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Gross III > Part III: Pelvis Pg 87-96 > Flashcards

Part III: Pelvis Pg 87-96 Flashcards

1
Q

What forms the obturator foramen?

A

Ischial ramus forms inferior margin

Inferior pubic ramus forms anteromedial portion

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2
Q

concavity between ischial spine and ischial tuberosity

A

Lesser sciatic notch

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3
Q

concavity superior to ischial spine (adjacent to ilium)

A

Greater sciatic notch

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4
Q

large posteroinferior protuberance on ischial ramus

A

Ischial tuberosity

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5
Q

What forms the acetabulum?

A
  • body of the ilium
  • body of the ischium
  • superior ramus of the pubis
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6
Q

What kind of joint is the pubic symphysis? What other joints are similar?

A

Fibrocartilaginous

  • IVDs, xiphisternal, manubriosternal, sacrococcygeal
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7
Q

What forms the pubic arch?

A

inferior pubic rami and ischial rami from both sides

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8
Q

What about the pelvic girdle differs by gender?

A

Subpubic angle

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9
Q

Describe the pelvis is in anatomical position?

A
  • ASIS and pubic symphysis are in same vertical plane

- Pelvic canal curves obliquely posterior relative to abdominal cavity

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10
Q

superior pelvic aperature open to abdominal cavity

A

Pelvic inlet

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11
Q

inferior pelvic aperature closed by muscular pelvic diaphragm

A

Pelvic outlet

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12
Q

The pelvic inlet is bounded by the pelvic brim which consists of:

A
  • Sacral promontory and ala
  • Ilial arcuate line
  • Superior pubic ramus and pubic symphysis
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13
Q

The pelvic outlet is bounded by:

A
  • Pubic arch
  • Ischial tuberosities
  • Sacrotuberous L
  • Tip of coccyx
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14
Q

The Inferior (pelvic) portion of abdominal cavity, located superior to pelvic inlet and Bounded by anterior abdominal wall, iliac alae and L5 vertebra.

A

Greater Pelvis

- Also known as false pelvis and pelvis major

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15
Q

What pelvic viscera are found in the greater pelvis?

A

Ilium and sigmoid colon

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16
Q

The space between the pelvic inlet and pelvic outlet that is closed inferiorly by musculofascial pelvic diaphragm

A

Lesser Pelvis

- Also known as true pelvis and pelvis minor

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17
Q

What viscera are contained in the lesser pelvis?

A

urinary bladder, uterus, ovaries, rectum

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18
Q

Weight bearing compound joint between sacrum and ilium

A

Sacroiliac Joint

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19
Q

What kind of joint is found posteriorly between tuberosities of sacrum and iliac at SI joint?

A

Syndesmosis

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20
Q

What kind of joint is found anteriorly between auricular surfaces of sacrum and iliac at SI joint?

A

Synovial joint

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21
Q

thin anterior part of capsule around synovial joint (anterior) SI joint

A

Anterior Sacroiliac L

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22
Q

broad fibrous connections between tuberosities of SI joint

A

Interosseus Sacroiliac L

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23
Q

What Ligament is Primarily responsible for weight transfer at the SI joint

A

Interosseus Sacroiliac L

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24
Q

Ligament with thick, obliquely oriented fibers (superolaterally) that will draw the ilia inward (medially) with weight bearing?

A

Posterior Sacroiliac L

Helps to firmly lock together the irregular surfaces of sacroiliac joint

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25
Q

What ligament spans from lateral sacrum to ischial tuberosity?

A

Sacrotuberous L

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26
Q

What ligament spans from lateral sacrum to ischial spine?

A

Sacrospinous L

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27
Q

What is the combined function of the Sacrospinous L and Sacrotuberous L?

A

limit upward movement of inferior part of sacrum and resist sacral rotational movement during periods of sudden weight gain, i.e. landing a jump from a high vertical distance

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28
Q

What ligaments contribute to formation of Greater and Lesser Sciatic Foramen?

A

Sacrotuberous L and Sacrospinous L

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29
Q

What are the components of the lumbosacral joint?

A

Anteriorly, IVD between L5-S1

Posteriorly, zygapophyseal joints between articular processes

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30
Q

What ligaments span from L5 transverse processes to medial surface of ilial ala

A

Iliolumbar L

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31
Q

What ligaments strengthen the sacrococcygeal joint?

