Parker SG

Question 1

What separates the true and false pelvis?

Answer 1

Terminal line

Question 2

What muscles make up the pelvic diaphragm?

Answer 2

Coccygeus and Levator Ani

Question 3

What two spaces are separated by the pelvic diaphragm?

Answer 3

Pelvis and Perineum

Question 4

What is the most important origin of levator ani?

Answer 4

Tendinous Arch of Levator Ani

Question 5

What is the tendinous arch of levator ani derived from?

Answer 5

Obturator internus fascia (thickening of parietal pelvic fascia)

Question 6

What is the most important part of the pelvic diaphragm that helps to maintain rectal continence?

Answer 6

Puborectalis muscle

Question 7

What are the 3 umbilical folds and what are they made from?

Answer 7

MediaN - obliterated urachus
medialL - obliterated umbilical artery
Lateral - inferior epigastric a.

Question 8

What vertebral level does the sigmoid colon begin at?

Answer 8

S3

Question 9

Which parts of the colon are in the pelvis?

Answer 9

Sigmoid (false)

Rectum (true)

Question 10

When does rectum become anal canal?

Answer 10

When it passes through the pelvic diaphragm into perineum

Question 11

Above Pectinate line.

• Nerves
• Blood
• Lymph

Answer 11

Nerves: AUTONOMIC
Sympathetic - Lumbar Splachnics
Parasympathetic - Pelvic Splanchnics

Blood:
Superior Rectal a. (SMA)
Superior Rectal v. (SMV –> PORTAL)

Lymphatics:
Internal Iliac Lymph Nodes

Question 12

Below Pectinate Line

• Nerves
• Blood
• Lymph

Answer 12

Nerves: SOMATIC
inferior rectal n. (pudendal n.)

Blood:
Middle and Inferior Rectal a. (CAVAL)

Lymph:
Superficial inguinal lymph nodes

Question 13

What type of hemorrhoids are painful?

Answer 13

Those that are below the pectinate line, because the innervation becomes somatic

Question 14

T or F: the middle rectal a. is above the pelvic diaphagm

Answer 14

True

Question 15

What fibers innervate the different parts of the bladder:

• detrussor
• internal urethral sphincter

Answer 15

Detrussor
Parasympathetic (pelvic splanchnics)

Internal Urethral Sphincter
Sympathetic (Lumbar? splachnics)

Question 16

T or F: the internal urethral sphincter prevents retrograde ejaculation?

Answer 16

True

Question 17

What is significant about the internal urethral sphincter preventing retrograde ejaculation?

Answer 17

Emission AND ejactulation (somatic and symp) are controlled by SYMPATHETIC stimulation

• internal urethral sphincter closes tightly under this stimulation to prevent retrograde ejaculation

Question 18

Where do the ureters cross the pelvic brim?

Answer 18

• The bifurcation of the common iliac a.

Question 19

What are the components of the UG diaphragm?

Answer 19

External Urethral Sphincter

Deep Transverse Perineal

Question 20

What is the innervation of the external urethral spincter?

Answer 20

• Perineal Branch of Pudendal

** Remember - ALL 5 Muscles of the PERINEUM are under PERINEAL N. Control

Question 21

What openings can be found in the seminal colliculus?

Answer 21

• Prostatic Utricle

- Ejactulatory Ducts

Question 22

Where do the Cowper’s glands empty?

Answer 22

• Spongy urethra

Question 23

What is the lowest part of the female peritoneal cavity?

Answer 23

Rectouterine pouch

**Fluid accumulation and ectopic pregnancy Sites

Question 24

What is anteVersion

Answer 24

Vaginal/Cervix angle

Question 25

What is anteflexion?

Answer 25

Cervix/Uterus angle

Question 26

What important structures are found in the suspensory ligament of the ovary?

Answer 26

Ovarian a/v and ovarian nerve plexus

Question 27

where is the vas deferens in relation to the epigastric vessels at the deep inguinal ring?

Answer 27

- Vas passes lateral to inferior epigastrics

Question 28

How does the vas deferens travel after exiting the inguinal canal?

Answer 28

Over the pubis Posterioly across body of the bladder then SUPERIOMEDIAl to ureter to join seminal vesicle

Question 29

What does the ejaculatory duct empty into, and what structures join to make it?

Answer 29

- empties to seminal colliculus in PROSTATIC URETHRA

Question 30

What are the two layers of Pelvic fascia and what makes up each of these?

Answer 30

Parietal: Continuation of TRANSVERSALIS of abdomin Visceral: ENDOPELVIC layer - continuation of EXTRAPERITONEAL CT

Question 31

What are the 2 specializations on the parietal layer of pelvic fascia? - What do these specializations do?

Answer 31

1. Tendinous Arch of Levator Ani - Separates Pelvis and Perineum - ORIGIN of Levator Ani 2. Tendinous Arch of Pelvis Facia ("white line") - suture site in pelvic surgery

Question 32

What are the 3 specializations of the Visceral layer of pelvic fascia?

Answer 32

1. Puboprostatic (males) or Pubovesical (females) - anchors the neck of the bladder 2. Cardinal (transverse cervical) Ligament (females) - Water under the bridge 3. Sacrogenital (males) and Uterosacral (females) - make rectovesical/rectouterine fold when covered in mucosa

Question 33

Where does the aorta bifurcate into the common iliacs?

Answer 33

L4

Question 34

Where does the ureter cross the pelvic brim?

Answer 34

- At the level of the of common iliac bifurcation

Question 35

What forms the anterior boundary of the ovarian fossa?

Answer 35

- External Iliac a.

Question 36

What are the 3 parietal branches from the posterior division of internal iliac?

Answer 36

- iliolumbar - lateral sacral a. - superior gluteal a. (terminal branch)

Question 37

What are the Parietal Branches of the anterior division of internal iliac?

Answer 37

1. obturator a. 2. inferior gluteal a. (terminal branch) 3. internal pudendal. a (terminal branch)

Question 38

What are the 4 Visceral branches of the anterior internal iliac?

Answer 38

1. Superior Vesical a. (from Umbilical A.) 2. Inferior Vesical a. 3. Middle Rectal a. 4. Uterine a.

Question 39

What iliac branch passes between lumbrosacral trunk and S1 root?

Answer 39

Superior Gluteal

Question 40

What iliac branch passes between S2 and S3?

Answer 40

Inferior Gluteal

Question 41

What iliac branch would have the ureter passing directly under it?

Answer 41

Uterine a.

Question 42

How to GVA PAIN fibers get back to the dorsal root ganglion?

Answer 42

They travel retrograde on GVE SYMPATHETIC nerve paths * *******Exception to this rule = PAIN LINE - below the pain line GVA PAIN travels via PELVIC spanchnics to DRG of S2, 3, and 4 ********This explains why epidurals at S2-4 work because pain is actually transmitted here for pelvic viscera and somatic (pudendal n. S2-S4)

Question 43

How do GVA REFLEX fibers get back to the dorsal root ganglia?

Answer 43

They travel retrograde on GVE PARAsympathetic nerve paths

Question 44

Contents and derivations of the Spermatic cord.

Answer 44

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