PELVIC CAVITY Flashcards
What is the most inferior portion of the abdominopelvic cavity? (Hint: A cavity)
Pelvic Cavity
What bony structure surrounds the pelvis?
PELVIC GIRDLE (bony pelvis - it’s part of the appendicular skeleton)
What are the 2 subdivisions of the Pelvis?
Greater Pelvis
Lesser Pelvis
What 3 bones help form the pelvic girdle?
Left Hip Bone
Right Hip Bone
Sacrum
What are the 3 main regions on the Left and Right Hip Bones?
Ilium (fan-shaped bone that has a wing called the ALA)
Ischium
Pubis
What forms a rim between the ASIS and PSIS? (Hint : It’s on the ILLIUM)
What vertebral level is this structured found at?
ILLIAC CREST
L4
What do we call the ANTEROMEDIAL surface of the ALA?
ILLIAC FOSSA
The Ischial Ramus of the ischium and the inferior ramus of the pubis helps form what opening?
(Remember.. Ischium has a body and a ramus).
Obturator Foramen
The postero-inferior protuberance on the ischium is called?
ISCHIAL TUBEROSITY
The postero-medial projection on the ischium is called?
ISCHIAL SPINE
What 2 structures does the Pubis have?
Body
SUPERIOR and INFERIOR RAMUS
Where is the pubic crest located? (like where on the left/right hip bone)
Body of Pubis
Where does the pubic crest end laterally? What do we call this location?
PUBIC TUBERCLE
The superior ramus of the pubis has an oblique ridge that is called? (Hint: it is continuous with the arcuate line)
PECTEN PUBIS
What do the ILLIUM, ISCHIUM, PUBIS contribute to?
ACETABULUM
The fusion of the S1-S5 vertebrae are called?
Remember.. the sacrum has a sacral promontory on the top/anterior edge of the body of the 1st sacral vertebrae.
SACRUM
What structure do the ventral and dorsal rami of S1-S5 spinal nerves pass through?
ANTERIOR and POSTERIOR SACRAL FORAMINA
What is considered the inferior end of the vertebral canal?
SACRAL CANAL
What structure is formed by the LOSS of the laminae and spinal process of S4 and S5?
This structure is where we would give caudal anesthesia during labor
SACRAL HIATUS
What are the 2 subdivisions of the PELVIS?
What divides the PELVIS ?
GREATER PELVIS (FALSE PELVIS) –> everything above the pelvic brim/inlet
LESSER PELVIS (TRUE PELVIS) –> everything below the pelvic brim/inlet (everything between pelvic inlet and and pelvic outlet)
PELVIC INLET
What is the bony ridge that surrounds the pelvic inlet?
What forms this structure?
PELVIC BRIM
ALA of ILLEUM, SACRAL PROMONTORY, LEFT and RIGHT LINEA TERMINALIS
What forms the LINEA TERMINALIS ? (There is a right and left linea terminalis)
ARCUATE LINE, PECTIN PUBIS, PUBIC CREST
It is a continuation of these 3.
What forms/ are the borders of the PELVIC OUTLET?
TIP OF COCCYX
PUBIC ARCH
SACROTUBEROUS LIGAMENTS
ISCHIAL TUBEROSITY
Between the articular surfaces of the sacrum and ileum, what joint is there?
What type of joint is it? (WIERD ONE)
Why is this joint weird?
SACRO-ILLIAC JOINT
Consists of ANTERIOR SYNOVIAL JOINT and POSTERIOR FIBROUS JOINT (has limited mobility)
Because it is both synovial and fibrous. There is a fibrous part of the joint thanks to the tuberosities that form a posterior SYNDESMOSIS (fibrous joint).
What ligaments help support the SACRO-ILLIAC JOINT? (3)
ANTERIOR and POSTERIOR SACRO-ILLIAC LIGAMENTS
INTEROSSEUOUS SACRO-ILLIAC LIGAMENT
What maintains the AP diameter and doesn’t allow the coccyx to swing back too much when we put our weight on the sacrum? (Hint: 2 ligaments)
These ligaments provide resistance to the sacroilliac region upon sudden weight increase on the vertebral column.