A

Anterior/posterior Sacrococcygeal L

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32
Q

Which gender typically has a thicker fibrocartilaginous disc in the pubic symphysis?

A

Females

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33
Q

Thickening of the pubic symphysis that spans pubic symphysis laterally to pubic tubercles

A

Superior pubic ligament

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34
Q

Thickening of the pubic symphysis that rounds the subpubic angle, forming the pubic arch

A

Inferior pubic ligament

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35
Q

The anterior pelvic wall is formed by:

A

bodies and rami of pubic bones and pubic symphysis

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36
Q

The lateral pelvic walls are formed by:

A

hip bones with Obturator Foramen

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37
Q

Obturator foramen is largely closed by:

A

Obturator Membrane

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38
Q

What attaches to internal surface of obturator membrane and ilium/ischium

A

Obturator internus muscle

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39
Q

From its attachment on the internal surface of the obturator membrane, what is the path of the obturator internus muscle?

A

Passes posteriorly from lesser pelvis through Lesser Sciatic Foramen and then turns sharply laterally to attach to Greater Trochanter of Femur

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40
Q

What innervates obturator internus muscle?

A

Nerve to obturator internus (L5-S2)

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41
Q

What is the action of obturator internus muscle?

A

laterally rotates thigh, holds head of femur in acetabulum

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42
Q

The tendinous Arch of Obturator Fascia is an attachment point for:

A

Levator Ani M

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43
Q

The posterior pelvic wall is formed by:

A

sacrum/coccyx, sacroiliac joints and associated ligaments

NOTE: Actually more like a roof in anatomical position

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44
Q

Where does the piriformis muscle attach?

A
  • Attaches to 2nd-4th sacral segments and Sacrotuberous L

- Attaches to Greater Trochanter of Femur

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45
Q

From its attachment on the 2nd-4th sacral segments and Sacrotuberous L, what is the path of the piriformis muscle?

A

Exits lesser pelvis laterally through Greater Sciatic Foramen and attaches to Greater Trochanter of Femur

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46
Q

What nerves cross internal surface of the piriformis?

A

Nerves of Sacral Plexus

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47
Q

What innervates the piriformis muscle?

A

S1-S2 ventral rami

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48
Q

What is the action of the piriformis muscle?

A

laterally rotates and abducts thigh, holds femur head in acetabulum

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49
Q

The pelvic floor is formed by:

A

Pelvic Diaphragm which is a Funnel shape spanning between lateral walls, pubis and coccyx

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50
Q

The pelvic diaphragm consists of which muscles and their fascial coverings?

A

Levator Ani M and Coccygeus M

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51
Q

What separates the pelvic cavity (lesser cavity) from the perineum?

A

Pelvic diaphragm

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52
Q

What forms a muscular sling for supporting abdominopelvic viscera and resists increases in intra-abdominal pressure?

A

Levator Ani M

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53
Q

What innervates levator ani muscle?

A

S4 ventral rami and Inferior Rectal N (from Pudendal N)

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54
Q

What is the action of the levator ani muscle?

A

raise pelvic floor and compress abdominopelvic contents

  • Important during forced expiration, coughing, sneezing, vomiting, urinating, defecating and lifting heavy objects
  • Also plays a role in voluntary control of urination and defecation
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55
Q

Narrow medial part of Levator Ani M that forms U-shaped sling from R/L Pubic bodies to anorectal junction.

A

Puborectalis M

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56
Q

What muscle surrounds the urogenital hiatus and and creates the puborectal sling?

A

Puborectalis M (a part of levator Ani M)

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57
Q

What is the puborectal sling?

A

It forms the anorectal flexure at the anorectal junction which is important in maintaining fecal continence

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58
Q

Levator ani M is divided into three parts:

A
  • puborectalis M
  • pubococcygeus M
  • Iliococcygeus M
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59
Q

What is the main intermediate par of Levator Ani M?

A

Pubococcygeus M

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60
Q

What muscle spans from pubis to coccyx?

A

Pubococcygeus M (the pain part of Levator ani M)

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61
Q

What muscle attaches, in part, to anterior part of tendinous arch of obturator fascia?

A

Pubococcygeus M

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62
Q

Posterolateral part of Levator Ani M; often thin and aponeurotic

A

Iliococcygeus M

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63
Q

What muscle spans from posterior part of tendinous arch to coccyx?

