module 3- pelvis Flashcards
what is the bony pelvis
- at the base of the spine which joins the lower limbs to the axial skeleton
what is the pelvic cavity bounded by
the bony pelvis
how is the pelvic cavity divided into?
by the pelvic brime (linea terminalis)
pelvic brim
landmark that helps delineate the greater (false) pelvis from the lesser (true) cavity
what is the greater (false) cavity
- the region above the pelvic brine
- forming the lower part of the abdominal cavity
- larger and sits superior to the lesser cavity
lesser (true) cavity
- below the pelvic brine
- contains a pelvic inlet (pelvic brim) and a pelvic outlet that is largely closed by the pelvic floor
the pelvic floor
also known as the pelvic diaphragm
- is wide but thin muscular layer of tissue that forms the inferior border of the abdominopelvic cavity
what are the joints of the pelvis
- sacroiliac joint
- pubis symphysis
what forms the sacroiliac joint
between the sacrum and ilium
what forms the pubic symphysis
right and left pubic bones
what is symphysis pubis dysfunction?
- during pregnancy, the ligaments of the pelvic girdle become more relaxed and elastic as delivery nears due to increase in hormones
- is it occur prematurely it can make the pelvic joint unstable
what does symphysis pubis dysfunction result in
increase symphyseal width and mobility
- disarticulation of the pubic symphsis is possible during birth but unlikely
symptoms of symphysis pubis dysfunctions
- difficulty walking
- pain
- pubic pain area
- pain that gets worse with weight activities
features of the pelvic floor
- levator ani
- coccygeus
- urogenital hiatus
- anal aperture
levator ani
a broad muscle group situated on either side of the pelvis and is the main pelvic floor muscle
coccygeus
make up the posterior portion of the pelvic floor
urogential hiatus
a u-shaped opening for the urethra and the vagina for females
anal aperture
passage for the anal canal
what is the puborectal sling
- fibers of the levator ani form a sling around the rectum
- attaches to the pubic bone and wraps posteriorly around the rectum, forming the anorectal flexure
contraction of the puborectal sling
keep the rectum closed until defecation
relaxation of the puborectal sling
- allow the anorectal flexure to straighten during defections
pelvic organ prolapse
- muscles and ligaments of the pelvic floor support the pelvic organs
- if the floor weakens, the pelvic viscera can drop from their normal place and push against the floor
who does pelvic organ prolapse mostly occur in
- predominantly in females, after childbirth as it can stretch and weaken the pelvic floor
- pelvic organs can push against vagina , resulting in protrusion at or near the vaginal opening
in females pelvic organs prolapse can cause prolapse of what organs
- bladder
- rectum
- uterus
- cervix
- vagina
- troubles with urine flow
what is the pelvic peritoneum
- forms the roof of the pelvic cavity and is continuous with the parietal peritoneum of the abdomen
- is the inferior portion of the abdominal paritetal peritoneum
in females what does the pelvic peritoneum form
- vesicouterine pouch
- rectouterine pouch
vesicouterine pouch location
- descends from the back of the anterior abdominal wall onto the upper surface of the urinary bladder and the onto the anterior surface of the uterus
rectouterine pouch location
- peritoneum continues over the fundus of the uterus and down its posterior wall to the upper part of the posterior vagina
- is then reflected up the anterior surface of the rectum, forming the rectouterine pouch (of douglas)
what is the rectouterine pouch between
the uterus and rectum
what does the pelvic peritonueum form for males
rectovesical pouch
rectovesical pouch
- parietal peritoneum descends from the back of the anterior abdominal wall to the superior surface of the urinary bladder
- after passing the posterior surface of bladder and the upper ends of the seminal vesicles, it passes to the anterior surface of the rectum
abdominal wall : urinary system
- as the ureters descend into the pelvic cavity, they cross over the common iliac arteries
- (renal stones may lodge)
pelvic cavity : : urinary system
the pelvic ureter continues along the lateral pelvic wall to enter the urinary bladder posteriorly
pelvic wall : : urinary system males
at the site where the ureters drain into the bladder, the ductus (vas) deferens can be seen crossing the ureter anteriorly
pelvic wall : : urinary system females
each ureter is crossed by the uterine artery
what is a urinary tract infection
- is a bacterial infection in any part of the urinary system
who is at higher risk of UTI + why
women due to the shorter urethra
how does UTI happen?