SACROTUBEROUS LIGAMENT
SACROSPINOUS LIGAMENT
When the bodies of the pubic bones unite, what structure do they form?
What type of joint is this?
PUBIC SYMPHISIS
SECONDARY CARTILAGINOUS JOINT
The subpubic angle aka pubic arch is what length in males versus females ?
MALES : 70 degrees
FEMALES : 90-100 degrees
What forms the LUMBOSACRAL JOINT ? (Hint: combo joint)
Intervertebral Joint (between L5 and S1)
2 Zygopophyseal Joints (Common facet joints) (SYNOVIAL JOINTS)
What does the ILIOLUMBAR LIGAMENTS do?
They unite the transverse processes of L4 and L5 to the Ilium.
What type of joint is the SACROCOCCYGEAL JOINT? (between the sacrum and coccyx)
SECONDARY CARTILAGINIOUS JOINT
What ligaments help reinforce the SACROCOCCYGEAL JOINTS?
ANTERIOR and POSTERIOR SACROCOCCYGEAL LIGAMENTS
What hormone helps to relax the pelvic joints and ligaments ? (This hormone increases during the latter half of pregnancy)
RELAXIN (helps to relax the sacroiliac joints and the pubic symphysis to allow for about 10-15% increase in diameter) –> helps to facilitate the passage of the fetus through the pelvic canal
What walls makes up the pelvic cavity?
ANTEROINFERIOR WALL
2 LATERAL WALLS
POSTERIOR WALL
What forms the pelvic floor?
PELVIC DIAPHRAGM
What muscles make up the pelvic diaphragm?
LEVATOR ANI
COCCYGEUS MUSCLES
What are subdivisions of the PELVIC FASCIA?
What is found in between the pelvic fascia?
PARIETAL PELVIC FASCIA
VISCERAL PELVIC FASCIA
ENDOPELVIC FASCIA
What makes up the anteroinferior wall of the Pelvic Cavity?
The bodies and rami of the pubic bones and pubic symphysis
What makes the lateral walls of the pelvic cavity?
The hip bones and OBTURATOR FORAMEN, OBTURATOR INTERNUS
What fills in the Obturator Foramen?
Obturator Membrane
What does the obturator fascia form? (Hint: It’s a white line that demarcates the obturator internus and Levator Ani)
TENDINOUS ARCH OF THE LEVATOR ANI
What muscle covers the obturator foramen?
OBTURATOR INTERNUS MUSCLES
What is the function of the OBTURATOR INTERNUS?
What nerve innervates the OBTURATOR INTERNUS?
LATERAL ROTATION and ABDUCTION of THIGH
NERVE OBTURATOR INTERNUS (L5-S2)
What muscle is found in the posterior wall of the the Pelvic Cavity?
PIRIFORMIS MUSCLE
What is the function of the Piriformis Muscle?
What nerve innervates the Piriformis Muscle?
LATERAL ROTATION and ABDUCTION of THIGH
Ventral Rami of S1 and S2
What structures make up the Pelvic Floor?
PELVIC DIAPHRAGM which itself is made up of the LEVATOR ANI muscles and COCCYGEUS muscles
What are the 3 parts of the LEVATOR ANI?
PUBORECTALIS
PUBOCOCYGEUS
ILLIOCOCCYGEUS
Given that the PUBORECTALIS MUSCLE helps maintain fecal continence, what does it wrap around?
It wraps around the ANORECTAL JUNCTION
What body/ligament does the PUBOCOCCYGEUS muscles help form?
It helps form part of the anococcygeal body/ligament
What is the posterolateral part of LEVATOR ANI?
ILIOCOCCYGEUS MUSCLE
What muscle is seen right under the Iliococcygeal muscle?
COCCYGEUS Muscle
What is the function of the Pelvic Diaphragm?
Support the pelvic viscera
Resists the increases in intra-abdominal pressure (for example, when you cough, sneeze, vomit)
What innervates the PELVIC DIAPHRAGM?
Nerve to Levator Ani
Inferior Rectal
Coccygeal Plexus
What innervates the Coccygeus Muscle?
