Pelvic Anatomy Flashcards
Divides the true and false pelvis
iliopectineal line
True Pelvis location
inferior to pelvic brim
True Pelvis
Anterior Boundary
symphysis pubis
True Pelvis
Posterior Boundary
sacrum and coccyx
True Pelvis
Posterolateral Wall
piriformis and coccygeus muscles
True Pelvis
Anterolateral Wall
hip bone and obturator internus muscles
True Pelvis
Lateral Boundaries
fused ilium an dischium
True Pelvis
Pelvic Floor
levator ani and coccygeus muscles
True Pelvis contains
female reproductive system, urinary bladder, distal ureters and bowl
False Pelvis location
superior to pelvic brim
False Pelvis
Anterior Boundary
abd wall
False Pelvis
Posterior boundary
flanged portions of the iliac bones and base of the sacrum
False Pelvis
Lateral Boundaries
abd wall
False Pelvis contains
loops of bowl
Levator ani group of muscles
puborectalis
iliococcygeus
pubococcygeus
what does the Levator ani
support and positions the pelvic organ
Levator ani position
- most caudal structure w/in pelvic cavity
- Medial to obturator internus muscle
- posterior to vag and cx
Levator ani sono appearence
- low-level, midly curved linear echoes posterior to the vag
- hypoechoic compared to the normal UT
Iliopsoas Muscle
- formed by psoas major and iliacus muscles
- lateral landmark of true pelvis
Iliopsoas location
- anterior and lateral through the false pelvis
- descend until attaching to lesser trochanter of femur
Iliopsoas sono appearence
loe-level gray echoes with a distinct central hyperechoic focus
Piriformis muscle
- arise from sacrum
- form part of pelvic floor
- course through the greater sciatic notch
Piriformis muscle location
- posterior to ut, ov, vag, and rectum
- anterior to sacrum
- course diagonally to the obturator internus muscle
piriformis muscle sono appearence
- low-level linear echoes
- hypoechoic compared to the normal UT
Psoas major
- arise from lumbar spine
- descends into false pelvis
psoas major location
- courses laterally and anteriorly into false pelvis
- exits posterior to the inguinal ligaments
psos major sono appearence
- low-level echogenicity
- round in shape in trans
obturator internus muscle
- lateral margin of true pelvis
- surround the obturator foramen
obturator internus muscle location
- posterior and medial to iliopsoas muscle
- level of vag
- lateral to ov
obturator internus muscle sono appearence
- low-level linear echoes abutting the lateral walls of the bladder
Broad ligaments support
UT
tubes
ov
broad ligaments location
lateral aspect of ut to side wall of pelvis
round ligaments supports
ut (fundus)
round ligaments location
ut cornua to labia majora b/t the folds of the broad ligaemnts
suspensory ligaments
ov
tubes
suspensory ligaments location
ov to pelvis sidewall
ov ligaments supports
ov
ovarian ligaments location
ov to laterl surface of ut
cardinal ligaments supports
ut
cardinal ligaments location
ut to sacrum
Arcuate Vessels
prominent vascular structures in the outer one third of myometrium
Radial arteries arise from
arcuate vessels
Spiral arteries of the endo arise from
radial arteries
Radial arteries branch into
straight arteries to support the inner myometrium and endo
Internal iliac arteries
(hypogastric arteries) supplies the
bladder, ut, vag, and rectum
Internal iliac arteries
(hypogastric arteries) give rise to the
uterine and ov arteries
Internal iliac arteries
(hypogastric arteries) 4 branches
obtruator
umbilical
uterine-vag
superior vesicle arties
Internal iliac vein drains
pelvic organ and muscle
ov arteries supplies t the
ov
ov arteries connect with the
ut arteries
ov veins course within
suspensory ligaments
ov vein supply the
cx, vag, ut, ov, and tubes
left ov vein empties into
left renal vein
right ov vein empties into
IVC
UT arteries supply
cx, vag, ut, ov, and tubes
UT arteries terminate at
the confluence with ov artery
Radial arteries are apart of the
deep layers of the myometrium
Ov has a dual supply from what arteries
ov and ut
Straight arteries (basal) are apart of what layer
basal
spiral arteries (coiled) are apart of what layer
decidual layer
Retrouterine Pouch
Posterior cul de sac, Pouch of Douglas
- Anterior to rectum
- Posterior to ut
- most common site for fluid to accumulate
Space of Retzius
Retropubic Space, Prevesical Space
- Anterior to bladder
- Posterior to symphysis pubis
Vesicouterine Pouch
Anterior cul de sac
- Anterior to ut
- Posterior to bladder
Vagina
collapsed muscular tube located poastior to bladder and urethra and anterior to rectum and anus
sides of vag are enclosed between
levator ani muscle
vag is supplied by the
vag and ut arteries
vag is emptied by
internal iliac veins
Uterus
hollow, pear shaped retorperitoneal organ
ut dervived from the
fused caudal portion of paired hollow mullerian ducts
The ut is supported by the
levator ani muscle, cardinal ligaments, and uterosacral ligaments
ut growth
