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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
Q

What is the path of urine from start to finish?

A

Kidneys -> Ureters -> bladder -> urethra

26
Q

What are the parts of the bladder?

A

Apex
Fundus
Body
Neck

27
Q

What are different about male and female bladders?

A

Males: Internal urethral sphincter is continuous with prostate

Females: Neck is continuous with urethra

28
Q

Describe the male urethra

A

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
Q

Describe the female urethra

A

4 cm long
Internal & external urethral orifice
only urine passes through
NO internal sphincter
innervation from vesical plexus and pudendal nerve

30
Q

What is the difference between the internal and external anal sphincters?

A

Internal: Involuntary
contracted by sympathetic fibers
Inhibited by parasympathetic fibers

External: Voluntary
contracts w/ puborectalis to maintain continence when internal sphincter is relaxed

31
Q

Where is the anal canal?

A

Begins at the pelvic diaphragm and ends at the anus

32
Q

Path of sperm from start to finish

A

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
Q

What do the bulbo-urethral glands do?

A

secrete mucous during sexual arousal

34
Q

What is the path of a fertilized oocyte from start to finish?

A

Ovary -> uterine tube (fertilized in ampulla) -> uterus -> uterine cavity -> implanted in endometrium

35
Q

What is the path of an unfertilized oocyte from start to finish?

A

Ovary -> uterine tube -> uterus -> uterine cavity -> shed out of uterus -> vagina during menstruation

36
Q

Where do the right ovarian veins drain into?

A

IVC

37
Q

Where do the left ovarian veins drain into?

A

Left renal vein

38
Q

What are the layers of the uterine wall and what are their special functions?

A
  • 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
Q

What structures support the uterus and keep it from prolapsing?

A

Broad ligament
-round ligament is around the broad ligament
Dynamic support: pelvic diaphragm
Passive support: Its position over the bladder

40
Q

What is an episiotomy?

A

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
Q

What are the two types of episiotomy?

A

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
Q

What is a cystocele prolapse?

A

bladder & urethra pushed against vagina
Hernia of the bladder that bulges into the vagina

43
Q

What is an Urethrocele prolapse?

A

altered position of the urethra due to anterior vaginal wall prolapsing

44
Q

What is an uterovaginal prolapse?

A

Prolapse of uterus, cervix, or upper vagina

45
Q

What is a rectocele prolapse?

A

posterior vaginal wall involving the rectum

46
Q

What is an enterocele prolapse?

A

posterior vaginal wall involving rectovaginal pouch & intestines

47
Q

What are the consequences of most prolapses?

A

Bladder control and fecal incontinence

48
Q

Treatments for prolapses relating to the pelvic floor

A

-Pelvic floor PT to strengthen pelvic floor muscles
-pessaries: devices placed in vagina to support structures
-medication
-surgery: vaginal retethering, bulking agents, slings

49
Q

What are different types of anesthesia available for child birth?

A

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
Q

What is an ectopic pregnancy?

A

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
Q

What is a pap smear?

A

Screening of the cervix for cervical cancer

visually inspected as well as using a spatula to rotate and scrape cells from mucosa

52
Q

What are the different types of Hysterectomy’s?

A

Subtotal: partial; some or supracervical/cervical

Total: all is removed; cervix & uterus

Radical: ovaries & uterus

53
Q

What are the different surgical approaches to a hysterectomy?

A

Transabdominal: through abdominal wall

Transvaginal: through the vagina

54
Q

Explain and describe a vasectomy

A

Ductus deferens is cut

incision in superior scrotum

fluid ejaculated has no sperm because it is unable to leave the epididymis

IS REVERSIBLE

55
Q

Explain and describe tubal sterilization

A

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
Q

What is BHP and how does it affect urination?

A

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
Q

What is TURP?

A

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
Q

What are hemorrhoids?

A

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
Q

What causes hemorrhoids?

A

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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