Coccygeal Plexus
VENTRAL RAMI OF S4 and S5
What is the Pelvic Fascia Continuous with?
Remember.. Pelvic Fascia is broken into 2 categories. (Parietal and Visceral)
Pelvic Fascia (connective tissue) that is continuous with the transversalis fascia.
What is the Parietal Pelvic Fascia continuous with?
(Parietal Pelvic Fascia is membranous fascia)
Transversalis Fascia and ILIOPSOAS FASCIA
What does the Visceral Pelvic Fascia line?
(Visceral Pelvic Fascia is membranous fascia)
It lines/ensheathes the pelvic Viscera.
It is continuous with the parietal pelvic fascia near the pelvic floor
IT FORMS ADVENTITIAL LAYER
Where the parietal pelvic fascia thickens, what does it form?
(Hint: this structures runs from the pubis to the sacrum)
TENDINOUS ARCH OF THE PELVIC FASCIA
This is where the parietal pelvic fascia meets the visceral pelvic fascia
What are the most anterior parts of the tendinous arch of pelvic fascia? (HINT: 2 ligaments, one in males and the other in females)
PUBOPROSTATIC LIGAMENT (in males)
PUBOVESICAL LIGAMENT (in females)
What is the pelvic fascia found between the parietal and visceral pelvic fascia?
Remember.. the endopelvic fascia is either “fatty” or “condensed”
ENDOPELVIC FASCIA
What does the condensed part of the endopelvic fascia form?
HYPOGASTRIC SHEATH
This is where the neurovasculature passes through to the pelvic viscera. Also where the ureters and the ductus (vas) deferens passes through.
What are the 3 parts/LAMINEA of the HYPOGRASTRIC SHEATH?
LATERAL LIGAMENT OF THE BLADDER (anterior part)
RECTOVESICAL SEPTUM (males) or CARDINAL LIGAMENT (females) (middle part)
LATERAL RECTAL LIGAMENT
What artery and vein (vessels) passes through the LATERAL LIGAMENT OF THE BLADDER (anterior 1/3rd of the hypogastric sheath)
SUPERIOR VESICAL VESSELS (artery and vein)
What are the components of the “middle” part of the hypogastric sheath?
What vessels and other structure pass through the (female ligament portion)? (Hint: water under the bridge)
RECTOVESICAL SEPTUM (between rectum and prostate in males)
CARDINAL LIGAMENT aka transverse cervical aka Mackenrodt’s ligament (in females)
- uterine vessels (artery and vein) pass through this
- ureter will pass inferior to the vessels
What passes through the LATERAL RECTAL LIGAMENT (posterior 1/3rd of the hypogastric sheath)?
What is the potential space that is found here called?
Middle rectal vessels (artery and vein)
PELVIRECTAL SPACES –> formed by the lateral rectal ligaments
What suspends the vagina?
Where is the vagina suspended?
PARACOLPIUM
Between the tendinous arches of the pelvic fascia
The thickened part of the endopelvic fascia that extends from the sacrum to the uterovaginal junction (cervix) is called?
UTEROSACRAL LIGAMENT (ONLY IN FEMALES)
The cardinal ligament and the uterosacral ligament together are known as?
PARAMETRIUM of the endopelvic fascia
In terms of innervation to the Pelvic Cavity, what plexuses do these nerves innervate from?
Sacral Plexus
Coccygeal Plexus
Pelvic Autonomic Plexus
What supplies the majority of blood to the Lesser Pelvis (true pelvis)?
Branches off of the INTERNAL ILLIAC ARTERIES
What vertebral level is the Sacral Plexus at?
Originates from the ventral rami of L4-S4
What are the 5 branches that come off of the Sacral Plexus? (Pneumonic : SPILS)
Through what structure do most of these branches pass through?
LUMBOSACRAL TRUNK (L4,L5) –> This is not a nerve that innervates a muscle.
SCIATIC NERVE (L4-S3)
PUDENDAL NERVE (S2-S4)
SUPERIOR GLUTEAL NERVE (L4-S1)
INFERIOR GLUTEAL NERVE (L5-S2)
These nerves pass through the greater sciatic foramen when leaving the pelvis.