bacteria from the external environment can enter the irethra and do not have to travel far to infect the bladder
what are the most common sites of UTI
urethra and bladder
symptoms of UTI
- burning when peeing
- painful
- localized pain in area of bladder, near center of pelvis and around the pubic bone
what is the sigmoid colon
- constinuation of the descending colon
- forms an S-shaped loop of variable length which lies in the upper pelvic cavity, ending at the middle sacrum (S3)
what is the rectum
- end of the sigmoid colon
- follows the curvature of the sacrum (sacral flexure) before turning posteriorly at the anorectal flexure to end at anal canal
what is the most posterior visceral organ
rectum
what drains the sigmoid colon and rectum
the inferior mesenteric vein
hemorrhoids (piles)
occurs when the veins in the lower rectum become enlarged and swollen
how do hemorrhoids develop + who do they mostly occur in
- alot during pregnancy (3rd trimester)
result of hemorrhoids?
- the swollen vessels, individuals will have painful and itchy swelling in the lower rectum, near anus
- diffiuclt to poop (constipation)
- stool have have blood if vessels rupture
what are rectal suppositories
are solid forms of medication that are interested into rectum
- works quickly, absorbing directly into the bloodstream from the large vasculature supply from the three arteries
what supplies the rectum
superior, middle and inferior rectal arteries
the vas defernes travels ____ to the epidiymis, towards the abdominal cavity
superior
as the vas deferns ascends into the abdominal cavity it travels towards the ____ surface of the bladder before metting the seminal vesicle to form the ejaculatory duct
posterior
the prostate sits ___ to the bladder and ___ to the semical vesicles
inferior
anterior
for males what travels in the inguinal canal
- vas deferens
- spermatic cord
what is epididymitis
- testis, epididymis, vas deferens, and bladder may all be affected
- bacterial infection causing swelling of epdidymitis
epididymitis in children
- infection may start in the bladder or kidney before spreading through the ejaculatory duct to the vas deferens to reach the epididymis
symptoms of epididymitis
- pain infected testicle
- fever
- swelling localized to the site of infection
- unilateral swelling of the testis
rectal examination
- anterior wall of the rectum has a number of close anatomical structures that can be significant for diagnosis purposes
- common to palapate the prostate gland and seminal vesicles
- check for hemorrhoids
prostate tumour
- one of the most common cancers in men over 50
- regular rectal examination can help detect
- when found early there a lots of treatment options
- complication occur when tumour metazises to the nearby bladder or distance structures thorugh the blood stream
normal prostate gland
- semen from the ejaculatory duct or urine, from the bladder can empty into the prostatic urethra
- contributes secretions to semen in the prostatic urethra
ejaculatory duct
vas deferens combines with the contents of the seminal vesicles in the ejaculatory ducts
prostate gland with tumour
is grows and pushses on other organs
symptoms prostate gland with tumour
- tumour can grow and press on the prostatic urethra where it can disrupt the flow of urine and/or semen
- diffiuclty urinating and discover blood in their urine and/or semen
vasculature of the spermatic cord
- testicular artery
- artery to the vas deferens
- pampiniform plexus (of testicular veins)
- cremasteric artery
testiuclar artery
a branch off the abdominal aorta
artery to the vas deferens
a branch off the internal iliac artery
pampiniform plexus (of testicular veins)
a network of veins that drains venous blood from the testis into the testicular vein
cremasteric artery
supplies the fascial coverings and muscle of the spermatic cord
testicular torsion
occurs when the testicles rotate, twisting the spermatic cord that supplies and drains blood to the testis
- if not restored with in 6h can lead to testicular nercrosis
who is testicular torsion most common in
ages 12-18 but can occur at any age even before birth
symptoms of testicular torsion
sudden, severe pain, swelling, and change in scrotum color (redness and darkening) on the affected side of the scrotum
- pain in inguinal region of the abdomen due to the spermatic cord
the vagina is ____ to the uterus, _____ to the rectum and _____ to the bladder
inferior, anterior, posterior
the sigmoid colon is ____ to the rectum and ___ to sacrum in females
superior, anterior
the uterine tubes are ___ to the uterus and ___ to the ovaries
superior, medial
what is ectopic pregnancy?
