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Anatomy Summer 2023 > Pelvic Viscera > Flashcards

Pelvic Viscera Flashcards

1
Q

List the Pelvic cavity boundaries

A

Pelvic inlet (Greater and lesser)
Pelvic outlet
Pelvic girdle

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2
Q

What are the pelvic divisions? (2)

A

Greater pelvis -> some abdominal viscera live here
Lesser pelvis -> between the pelvic inlet and outlet

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3
Q

What are the contents of the pelvic cavity?

A

Distal ureters
urinary bladder
rectum
pelvic genital organs
blood vessels
lymphatics
nerves
Abdominal viscera over flow - small intestine (ileum) and large intestine (appendix, sigmoid colon)

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4
Q

What is the perineum?

A

Between the thighs and buttocks and from the pubic symphysis to ischial tuberosities
make up of the genitalia and anus

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5
Q

What is the anterior triangle of the perineum called?

A

Urogential triangle

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6
Q

What is the posterior triangle of the perineum called?

A

Anal triangle

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7
Q

What bones make up the pelvis?

A

Pelvic girdle that includes - Ilium, Ischium, and Pubis
Sacrum

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8
Q

How are the bones of the pelvis put together?

A

The Ilium, Ischium, and pubis all come together to form the Acetabulum and form the hip joint

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9
Q

What muscles are included in the pelvic floor?

A

Coccygeus
Levator Ani - Puborectalis, Pubococcygeus, and Iliococcygeus

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10
Q

What are the muscles of the pelvic floor also called?

A

Pelvic Diaphragm

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11
Q

How are the muscles of the pelvic floor arranged?

A

Form somewhat of a funnel/hammock across the floor of the pelvis
supports the organs above it

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12
Q

How does the puborectalis assist with fecal continence?

A

it forms a sling around the anorectal junction

pulls anorectum anteriorly to prevent fecal incontinence

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13
Q

Describe the difference between male and female pelvic girdles

A

Males -> Android shape, usually for heavier builds, holds larger muscles and is more heart shaped

Females -> Gynecoid shape, rounded and more oval with a wider transverse diameter, adapted for child birth

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14
Q

Describe the peritoneal coverage of pelvic viscera in males

A

Covers from the anterior abdominal wall -> over bladder -> to the rectum

inferior 1/3rd of rectum is sub peritoneal

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15
Q

Describe the peritoneal coverage of pelvic viscera in females

A

Covers from the anterior abdominal wall -> over bladder -> over uterus -> to rectum

inferior 1/3rd of rectum is sub peritoneal

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16
Q

What is the Broad Ligament of the uterus?

A

Extraperitoneal
contains uterine tubes, ovaries & ligaments, and round ligaments of the uterus
connects it to the lateral pelvic sidewalls
makes uterus look like a butterfly

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17
Q

Tree map of the arterial supply and branches to the pelvis

A

Aorta -> Common Iliac artery -> Internal and External Iliac artery

Internal Iliac artery
-> anterior -> viscera
-> posterior
-> 1) Iliolumbar -> either a) Iliac branch (Ilium) OR b) Lumbar branch (Psoas major, QL)
-> 2) Lateral sacral arteries -> spilt into Superior/inferior which split into spinal branches of anterior (meninges of sacral roots) & posterior (erector spinae)
-> 3) Superior Gluteal (gluteal muscles)

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18
Q

Level of vessels from most medial to most lateral in pelvis

A

Arteries
Veins & lymphatics
Nerves

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19
Q

How do male gonadal arteries differ from other arteries entering the pelvis?

A

Aorta -> Gonadal (testicular) artery -> transverses inguinal cavity -> enters scrotum

Doesn’t enter the lesser pelvis

supplies abdominal ureter, testis, and epididymis

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20
Q

How do female gonadal arteries differ from other arteries entering the pelvis?

A

Aorta -> Ovarian artery (above inferior mesenteric artery but below renal arteries) -> runs along ureters -> crosses external iliac vessels & then runs medially and divides -> to Ovarian and Tubal branches

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21
Q

Map of venous drainage from the pelvis

A

Internal & External Iliac veins -> Common Iliac veins -> IVC

some drainage through superior rectal vein -> inferior mesenteric vein -> Hepatic portal vein

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22
Q

Map of lymph drainage from the pelvis

A

External Iliac nodes -> Internal Iliac nodes -> Common iliac nodes

Sacral nodes either through Internal OR common Iliac nodes

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23
Q

Describe the Somatic nerve supply to the pelvis

A

Sacral Plexus (L4-S3/4)
- Pudendal (S2-4)
serves perineum & sensory to external genitalia

Coccygeal Plexus (S4-5) & coccygeal nerves
- serves coccygeus & levator Ani muscles (pelvic
floor)

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24
Q

Describe the Autonomic nerve supply to the pelvis

A

Sympathetic (3 routes)
- Sacral trunks
vasomotion, pilomotion, sudomotion to lower
limbs
- Peri-arterial plexuses
vasomotion to superior rectal, ovarian, & internal
iliac arteries
- Hypogastric plexuses
Pelvic viscera
Superior hypogastric plexus
R/L hypogastric nerves & Inferior hypogastric
plexus