What vertebral level is the coccygeal plexus at?
ventral rami branches of S4 - Co1 (coccygeal 1)
What do sympathetics do in terms of the Pelvic Area ?
Produce vasomotion
Inhibit Peristaltic Contraction of the rectum
Stimulate contraction of the genital organs during orgasm (leads to ejaculation)
What do parasympathetics do in terms of the Pelvic Area?
Stimulate contraction of the rectum (deification – shitting), bladder (urination)
Supply erectile bodies of the external genitilia (leads to an erection)
Where is the SUPERIOR HYPOGASTRIC PLEXUS found at?
just INFERIOR to the bifurcation of the AORTA (right under L4)
What does the SUPERIOR HYPOGASTRIC PLEXUS split into?
Bifurcates into the LEFT and RIGHT HYPOGASTRIC NERVES
What 2 plexuses does the LEFT and RIGHT Hypogastric nerves connect?
Connects the SUPERIOR AND INFERIOR HYPPOGASTRIC PLEXUSES
What are the 3 smaller visceral nerve plexuses that come off of the INFERIOR HYPOGASTRIC PLEXUSES? (3)
VESICAL PLEXUS
RECTAL PLEXUS
PROSTATIC PLEXUS (males)
UTEROVAGINAL PLEXUS (females)
Where is the IMAGINARY PELVIC PAIN LINE?
It would be found at the INFERIOR LIMIT OF THE PERITONEUM
VA FIBERS transmit pain sensations from the viscera either superior or inferior to the PELVIC PAIN LINE.
What do Sympathetics travel?
What do PARASYMPATHETICS travel with?
Sympathetics travel the pain sensations from the viscera superior to the Pelvic Pain Line
Parasympathetics travel with the pain sensations from the viscera inferior to the Pelvic Pain Line
What plexus contains “ganglion-like cells?
INFERIOR HYPOGASTRIC PLEXUSES
What nerves would synapse at the “ganglion-like cells” of the inferior hypogastric plexus?
Do they actually synapse? (they are mostly sym/post, but the ones that would synapse would have sym/pre fibers).
Sacral Splanchnics (S1-S4)
They normally do not synapse at “ganglion-like” cells.
How do the para/pre fibers get to the hindgut?
Pelvic Splanchnic Nerves (S2 - S4)
What do the Pelvic Splanchnic lead into? (Pelvic Splanchnics coming off of S2-S4)
INFERIOR HYPOGASTRIC PLEXUS
What are the main arteries that supply blood to the Lesser Pelvis (true pelvis)? (Hint: 3 in males, 4 in females) (SIM - O)
INTERNAL ILIAC ARTERY (supplies blood to most of the pelvic region)
MEDIAN SACRAL ARTERY
SUPERIOR RECTAL ARTERY (supplies blood to most of the rectum)
OVARIAN ARTERIES (females) (supplies most of the blood to the ovaries)
Which artery delivers most of the blood to the pelvic region?
INTERNAL ILIAC ARTERY (branch off of the common iliac artery)
Anterior internal iliac artery gives of most of the distal branches
What artery branches off of the aorta when it bifurcates? (Hint: it gives off the 5th lumbar arteries)
MEDIAN SACRAL ARTERY
What artery branches off of the inferior mesenteric artery and SUPPLIES MOST OF THE RECTUM?
SUPERIOR RECTAL ARTERY
Which artery supplies the ovaries? (It comes off of the abdominal aorta)
OVARIAN ARTERY
What are the 2 divisions of the INTERNAL ILLIAC ARTERY?
ANTERIOR
POSTERIOR
What comes of the Anterior Division of the internal iliac artery in males and females?
