pelvic viscera Flashcards
pelvic cavity
1
Q
fpelvis
what are the 3 bony pelvis parts?
A
innominates (hip bones, os coxae)
sacrum
coccyx
2
Q
pelvis
What are the 3 parts of the innominates of pelvis?
A
ilium
ischium
pubis
3
Q
label
A
4
Q
A
5
Q
what is the normal coccyx mobility degree range?
A
5°-20°
6
Q
clinical importance
Do all pelvic floor muscles connect into the coccyx?
A
yes
7
Q
what does nutation mean?
A
nodding (as in anterior pelvic tilt)
occurs in sagittal plane
The sacrum moves forward, down, and rotates to the opposite side of the body. This happens when the sacrum absorbs shock.
8
Q
What does counternutation mean?
A
moves posteriorly (as in PPT)
occurs in sagittal plane
The sacrum moves backward, up, and rotates to the same side of the body that absorbed the force. The ilium rotates in the opposite direction
9
Q
there are 2 sacroiliac joints taht are made of what type of cartilage?
A
hyaline cartilage and fibrocartilage
10
Q
What type of cartilage is hyaline?
A
type II collagen and proteoglycans providing a smooth, low friction surface for joints
most common type of cartilage
11
Q
what type of cartilages is the pubic symphysis composed of?
A
hyaline cartilge and fibrocartilage
12
Q
What is fibrocartilage?
A
thickest fibers, that is the strongest and least flexible of the 3 cartilage types
13
Q
A
14
Q
A
15
Q
A
16
Q
what is the superior border and inferior border of the pelvic cavity/true pelvis
A
superior border: pelvic brim/pelvic inlet
inferior border: pelvicdiaphragm (levator ani)
17
Q
the pelvic cavity is continous with what other cavity?
A
with abdominal cavity
18
Q
what is the function of the pelvic inlet?
A
entrance to the birth canal
19
Q
A
20
Q
what position of the hips is best to widen pelvic outlet?
A
internal rotation
21
Q
T/F the coccyx can not be injured during childbirth?
A
false - it can althought it’s rare
22
Q
what can occur at the pubic symphysis during delivery?
A
diastasis (these people are typically non ambulatory right after birth)
23
Q
What is the difference in the greater pelvis between male and female?
A
male: deep
female: shallow
24
Q
what is the shape of the lesser pelvis for male and female?
A
male: narrow, deep, tapering
female: wide, shallow, cylindrical
25
what is the pelvic inlet shaped like for male and female?
male: heart shaped, narrow
female: oval or rounded,wide
26
What is the size of pelvic outlet for male and female?
male: comparatively small
female: comparatively wide
27
What is the size of pubic arch adn subpubic angle in male and female?
male: narrow
female: wide
28
The uterus is found typically?
within pelvic cavity and into greater pelvic
29
where will the uterus expand into with a growing fetus?
abdominal cavity
30
the uterus is typically found in which position?
anteverted
31
which ligament helps uterus maintain anteveretd position during pregnancy?
round ligament
32
33
what are the 3 parts to the broad ligament?
- mesometrium
- mesosalpinx
- mesovarium
## Footnote
- mesovarium is closes to ovary
- mesometrium is covering uterus
34
what is the orgin, insertion of round ligament?
origin: uterine cornu of uterus (anterior lateral prtion of uterus)
insertion: runs through inguinal ring and lbends into mons pubis and labia majora
35
ovarian ligament orgin and insertion?
origin: medial to ovary
insertion: posterolateral aspect of uterus (wrapped in mesovarium)
36
overian suspensory ligament orgin and insertion?
origin: folds of pelvic parietal peritoneum from over external iliac arteries along pelvic wall
insertion: ovary and broad ligament
37
uteroscacral ligament orgin and insertion?
origin: base of uterus at the level of the cervix
insertion: anterior border of sacrum
38
what are 3 signs that endometrial lesions are present?
1. chronic sacroiliac joint pain
2. worsens with menstrual cycles
3. pain with intercourse and bowl movements
39
What are the 4 parts of the fallopian tubes?
infundibulum
ampulla
isthmus
uterine part
40
What does the infundibulum contain?
the opening (abdominal ostium) with the fimbriae to encourage oocyte to enter
41
the sartorius muscle contributes to the formation of?
adductor canal - medial boundry
femoral triangle -lateral boundry
42
What is the ampulla a common site for?
widest section - therefore common site for fertilization
43
isthmus is a narrow portion with?
thicker walls as itenters into outerus
44
uterine part is the portion of the fallopian tubes that?
passes through uterine wall into uterus
45
46
is the ovary connected to the fallopian tube?
NO
47
what is the role of the ovary?
to produce oocytes for fertilization
48
What production is the ovary responsible for?
estrogen and progesterone production
49
an oocyte is swept up into fallopian tube via?
fimbriae
50
what is the pH level of the vagina?
