Pelvic anatomy Flashcards
Which structures are a hydrocele found
Parietal and visceral layers of tunica vaginalis
If there is a rupture of the urethra where membranous meets bulbar where does the urine go
Anteriorly into connective tissue surrounding scrotum
Roots supplying external anal sphincter
S2,3,4- from inferior rectal
Keeps poo off the floor
Nerves damaged on left sided colonic resections
Parasympathetic plexus
Impaired detrusor contraction
Where does the membranous and prostatic urethra drain
Internal iliac
Where does bulbar urethra drain
Glans- deep inguinal
Skin- superficial
Crura- to internal
Which veins drain which haemorrhoids
Internal hemorrhoids drain through the superior rectal vein into the portal system.
External hemorrhoids drain through the inferior rectal vein into internal pudendal and into the inferior vena cava.
First bit of resistance when inserting catheter in male
Membranous
Due to external sphincter
Contents of deep peroneal pouch
External Urethral sphincter
Deep Transversus perinei
Dorsal nerve of penis, muscular branches of the perineal nerve
Deep and dorsal arteries of penis, stem of origin of artery to the bulb of penis, urethral artery
Location of deep and superficial peroneal pouch
Deep - between peroneal membrane and deep fascia of pelvic floor
Superficial- peroneal membrane and superficial perineal fascia
Content of superficial peroneal pouch
Erectile tissues that form the penis and clitoris- corpa cavernosum and spongiosum
three muscles – the ischiocavernosus, bulbospongiosus and superficial transverse perineal muscles.
The greater vestibular glands (Bartholin’s glands) are also located in the superficial perineal pouch
Posterior scrotal artery and nerve
In females the internal pudendal artery branches to become the posterior labial arteries in the superficial perineal pouch.
Lymphatics of urethra
Glans- deep inguinal
Prostatic, membranous- internal illiac
Blood supply of urethra
Prostatic- inferior vesicle
Membranous urethra – supplied by the bulbourethral artery (branch of the internal pudendal artery)
Penile urethra – supplied directly by branches of the internal pudendal artery.
Autonomic nerves and plexus of abdomen and pelvis, their origin and what they supply
Abdo
Symp
T5-9 - Greater splanchnic nerve - Coeliac plexus- Foregut
T10-11- Lesser SN- SM plexus- midgut
T12- Least SN- aorticorenal- renal and adrenals
L1-3- Lumbar- Inf M plexus - Hindgut
Para- Vagus- all up to end of midgut
Pelvic splanchnic- Hindgut (via inf Hypogastric)
Pelvis
Symp- Sacral splanchnic- Hypogastric plexus - hypogastric nerve (bladder), pudendal (penis)
Para- pelvic splanchnic (via inf hypogastric plexus)
Where is penile urethra situated, what surrounds it
Located in bulb of penis
Corpus spongiosum surrounds it
Function of bulbospongiosum and ischiocavernosum
Bulbospongiosum - in males to empty urethra
-In females, it helps to empty the greater vestibular glands by constricting the vaginal orifice. The anterior fibers compress the deep dorsal vein of clitoris, facilitating the erection of this structure.