MALES
- Umbilical artery
- Superior Vesical artery
- Obliterated Umbilical Artery
Obturator Artery
Inferior Vesical Artery
Middle Rectal Artery
Internal Pudendal Artery
Inferior Gluteal Artery
FEMALES
everything same EXCEPT –> there is a UTERINE ARTERY which gives off a VAGINAL ARTERY which gives off the INFERIOR VESICAL ARTERY
What comes of the POSTERIOR Division of the internal iliac artery in males and females? (males and females are the same)
ILIOLUMBAR ARTERY
LATERAL SACRAL ARTERY
SUPERIOR GLUTEAL ARTERY
What are the 9 Pelvic lymph nodes ?
(pneumonic - PEDS are an L, I luv CSI)
Where do they eventually drain to before going to the thoracic duct?
LUMBAR LYMPH NODE
INFERIOR MESENTERIC LYMPH NODE
COMMON ILIAC LYMPH NODE
INTERNAL ILIAC LYMPH NODE
SACRAL LYMPH NODE
PARARECTAL LYMPH NODE
EXTERNAL ILIAC LYMPH NODE
SUPERFICIAL INGUINAL LYMPH NODE
DEEP INGUINAL LYMPH NODE
Lymph eventually makes its way to cisterna chyli and then to the thoracic duct
What is the function of the ureters?
Rememeber.. the ureters pass inferioly to the uterine artery and ductus (vas defernse)
They carry urine from the kidney to the urinary bladder.
They are retroperitoneal
What arteries supply blood to the ureters? (Pneumonic: U-SIG-RIC)
INFERIOR VESICAL ARTERY
UTERINE ARTERIES
RENAL ARTERIES
GONADAL ARTERIES
SUPERIOR VESICAL ARTERIES
COMMON ILIAC ARTERY
INTERNAL ILLIAC ARTERY
Where does the lymph from the ureters drain too? (Pneumonic : LICE)
LUMBAR LYMPH NODE
COMMON ILLIAC LYMPH NODE
EXTERNAL and INTERNAL ILIAC LYMPH NODE
What nerves innervate the ureter? (Pneumonic : HIS- AR)
AUTONOMIC FIBERS from..
RENAL PLEXUS
AORTIC PLEXUS
SUPERIOR/INFERIOR HYPOGASTRIC PLEXUS
Kidney Stones found anywhere along the ureter is called?
What can we do to fix it?
URETERIC CALCULI (stones) –> lead to obstruction of urinary flow
- usually occurs where the ureter is constricted (3 points of constriction)
Calculi can be removed via open surgery, endoscopically, and using LITHOTRIPSY.
LITHOTRIPSY –> using shock waves to break up the stones into smaller fragments
What separates the urinary bladder from the pubic symphysis?
RETROPUBIC SPACE
What are the 4 parts of the urinary bladder?
Remember.. the bladder fill from the bottom up.
APEX
BODY
FUNDUS
NECK (urethra connects to the neck of the urinary bladder)
What muscles are in the walls of the urinary bladder?
What innervates it?
DETRUSOR MUSCLE. (Near the neck of the bladder, the detrusor muscle fibers form the INTERNAL URETHRAL SPHINCTER.
Parasympathetics innervate this muscle causing contraction of the bladder
Near the neck of the bladder (part that the urethra goes into) what is the sphincter called?
What innervates it? (specifically in males, why does is this important)
INTERNAL URETHRAL SPHINCTER (formed by the detrusor muscle fibers)
SYMPATHETICS innervate this sphincter and cause it to contract so that sperm doesn’t travel up into the bladder during ejaculation (PREVENT REFLUX OF SEMEN).
sympathetics also stimulate ejaculation
Looking inside the urinary bladder, what do we see?
What structures are at the angles of this space?
TRIGONE OF THE BLADDER
URETERIC ORIFICES (2 of them) at each upper angle
INTERNAL URETHRAL ORIFICE at the bottom
- there is a slight elevation of the trigone in this orifice called the BLADDER UVULA
What arteries supply blood to the urinary bladder?
SUPERIOR VESICAL ARTERY
INFERIOR VESICLE ARTERY
in females.. also.. VAGINAL ARTERY
Where does lymph from the urinary bladder go?
EXTERNAL and INTERNAL ILIAC LYMPH NODES
Where does the female urethra lie in respect to the vagina?
It lies anterior to the vagina
Between the female urethra and the vagina, there are some glands. What are these glands called?
