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Anatomy (MPAS) > Lecture 21: Anatomy of the pelvis, perineum and female reproductive organs > Flashcards

Lecture 21: Anatomy of the pelvis, perineum and female reproductive organs Flashcards

1
Q

What are the innominate bones? What do they form?

A

Ilium, pubis and ischium

Form hip bone (os coaxae)

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2
Q

What are the right and left hip bones connected to?

A

Os sacrum

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3
Q

What bones form the pelvic girdle?

A

Os sacrum

Both hip bones

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4
Q

What is the acetabulum formed by? articulation?

A

The 3 innominate bones

Articulates with femur

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5
Q

What is the sacrum formed by?

A

Fusion of 5 sacral vertebrae

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6
Q

What is the coccyx formed by?

A

Fusion of 3 to 4 rudimentary vertebrae

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7
Q

What separates the greater pelvis from the lesser pelvis?

A

Pelvic brim

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8
Q

When does the ossification of the 3 hip bones occur?

A

At birth, these three components are separated by hyaline cartilage.

They join each other in a Y-shaped portion of cartilage in the acetabulum.

By the end of puberty the three regions will have fused together, and by the age of 25 they will have ossified

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9
Q

What are the joints of the pelvic girdle?

A

Sacroiliac joints

Pubic symphysis

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10
Q

Sacroiliac joint (*) - joint type, support

A

Synovial joints (have joint cavity and capsule)

Supported by strong ligaments

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11
Q

Function of sacroiliac joints

A

Transfer most of the body weight to the hip bones

Allow only limited movements (lateral direction)

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12
Q

What is the shape of the articulating surface of the ilium?

A

Auricle (ear shaped)

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13
Q

Pubic symphysis- joint type, strengthened by

A

cartilaginous joint

Interpubic disc

Strengthened by superior and inferior pubic ligaments

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14
Q

What are the differences between the female and male pelvis?

A

See figure

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15
Q

What does the sacrotuberous ligament connect to?

A

Connects posterolateral border of sacrum with ischial tuberosity

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16
Q

What does Sacrospinous ligament attach to?

A

Connects anterolateral border of sacrum with ischial spine

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17
Q

What are the major pelvic foramina?

A

Greater sciatic foramen

Lesser sciatic foramen

Obturator foramen

See figure

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18
Q

Where is the greater sciatic foramen?

A

*

Between the greater sciatic notch, the sacrospinous and the sacrotuberous ligament

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19
Q

Where is the lesser sciatic foramen?

A

+

Between the lesser sciatic notch and both ligaments

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20
Q

Where is the obturator foramen?

A

Surrounded by the rami of the pubic and ischial bone and closed by the obturator membrane

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21
Q

What is the function of the major pelvic foramina?

A

Provide exit pathways for vessels and nerves from the pelvic cavity to the gluteal region and the thigh

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22
Q

Where is the rectouterine pouch?

A

aka pouch of douglas

Most caudal part of the abdominopelvic cavity in women (behind uterus)

See figure

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23
Q

Why is the pouch of douglas clinically important?

A

Fluid from the abdominal organs can collect here = Can cause pelvic pain

Can sample fluid via the vagina to identify cause of pelvic pain

Can get uterine pregnancies in this space, can ultrasound the area

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24
Q

Where is the vesicouterine pouch?

A

located anterior to the uterus in women

See figure

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25
Q

Where is the rectovesical pouch?

A

Most caudal part of the abdominal cavity in men

See figure

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26
Q

What is the floor of the abdominopelvic cavity?

A

Funnel-shaped pelvic diaphragm

Musculofascial inferior closure of the abdominopelvic cavity and supports the position of the viscera

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27
Q

What muscles make up the pelvic floor?

A

Levator ani muscle and coccygeus muscle and their fascias

See figure

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28
Q

What muscles make up the levator ani?

A

Illiococcygeus muscle

Pubococcygeus muscle

Puborectalis muscle

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29
Q

Role of the pelvic diaphragm

A

supports the position of the viscera

Maintains fecal and urinary continence through tonic contraction

Relaxes during urination and defecation

Actively contracts during activities causing increased intra-abdominal pressure (coughing, sneezing, lifting heavy objects)

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30
Q

What is the levator hiatus?

A

aka urogenital hiatus

Anterior gap in the levator ani muscle

Allows passage of urethra, vagina and rectum

See figure

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31
Q

Female reproductive organs

A

Uterus

Fallopian tubes

Ovary

Vagina

See figure

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32
Q

What are the three layers of the uterus?

A

Myometrium - thick muscle layer

Endometrium - inner layer

Parametrium - surrounding connective tissue (perimetrium: peritoneal lining of fundus and corpus)

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33
Q

What part of the fallopian tubes have the fimbriae?

