Module 10 - Pelvis Flashcards
1
Q
Bony pelvis (pelvic girdle) description
A
“Ring of bone” formed by R/L hip bones, sacrum, coccyx
2
Q
Function of pelvic girdle
A
Supports abdomen
Provides dynamic link between vertebral column and lower limbs
3
Q
Iliopectineal line (pelvic brim)
A
Divides the pelvis into pelvic major (false) and pelvic minor (true)
4
Q
Hip bones
A
Ilium
Ischium
Pubis
5
Q
Landmarks of Ilium
A
Body, iliac crest, iliac tubercle ASIS, AIIS, PSIS, PIIS Auricular surface Arcuate line Iliopectineal line Greater sciatic notch
6
Q
Landmarks of Ischium
A
Body Ischial spine Lesser sciatic notch Ischial tuberosity Ramus
7
Q
Landmarks of Pubis
A
Superior and inferior pubic rami Pubic symphysis, crest, tubercle Pectin pubis (pectineal line) Iliopectineal line Obturator canal
8
Q
Landmarks of Sacrum
A
Base (superior portion) Apex (inferior portion) Median and lateral sacral crests Ala Promontory Sacral cornu, hiatus
9
Q
Pelvis apertures
A
Superior (pelvic inlet/brim) - sacrum, ilium, pubis
Inferior (pelvic outlet) - diamond shaped
10
Q
Superior pelvic aperture (inlet) - posterior, lateral, anterior boundaries
A
Posterior: promontory and anterior border of ala of sacrum (sacrum)
Lateral: ilipectineal line (illium)
Anterior: pubic symphysis, pectin pubis, pubic crest (pubic)
11
Q
Pelvis major
A
“False” pelvis
Region above iliopectineal line
12
Q
Pelvis minor
A
“True” pelvis
Region below iliopectineal line
13
Q
Inferior pelvic aperture (outlet) - posterior, lateral, anterior boundaries
A
Posterior: sacrum and coccyx
Lateral: ischial tuberosities, sacrotuberous ligaments
Anterior: pubic symphysis, arcuate ligament, rami of pubis and ischium
*Pelvic “floor”
14
Q
Pelvis major contains:
A
Ileum of small intestine
Sigmoid colon
15
Q
Pelvis major boundaries
A
Abdominal wall, iliac fossae, L5/S1
16
Q
Pelvis minor contains:
A
Urinary and reproductive organs
17
Q
Pelvis minor boundaries
A
Pelvic surfaces of hip bones, sacrum and coccyx
18
Q
Acetabulum is formed by:
A
Junction of 3 hip bones (ischium, ilium, pubis)
19
Q
Acetabulum features
A
Acetabular notch, lunate, margin
20
Q
T/F: Acetabulum is round in females
A
FALSE, it is round in males
21
Q
Obturator foramen is formed by:
A
Rami of pubis and ischium
22
Q
What passes through obturator foramen?