PARAURETHRAL GLANDS (Skene’s glands) –> Some nerves here (G SPOT)
What arteries supply blood to the female urethra? (Pneumonic: V-IP)
INTERNAL PUDENDAL ARTERY
VAGINAL ARTERY
Where does lymph from the female urethra go to? (Pneumonic: DISS)
SACRAL LYMPH NODE
INTERNAL ILIAC LYMPH NODE
SUPERFICIAL INGUINAL LYMPH NODE
DEEP INGUINAL LYMPH NODE
What nerves innervate the FEMALE URETHRA? (Pneumonic : VNP - P)
VESICLE NERVE PLEXUS
PUDENDAL NERVE
What are the 4 parts of the MALE URETHRA?
Remember.. male urethra has urine and semen running through it
INTRAMURAL (preprostatic)
PROSTATIC
INTERMEDIATE (membranous)
SPONGY (penile) –> longest part of urethra
What arteries supply blood to the MALE URETHRA? (Pneumonic: MID)
INFERIOR VESICAL ARTERY
MIDDLE RECTAL ARTERY
DORSAL ARTERY OF THE PENIS
Where does lymph from the male urethra drain to? (Pneumonic: EID)
INTERNAL and EXTERNAL ILLIAC LYMPH NODES
DEEP INGUINAL LYMPH NODE
What nerves innervate the male urethra? (Pneumonic: PNP - D)
Autonomics from the PROSTATIC NERVE PLEXUS
DORSAL NERVE OF THE PENIS
In order to see inside the bladder, we can go through the urethra and into the bladder. What instrument do we use?
CYTOSCOPE
Vagina is a musculomembranous tube that goes from the cervix (of uterus) down to the vestibule of the vagina.
REMEMBER.. Vagina has vaginal rugae on the inside
What is the recess found on the vagina that extend around the cervix?
VAGINAL FORNIX. (Anterior fornix, 2 lateral fornices, POSTERIOR FORNIX)
What is special about the POSTERIOR FORNIX? (Hint: Culdocentesis –> a procedure that checks for abnormal fluid just behind the vagina.)
When doing a CULDOCENTESIS, surgeons make an incision in the posterior fornix and into the peritoneal cavity to drain a pelvic abscess in the RECTOUTERINE POUCH OF DOUGLAS.
There are 4 muscles that compress the vagina and act like sphincters. What are they? (Pneumonic: PUBE)
PUBOVAGINALIS muscles
URETHROVAGINAL SPHINCTER
EXTERNAL URETHRAL SPHINCTER
BULBOSPONGIOSUS
What arteries supply blood to the Vagina? (
UTERINE ARTERY (first 1/5th)
VAGINAL ARTERY (middle 3/5ths)
INTERNAL PUDENDAL ARTERY (last 1/5th)
Where does the lymph from the vagina drain too? (Pneumonic: ICE - SIS)
INTERNAL and EXTERNAL ILIAC LYMPH NODES
COMMON ILIAC LYMPH NODES
SUPERFICIAL INGUINAL LYMPH NODE
SACRAL LYMPH NODE
What nerves innervate the vagina? (Pneumonic: UV-P)
PUDENDAL NERVE
UTEROVAGINAL PLEXUS (autonomics)
Sympathetics stimulate smooth muscle contraction and vasoconstriction of blood vessels
Parasympathetics are involved transudation.
What are the 3 parts of the UTERUS?
FUNDUS
BODY
CERVIX (has a supravaginal and vaginal portion)
What are the 3 walls of the uterus (3 layers) ?
PERIMETRIUM (outer)
MYOMETRIUM (middle)
ENDOMETRIUM (inner)
What arteries supply blood to the uterus?
UTERINE ARTERIES
Where does the lymph from the uterus drain into? (Pneumonic: ISLES)
LUMBAR LYMPH NODE
SUPERFICIAL INGUINAL LYMPH NODE
EXTERNAL and INTERNAL ILIAC LYMPH NODE
SACRAL LYMPH NODE
What nerve innervates the uterus?