Ischiocavernosus - maintain erection by forcing blood into corpus cavenosum
Compressing deep dorsal vein of penis
Vestible glands of female
Greater- Bartholin- inf/post portion
Lesser- Skene - super/ant
Pudendal nerve route
Greater sciatic then lesser
After travels through Alocks canal with pudendal artery and vein
Which is formed by obturator interns fascia
Most important ligament for supporting uterus
Central perineal tendon- damage can cause prolapse
Which muscle is the pudendal canal inferior to
Obturator internus
What will happen in nerves by IMA are damaged in high anterior resection
Impaired contraction of detrusor
Para damage
Lymphatic drainage of female urethra
Internal iliac
Main drainage of bladder
vesicoprostatic plexus
Initial location of the metanephric cap from which the kidney is derived
Medial to uteric bud in the pelvis
What are the ureters related to and could be affected in its removal
Internal iliac
Ovarian artery
Peritoneum
Sigmoid
Round lig is not
Blood supply of prostate
Inferior vesical artery
Which muscle lies superior to pudendal canal
Obturator interns
Where is the resection of prostate limited to
The vermontanum distally to avoid sphincter and continence
Does the membranous urethra cross urogenital diaphragm
No
What is the continuation of scarpers fasciae in perineum and where is it found
Colles
Attaches to ischipubic rami and perineal membrane
Dividing prostate from penis bulb
Most Likely location of ectopic pregnancy
Ampulla
Isthmus 2nd
What arises from urogenital sinus
Urethra, bladder (not trigone), prostate and bulbourethral gland
Location and Purpose of bulbourethral gland
Inferior to prostate, posterolateral to membranous urethra
Secrete lubrications to spongy urethra and PSA
Colles fascia and what is it a continuation of
Deep layer of perineal (Colles’ fascia) – continuous with Scarpa’s fascia of the anterior abdominal wall
Rectum vs sigmoid- taeni coli
Sigmoid has
These blend together 5cm above rectum giving rise to longitundical that surrounds rectum
Rectum does not have coli
Which nerve exits with pirifomis causing buttock parathesia
Scatic
Transtubercular plane
L5
Pudendal block
1 cm inferior and medial relative to the attachment of the sacrospinous ligament to the ischial spine
Bones forming acetabulum
Ischium (post), ilium and pubic (ant)
Erectile dysfunction and wasting of buttock but femoral pulse present
Internal iliac
Superficial femoral artery
Femoral after giving off profunda branch
Layers of uterus
Endo- inner
Myometrium
Perimetrium
Who is at risk of Alock syndrome and feature
Cyclist
Compression of pudendal - S2-4
Penile scrotal para, weird ejac, incontinence
What pierces the femoral sheath
Great saphenous at medial border
Where does the femoral sheath end proximally and distally
4cm below inguinal ligament
End distally by blending into tunica adventitia of vessels
What are the structures palpable on DRE in female vs male
Both- coccyx, sacrum, ischial spines
Prostate men
Cervix women
Uterosacral and ovaries sometimes
Lymphatics of anal canal
Below dentate- superficial
Above- internal lilac
Where does rectum start
S3
Lymphatics of rectum
Upper 2/3 IM
Lower 1/3 internal iliac
Patient presents with rectocele what muscle weakness is the cause
Levator ani
Where to perform iliohypo/ilioinguinal block
2cm medial and cephalic to ASIS
Posterior sciatic block location
4cm distal to midpoint of greater trochanter and PSIS
Obturator nerve block
4cm medial to pubic tubercle
3cm cepahlad to adductor longus
Formation of anterior and posterior triangle
Anterior – pubic symphysis.
Posterior – tip of the coccyx.
Laterally – inferior pubic rami and inferior ischial rami, and the sacrotuberous ligament.
Roof – pelvic floor.
Base – skin and fascia.
Structures attaching to perineal body
Bulbospongiosus
Transverse perineal superficial and deep
Anterior levator ani
External Urethral sphincter
External anal
What makes up pelvic floor
Levator ani
Coccygeus
Fascia
Borders of sischioanal fossa
Ant- transversus perinea superfiicalis
Glut max- post
Ischial tuberosity and OI- laterally
Levator ani- medial and sup
Most common nodes mets from cervix
Obturator
?or external
2 regions of cervic
Endocervix- columnar, mucus
External to internal os
Ectocervix - squamous
Starts at external Os into vaginal
Which part does ejaculatory ducts flow into
Prostatic urethras
Sympathetic innervation of testes
Lesser splanchnic T10
Which veins spreads prostatic mets
Intervertebral venous plexus
Lymphatic drainage of prostate
Obturator and internal
Zones of prostate
Central, peripheral, transisitonal and anterior fibromuscular
Littres hernia
Meckels
Shoudlice repair
Open inguinal without mesh
Useful when CI- contaminated or perf
Lower border of greater sciatic foramen
Sacrospinous
Borders of lesser sciatic
Upper sacrospinous
Lower Sacrotuberous
Tumour in ant vagina likely to affect
Fundus of bladder
Peritoneal covering of bladder
Superior surface and some of base
Borders of inguinal canal
Posterior- Lateral 2/3 TF
Conjoint medially (TA IO)
Roof- TA, IO
Anterior- EO
Floor- IL
What does lumbosacral trunk lie anterior to and pass under
Anterior to Piriformis
Pass under common lilac
Uterie artery relation with uterers by lateral fornix
Superior and anteriro
Where does uterine artery and uteres cross
2cm superior to ischial spine
