Male Pelvis Flashcards
Where does the false pelvis begin? Where does it end?
Begins @ the iliac crest
Ends @ the pelvic brim
**continuous w/ abdominal cavity
*also called the pelvic inlet
The pelvic outlet is formed by the boundaries of the ______.
perineum.
What is the origin of the inguinal ligament and sartorius muscle?
the anterior superior iliac spine
What are 3 important structures found on the ilium?
iliac crest
anterior superior iliac spine
greater sciatic notch
What are the 3 major bones of the pelvis? When do they all connect? At what point do they connect?
Ilium, Ischium, Pubis
- *connect @ the acetabulum
- *fuse entirely only after puberty
Which part of the pelvis does the ischium make up?
the posterior inferior part
What are 3 important structures on the ischium?
ischial spine
ischial tuberosity
lesser sciatic notch
Which structure serves as an attachment of lower limb muscles & support during sitting?
the ischial tuberosity; called the sit bone
What is the wing-looking part of the ilium called?
ala
Where are bone marrow biopsies taken from?
the iliac crest
What does the sacrospinous ligament attach to?
the ischial spine
Where is the pubis located relative to the pelvic bones?
anterior & inferior
What is an important structure of the pubis?
the pubic tubercle
Where does the true pelvis begin?
after the pelvic brim
What forms the pelvic brim?
the linea terminalis
What is the obturator canal?
this is the small space of the obturator foramen that isn’t covered by the obturator membrane…the obturator nerve runs thru this…
Which 2 bones form the obturator canal?
the ischium & pubis
What makes up the sacrum?
5 fused vertebrae
What is the coccyx made up of? Where is it found?
4 fused vertebrae
found beneath the sacrum
Where is the sacral promontory found?
it is a ridge found @ the S1 vertebrae
How does the sacrum articulate w/ the pelvis?
@ the superior articular facets of L1 vertebrae?
What is the arcuate line? What is the pectineal line?
Pectineal line: thickened region of the pubis bone
Arcuate line: thickened region of the ilium
What is the significance of the linea terminalis? What makes it up?
this is sort of the pelvic brim…separates the false pelvis from the true pelvis.
Starts @ sacral promontory & goes thru arcuate line & pectineal line…
What is the subpubic angle? How does it differ b/w men & women?
the angle b/w the 2 pubic bones @ the pubic symphysis. In males: 70 degrees; In females: 80 degrees…
Describe the difference of the male pelvis.
ala less flared subpubic angle narrower pubic symphysis taller & thinner ischial tuberosities inverted conjugate diameter smaller transverse diameter smaller more curved sacrum
What is the narrowest distance in the pelvis? What is the significance of this?
Interspinous distance
the distance b/w the 2 ischial spines…significant b/c this is where the baby has to fit thru!!
What is the conjugate diameter of the pelvis?
True obstetrical diameter aka sagittal inlet
widest part of the pelvis
the distance b/w the sacral promontory & the top of the pubic symphysis
The female pelvis is _____ shaped while the male pelvis is _____ shaped.
Female Pelvis: Oval Shaped
Male Pelvis: Heart Shaped
What is the approx distance of the sagittal inlet or true obstetrical conjugate or conjugate diameter of the pelvis…in a woman? How about the bispinous outlet?
11-12 cm
bispinous: 9 cm
What is the sagittal outlet & about how long is it?
this is the distance b/w the sacral promontory & the bottom part of the pubic symphysis…
this is about 10 cm
What are some ways of making pelvic measurements in obstetrics?
Plain film, CT, MRI, digital exam
What is the diagonal conjugate & why is it important in obstetrics?
distance b/w sacral promontory & bottom of pubic symphysis…determined via a bimanual exam
it approximates the sagittal inlet/true conjugate distance
T/F The true diameter of the pelvis widens during pregnancy.
FALSE
What gives pregnant women that waddle during pregnancy?
the pelvis gets wider in the transverse direction
relaxin (a hormone) relaxes the pelvic ligaments
pubic symphysis thickens
the true pelvis gets larger
coccyx moves posteriorly
What is the android pelvic shape? Which women typically have this shape?
a pelvic shape similar to a man, more narrow @ the front
tall African American women sometimes have…makes childbirth more difficult.
Where does the peritoneum that covers the top of the pelvic cavity become mesocolon?
it becomes the mesocolon for the sigmoid colon @ S3
What is found on either side of the bladder? What is found on either side of the rectum?
Paravesical fossa on each side of the bladder
Pararectal fossa on each side of the rectum
What is the clinical significance of the rectovesical pouch?
it can be a place for infection & fluid accumulation in the case of peritonitis
T/F the rectum does NOT have fatty appendages or teniae. It has 3 transverse rectal folds.