the egg attaches itself somewhere outside the uterus; commonly in uterine tube
- typically cannot proceed pregnancy passed first trimester
symptoms of ectopic pregnancy
- usual early pregnancy, normal hormonal changes associated with fertilization (missed period, breast tenderness, nausea, positive pregnancy test)
- pelvic pain on the affected side
- is fallopian tube burst pain is sharp
arterial supply of female internal viscera
- ovarian arteries
- uterine arteries
ovarian arteries
- lateral branches off the abdominal aorta at the level of L!
- supply ovaries and distal uterine tubes
uterine arteries
- branches of the internal iliac arteries
- cross over the ureters
- anastomes with the ovarian artery
- supplies vagina, proximal uterine tubes
what is the vagina supplies by
vaginal branches of the uterine and internal iliac arteries
what structures would be affected from ovarian cysts
ovaries, mesosalpinx (pelvic peritoneum), ovarian arteries
ovarian cyst what can it affect?
- ovaries, mesosalpinx (pelvic peritoneum) and ovarian arteries
- if cyst increases it may weigh down the ovary causing tension within the mesosalpinx and potentially block ovarian arteries
symptoms of ovarian cysts
- unilateral pelvic pain (dull and heavy)
- localilzed to the ovary with the cyst
- pain worse during intercourse as fluid can leak from the cysts causing sudden-sharp pain
what is the perineum
- part of the pelvic cavity inferior to the pelvic floor and contains structures that support the urogenital and gastrointestinal systems
about the perineum
- it is a diamond shaped area
what bounds the perineum anteriorly
pubic symphysis
what bounds the perineum laterally
ischial tuberosities
what bounds the perineum posteriorly
coccyx
what divides the perineum + what does it divide into
a line joining the ischial tuberosities into the anal triangle posteriorly and the urogenital triangle anteriorly
lithotomy position
stirrups are used to elevate and abduct the lower limbs while an individual is supine (lying face upward)
what is urogenital triangle divided into?
superficial and deep pouch by the perineal membrane
what is the perineal membrane
is a layer of deep fascia that contributes to the stability of the anterior part of the pelvic floor as well as an attachment for the external genitalia
what passes through the perineal membrane
- urethra and vagina
what is attached to the posterior border of the perineal membrane
is the perineal body
the superficial perineal pouch
lies superficial to the perineal membrane and contains muscle, skin, and external genitalia
deep perineal pouch
contains the urogenital diaphragm, layer of skeletal muscle composed of the external urethral sphincter, and deep transverse perineal muscles
what is the perineal body
- fibromuscular mass at the center of the perineum
- provides attachment for muscles of the perineum
- central tendon of perineum
- stenghtens the pelvic floor
what gender is the perineal body bigger
females
ischiorectal fossa
- wedge shaped triangular space between the ischium and anal canal
ischiorectal fossa- fat-filled space
allows for expansion of the anal canal during defecation
lateral wall of ischiorectal fossa
is the pudendal canal
pudendal canal
formed within the obturator fascia and contains the pudendal nerve and internal pudenal vessels
anal glands of ischiorectal fossa
drain into the anal canal
ischiorectal abscesses
if anal glands are infected abscesses that perforate laterally through the external sphincter into the lower ischiorectal
what is the penis composed of
three cylinders of erectile tissue:
- corpus spongiosum
- corpus cavernosum
ischiorectal abscesses symptoms
- discomfort/pain when walking and sitting
- painful defaction due to close anal canal
- site of absecess painful, swollen and tender
muscle of root of penis
- two cura of the penis are covered by ischiocavernosus muscles
- bulb covered by bulbospongiousus muscles
function of ischiocavernosus muscles and bulbospongiousus
voluntary skeletal muscles compress the crura and bulb of penis during erection
- bulbospongiousus compress urethra during urination or ejaculation