UTEROVAGINAL PLEXUS
What is a hysterectomy?
Where is it performed?
Removal the uterus
It can be performed through the lower abdominal wall or through the vagina.
What is inspected when you perform a pap smear?
The cervix (specifically cellular material from the vaginal surface of the cervix and the supravaginal cervical mucosa)
Vaginal speculum holds the vagina open to enable inspection.
A spatula is then placed on the external os of uterus and rotated to collect cellular material from the vaginal surface of the cervix.
Then you use a cyto-brush and go inside the cervical canal to collect cellular material from the SUPRAVAGINAL CERVICAL MUCOSA.
What types of regional anesthetics can be given for child birth?
LUMBAR EPIDURAL and LOW SPINAL BLOCK –> anesthetize somatic and VE fibers below the waist (include intra and subperitoneal, and somatic areas. –> therefore the uterus, entire birth canal, perineum, and lower limbs will not feel anything.
CAUDAL UPIDURAL BLOCK –> CAN ONLY BE DONE FOR PARTICIPATORY CHILD BIRTH (in advance, and not for precipitous child birth)
- Anesthetize subperitoneal and somatic areas from pelvic pain line and inferiorly.
- birth canal is anesthetized but uterine contractions are still felt (lower limbs are not anesthetized)
PUDENDAL NERVE BLOCK –> only anesthetizes the areas innervated by the pudendal nerve (perineum)
What are the 3 main parts of the BROAD LIGAMENT? (broad ligament is double layer of peritoneum)
MESOMETRIUM (mesentery of uterus)
MESOSALPINX (mesentery of uterine tube)
MESOVARIUM (suspends the ovary)
The superolateral extension of the Broad Ligament is called? (Hint: INFUNDIBULOPELVIC LIGAMENT)
SUSPENSORY LIGAMENT OF THE OVARY
What ligament attaches the ovary to the uterus?
It is a remnant of what?
OVARIAN LIGAMENT
Remnant of GUBERNACULUM
What attaches the fundus of the uterus to labia majora?
It is a remnant of what?
ROUND LIGAMENT
Remnant of GUBERNACULUM
What two positions does the adult uterus usually rest in?
Antiverted position (bend in the cervix of the uterus)
Antiflexed position (bend in the body of the uterus)
If the uterus is not sitting on top of the bladder, what position is it in?
When the uterus is sitting on top of the bladder, but has slid a bit backwards, what position is it in?
RETROVERTED POSITION (1st, 2nd, 3rd degree)
RETROCESSION position
What supplies blood to the uterine (fallopian tubes)?
OVARIAN ARTERY
UTERINE ARTERY
Where does the lymph from the Uterine (fallopian) tubes drain into?
LUMBAR LYMPH NODE
What innervates the uterine (fallopian) tubes?
OVARIAN PERIARTERIAL PLEXUS (autonomics)
UTEROVAGINAL PLEXUS
sympathetics constrict and parasympathetics vasodilate
Abdominal tubal ligation is usually performed laproscopically just at the pubic hairline.
What are we doing when we do that procedure? (Hint: this is a surgical method of birth control –> prevents pregnancy)
LIGATION OF UTERINE TUBES
When a blastocyst fails to reach the uterus and implants into the mucosa of the uterine tube (fallopian tubes, usually at the ampulla), what is this called?
ECTOPIC TUBAL PREGNANCY
80% - happens at ampulla of uterine tube
12% tubal implantation
1.4% - implants in the rectouterine pouch of Douglas
What 2 ligaments are associated with the ovaries?
OVARIAN LIGAMENT
SUSPENSORY LIGAMENT
What supplies blood to the ovaries?
Where does the Left Ovarian Vein drain too?
OVARIAN ARTERY
LEFT OVARIAN VEIN –> LEFT RENAL VEIN –> IVC
RIGHT OVARIAN VEIN –> IVC
Where does the lymph from the ovaries go to?
LUMBAR LYMPH NODE
What innervates the ovaries?
OVARIAN PERIARTERIAL PLEXUS (autonomics)
UTEROVAGINAL PLEXUS
sympathetics constrict
parasympathetics dilate
What is the ductus (vas) deferens a continous of?