A
Obturator nerve, blood vessels
23
Q
Joints of the pelvis:
A
Sacroiliac
Pubic symphysis
24
Q
Sacroiliac joint type
A
Synovial, irregular plane with “ear shaped” auricular surfaces
25
Sacroiliac joint ligaments
Posterior, interosseous, anterior SI ligaments
26
Movements at the sacroiliac joint
Slight gliding and rotation
| *Research agrees that there is movement, but disagrees on magnitude/direction
27
Pubic symphysis joint type
Fibrocartilaginous
28
T/F: Interpubic disc of pubic symphysis is thicker in males
FALSE, it is thicker in females
29
Ligaments of the pubic symphysis
Superior pubic - connects superior pubic bodies, R/L tubercles
Inferior pubic - arcuate ligament
30
Vertebropelvic ligaments
Iliolumbar
Sacrotuberous
Sacrospinous
Ligaments of sacroiliac joint
31
Iliolumbar ligament
L4/5 to iliac crest
32
Sacrotuberous ligament
Lateral sacrum/coccyx/PIIS to ischial tuberosity
33
Sacrospinous ligament
Caudal border of sacrum to ischial spine
34
Ligaments of sacroiliac joint
Posterior and interosseous = very strong
| Anterior = thin
35
Anterior pelvic wall
Bodies and rami of pubic bones, obturator internus muscle/fascia, pubic symphysis
36
Lateral pelvic wall
Obturator internus muscle, obturator nerves and vessels, branches of internal iliac vessels
37
Obturator internus attachments
Ilium/ischium + greater trochanter femur
38
Obturator internus innervation
Nerve to obturator internus (L5-S2)
39
Obturator internus actions
External rotation of femur
| Stabilize head of femur
40
Piriformis attachments
Sacrum/greater sciatic notch + greater trochanter femur
41
Piriformis innervation
Ventral rami of S1-S2
42
Piriformis actions
External rotation, abduction of femur
| Stabilize head of femur
43
Posterior pelvic wall
Sacrum and adjacent parts of ilium
Sacroiliac joints and their ligaments
Piriformis muscle
Sacral plexus and internal iliac vessels
44
Piriformis syndrome
Myofascial trigger points
| Potential for entrapment of sciatic nerve
45
Pelvic diaphragm consists of:
Levator ani and coccygeus muscles
46
Levator ani function
Supports pelvic viscera
| Resists intra-abdominal pressure
47
Levator ani parts
Puborectalis
Pubococcygeus
Iliococcygeus
48
Puborectalis
U-shaped, lasso around anorectal junction
49
Pubococcygeus
Main part of levator ani
50
Levator ani attachments
Body of pubis/obturator membrane/ischial spine + coccyx/walls of prostate or vagina/rectum/anal canal
51
Levator ani actions
- Raise pelvic floor (assisting in compression of abdominal/pelvic contents)
- Voluntary control of urination, fecal incontinence
52
Pelvic floor consists of:
Levator ani
| Ischiococcygeus (small portion of pelvic floor)
53
Ischiococcygeus attachments
Ischial spine to coccyx and lower sacrum
54
Ischiococcygeus actions
Assists levator ani in supporting pelvic viscera, flex coccyx
55
Blood vessels of pelvis
```
Common iliac
External iliac
Internal iliac
Superior rectal
Median sacral
Gonadal
```
56
Common iliac artery bifurcates at:
L4
57
External iliac artery passes through ______ only
False pelvis
58
External iliac artery runs along _____
Medial border of psoas
59
Branches of external iliac artery:
Inferior epigastric
| Deep circumflex
60
External iliac artery exits _____ deep to _____ and becomes ______
False pelvis
Inguinal ligament
Femoral artery
61
Internal iliac artery descends in pelvis to ______ where it divides into _____
Greater sciatic foramen
| Anterior and posterior divisions
62
Posterior division of internal iliac artery and what they supply
- Superior gluteal: piriformis, 3 glutes, TFL
- Iliolumbar: psoas, iliacus, quadratus lumborum
- Lateral sacral: piriformis, sacral canal, erector spinae
63
Anterior division (visceral branches) of internal iliac artery and what they supply
- Umbilical: superior bladder
- Superior vesical: superior bladder, pelvic part of ureter
- Inferior vesical (male): inferior bladder, ductus deferens, prostate
- Vaginal: inferior bladder, vagina
- Uterine: uterus, ligament of uterus, vagina
