Lower abdomen Flashcards
What distinguishes the abdominal cavity from the pelvic cavity?
The pelvic inlet (pelvic brim)
What forms the pelvic brim?
Sacral promontory and ala
Iliopectineal line
Symphysis pubis
What resists forward rotation of upper sacrum?
The Interosseous sacroiliac ligament
Where is the interosseous sacroiliac ligament?
Suspends sacrum b/w two iliac bones
Which sacroiliac ligament is larger/stronger, anterior or posterior?
Posterior
What resists backward rotation of the lower sacrum?
Sacrotuberous ligament and sacrospinous ligament
Where is the sacrotuberous ligament?
From ischial tuberosity to lower sacrum and coccyx
Where is the sacrospinous ligament?
From ischial spine to lower sacrum and coccyx
What is the true conjugate diameter of the pelvis?
The shortest diameter through which the head must pass
From sacral promontory to a point just below the superior margin of the pubic symphysis
What is the diagonal conjugate diameter?
Distance from sacral promontory to lower border of pubic symphysis
What is the obstetric conjugate diameter?
From sacral promontory to thickest part of the pubic bone
What muscles make up the pelvic walls?
Obturator internus
Piriformis
What makes up the pelvic floor…thus separating pelvis from the perineum?
The pelvic diaphragm…hammock suspended from iliacus fascia
What makes up the anterior portion of the pelvic diaphragm?
Levator ani
What makes up the posterior potion of the pelvic diaphragm?
Coccygeus
What reproductive organs are contained in the female pelvis?
Ovaries
Uterine tubes
Uterus
Vagina
What does the endopelvic fascia do?
Covers/supports pelvic viscera
Transmits neurovasculature to the organs
What does the endopelvic fascia form from?
The endopelvic fascia is continuous with the fascia transversalis in the abdomen
What is the endopelvic fascia divided into?
Parietal pelvic fascia
Visceral pelvic fascia…more important in repair of prolapsed structures than muscles
What separates the bladder from the uterus?
Vesicouterine pouch
What separates the rectum from the uterus?
Rectouterine pouch (of Douglas)
What is the broad ligament of the uterus?
Two layered fold of peritoneum that extends across the pelvic cavity from the uterus to the lateral pelvic walls
What are the four divisions of the broad ligament?
Mesovarium
Suspensory ligament
Mesosalpinx
Mesometrium
What does the mesovarium do?
Connects the ovary to the posterior layer of the broad ligament
What does the suspensory ligament do? Where is ti?
Transmits ovarian vessels, lymphatics, and nerves
Lies lateral to the attachment of the mesovarium
What is the mesosalpinx?
The superior margin of the broad ligament
What is the mesometrium?
Below the mesovarium and mesosalpinx
What connects the ovary to the uterus?
The round ligament of the ovary (proper ovarian ligament)
What represents the lower remnant of the gubernaculum? Where does it pass?
Round ligament of the uterus
Passes from the uterus to the deep inguinal ring and through the inguinal canal
What is the most common cause of a prolapsed uterus?
Laxity or atonia from repeated obstetrical trauma
What is the most common cause of a cystocele (bulging of the bladder through the vaginal wall)?
Weakened/torn pelvic diaphragm from repeated obstetrical trauma
What is the most likely cause of a rectocele (bulging of the rectum through the vaginal wall)?
Incompetent pelvic diaphragm
What reproductive organs are contained in the male pelvis?
Ductus (vas) deferens Seminal vesicles Ejaculatory ducts Prostate gland Urethra
What contributes to the sacral plexus?
Lumbosacral trunk (0.5 of L4 and L5) Ventral rami of S1-4
What type of nerves make up the sacral plexus?
Somatic nerves
Where do the nerves of the sacral plexus go?
Through the greater sciatic foramen
Into the pelvis
What branches of the sacral plexus go to the pelvis (what is their origin)?
Nerve to piriformis (S1, 2)
Branches to levator ani (S3, 4)
With the exception of the gonads, all of the pelvic organs have the same autonomic innervation: where is it from?
Inferior hypogastric (pelvic) plexus
Where is the inferior hypogastric plexus?
The extraperitoneal tissues of the pararectal fossae
What makes up the sympathetic component of the pelvic plexus?
Lumbar splanchnics
Sacral splanchnics
What is the effect of the sympathetics of the pelvic plexus?
Inhibit contraction of the wall of the rectum and bladder
What makes up the parasympathetic component of the pelvic plexus?
Pelvic splanchnic nerves (from S2-4)
What is the effect of the parasympathetics of the pelvic plexus?
Contraction of detrusor muscle of bladder and muscular wall of rectum
Relaxation of internal sphincters of rectum and bladder
There are visceral afferent fibers in the inferior hypogastric plexus, what messages do they send?
Pain
Distention
Which artery do nerves off the hypogastric plexus follow to form subsidiary plexi?
Internal iliac artery
What are the parts of the uterine tube from lateral to medial?
Infundibulum
Ampulla
Isthmus
Uterine part
Where/what are fimbriae? What do they do?
Finger-like projections coming off the infundibulum
Catch the oocyte and insert it into uterine tube
Where is the most likely site of fermentation?
Ampulla
