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Repro > Lecture 19 - The Pelvic Floor > Flashcards

Lecture 19 - The Pelvic Floor Flashcards

1
Q

What are the functions of the pelvic floor?

A

Support the pelvic organs
Maintain Intra-abdominal pressure during coughing, vomiting, sneezing and micturition

CONTINENCE
FACILITATE CHILDBRITH
Facilitate defaecation adn micturtiion

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2
Q

What are the main pelvic organs the pelvic flor supports?

A

Vagina
Uterus
Ovaries
Bladder
Rectum

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3
Q

What are some structures that go through the pelvic floor?

A

Urethra
Vagina
Anus

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4
Q

What are the 3 mechanisms of support for the pelvic floor?

A

Suspension
Attachment
Fusion

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5
Q

What are the 3 ligaments important in suspension in the pelvic floor?

A

Cardinal ligament
Uterosacral ligaments
Round ligament

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6
Q

What does the cardinal ligament do?

A

Transverse ligament between the cervix and vagina holding them in place

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7
Q

What does the uterosacral ligament do?

A

Holds the back of the cervix and upper vagina laterally

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8
Q

What does the round ligament do?

A

Maintains the anteverted postiion of the uterus

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9
Q

What provides the attachment in the pelvic floor?

A

Arcus tendinosus fascia pelvis (THE WHITE LINE)

Endopelvic fascia

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10
Q

How does the endopelvic fascia run?

A

From lateral to medial.

Stretches like a hammock from the white line laterally to the vaginal wall medially

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11
Q

What fascia compresses the urethra when intraabdominal pressure increases to help matintain urinary continence?

A

Endopelivc fasica

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12
Q

What structures are fused in the pelvic floor?

A

Urogenital diaphragm and perineal body

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13
Q

What structures are fused to support the lower half of the vagina?

A

Endopelvic fascia to perineal body posteriorly, levator ani laterally and urethra anterioly

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14
Q

What structures make up the pelvic floor?

A

Levator ani muscles
Urogential diaphragm/perinal membrane
Perineal body
Perineal muscles
Posterior compartment

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15
Q

Look at the last slide:
Image 1

What are the muscles labelled 1:

A

Levator ani muscles

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16
Q

What are the 3 levator ani muscles?

A

Puborectalis
Pubococcygeus
Iliococcygeus

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17
Q

What is the origin and insertion of puborectalis?

A

Pubic symphysis to rectum

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18
Q

What is the origin and insertion of pubococcygeus?

A

Pubis to coccyx

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19
Q

What is the origin and insertion of iliococcygeus?

A

Ilium to coccyx

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20
Q

Look at the last slide at image 2

Label:

A

1 = sacrum
2 = ilium
3 = iliococcygeus
4 = pubococcygeus
5 = Puborectalis \

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21
Q

Look at slide 18 and label:

A

1 = piriformis
2 = Puborectalis
3 = pubococcygeus
4 = iliococcygeus

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22
Q

What is the next more superficial layer to the levator ani muscles?

A

Perineal muscles

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23
Q

What are the 2 most important perineal muscles?

A

Transverse perineal muscles
Bulbospongiosus

24
Q

What is an episiotomy?

A

Cutting the perinum to aid birth to help ensure tearing of the perineum doesn’t occur

25
Q

Go to slide 23:

Label the perineal muscles:

A

1 = transverse perineal muscles

2 = bulbospongiosus

26
Q

What is the next more superficial layer to the perineal muscles?

A

Urogenital diaphragm

27
Q

What is the urogenital diaphragm?

A

A triangular sheet of dense fibrous tissue in the anterior half of the pelvis

28
Q

What is the function of the urogenital diaphragm?

A

Supports the pelvic floor
Atttatches medially to the urethra, vagina and perineal body

29
Q

What makes up the perineal body?

A

Insertion point of levator ani muscles

30
Q

Where is the perineal body located and what does it attach to?

A

Central position on pelvic floor between the vagina and rectum

Attathces posteriorly to the external anal sphincter and coccyx

31
Q

Go to the last slide and label image 3:

A

1 = clitoris
2 = bulbospongiosus
3 = perineal body
4 = levator ani muscles

32
Q

What is the blood supply and nerve supply to the pelvic floor?

A

Pudendal arteries and veins

Pudendal nerve

33
Q

What nodes drain the lymphatics from the pelvic floor?

A

Inguinal lymph nodes

34
Q

What are the spinal nerve roots of the pudendal nerve?

A

S2, S3, S4

35
Q

What are the layers of the pelvic floor from deep to more superficial?

A

Levator ani
Perineal muscles
Urogential diaphragm
Perineal body

36
Q

What is pelvic organ prolapse?

A

When there’s a loss of support to the uterus, bladder, colon or rectum leading to prolapse into the vagina

37
Q

What can a pelvic organ prolapse cause?

A

Functioanl disturbances to:

-anorectal
-urinary
-sexual

38
Q

What is an anterior compartment/bladder related pelvic organ prolapse called?

A

Cystocele
Urethrocoele (urethra)
Cystourethocoele

39
Q

What structure is not supported in a middle compartment pelvic organ prolapse?

A

Uterus

40
Q

What is the term for an entire uterus prolapse?

A

Procidentia

41
Q

What structure prolapses in a posterior compartment pelvic organ prolapse?

A

Rectum

42
Q

What can the rectum prolapse into in a posterior compartment pelvic Organ prolapse?

A

Rectovaginal space (Pouch of Douglas)

43
Q

What are the causes and risk factors for pelvic organ prolapse?

A

Post menopausal oestrogen deficieny
Child birth
Perineal Trauma
Obesity
Connective tissue disease

44
Q

Why does obesity increase risk of pelvic organ prolapse?

A

Increased Intra-abdominal pressure

45
Q

What are some connective tissue disorders increasing risk of pelvic organ prolapse?

A

Marfan’s
Ehlers Danlos syndrome

46
Q

How can we try and reduce the risk of pelvic organ prolapse due to child birth?

A

Episiotomy

Encouraging mother to not push when head not crowning

47
Q

What structures are cut thorough in an episiotomy?

A

Bulbocavernous muscle
Transverse perineal muscle

48
Q

What are the symptoms of prolapse?

A

Dragging sensation
Lump
Feeling of incomplete emptying of bladder
Double voiding

49
Q

What causes stress incontinence?

What causes urge incontinence?

A

Stress = pelvic floor dysfunction

Urge = bladder dysfunction

50
Q

What is femal genital mutilation? (FGM)

A

Partial or total removal of external female genitalia or other injury to femal genital organs

51
Q

Why may FGM be carried out?

A

Culture
Social acceptance
Fear of social exclusion

52
Q

Go to slide 54 and label the vulva:

A

1 = labia minora
2 = labia majora

53
Q

What are some consequences of FGM?

A

Haemorrhage
Sepsis
Blood borne infections

Sexual difficulties
Fertility issues
Chronic
Fear of childbirth
PPH
PTSD

54
Q

What is the legality of FGM?

A

Illegal to perform
Illegal to close back up after episiotomy

55
Q

Why is the pelvic floor importnat?

A

Support
Continence
Aiding micturition
Defaecation
Childbirth

56
Q

What is the main central structure of the pelvic floor?

A

Perineal body

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