- Middle rectal: seminal vesicles, lower rectum
- Internal pudendal: perineum
- Obturator: pelvic muscles, femur head, medial thigh muscles
- Inferior gluteal: pelvic diaphragm, piriformis, quadratus femoris, upper hamstrings, glut max, sciatic nerve
64
Superior rectal artery supplies:
Upper portion of rectum
| *Branch of inferior mesenteric artery
65
Median sacral artery supplies:
Lower lumbar vertebrae, sacrum, coccyx
| *Branch of abdominal aorta
66
Gonadal arteries
Ovarian (female)
Testicular (male)
*Branches of abdominal aorta
67
Nerves of the pelvic region
Lumbar plexus
| Sacral plexus
68
Lumbar plexus is formed by:
Ventral primary rami of L1-L4
69
Roots of the lumbar plexus split into _____ within the _____ muscle
Anterior and posterior divisions
| Psoas
70
Terminal branches of the lumbar plexus
```
Iliohypogastric
Ilioinguinal
Lateral femoral cutaneous
Femoral
Obturator
Genitofemoral
Branch to lumbosacral trunk
```
71
Ilioinguinal and iliohypogastric nerves
- L1
- Pass inferolateral and anterior to quadratus lumborum
- Supply skin to suprapubic and inguinal regions
- Motor supply to abdominals
72
Lateral femoral cutaneous nerve
- L2, L3
| - Cutaneous supply to anterior and lateral thigh
73
Femoral nerve
- L2 thru L4
- Posterior divisions
- Supply hip flexors and extensors of knee
- Lateral to BV as it enters thigh deep to inguinal ligament
74
Obturator nerve
- L2 thru L4
- Anterior divisions
- Supply adductors of thigh
75
Genitofemoral nerve
- L1, L2
- Pierces anterior surface of psoas
- Divides into genital and femoral branches (cutaneous anterior thigh)
76
Branch to lumbosacral trunk
- L4
| - Contributes to formation of sacral plexus
77
Sacral plexus is formed by:
Lumbosacral trunk (L4, L5) and ventral primary rami of S1-S4
78
Sacral plexus runs ______ into _____ region through the ______
Inferolaterally
Gluteal
Greater sciatic foramen
79
Sacral plexus supplies:
- Musculature and skin of buttocks
- Posterior compartment of thigh
- Entire leg and foot below the knee
80
Anterior division branches of sacral plexus
Nerve to quadratus femoris
Nerve to obturator internus
Pudendal
Nerves to levator ani and coccygeus
81
Posterior division branches of sacral plexus
Superior gluteal
Inferior gluteal
Perforating cutaneous nerve
Nerve to piriformis
82
Sacral plexus branches from both anterior and posterior divisions
Sciatic nerve
| Posterior femoral cutaneous
83
Superior gluteal nerve
- L4, L5, S1
- Passes out of greater sciatic foramen superior to piriformis
- Supplies glut minimus, glut medius, TFL
84
Inferior gluteal nerve
- L5, S1, S2
- Passes inferior to piriformis
- Supplies glut max
85
Perforating cutaneous nerve
- S2, S3
| - Skin of medial buttock
86
Nerve to piriformis
- S1, S2
| - Supplies piriformis
87
Nerve to quadratus femoris
- L4, L5, S1
| - Supplies quadratus femoris AND inferior gemellus
88
Nerve to obturator internus
- L5, S1, S2
| - Supplies obturator internus AND superior gemellus
89
Pudendal nerve
- S2 thru S4
| - Major nerve of perineum (supplies muscles and skin)
90
Nerves to levator ani and coccygeus
- S3, S4
| - Supplies levator ani and coccygeus
91
Sciatic nerve
- L4, S3
| - Splits into common fibular and tibial nerves
92
Common fibular nerve
- L4 thru S2
- Branch of sciatic
- Posterior divisions
93
Tibial nerve
- L4 thru S3
- Branch of sciatic
- Anterior divisions
94
Posterior femoral cutaneous nerve
- S1 thru S3
| - Buttock, upper posterior and medial thigh
95
Function of urinary bladder
Temporary storage of urine
96
Location of urinary bladder
```
True pelvis (below brim)
*Will extend above brim when full
```
97
Anterior surface of urinary bladder
Located posterior to pubic symphysis
98
Superior surface of urinary bladder
Males: located inferior to peritoneum of abdom cavity
Females: located inferior to uterus and vesicouterine pouch
99
Vesicouterine pouch
Females
| Peritoneal space between bladder and uterus
100
Posterior surface of urinary bladder
Males: located anterior to rectovesical pouch, rectum, seminal vesicles, ampulla of ductus deferens
