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Reproductive system > Pelvic anatomy > Flashcards

Pelvic anatomy Flashcards

1
Q

Pelvic inlet (pelvic brim) boundaries

A

Posterior: sacral promontory
Anterior: pubic symphysis
Lateral: iliopectineal line

It is the boundary between the true and false pelvis

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2
Q

What vessels cross the pelvic inlet?

A

Ovarian vessels
Median sacral artery
Inferior mesenteric artery -> superior rectal artery

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3
Q

Pelvic outlet boundaries

A

Posterior: tip of coccyx
Anterior: pubic arch
Lateral: ischial tuberosity + sacrotuberous ligament

Border between pelvic cavity and perineum

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4
Q

What are the main differences between the male and female pelvis?

A
  • Subpubic angle (M = <70 degrees; F = >8- degrees)
  • Pelvic outlet (M = small; F = large)
  • True pelvis (M = narrow, deep; F = wide, shallow)
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5
Q

Contents and boundaries of lesser (true) pelvis

A

Contents:

  • True pelvic cavity
  • Deep perineum

Boundaries:

  • Pelvic surfaces of the hip bones
  • Sacrum and coccyx
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6
Q

Attachments of the sacrotuberous ligament

A

From the sacrum to the ischial tuberosity

- Forms the sciatic notch border to make it a foramen

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7
Q

Attachments of the sacrospinous ligament

A

From the sacrum to the ischial spine

- Separates sciatic foramen into greater and lesser sciatic foramen

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8
Q

What are the four different shapes of the pelvic girdle?

A

Android - most common in males
Gynecoid - most common in females
Anthropoid - common, not good for child birth
Platypelloid - uncommon, not good for child birth

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9
Q

Differentiate between the true conjugate, obstetric conjugate and diagonal conjugate measurements

A

True: sacral promontory to superior border of pubic symphysis; 1.5cm less than diagonal conjugate

Obstetric: sacral promontory to middle of pubic symphysis, smallest diameter baby must pass through

Diagonal: sacral promontory to inferior aspect of pubic symphysis, estimate of obstetric

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10
Q

What is the plane of least dimensions?

A

It is the smallest part a baby must pass through
Boundaries:
- Anterior: lower border of pubic symphysis
- Posterior: lower border of sacrum
- Lateral: ischial spines

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11
Q

Obturator internus muscle

A

Lateral wall muscle, from pelvic surfaces of ilium, ischium and obturator membrane to greater trochanter of the femur.
Innervated by nerve to obturator internus (L5, S1, S2)

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12
Q

Piriformis muscle

A

Posterosuperior wall muscle, S2-S4 vertebrae to superior greater sciatic notch and sacrotuberous ligament
Innervated by anterior rami of S1 and S2

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13
Q

What are the muscles of the pelvic floor?

A 
Coccygeus
Levator ani:
- Puborectalis
- Pubococcygeus 
- Pubovaginalis
- Iliococcygeus
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14
Q

Coccygeus muscle

A

Ischial spine to inferior coccyx

Innervated by S4 and S5

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15
Q

Individual functions of levator ani muscles

A

Pubococcygeus: main muscle
Iliococcygeus: elevates pelvic floor and anorectal canal
Puborectalis: maintains continence
Pubovaginalis: maintains urinary continence

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16
Q

Collective role of levator ani muscles and innervation

A

Collectively function to support pelvic viscera and resists increases in intra-abdominal pressure
Innervated by pudendal nerve (S2, S3, S4)

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17
Q

What is the broad ligament?

A

Double layer of peritoneum that connects the uterus to the lateral walls and floor of pelvis
3 parts:
- Mesometrium - extends laterally from uterus
- Mesosalpinx - drapes over the fallopian tubes
- Mesovarium - drapes over the ovaries

18
Q

Contents of the broad ligament

A

Organs:

  • Uterus
  • Fallopian tubes
  • Ovaries

Vessels:

  • Ovarian artery
  • Uterine artery

Ligaments:

  • Ovarian ligament
  • Round ligament of uterus
  • Suspensory ligament of uterus
19
Q

Pouches of the pelvic cavity

A

Males have 1, females have 2
Rectovesical pouch (males):
- Between rectum and bladder
- Most inferior part of the peritoneal cavity

Rectouterine pouch (females):

  • Called the “Pouch of Douglas”
  • Between rectum and uterus
  • Most inferior part of peritoneal cavity - fluid accumulates here when erect
Vesicouterine pouch (females):
- Between bladder and uterus
20
Q

Somatic nervous supply to the peritoneum

A 
Mostly derived from the sacral plexus (L4, L5, S1, S2, S3, S4) - most branches exit pelvis through greater sciatic foramen
Main nerves:
- Sciatic nerve (L4, L5, S1, S2, S3)
- Pudendal nerve (S2, S3, S4)
- Obturator nerve (L2, L3, L4)
- Superior gluteal nerve
- Inferior gluteal nerve
21
Q