A

Iliococcygeus M (part of levator Ani M)

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64
Q

What muscle spans from ischial spine to inferior sacrum and coccyx and lies on pelvic surface of Sacrospinous L?

A

Coccygeus M

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65
Q

What innervates coccygeus M?

A

S4-S5 ventral rami

66
Q

What is the action of Coccygeus M?

A

Contributes to Levator Ani M in forming the pelvic diaphragm

67
Q

Pelvic fascia consists of CT in space between ______ and _______.

A

parietal peritoneum and muscular pelvic walls

68
Q

Pelvic fascia is continuous with _________ in the abdomen.

A

Endoabdominal fascia

69
Q

Describe the parietal Pelvic Fascia

A

Membranous CT lining pelvic surface of muscles on pelvic floor and walls

70
Q

Describe the visceral pelvic fascia

A

Adventitial layer of CT ensheathing and allowing for distinction of pelvic organs including Urinary Bladder, Prostate, Vagina, Uterus and Rectum

71
Q

Visceral pelvic fascia is continuous with ______ at point pelvic organ penetrates pelvic floor

A

parietal fascia

72
Q

The continuous bilateral fibrous sling of fascia that spans from pubis to sacrum along pelvic floor

A

Tendinous arch of pelvic fascia

73
Q

The tendinous arch of pelvic fascia in males, forms the ______ spanning anteriorly from prostate to pubis _____ spanning posteriorly from sacrum to prostate.

A
  • puboprostatic L

- sacrogenital L

74
Q

The tendinous arch of pelvic fascia in females, forms the _______ spanning anteriorly from urinary bladder to pubis _______ spanning posteriorly from sacrum to vagina

A
  • pubovesical L

- Uterosacral L

75
Q

Internal iliac is a branch of:

A

Common iliac which branches from abdominal aorta

76
Q

What are the two division of the internal iliac artery?

A

Anterior and posterior

77
Q

The anterior branch of the internal iliac artery can have many branches (6 in males and 7 in females). What are those?

A
  • umbilical A
  • Obturator A
  • inferior vesicle A (only in males)
  • Uterine A (only in females)
  • Vaginal A (only in females)
  • MIddle rectal A
  • Internal Pudendal A
  • inferior gluteal A
78
Q

Where is the umbilical A located?

A

between urinary bladder and lateral wall of pelvis. It becomes mostly obliterated.

79
Q

What branches from the Umbilical A to supply the surface of the bladder?

A

Superior vesicle A

80
Q

Prenatally, what does the umbilical artery do?

A

carries blood from fetus to placenta for reoxygenation

81
Q

Postnatally, what does the umbilical artery do?

A

atrophies and becomes fibrous distal to Superior Vesical A. The fibrous umbilical artery is then known as the medial umbilical L in the medial umbilical fold

82
Q

Where is the obturator artery located?

A

Passes along lateral wall of pelvis to Obturator Canal, where it exits the pelvis with obturator V and N

83
Q

What does the obturator artery supply?

A

Muscles of the medial thigh

Also provides small branches to the ilium and pubis

84
Q

Although the obturator artery usually branches from the anterior division of internal iliac artery, 25-30% of the time, it originates from ______ or ______.

A

External Iliac A or Inferior Epigastric A

85
Q

In males, what supplies blood to inferior surface of urinary bladder, seminal vesicles and prostate and may also provide a branch to ductus deferens?

A

Inferior vesicle A

86
Q

In females, what artery supplies numerous branches to anterior/posterior surfaces of vagina, inferior surface of urinary bladder and pelvic urethra?

A

Vaginal artery

87
Q

There are two branches of the anterior division of internal iliac artery, one in males and one in female, that homologous. What are these two arteries?

A

Inferior vesicular A in males and vaginal A in females

88
Q

What artery branching from the anterior division of internal iliac artery in females on, supplies uterus, cervix and superior parts of vagina?

A

Uterine artery

89
Q

The uterine artery is the female homologous to what male structure?

A

Ductus deferens

90
Q

What branch of the anterior division of internal iliac artery supplies the inferior part of the rectum?

A

Middle rectal artery

91
Q

The middles rectal artery anastomoses with two other arteries to supply the rectum. What are they and where do they branch from?

A
  • Superior rectal A from inferior mesenteric A

- Inferior rectal A from internal pudendal A

92
Q

What is the path of internal pudendal A as it exits the pelvis?