When the ductus deferens swells up, what does it form?
DUCTUS DEFERNS is a continuation of the epididymis
AMPULLA OF the DUCTUS DEFERENS
What arteries supply blood to the ductus (vas) deferens?
ARTERY OF THE DUCTUS DEFERENS
TESTICULAR ARTERY
Where does the lymph from the ductus (vas) deferens drain to?
EXTERNAL and INTERNAL ILIAC LYMPH NODES
What innervates the Ductus (vas) deferens?
DUCTUS DEFERENS PLEXUS
Sympathetics stimulate rapid peristaltic contraction (propel sperm from epididymis into pelvis)
Ligating the ductus (vas) deferens is called what?
DEFERENTECTOMY (VASECTOMY) –> now the fluid that comes out has no mo sperm
Do the seminal vesicles store sperm?
NOOOO
They produce an alkaline fluid that mixes with the sperm to help it pass into the ejaculatory ducts and urethra
What supplies blood to the Seminal Vesicles?
INFERIOR VESICAL ARTERY
MIDDLE RECTAL ARTERY
Where does lymph from the seminal vesicle drain too?
EXTERNAL and INTERNAL ILLIAC LYMPH NODES
What innervates the seminal vesicle?
PROSTATIC NERVE PLEXUS (sympathetics)
Sympathetics stimulate contraction and secretion of the glands
When the ductus deferens and the seminal vesicles unite, what do they form?
EJACULATORY DUCT
What supplies blood to the ejaculatory duct?
ARTERY OF THE DUCTUS DEFERNS
Where does lymph from the ejaculatory duct drain to?
EXTERNAL ILIAC LYMPH NODE
The prostate gland surrounds the prostatic urethra.
The prostatic fluid passes through what two structures? (also this fluid contains 20% of the volume of semen)
Prostatic fluid passes through 20-30 PROSTATIC DUCTS that mainly open into the prostatic sinuses. (These prostatic sinuses lie on either side of the seminal colliculus)
What are the 4 zones of the PROSTATE?
PERIURETHRAL/TRANSITION ZONE (5% of total gland) –> associated w/ benign prostatic hypertrophy as you age
CENTRAL ZONE (20-25% of total gland) –> more aggressive prostate cancers originate from this zone (less than 5% of prostate cancers)
PERIPHERAL ZONE (70% of total gland) –> 70-80% of prostate cancers originate from here)
ANTERIOR/FIBROMUSCULAR ZONE (5% of total gland) –> no glandular tissue. (only fibrous and muscular tissue)
What supplies blood to the prostate?
INFERIOR VESICAL ARTERY
MIDDLE RECTAL ARTERY
INTERNAL PUDENDAL ARTERY
Where does the lymph of the prostate go to?
INTERNAL ILLIAC LYMPH NODE
SACRAL LYMPH NODE
What nerve innervates the prostate gland?
PROSTATIC NERVE PLEXUS (sympathetics)
Sympathetics stimulate contraction and secretion of the prostate gland
What is Brachytherapy?
They include it here because the example shows prostate brachytherapy.
Brachytherapy (internal radiation) involves placing radioactive materials inside your body to treat cancer.
You can deliver higher doses of radiation to more specific areas of the body compared to traditional radiation.
What is a benign prostatic hypertrophy?
What zone of the prostate does the benign prostatic hypertrophy associate with?
Enlarged prostate the projects onto the bladder and impedes urination by obstructing the internal urethral orifice and distorting the prostatic urethra.
It is commonly associated with the periurethral/transition zone.
What does the bulbourethral (Cowper’s) glands do?
They secrete a mucus-like substance into the urethra during sexual arousal in the male.
What artery supplies blood to the bulbourethral gland?
artery of the bulb of the penis
Where does the lymph of the bulbourethral gland go to?
EXTERNAL and INTERNAL ILIAC LYMPH NODE
What innervates the BULBOURETHRAL GLANDS?
PROSTATIC NERVE PLEXUS (sympathetics)
sympathetics stimulate constriction and secretion