A

The Infundibulum

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34
Q

Clinical significance of endometrium

A

Highly dynamic under the influence of sex steroid hormones

Endometrial cancer

Endometriosis

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35
Q

Parts of the uterus

A

Fundus - rounded superior part of body above oviducts, lies superior to bladder

Body - mobile part extending from cervix to fundus

Cervix - communicates with vagina (external os) and with the uterine lumen (internal os)

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36
Q

Parts of the uterine tubes

A

Infundibulum - fimbriated highly motile end that opens into the abdominal cavity; fimbriae move toward ovulating surface of ovary

Ampulla - widest and longest part

Isthmus - thick-walled art of fallopian tube that enters the uterus

Uterine part - traverses the uterine wall and opens into the uterine cavity

37
Q

Clinical significance of ampulla of uterine tubes

A

Common location of extrauterine pregnancies

38
Q

What connects the ovary to the uterus?

A

Ovarian ligament

See figure

39
Q

What artery supplies the ovary?

A

Ovarian artery

Derived from the abdominal aorta

Reaches ovary through suspensory ligament of ovary (infundibulopelvic ligament)

40
Q

What do the ovarian veins drain into?

A

Right ovarian vein drains into inferior vena cava

Left ovarian vein drains into left renal vein

41
Q

How is the ovary attached to the broad ligament?

A

Via the mesovarium

42
Q

Why do the ovaries stop higher in the abdominopelvic cavity than testis do during development?

A

Lack of testosterone stops ovaries from descending further

43
Q

Orientation of fallopian tubes

A

Always reaching posteriorly

44
Q

What is the broad ligament?

A

Peritoneal fold reaching from the lateral pelvic wall to the uterus.

Contains the uterine artery and vein and autonomous nerves.

45
Q

What are the mesovarium and mesosalpinx?

A

Parts of the broad ligament reaching to ovary and uterine tube.

46
Q

What is the suspensory ligament of the ovary?

A

Carries ovarian blood and lymph vessels connecting the ovary to the retroperitoneal abdominal space.

47
Q

What is the function of the ovarian ligament?

A

is a caudal connection to the uterus.

48
Q

Round ligament - where is courses, what it connects

A

Courses within the broad ligament

Connects the fundus of the uterus through the inguinal canal to the labia majora.

49
Q

Cardinal ligament - location? Connection? Function?

A

Mackenrodt ligament

Below peritoneal lining

Connects uterine cervix to lateral pelvic wall

Stabilizes position of the uterus

50
Q

Examination of the uterus

A

Angle of anteflexion (*)

Angle of anteversion (@)

Fundus points toward anterior wall

See figure

51
Q

What does the vagina form around the cervix?

A

Two lateral fornices

52
Q

What is the posterior fornix related to?

A

Rectouterine pouch (doulas pouch)

53
Q

Functions of the fallopian tubes

A

Pick-up of ovulated oocytes
(infundibulum)

Transport of the maturating oocyte (infundibulum and ampulla)

Nourishment of oocyte and blastocyst (ampulla)

Sperm reservoir (isthmus)

54
Q

Functions of the vagina

A

Forms the inferior part of the birth canal

Receives penis and ejaculate during sexual intercourse.

55
Q

Functions of the ovary

A

Secretion of the steroid hormones
estrogen and progesterone

Production of ova
(ovarian follicles)

56
Q

Functions of the uterus

A

Harbouring and nourishing the embryo/fetus (endometrium and myometrium)

57
Q

What are the major branches of the internal iliac artery?

A

Parietal branches: supply pelvic wall and gluteal region

Visceral branches: supply pelvic viscera

58
Q

What are the parietal branches of the internal iliac artery and what do they supply?

A

Iliolumbar a. – supplies iliacus, psoas and quadratus lumborum muscle

Lateral sacral a. – branches enter pelvic sacral foramina

Superior gluteal a. – runs between Lumbosacral trunk and 1. sacral nerve above the piriformis muscle, supplies gluteus medius and minimus muscle and tensor fasciae lata muscle

Obturator a. – leaves through obturator foramen; supplies obturator muscles

Internal pudendal a. – supplies perineum (skin, muscles, erectile tissues)

Inferior gluteal a. – separates 1. from 2. sacral nerve, leaves greater sciatic foramen inferior to piriformis
supplies gluteus maximus, hamstrings, quadratus femoris.

59
Q

What are the visceral branches of the internal iliac artery and what do they supply?

A

Umbilical a. – distal part obliterated, gives rise to superior vesical artries to bladder

Superior and inferior vesical a. – supplies bladder and ureter, seminal vesicle and prostate (in men)

Middle rectal a. – supplies inferior rectum and seminal vesicles

Uterine a. – may arise from umbilical or directly from internal iliac artery

See figure

60
Q

Anastomoses between uterine artery and ovarian artery

A

The ovarian branch of the uterine artery anastomoses with the ovarian artery which brings the main blood supply to the ovary

61
Q

What does the uterine artery travel in?