A

It passes through the inferior part of Greater Sciatic Foramen, over the sacrospinous ligament, through the lesser sciatic foramen in the pudendal canal with the pudendal N

93
Q

What is the Primary arterial supply to perineum and external genitalia?

A

Internal Pudendal A

NOTE: often larger in males

94
Q

Inferior gluteal A is a branch of anterior division of internal iliac A. What does it supply?

A

Supplies lower gluteal muscles and upper posterior thigh muscles

95
Q

As the inferior gluteal artery branches from anterior division of Internal Iliac A, where is it located?

A

The branch passes posteriorly between S2 and S3 ventral rami

96
Q

Inferior gluteal A exits the pelvis by passing through where?

A

inferior part of Greater Sciatic Foramen, inferior to piriformis M

97
Q

The posterior division of Internal iliac A typically has three branches. What are they?

A
  • iliolumbar A
  • lateral sacral A
  • superior gluteal A
98
Q

What is the course of the iliolumbar artery?

A

Superolateral to iliac fossa where is divides

99
Q

Iliolumbar Artery divides into:

A

Iliac branch

Lumbar branch

100
Q

The iliac branch of iliolumbar artery supplies what?

A

Iliacus M

101
Q

The lumbar branch of iliolumbar A supplies what?

A

Psoas major M and quadratus lumborum M

102
Q

What does the lateral sacral A supply?

A
  • Spinal meninges around roots of sacral nerves

- skin and deep muscles overlying posterior aspect of sacrum

103
Q

Superior gluteal artery passes between ______ and _____.

A

Lumbosacral Trunk and S1 ventral ramus

104
Q

Superior gluteal A exits the pelvis by passing through what?

A

superior part of Greater Sciatic Foramen and superior to piriformis M

105
Q

What does the superior gluteal artery supply?

A

upper gluteal muscles and Tensor Fascia Lata M

106
Q

Ovarian/testicular artery is a branch of?

A

Abdominal aorta, inferior to the renal A

107
Q

What does the ovarian A supply?

A

Ovaries and uterine tube

108
Q

In the pelvis, the ovarian A passes medically through _________.

A

suspensory ligament of ovary

109
Q

How does the testicular artery exit the pelvis?

A

Enters deep inguinal ring and then passes through inguinal canal to scrotum

110
Q

What does the testicular artery supply?

A

Testis and epididymus

111
Q

Where does the median sacral artery arise from?

A

Posterior surface of abdominal aorta just superior to the bifurcation

112
Q

The medial sacral artery represents what embryological structure?

A

Caudal end of embryonic dorsal aorta

113
Q

Superior rectal artery is a terminal branch of what?

A

Inferior mesenteric artery

114
Q

What does superior rectal artery supply

A

Superior part of rectum

Anastomoses with middle and inferior rectal artery

115
Q

What is the primary venous drainage of the pelvis?

A

Internal iliac vein which drains to common iliac V and then IVC

116
Q

The right and left common iliac veins join to form IVC at what vertebral level

A

L5

117
Q

The Pelvic Venous Plexuses is a venous network around rectum, urinary bladder, prostate, uterus and vagina that usually drains to _______.

A

Internal iliac vein

118
Q

The Pelvic Venous Plexuses is a venous network around rectum, urinary bladder, prostate, uterus and vagina that sometimes drains to _______ and _______.

A

Superior rectal V -> IMV

Lateral sacral V -> internal vertebral plexus

119
Q

What nerves do the lumbar plexus give rise to?

A

Obturator N

Lumbosacral TRunk

120
Q

What spinal segmental VPR give rise to Obturator N?

A

L2-L4

121
Q

Obturator nerve enters the pelvis on the medial border of what muscle?

A

Psoas major M

122
Q

What is the obturator canal?

A

An opening in the obturator membrane that otherwise fills the obturator foramen

123
Q

What does the obturator N supply?

A

Adductors of the medial thigh after it splits into anterior/posterior division

124
Q

What spinal segmental VPR give rise to lumbosacral trunk?

A

L4-L5

125
Q

The lumbosacral trunk passes anterior to _______ to join sacral plexus?

A

Ala of sacrum

126
Q

The sacral plexus Nerves lie on the ventral surface of _______.

A

Piriformis M

127
Q

What spinal segment VPR comprise the sacral plexus?

A

L4-S4

128
Q

How do most branches of sacral plexus exit the pelvis?

A

Via grater sciatic foramen

129
Q

What is the largest, broadest nerve in the body?