Females: located anterior to vagina
101
Rectovesical pouch
Males
| Peritoneal space between bladder and rectum
102
Landmarks of urinary bladder
Apex (anterior portion)
Fundus (posterior portion)
Neck (inferior portion leading to urethra)
Trigone (posterior wall)
103
In males, the _____ is located inferior to neck of urinary bladder
Prostate gland
104
In females, the _____ is located inferior to neck of urinary bladder
Urogenital diaphragm
105
Trigone of bladder
- "Triangle" formed by 2 openings of ureters and opening or urethra
- Specialized smooth muscle of bladder wall
106
Muscles of bladder
Detrusor
Internal urethral sphincter
External urethral sphincter
107
Detrusor muscle
Smooth muscle that lines walls of bladder
108
Internal urethral sphincter
Smooth muscle that forms a sphincter at junction of bladder and urethra
109
External urethral sphincter
SKELETAL muscle that forms a sphincter around urethra as it passes through urogenital diaphragm
110
Micturation
Reflex action that can be controlled voluntarily via higher CNS influence
111
At "rest" when bladder is not full:
- Sympathetic nerves cause internal urethral sphincter to contract
- Detrusor wall is relaxed
- External urethral sphincter is contracted
112
At _____ mL, you begin to be slightly aware of bladder
150
113
At more than ____ mL, increased stimulus of stretch receptors in bladder wall
300-400
114
At _____ mL, urgency!
600+
115
Distension of bladder stimulates:
- Parasymp nerves (S2-4) to contract detrusor
* Higher CNS centers can voluntarily inhibit this reflex
- Parasymp nerves (S2-4) to relax internal urethral sphincter
- Voluntary relaxation of external urethral sphincter
116
Male reproductive organs
```
Testes
Epididymis
Ductus deferens
Seminal vesicle
Prostate gland
Bulbourethral (Cowper's) gland
External genitalia (testes, scrotum, penis)
```
117
Female reproductive organs
```
Ovaries
Uterine tube
Uterus
Vagina
External genitalia (vestibule, clitoris, labia majora)
```
118
Testes develop ____ and descend into _____
Retroperitoneally
| Scrotum
119
Testes function
Produce sperm and sex hormones
120
Sperm produced in:
Seminiferous tubules of testes
121
Epididymis structure and functions
- Convoluted duct (head, body, tail)
- Storage and maturation of sperm (head)
- Propulsion of sperm into ductus deferens
122
Ductus deferens arises from _____, travels up through ____ and _____
Epididymis
| Spermatic cord and Inguinal canal
123
Ductus deferens enters pelvis via ____
Deep inguinal ring
| lateral to inferior epigastric artery
124
Ductus deferens ends as the:
Ampulla of ductus deferens
125
Ejaculatory duct =
Ductus deferens merged with seminal vesicle
126
Ejaculatory duct passes through ____ and enters ____
Prostate
| Prostatic urethra
127
____ provides nutrition for sperm
Fructose
128
Seminal vesicle location
Along posterolateral portion of bladder just lateral to ductus deferens
129
Seminal vesicle functions
- Produces seminal fluid (contains fructose and choline)
| * Fructose is not produced anywhere else in body so forensic science uses it to determine if sexual assault has occurred
130
Florence's test
Determine presence of semen via choline crystals in sexual assault cases
131
Prostate gland location
Base of urinary bladder
| Surrounds urethra
132
Prostate gland functions
- Produces fluid that combines with sperm and other fluids to form semen (seminal fluid)
- Secretes PSA and acid phosphatase
133
Prostate gland lobes
- Anterior: isthmus, located anterior to urethra, NO glandular tissue
- Middle: located between urethra and ejaculatory ducts, physically constricts urethra and obstructs urine flow
- Posterior: posterior to urethra and inferior to ejaculatory duct
- R/L Lateral: major portion of gland on each side of urethra
134
Which lobe(s) of the prostate is prone to BPH?
Middle and lateral lobes
135
Which lobe of the prostate is easily palpated upon digital exam?
Posterior
136
Which lobe of the prostate does cancer typically begin?