Parasympathetic (1 route)
- Pelvic splanchnic nerves (S2-4)
- to pelvic viscera

25
What is the path of urine from start to finish?
Kidneys -> Ureters -> bladder -> urethra
26
What are the parts of the bladder?
Apex Fundus Body Neck
27
What are different about male and female bladders?
Males: Internal urethral sphincter is continuous with prostate Females: Neck is continuous with urethra
28
Describe the male urethra
18-22cm long Internal/external urethral orifice urine & semen pass through Internal urethral sphincter tonically contracted during filling and relaxes during voiding Innervation from the prostatic plexus
29
Describe the female urethra
4 cm long Internal & external urethral orifice only urine passes through NO internal sphincter innervation from vesical plexus and pudendal nerve
30
What is the difference between the internal and external anal sphincters?
Internal: Involuntary contracted by sympathetic fibers Inhibited by parasympathetic fibers External: Voluntary contracts w/ puborectalis to maintain continence when internal sphincter is relaxed
31
Where is the anal canal?
Begins at the pelvic diaphragm and ends at the anus
32
Path of sperm from start to finish
Testis -> Epididymis (tail) -> Ductus deferens -> spermatic cord -> through inguinal canal -> anterior abdominal wall -> crosses over external iliac vessels -> enter pelvis -> ductus deferens joins seminal glands to form -> Ejaculatory ducts -> Prostate -> urethra
33
What do the bulbo-urethral glands do?
secrete mucous during sexual arousal
34
What is the path of a fertilized oocyte from start to finish?
Ovary -> uterine tube (fertilized in ampulla) -> uterus -> uterine cavity -> implanted in endometrium
35
What is the path of an unfertilized oocyte from start to finish?
Ovary -> uterine tube -> uterus -> uterine cavity -> shed out of uterus -> vagina during menstruation
36
Where do the right ovarian veins drain into?
IVC
37
Where do the left ovarian veins drain into?
Left renal vein
38
What are the layers of the uterine wall and what are their special functions?
- Perimetrium: outer layer - Myometrium: middle smooth layer that contracts during labor - Endometrium: inner layer where fertilized egg implants IF not fertilized, sheds during menstruation
39
What structures support the uterus and keep it from prolapsing?
Broad ligament -round ligament is around the broad ligament Dynamic support: pelvic diaphragm Passive support: Its position over the bladder
40
What is an episiotomy?
surgical incision to enlarge the vaginal orifice usually occurs when: -fetal descent has stopped/protracted -instrumentation is needed -speed of delivery needs to increase
41
What are the two types of episiotomy?
Median: -towards anal canal -associated w/ long term incontinence, pelvic prolapse, & anovaginal fistulae Mediolateral: -incision more towards ischial tuberosity -lower incidence of laceration -less associated w/ damage to anal sphincters & canal
42
What is a cystocele prolapse?
bladder & urethra pushed against vagina Hernia of the bladder that bulges into the vagina
43
What is an Urethrocele prolapse?
altered position of the urethra due to anterior vaginal wall prolapsing
44
What is an uterovaginal prolapse?
Prolapse of uterus, cervix, or upper vagina
45
What is a rectocele prolapse?
posterior vaginal wall involving the rectum
46
What is an enterocele prolapse?
posterior vaginal wall involving rectovaginal pouch & intestines
47
What are the consequences of most prolapses?
Bladder control and fecal incontinence
48
Treatments for prolapses relating to the pelvic floor
-Pelvic floor PT to strengthen pelvic floor muscles -pessaries: devices placed in vagina to support structures -medication -surgery: vaginal retethering, bulking agents, slings
49
What are different types of anesthesia available for child birth?
General: emergencies; mother is asleep during procedure Regional: - Epidural: L3-4; needle only in epidural space; numbs entire birth canal, pelvic floor, & perineum - Spinal: L3-4; needle pierces dura & arachnoid space; numbs everything from the waist down -Pudendal: nerves S2-4 dermatomes (perineum) & inferior 1/4 vagina EPIDURAL AND SPINAL HAVE RISK OF CSF LEAKAGE
50
What is an ectopic pregnancy?
When implantation occurs outside of the uterus (1/250) a tubal pregnancy is most common uterine tube could rupture and if not caught early enough death of embryo could occur and life threatening to mother
51
What is a pap smear?
Screening of the cervix for cervical cancer visually inspected as well as using a spatula to rotate and scrape cells from mucosa
52
What are the different types of Hysterectomy's?
Subtotal: partial; some or supracervical/cervical Total: all is removed; cervix & uterus Radical: ovaries & uterus
53
What are the different surgical approaches to a hysterectomy?
Transabdominal: through abdominal wall Transvaginal: through the vagina
54
Explain and describe a vasectomy
Ductus deferens is cut incision in superior scrotum fluid ejaculated has no sperm because it is unable to leave the epididymis IS REVERSIBLE
55
Explain and describe tubal sterilization
Open abdominal procedure - suprapubic incision -part or all of uterine tubes are removed Laparoscopic procedure - Incision near umbilicus -uterine tubes cauterized, rings, or clips around the tubes NOT REVERSIBLE
56
What is BHP and how does it affect urination?
Benign Hypertrophy of the prostate -Enlarges the prostate and pushes it against the bladder -distorts prostatic urethra and impedes urination which causes nocturia and dysuria
57
What is TURP?
Transurethral resection of the prostate instrument inserted through the urethra to prostate -may remove all or part of prostate to allow for flow of urine
58
What are hemorrhoids?
Internal: prolapses of renal mucosa - contain internal rectal venous plexus veins - usually from a breakdown of smooth muscle deep to mucosa External: Thromboses in external rectal venous veins - covered by skin - painful
59
What causes hemorrhoids?
Pregnancy chronic constipation prolonged sitting on the toilet/straining increased abdominal pressure disorders impeding venous return

Anatomy Summer 2023 (8 decks)

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