Pelvic Viscera Flashcards
List the Pelvic cavity boundaries
Pelvic inlet (Greater and lesser)
Pelvic outlet
Pelvic girdle
What are the pelvic divisions? (2)
Greater pelvis -> some abdominal viscera live here
Lesser pelvis -> between the pelvic inlet and outlet
What are the contents of the pelvic cavity?
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)
What is the perineum?
Between the thighs and buttocks and from the pubic symphysis to ischial tuberosities
make up of the genitalia and anus
What is the anterior triangle of the perineum called?
Urogential triangle
What is the posterior triangle of the perineum called?
Anal triangle
What bones make up the pelvis?
Pelvic girdle that includes - Ilium, Ischium, and Pubis
Sacrum
How are the bones of the pelvis put together?
The Ilium, Ischium, and pubis all come together to form the Acetabulum and form the hip joint
What muscles are included in the pelvic floor?
Coccygeus
Levator Ani - Puborectalis, Pubococcygeus, and Iliococcygeus
What are the muscles of the pelvic floor also called?
Pelvic Diaphragm
How are the muscles of the pelvic floor arranged?
Form somewhat of a funnel/hammock across the floor of the pelvis
supports the organs above it
How does the puborectalis assist with fecal continence?
it forms a sling around the anorectal junction
pulls anorectum anteriorly to prevent fecal incontinence
Describe the difference between male and female pelvic girdles
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
Describe the peritoneal coverage of pelvic viscera in males
Covers from the anterior abdominal wall -> over bladder -> to the rectum
inferior 1/3rd of rectum is sub peritoneal
Describe the peritoneal coverage of pelvic viscera in females
Covers from the anterior abdominal wall -> over bladder -> over uterus -> to rectum
inferior 1/3rd of rectum is sub peritoneal
What is the Broad Ligament of the uterus?
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
Tree map of the arterial supply and branches to the pelvis
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)
Level of vessels from most medial to most lateral in pelvis
Arteries
Veins & lymphatics
Nerves
How do male gonadal arteries differ from other arteries entering the pelvis?
Aorta -> Gonadal (testicular) artery -> transverses inguinal cavity -> enters scrotum
Doesn’t enter the lesser pelvis
supplies abdominal ureter, testis, and epididymis
How do female gonadal arteries differ from other arteries entering the pelvis?
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
Map of venous drainage from the pelvis
Internal & External Iliac veins -> Common Iliac veins -> IVC
some drainage through superior rectal vein -> inferior mesenteric vein -> Hepatic portal vein
Map of lymph drainage from the pelvis
External Iliac nodes -> Internal Iliac nodes -> Common iliac nodes
Sacral nodes either through Internal OR common Iliac nodes
Describe the Somatic nerve supply to the pelvis
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)
Describe the Autonomic nerve supply to the pelvis
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
What is the path of urine from start to finish?
Kidneys -> Ureters -> bladder -> urethra
What are the parts of the bladder?
Apex
Fundus
Body
Neck
What are different about male and female bladders?
Males: Internal urethral sphincter is continuous with prostate
Females: Neck is continuous with urethra
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
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
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
Where is the anal canal?
Begins at the pelvic diaphragm and ends at the anus
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
What do the bulbo-urethral glands do?
secrete mucous during sexual arousal
What is the path of a fertilized oocyte from start to finish?
Ovary -> uterine tube (fertilized in ampulla) -> uterus -> uterine cavity -> implanted in endometrium
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
Where do the right ovarian veins drain into?
IVC
Where do the left ovarian veins drain into?
Left renal vein
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
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
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
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
What is a cystocele prolapse?
bladder & urethra pushed against vagina
Hernia of the bladder that bulges into the vagina
What is an Urethrocele prolapse?
altered position of the urethra due to anterior vaginal wall prolapsing
What is an uterovaginal prolapse?
Prolapse of uterus, cervix, or upper vagina
What is a rectocele prolapse?
posterior vaginal wall involving the rectum
What is an enterocele prolapse?
posterior vaginal wall involving rectovaginal pouch & intestines
What are the consequences of most prolapses?
Bladder control and fecal incontinence
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
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
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
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
What are the different types of Hysterectomy’s?
Subtotal: partial; some or supracervical/cervical
Total: all is removed; cervix & uterus
Radical: ovaries & uterus
What are the different surgical approaches to a hysterectomy?
Transabdominal: through abdominal wall
Transvaginal: through the vagina
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
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
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
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
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
What causes hemorrhoids?
Pregnancy
chronic constipation
prolonged sitting on the toilet/straining
increased abdominal pressure
disorders impeding venous return