prepuce or foreskin
- covers body of penis, thin loose skin covers glans
what attaches the prepuce to the ventral surface of the glans
fold of skin called the frenulum
what is balanitis
inflammation of the foreskin or head of the penis due to infection or chronic skin conditions
- occur alot in unciricumcised men
sympthoms of balanitis
- painful (not serious)
- red
- swollen
- inflammed tissue can compress the urethra making painful urination
what is the clitoris
consist of mainly erectile tissues and is attached to the perineal membrane by the 2 cura and 2 vestibular bulds
what can the clitoris be divided into
body of clitoris
glans of the clitoris
body of clitoris
the right and left crus of the clit, which are attached to the perineal membrane
- unite anteriorly to form the body
glans of the clitoris
- located on the distal portion of the body
- on each side of the vaginal orifice, anchored to the perineal membrane, are the vestibular bulbs which unite anteriorly to form the glans clitoris
female external genitalia
referred to as the vulva or pudendum
- mons pubis
- prepuce
- frenulum
mons pubis
a rounded mass of fatty tissue formed by the union of the labia majora
prepuce
anterior and superior to the clitoris, the prepuce is formed from the fusion of the labia minora
frenulum
anterior and inferior to the clitoris, the fusion of the labia minora forms one frenulum
vulvitis
inflammation and infection of the vulva (labia majora and minora)
- can also affect vestibular glands
symptoms of vulvitis
- redness
- swelling
- ithcing
- burning
- may turn white, crack or develop fluid-filled blisters that break open, ooze and crust over
greater vestivular glands
lie posterior to the bulds of the vestibule on each side of the vaginal orifice
- produce mucus during sex that is carried by ducts that open at the posterolateral margins of the vaginal ordidce
what are the greater vestibular glands homologous to
the bulbourethral glands in males
muscles of the clitoris
root of clit covered by ischiocavernosus muscle and bulbospongiousus muscle
ischiocavernosus muscle female
cover the crura of the clit
bulbospongiousus muscle female
2 of them cover the bulbs of the vestibules and greater vestibular glands
what do the muscle of the clit do?
compress the crura of the clit and bulb of the vestibule during erection of the clit
internal iliac artery branches (vasculature of the pelvic and perineum)
- umbilical artery
- inferior vesicle
- internal pudendal artery
umbilical artery
- transports deoxygenated blood from the fetus to the placenta
- after birth the proximal branches becomes the superior vesicle artery that supplies the upper part of the bladder
inferior vesicle artery
supplies structures such as the bladder, ureter, seminal vesicles (glands), prostate, ductus deferens
internal pudendnal artery pathway
- exits through the greater sciatic foramen and enters the lesser sciatic foramen to the perinuem through the pudendal canal
internal pudendnal artery supplies
the skin, muscles of the anal triangle, urogenital triangle, and associated erectile bodies
what is priapism
- uncommon disorder
- common side effect of drug use and is medial emergency
- prolonged (6h+) and painful erection of the penis or clitioris
- unassociated with sexual arousal
- permanent tissue damage
priapism female
- impaired outflow of blood from the corpora cavernose
- the clit can appear red and swollen due to poor drainage
- pain can get worse
priapism males
- several types
- involves uncontrolled inflow of blood into the corpus cavernosum from branches of internal pudendal artery
- glans and shaft of penis red and swollen
- pain can get worse
what is the main branch of the sacral plexus to the perineum is?
pudendal nerve (S2-4)
pudendal nerve (S2-4)
- leaves the pelvis through the greater sciatic foramen, crossing the ischial spine, enters the perineum through lesser sciatic foramen
what does the pudenal nerve innervate
- runs deep in perineal pouch to the superifical pouch to supply sensory and motor to the urogenital region (including external urethral sphincter)