TRUE
Where is the ampulla of the rectum located?
above the levator ani muscles.
Why is the internal urethral sphincter so important?
b/c it prevents retrograde transport of semen
What happens when the bladder is empty v. when it is full?
When it is empty: in the true pelvis; When it is full: extends into the false pelvis
What is the arterial blood supply to the anterosuperior bladder?
superior vesical arteries
What is the blood supply to the fundus & neck of the bladder?
inferior vesical arteries
In addition to the superior & inferior vesical arteries…which other arteries contribute some blood supply to the bladder?
obturator arteries
inferior gluteal arteries
What are the 2 ways in which the pelvic veins don’t follow the course of the internal iliac artery?
umbilical & iliolumbar arteries
Generally speaking: where do the pelvic veins drain?
into internal iliac veins–>common iliac veins
Roughly describe the venous drainage of the male pelvis.
deep dorsal vein of the penis venous plexus (vesical/prostatic) inferior vesical vein internal iliac vein
How long is the ureter? What is its course?
25-30 cm long
retroperitoneal by the IVC & Aorta until it crosses the pelvic brim & enters the pelvic cavity @ the bifurcation of the iliacs
the ureter is in contact with the peritoneum until….
until the ductus deferens passes over it
T/F Seminal Glands store sperm.
FALSE
Note: the seminal glands meet the vas deferens to form the ejaculatory duct. What are the components of the secretion from the seminal glands?
it is alkaline & contains fructose & coagulating agents
What is the blood supply/venous drainage of the seminal glands?
inferior vesical artery/vein
middle rectal artery/vein
Which lobe of the prostate causes problems with urination?
the median lobe
Which lobe of the prostate gland do you feel with a physical exam?
the posterior lobe
Which lobe of the prostate is also called the isthmus?
the anterior lobe
What are the different lobes of the prostate & where is each located?
anterior: anterior to the urethra
lateral: either side of the urethra
posterior: posterior to the urethra & inferior to the ejaculatory duct
median: posterior to the urethra & superior to the ejaculatory duct
What is the relationship b/w the 3 venous plexuses?
they are continuous w/ each other
the vesical venous plexus is superior to the prostatic venous plexus
the internal vertebral venous plexus is posterior to the prostatic venous plexus
What is the venous drainage of the prostate gland?
prostatic venous plexus–>internal iliac veins
What is the arterial blood supply to the prostate gland?
inferior vesical
middle rectal
internal pudendal arteries
What are the 4 parts of the urethra & where is each located?
Preprostatic Urethra: before the internal urethral sphincter
Prostatic Urethra: thru the prostate gland
Membranous Urethra: thru the external urethral sphincter & deep perineal pouch
Spongy Urethra: thru the corpus spongiosium part of the penis
Where do the ejaculatory ducts open into?
the seminal colliculus below the prostatic utricle in the male urethra
Where do the bulbourethral glands open up?
their ducts are distal to the external urethral sphincter & go into the spongy part of the urethra
Where does sperm leave the penis?
@ the external urethral orifice
Where can sperm be stored?
epididymis & vas deferens
What percentage of the semen volume is from seminal glands? What are the components of this secretion & their purpose?
60% of semen volume
alkaline–fight the acidic environment of the female
fructose–a snack along the way
ascorbic acid–protection
prostaglandins–motility & protection
fibrinogen–clotting, keep the semen in the female reproductive tract
What percentage of the semen volume is from the prostate gland? What are the components of this secretion & their purpose?
20% of semen volume
slightly acidic
Zinc–chromatin stability
Citric Acid–protection
Acid Phosphatase–liquefaction of semen
PSA–liquification of semen & dissolving of cervical mucus
profibrinolysin–liquefies coagulated semen
What percentage of the semen volume is from the bulbourethral glands? What are the components of this secretion & their purpose?
1% of semen volume a little phosphate & bicarb MainlY: Go Make Peter galactose--snack along the way mucus pre-ejaculate
Which 2 things are sometimes elevated in prostate cancer? Which gland do they come from?
Acid Phosphatase
PSA
From the prostate gland
Which lobe of the prostate usu causes problems for the bladder? What does this look like in terms of benign hypertrophy of the prostate?
median lobe projects into the bladder causes nocturia, dysuria, urgency can cause cystitis & kidney damage incomplete voiding
Which lobe does prostatic carcinoma usu occur in?
the posterior lobe
What are 2 routes of metastasis of prostate cancer?
Venous:
prostatic plexus–>internal iliac vein–>vertebral venous plexus–>vertebrae–>brain
Lymph:
internal iliac & sacral lymph nodes–>distant lymph nodes