Posterior
137
Venous return of the prostate
2 pathways
Prostatic venous plexus drains into:
1. Internal iliac > IVC
2. Vertebral venous plexus > cranial dural sinuses
138
Where does prostate cancer usually metastasize to?
Heart/lungs and vertebral column/brain
139
Why does prostate cancer metastasize to heart/lungs and vertebral column/brain?
Two pathways of venous return from the prostate:
1. Internal iliac > IVC > heart/lungs
2. Vertebral venous plexus > cranial dural sinuses
140
Bulbourethral (Cowper's) gland description/location/function
- 2 small glands located posterior to membranous urethra
| - Secrete mucus-like secretion into urethra
141
Scrotum
Cutaneous pouch that does not have any fat
142
Why doesn't the scrotum have any fat?
Allows for maintaining lower temperature
143
Scrotum contains:
Testes and epididymis
144
Penis structures
Body
Root
Head (glans penis)
Urethra
145
Penis body is formed by:
3 columns:
- one Corpus Spongiosum
- two Corpus Cavernosa
146
Penis root consists of:
2 crura
| Bulb of penis
147
Glans penis is formed by:
Terminal portion of corpus spongiosum
148
Male urethra passes through:
Corpus spongiosum
149
Prostatic urethra description
Surrounded by prostate
Urethral crest located on posterior wall
Ejaculatory and prostatic ducts enter urethra here
150
Seminal colliculus
- Oval raised portion of urethral crest of prostatic urethra
| - Contains openings of ejaculatory, prostatic ducts, prostatic utricle
151
Prostatic utricle
- Located in seminal colliculus of urethral crest of prostatic urethra
- Blind outpocket that is analogous to vagina and uterus in female
152
Male urethra passes through ___ and consists of:
Corpus spongiosum
| Prostatic, membranous, spongy (cavernous) urethra
153
Prostatic utricle
- Located in seminal colliculus of urethral crest of prostatic urethra
- Blind outpocket that is analogous to vagina and uterus in female
154
Membranous urethra
External urethral sphincter
155
Spongy (cavernous) urethra
- Passes through length of penis within corpus spongiosum
| - Duct of bulbourethral gland enters here
156
Ovaries location
Lateral to infundibulum of uterine tube
157
Ovaries contain:
Ovarian follicles
158
Ovaries function
Secrete estrogen and progesterone
159
Ovulation process
- Oocyte release from ovary into peritoneal cavity near ostium of infundibulum
- Fimbriae of infundibulum trap oocyte and bring it into uterine tube
160
Uterine tube parts
Intramural portion - lies within uterine wall
Isthmus - thick muscular wall, extends from uterine wall to ampulla
Ampulla - dilated, longest segment
Infundibulum - distal segment, terminates in fimbriae, contains abdominal ostium which opens into peritoneal cavity
161
Which part is the longest segment of the uterine tube?
Ampulla
162
Which part of the uterine tube ends in fimbriae?
Infundibulum
163
Which part of the uterine tube is most common site for fertilization?
Ampulla
164
Which part of uterine tube is most common site for ectopic implantation?
Ampulla
165
Uterus location
Between rectum and bladder
166
Uterus function
Facilitates movement of sperm from cervix
Provides safe, nourishing environment for fetus
Contracts to push fetus and placenta out during birth
167
Divisions of the uterus
Body - fundus, isthmus
Cervix (neck) - narrow cylinder that enters and projects into vagina; consists of internal os, cervical canal, external os
168
T/F: Body is the upper 2/3 of uterus
True
169
Fundus of uterus
Rounded portion of uterus located above uterine tubes
170
Isthmus of uterus
Narrow region of body of uterus that connects to cervix
171
External os
Opening into vagina
172
Various positions of uterus
Anteverted (50%)
Retroverted (25%)
Midposition (25%)
173
Wall of the uterus contains 3 layers:
Perimetrium (outer serous coat)
Myometrium (middle muscular coat)
Endometrium (inner mucous coat)
174
Structures that provide support to uterus
```
Pelvic & urogenital diaphragms
Round ligament of uterus
Transverse cervical ligament
Uterosacral ligament
Pubocervical ligament
Broad ligament
```
175
Broad ligament of uterus
- Double fold of peritoneum that extends from uterus to pelvic wall
- Supports ovary, uterine tubes, uterus
176
Broad ligament of uterus contains:
- Uterine tube, round ligament, many duct remnants of embryo
- Ovarian artery, vein, nerve
- Uterine artery, vein, nerve
177
What is the MC gynecological malignancy?