A

Sciatic N, a branch of the sacral plexus of nerves

130
Q

The ventral rami that form the sciatic nerve converge on the anterior surface of _______.

A

Piriformis muscle

131
Q

How does the sciatic nerve exit the pelvis?

A

Inferior to piriformis M via the greater sciatic foramen

132
Q

What does the sciatic nerve innervate?

A

Posterior thigh and entire leg and foot via its branches

133
Q

What is the main motor and sensory nerve of the perineum?

A

Pudendal N

134
Q

Where does the pudendal N terminate?

A

In genitalia as dorsal N of penis/clitoris

135
Q

What Spinal nerve VPR form the pudendal N?

A

Anterior divisions of S2-S4

136
Q

How does the pudendal N exit the pelvis?

A

With pudendal artery and vein via greater sciatic foramen, posterior to ischial spin and over sacrospinous L

137
Q

How does the pudendal N enter the perineum?

A

By passing through the lesser sciatic foramen

138
Q

Superior gluteal nerve arises from what VPR?

A

Posterior division of L4-S1

139
Q

How does superior gluteal nerve exit the pelvis?

A

Superior to piriformis M via greater sciatic foramen, paralleling superior gluteal AV

140
Q

What does the superior gluteal N innervate?

A

Gluteus Medius M, Gluteus Minimus M and Tensor Fascia Lata M

141
Q

Inferior gluteal N arises from what VPR?

A

posterior divisions of L5-S2

142
Q

How does the inferior gluteal N exit the pelvis?

A

Inferior to piriformis M via the greater sciatic foramen, paralleling inferior gluteal AV

143
Q

What does the inferior gluteal N innervate?

A

Gluteus Maximus M

144
Q

What is the small network of nerves arising from S4-S5 ventral rami?

A

Coccygeal plexus of nerves

145
Q

Coccygeal plexus of nerves lies on pelvis surface of ________.

A

Coccygeus M.

146
Q

What does coccygeal plexus of nerves innervate?

A

Coccygeus M and Levator Ani M and skin between coccyx and anus

147
Q

The Inferior continuation of lumbar sympathetic trunks - Usually comprised of four ganglia (smaller in size than lumbar ganglia)

A

Sacral sympathetic trunks

148
Q

What is the Small, median convergence of sacral sympathetic trunks, located anterior to coccyx?

A

Ganglion impair

149
Q

What is the function of sacral sympathetic trunk?

A

Provide postsynaptic sympathetic innervation in lower limbs for vasomotor, sudomotor and pilomotor

150
Q

The pelvic splanchnic N contains what kind of neurons?

A

presynaptic neurons arising from S2-S4 spinal cord segments

151
Q

What does the pelvic splanchnic N innervate?

A
  • muscles of urinary bladder and rectum

- erectile tissue of the penis and clitoris

152
Q

The pelvic splanchnic N contains visceral afferents from pelvic organs that may refer pain to what dermatomes?

A

S2-S4

153
Q

Where is the superior hypogastric plexus?

A

Inferior to the biforcation of the abdominal aorta

154
Q

The superior hypogastric plexus contains sympathetics from ______.

A

Lumbar splanchnic N

155
Q

Sympathetics from lumbar splanchnic N that lie in the superior hypogastric plexus function is?

A

Vasomotor

156
Q

There is minimal parasympathetic contribution to the superior hypogastric plexus via ______.

A

Pelvic splanchnic N.

157
Q

What Connects Superior Hypogastric Plexus with Inferior Hypogastric Plexus?

A

Right and Left hypogastric N

NOTE: Sympathetics pass inferiorly to join with Inferior Hypogastric Plexus and Parasympathetics pass superiorly to join with Superior Hypogastric Plexus

158
Q

Inferior hypogastric plexus follows branches of _____ to pelvic viscera?

A

Internal iliac A.

159
Q

where is the inferior hypogastric plexus?

A

Between Internal iliac AV, lateral to rectum, vagina and urinary bladder

160
Q

In males, what does the inferior hypogastric plexus innervate?

A

prostate, seminal vesicles, penile erectile tissue

161
Q

In females, what does the inferior hypogastric plexus innervate?

A

ovary, uterine tube, uterus, vagina, clitoral erectile tissue

162
Q

In both sexes, what does the inferior hypogastric plexus innervate?

A

Rectum and urinary bladder

Gross III (20 decks)

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