begins at approx 7 to 8 yrs of age, accelerates during puberty and continues to grow until approx 20 yrs of age
Perimetrium
- serosal/ external surface of ut
- part of parietal peritonium
Myometrium
- thickest layer of ut
- three layers: outer, intermediate, and inner layer
Myometrium
Outer layer
- adj to serosa
- seperated from the intermediate layer by arcuate vessels
Myometrium
Indermediate layer
thickest of three layers
Myometrium
inner layer
- junctional zone
- thin layer adj to endo
Endo
- muscous membrane lining the ut cavity
- thickness is related to hormone level
- two layers: functional and basal
Ut size varies ccording to
age
# of pregnancies
day of menstrual cycle
ut is smallest on day
12
ut is largest on day
27
ut size does what post menopausal
decreases
Dextroposed
ut body angle to rt of cx
Levoposed
ut body angled to lt of cx
retroverted
whole ut is displaced posteriorly
most common
Retroflexed
only fundus is displaced posteriorly
Retrocession
is the whole ut and cx is displaced posteriorly
Anteverted
typical version
body is tilts forward, forming 90 degree angle or less with cervix
Anteflexed
ut body tilts forward and comes in contact with cervix forming an acute angle between body and cx
Basal layer sono appearence
hypoechoic
functional layer sono appearence
hyperechoic
What is not included in endo measurement
basal and fluid w/in endo
UT agenesis
- failure of the caudal mullerian ducts to develop
- fallopian tubes are present
UT arcuate
septum between the mullerian duct is almost complete resorption of septum with only mild indention of the endo of the fundus
UT bicornuate
- partial fusion of the mullerian ducts
- two uteri in superior portion of ut
UT didelphys
complete fusion of the mullerian ducts to fuse
ut septae
- complete fusion of the mullerian ductss with failure to completely reabsorb the septum
- two ut cavities and one ut fundus
ut subseptae
complete fusion of the mullerian ducts with partial failure to completely resorb the septum
ut unicornuate
unilateral development of the paired mullerian ducts
Ovaries
paired, almond-shaped endocrine gland located lateral to the ut
without hormone replacement therapy, the ovaries
decrease in size
The ovaries are attached to the posterior surface of the broad ligaments by
the mesovarian
What organ is the only abdominpelvic cavity not lined by peritonuem
ov
Ov dual supply is through the
uterine and ov arteries
Cortex of the ov
consists of follicles and is covered with tunica albuginea
medulla of the ov
composed of connective tissue and contains nerves, blood, lymph vessels, and smooth muscle at the hilus region
tunica albuginea
- outer layer
- surrounded by a thin layer of germinal epithelium
Each ov is connected by
- mesovarian lig to the broad lig
- uterovarian lig to inf portion of ut
- suspensory lig to pelvic sidewall
- medial, lateral and posterior borders of each ov are not attached
Function of ov
- produce ova
- produce hormones
Estrogen is secreted by
follicles
progestrone is secreted by
corpus luteum
Sono appearence of ov
isoechoic to hypoechoic compared to ut
Hypoechoic periphery of the ov represents the
tunica albuginea
During mensas and early proliferative phases, the ov artery demonstrated what kind of flow
high resistive with a low flow velocity
Resistive index of ov
.4-.8
Pulsatiliyu index of ov
.6-2.5
Menarche ov measurements
2.5-5 cm length
1.5-3 cm height
.9-2.2cm width
ov valume varies with
age, menstural status, body habitus, preg status, and phase of menstrual cycle
lowest volume of ov is during
luteal phase
highest volume of ov is during
periovartory phase
Large volumes of ov at birth as a result of
maternal hormones
stable volume of ov up to age
5 yrs old
volume of ov peaks in
3rd decade
volume of ov declines at
5th decade
L-shaped ovaries
normal ov variant giving the appearence of two arms
Agenesis of the ov is assoc with
abnormal karyotype
Fallopian tubes
paired muscular tubesbes
Fallopian tubes are derived from
nonfused cranial portion of the mullerian ducts
Fallopian tubes contained in
the superior portion of the broad lig and covered by peritoneum
Fallopian tubes are composed of an
outer layer of peritoneum, middle muscular layer, and an internal mucosal layer
Function of the fallopian tubes
attract and transfer ova from the surface of the ov to the endo cavity
Interstitial of fallopian tubes
- passes through the cornua of the ut
- narrowest portion
isthmus of fallopian tubes
- immedialty adj to ut wall
- short, straight, narrow portion of tube
ampulla of fallopian tubes
- widest, longest, and most coiled portion
- region where fertilizationg occurs
- most common area for ectpoics
infundibulum of fallopian tubes
- funnel-shaped distal portion of tubes
- terminates at fimbrial processes
- one fimbriae is attached to ov
- opens into the peritoneal cavity adj to ov
size of fallopian tube
- 7 - 12 cm
- 8 - 10 mm in diameter
fallopian tube is lined with
mucosa