Cervical cancer
178
Uterine fibrinoids
Benign neoplasms of smooth muscle origin
| Can cause infertility if it blocks uterine tubes
179
Potential locations of uterine fibrinoids
```
Within myometrium
Beneath endometrium (expand inward into uterine cavity)
Along external serosal layer (expand outward into peritoneal cavity)
```
180
Vagina
Tube that connects uterus to vestibule
Dilates/extends width of pelvic outlet during childbirth
Fornix (superior portion) encircles cervix of uterus
181
Three regions of vaginal fornix
Anterior - can palpate bladder on digital exam
Lateral
Posterior - can palpate rectum on digital exam
182
What is the site for culdocentesis?
Posterior fornix of vagina
183
Culdocentesis of vagina
Insert needle to collect fluid sample
| Assess pelvic conditions (PID, ectopic preg) OR to collect oocytes for in vitro fertilization
184
Vestibule
Region in which the vagina and urethra open into after passing through urogenital diaphragm
185
Clitoris
Body and glans formed from two corpus cavernosa
| Located anterior to opening of urethra
186
Female urethra descends ____ distance from ____ to _____
Short
Bladder
Urethral opening
187
Labia majora
Analogous to male scrotum
Contains connective tissue layers
Round ligament passes through inguinal canal and ends blindly in labia majora
188
Where does the round ligament of the ovary end?
Labia majora
189
Labia minora
Medial to labia majora
| Form lateral walls of vestibule
190
Perineum description
Diamond shaped space that is part of pelvic outlet
191
Perineum boundaries (anterior, anterolateral, lateral, posterolateral, posterior)
```
Anterior: pubic symphysis
Anterolateral: ischiopubic rami
Lateral: ischial tuberosities
Posterolateral: sacrotuberous ligaments
Posterior: Coccyx
```
192
Perineum can be divided into 2 smaller triangles:
Urogenital
| Anal
193
Vertical boundaries of perineum
```
Roof = skin/fascia
Floor = pelvic diaphragm
```
194
Urogenital triangle
Superficial perineal space
| Deep perineal space
195
Superficial perineal space of urogenital triangle
- Between Colle's fascia and inferior fascia of urogenital diaphragm (perineal membrane)
- Muscles: ischiocavernosus, bulbospongiosus, superficial transverse perineal
196
Deep perineal space of urogenital triangle
- Between perineal membrane and superior fascia of urogenital diaphragm
- Muscles: deep transverse perineal, sphincter urethrae, sphincter urethrovaginalis (female), compressor urethrae (female)
197
Anal triangle muscles
Obturator internus
Levator ani
Sphincter ani externus
Coccygeus
198
Rectum location, function, venous return
- Extends from sigmoid colon to anal canal
- Dilated portion known as ampulla for feces storage
- Located just superior to pelvic diaphragm
- Inferior and middle rectal veins connect to IVC
- Superior rectal vein connects to portal venous system
199
What separates the anal canal from rectum?
Pelvic diaphragm
200
Anal canal begins at ____ and ends at ____
Pelvic diaphragm
| Anus
201
Anal canal is divided into these 2 portions:
Visceral (upper 2/3)
| Somatic (lower 1/3)
202
What divides the visceral and somatic portions of anal canal?
Pectinate line
203
Visceral portion of anal canal
Internal anal sphincter (smooth muscle)
Internal hemorrhoids occur her
Venous return is mainly through portal system
204
Somatic portion of anal canal
Externa anal sphincter
External hemorrhoids occur here
Venous return is mostly through caval system (IVC)