A

Base of broad ligament

62
Q

Where is the perineum? What does it contain?

A

Diamond-shaped area beneath the pelvic floor

Harbours external genitalia

See figure

63
Q

Why is the uterine artery a corkscrew shape?

A

So that it can stretch in pregnancy

64
Q

What provides support in the area of the urogenital triangle?

A

Perineal membrane and associated muscular and fibrous structures

Provides support in the area of the urogenital triangle

See figure

65
Q

Distance between perineal structures in women

A

External urethral meatus, vaginal orifice and anus are in close proximity

66
Q

External genitalia of women vs men

A

Women: bulb of vestibule, crus of clitoris and greater vestibular (Bartholin’s) glands

Men: bulb of penis, crus of penis and bulbourethral (cowper’s) glands

See figure

67
Q

What are the muscles of the perineum? Innervation?

A

Deep transverse perineal muscle (covered by perineal membrane)

Superficial transverse perineal muscle (inconsistent)

Bulbospongiosus muscle: covers the bulb of penis / vestibule

Ischiocavernosus muscle: covers crus penis / clitoris

External anal sphincter muscles

Innervated by pudendal nerve

See figure

68
Q

Course of the pudendal nerve

A

Exits pelvic through greater sciatic foramen

Winds around the ischial spine and sacrospinous ligament

Enters pelvis again through the lesser sciatic foramen

Reaches perineum below the pelvic diaphragm muscles

See figure

69
Q

What does the pudendal nerve innervate?

A

Somatic motor nerve of the perineum

Sensory supply for perineal skin (including posterior scrotum)

Motor to the external anal sphincter (inferior rectal nerve) and external urethral sphincter

Cutaneous innervation of perineal skin (pain)

70
Q

Location of pudendal nerve in women

A

Winds around ischial spine

See figure

71
Q

What is a pudendal nerve block?

A

Anaesthetic administered near ischial spine

72
Q

What is a pudendal nerve block effective for?

A

Anaesthesia effective for perineal skin and lower part of vagina

Reduces perineal pain associated with the second stage of labour or with
episiotomy or the repair thereof

Not effective for cervix and upper part of vagina

73
Q

What does the mother feel during pudendal nerve block?

A

Mother is aware of uterine contractions and associated pain

74
Q

When is re-administration of pudendal nerve block a problem?

A

Re-administration is problematic during prolonged birth phase

75
Q

Does pudendal nerve block eliminate all perineal pain?

A

No

See figure

76
Q

Where is the lymphatic drainage of the pelvic organs

A

Pelvic organs: uterus, cervix, upper vagina, fallopian tubes

Internal iliac lymph nodes

External iliac lymph nodes

77
Q

Where is the lymphatic drainage of the ovaries and testis?

A

Para-aortic lymph nodes

78
Q

Where is the lymphatic drainage of the perineum?

A

Organs of perineum: labia major, vulva (scrotum), anus interior to pectinate line

Superficial inguinal nodes

79
Q

What is the function of the rectum?

A

Storage and controlled release of feces

80
Q

Where is the rectum located in reference to large intestine?

A

Distal end of large intestine

81
Q

Where is the rectal ampulla? What does it transition into?

A

Rectal ampulla is above pelvic floor

Rectal ampulla transitions into anal canal

82
Q

Arterial supply of rectum

A

Upper 2/3: inferior mesenteric artery

Superior rectal artery (from inferior mesenteric artery)

Left middle rectal artery (from left internal iliac artery)

Left internal pudendal artery

Left inferior rectal artery

See figure

83
Q

Venous drainage of the rectum

A

Inferior mesenteric vein

Superior rectal vein

Left common iliac vein

Left middle rectal vein

Left internal pudendal vein

Left inferior rectal vein

Venous drainage goes to portal vein and to inferior vena cava

See figure

84
Q

Anastomoses in anal region

A

Porto-caval venous anastomoses

85
Q

What may form in portal hypertension?

A

Anal hemrroids

86
Q

What are the anal sphincter muscles? Type of muscle?

A

Internal anal sphincter (smooth muscle)

External anal sphincter (striated muscle)

See figure

87
Q

Control of internal and external anal sphincters

A

Internal: sympathetic control and normally permanently contracted to close the anal canal.

External: voluntary closure of the anus; innervated by pudendal nerve.

88
Q

What is the ischioanal fossa?

A

Space beneath pelvic diaphragm

89
Q

What pathological conditions are common to the ischioanal fossa?

A

Anal fissures and fistulas: extremely painful (inferior rectal nerves), can cause partial focal incontinence

Peri-anal accesses (wounds, chron’s): may be drained through the skin, can spread to other side (horseshoe-type), may spread into pelvis

Anatomy (MPAS) (22 decks)

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