Function of sciatic nerve

A
  • Posterior thigh muscles

- Sensory innervation of lower leg and foot

22
Q

Course of pudendal nerve

A

Exits pelvis via greater sciatic foramen, re-enters via lesser sciatic foramen
Travels through pudendal canal

23
Q

Function of pudendal nerve

A

Supplies:

  • Pelvic floor muscles
  • External urethral and anal sphincters
  • Sensory innervation of perineum
24
Q

Function of the obturator nerve

A

Motor and sensory innervation to the medial thigh

25
Q

Superior gluteal nerve

A

Leaves pelvis via greater sciatic foramen (above piriformis), supplies gluteal region

26
Q

Inferior gluteal nerve

A

Leaves pelvis via greater sciatic foramen (below piriformis), supplies gluteal region

27
Q

What are the four routes through which autonomic nerves enter the pelvis?

A
  1. Sacral sympathetic trunks
  2. Peri-arterial plexuses
  3. Hypogastric plexuses
  4. Pelvic splanchnic nerves
28
Q

Sacral sympathetic trunks (autonomic supply to pelvis)

A
  • Continuation of lumbar sympathetic trunks
  • Descend down the pelvic side of the sacrum
  • Provide post-synaptic sympathetic fibres to sacral plexus for sympathetic innervation of lower limb
29
Q

Peri-arterial plexuses (autonomic supply to pelvis)

A
  • Supply the ovarian, superior rectal and internal iliac arteries
  • Main function is vasomotion
30
Q

Hypogastric plexuses (autonomic supply to pelvis)

A

There are superior and inferior hypogastric plexuses

31
Q

Course of the superior hypogastric plexus

A
  • Enters the pelvis and becomes right and left hypogastric nerves - these descend on anterior surface of the sacrum
  • They merge with pelvic splanchnic nerves to become left and right inferior hypogastric plexuses
32
Q

Inferior hypogastric plexuses function

A

Sympathetic fibres:
- Sacral splanchnic nerves provide fibres to pelvic vessels and structures

Parasympathetic fibres:
- Pelvic splanchnic nerves innervate all viscera below the splenic flexure

33
Q

Pelvic splanchnic nerves (autonomic supply to pelvis)

A
  • Arise from S2-S4 nerve roots

- Carry pre-synaptic parasympathetic fibres and visceral afferent fibres

34
Q

General function of sympathetic and parasympathetic fibres in the pelvic region

A

Sympathetic:

  • Mainly from lumbar splanchnic nerve
  • Inhibit peristaltic movement of rectum
  • Stimulates contraction of internal genital organs during orgasm
  • Vasomotion

Parasympathetic:

  • Mainly from pelvic splanchnic nerve
  • Stimulate contraction of rectum and bladder
  • Stimulate erections
35
Q

Lymphatic drainage of the perineum

A

Testes/Ovaries - para-aortic lymph nodes
Superior rectum + sigmoid colon - para-rectal + inferior mesenteric lymph nodes
Scrotum, perianal skin, anal canal (below dentate line), skin of perineum + round ligament - superficial inguinal lymph nodes

36
Q

Contents of the suprapiriform foramen

A

Superior gluteal a., v. and n.

37
Q

Contents of the infrapiriform foramen

A

Internal pudendal a. and v.
Inferior gluteal a., v. and n.
Sciatic n.
Pudendal n.

38
Q

Contents of the lesser sciatic foramen

A

Internal pudendal a. and v.
Pudendal n.
- Both are ENTERING the pelvis

39
Q

Vascular supply to the pelvis

A
  • Most comes from internal iliac artery
  • Aorta -> common iliac @ L4 -> int/ext iliac @ L5/S1
  • Internal iliac crosses the pelvic inlet and splits into anterior and posterior trunks at superior border of greater sciatic foramen
40
Q

Anterior trunk of CIA divisions

A

9 divisions
REMEMBER: 3 to walls, 3 to bladder, 3 to viscera
Walls:
- Internal pudendal (terminal divisions are perineal artery, dorsal arteries of penis/clitoris)
- Inferior gluteal (supplies gluteus maximus, skin of buttocks)
- Obturator artery (through obturator canal)

Bladder:

  • Umbilical (forms medial umbilical ligament)
  • Superior vesical (supplies superior bladder)
  • Inferior vesical (supplies inferior bladder)

Viscera:

  • Uterine (supplies uterus, runs over ureter)
  • Middle rectal (supplies distal rectum)
  • Vaginal (supplies inferior bladder, vagina and rectum)
41
Q

Posterior trunk of CIA divisions

A

Iliolumbar arteries

  • Lumbar division: post. abdominal wall, psoas major
  • Iliac division: iliac fossa

Lateral sacral arteries
- Piriformis, erector spinae, associated skin

Superior gluteal arteries
- Piriformis, all three gluteal muscles

Ovarian artery

  • Branches off aorta inferior to renal arteries and superior to IMA
  • Gives of ovarian and tubule branches

Reproductive system (9 decks)

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