulva composed of and its function?
mons pubis, labia, vestibule, clitoris.
fxn: sensory tissue, urination, prevent infection
What is the mons pubis?
fat pad (fupa)
What is the labia majora and minora?
Majora: 2 external folds w/ hair
Minor: 2 internal folds w/o hair
fuse anteriorly to form the prepuce (hood) of the clitoris
What is the vestibule?
Contains urethra + external vaginal orifice
surrounded by bulbospongiosus m
What is bartholin’s glands?
secretes lubricating mucus
What the clitoris?
erectile tissue=corpora cavernosa
crura (ischiocavernosus m.) on either side
What are the fxn’s of the vagina?
sex, childbirth, menstruation
What are the borders off the vagina?
anterior= bladder + urethra
posterior= rectum
lateral= ureters +uterine arteries
What are fornices of the vagina?
recesses in the vaginal canal
anterior, posterior(longest), lateral
What is the blood supply of the vagina?
uterine + vaginal arteries (off ant, trunk of internal iliac a)
What two structures project into the vagina?
ectocervix (and external os)
What is the normal position of the uterus?
a. Anteflexed and retroverted
b. Retroflexed and retroverted
c. Anteflexed and anteverted
d. Retroflexed and anteverted
c
What important prostatic structure do the prostatic ducts empty or drain into?
a. Prostatic utricle
b. Prostatic sinus
c. Seminal colliculus
d. Urethral crest
b
Which of the following structures provides the primary support for the cervix?
a. Uterosacral ligament
b. Broad ligament
c. Transverse cervical (cardinal) ligament
d. Round ligament
c
Identify this penile structure:
a. Bulbospongiosum
b. Right crura of the penis
c. Ischiocavernosus
d. The bulb of the penis
a
What major blood vessel crosses superior to the ureters?
a. Ovarian artery
b. Umbilical artery
c. Vaginal artery
d. Uterine artery
d
What structure passes through the indicated foramen?
a. Piriformis
b. Inferior gluteal nerve
c. Obturator internus
d. Sciatic nerve
c
A young patient with pain and swelling of the left testicle is likely experiencing thrombosis due to a blockage in a major vessel. Which of the following veins is
most likely affected?
a. Left renal vein
b. Inferior vena cava
c. Left inferior epigastric vein
d. Internal pudendal vein
a
Which of the following structures plays the most important role in the support of the uterus?
a. Uterosacral ligament
b. Broad ligament
c. Levator ani
d. Arcuate pubic ligament
c
A patient who received a gunshot wound to the pelvic region suffers from
damage to the sacral splanchnic nerves. Which of the following nerve fibers
would primarily be damaged?
a. Postganglionic sympathetic fibers
b. Preganglionic sympathetic fibers
c. Postganglionic parasympathetic fibers
d. Preganglionic parasympathetic fibers
b
An older patient is unable to produce a penile erection after having undergone a
prostatectomy. The surgeon most likely damaged which of the following nerves?
a. Sacral splanchnic nerve
b. Pelvic splanchnic nerve
c. Dorsal nerve of the penis
d. Pudendal nerve
b
A fracture to the pelvic inlet is most likely in which of the following structures?
a. Iliac crest
b. Anterior inferior iliac spine
c. Ischiopubic ramus
d. Promontory
d
Which of the following structures contribute to the pelvic diaphragm?
a. Piriformis
b. Obturator internus
c. Levator ani
d. External urethral sphincter
c