4.2-4.8 - acidic
51
with age the prostate?
grows - increased and common site for cancer
52
the internal and external urethral sphincters are located where in relation to the prostate?
IUS: superior to prostate
EUS: inferior to prostate
53
the gland in the prostate secrete what type of fluid to counteract vaginal canal?
alkaline?
54
Where does sperm come from?
epididymis via ductus deferens
55
what gland secretes seminal fluid?
cowpers gland - small glands which open into the urethra at base of penis
56
what 2 things connect and enter the posterior prostate via ejacultory duct?
ductus deferens and seminal vesicles
57
the seminal vesicfle releases what type of fluid?
seminal
58
the internal anal sphincter is made of what type of muscle? it has what type of control?
smooth, involuntary control
59
external anal sphincter is made of what type of muscle? has what kind of control?
skeletal muscle, voluntary control
60
What are 3 common sites for hemmroids in the anal canal?
1. pectinate or dentate line
2. internal sphincter
3. external sphincter
61
62
63
what are the 3 main arteries and 3 main veins taht supply blood to rectum?
ateries: superior, middle, inferior rectal arteries
veins: superior, middle, inferior rectal veins
64
the bladder is pear shaped and holds up to how many ml of urine?
500-600ml
65
how many ml of urine do you need to feel the first urge to urinate?
150ml
66
how many ml do we usually hold before needed to empty bladder?
~300ml
67
can the bladder expand into abdominal cavity when full?
YES
68
what muscle contracts to expel urine during urination?
detrusor muscle
69
waht is the trigone?
smooth area of bladder where openings of uerter and urethra enter into bladder
70
what prevents backflow of urine back up to kidney?
trigone
## Footnote
small flaps of mucosa cover openings of uereter
71
what is the main symptom of endometriosis?
pain
72
what isthe estimated prevalence of endometriosis?
10%
73
when are symptoms of endo exasturbated?
during menstruation cycle
74
what is the only way to officially diagnose endo?
laparoscopic surgery and biopsy of tissues
75
pelvic organ prolapse can be an integrity issue with what type of tissue?
ligaments
76
what are 3 important considerations with pelvic organ prolapse?
1. abdominal pressrue managment is necessary
2. possible history of levator avulsion tear
3. strainign to empty
77
# female perineum
where is the perineum located?
inferior to pelbic diaphragm, inferior portion of the pelvic outlet
78
# female perineum
what are the boundaries of the female perineum?
Antierior: pubic symphsis
posterior: coccyx
lateral: ischial tuberosities
79
# perineum
what are the 2 halves of the perineum?
urogential triangle
posterior anal triangle
80
# female external genitalia
contains what structures?
mons pubis
labia major
labia minora
posterior fourchette
clitoris
clitoral hood
vulva
perineal body
vulvar vestibule
urethral opening - meatus
vaginal opening - introitus
hymen
vestibular glands
anus
81
# female genitalia
label the parts of the clitoris
82
# male perineum
describe location of male perineum
inferior to pelbic diaphragm
infeiror portion of the pelvic outlet
83
# male perineum
what are the boundaries of the male perineum?
anterior: pubic symphsis
posterior: coccyx
lateral: ischial tuberosities
84
# male perineum
the male perineum contains?
- shaft of penis
- testicles
- perineal body
- anus
85
# male genitalia
label male external genitalia
86
# female genitalia
what are the actions of the superficial pelvic floor (layer 1) in female anatomy?
assists in arousal and mataining arousal via connections into clitoris
helps stabilize perineal body
EAS: voluntary bowl control
| EAS = external anal schincter
87
# female genitalia
what are common disorders of the superficial pelvic floor in females? (layer one)
1. vulvodynia
2. vaginismus
3. dyspareunia
4. inability to achieve or maintain an orgasm
88
# female genitalia
what are the actions of the second layer of female pelvic floor?
assists in urinary control
assist in closing introitus (vaginal opening)
further support to perineal body
89
# female genitalia
what are common pelvic floor disorders associated with layer two in female anatomy?
dyspareunia
post-void dribbling
difficulties fully emptying
stream that splits/sprays
vaginismus
**vulvodynia
90
# female genitilia
what are the actions of layer three in pelvic floor of female anatomy?
- supports pelvic viscera
- external urethral urinary sphincter control to assist in emptying and filling of bladder
- maintains puborectalis angle to assist in bowel control
- balance
- load transfer
- spine stabilization
91
# female genitilia
what are common disorders of the third layer of pelvic floor muscles in female anatomy?
urinary bowl incontienecy and retention
pelvic organ prolapse
low back pain **
hip pain **
sacroiliac joint pain **
92
# female genitilia
what layer of pelvic floor muscles is most commonly associated with pelvic organ prolapse?
third layer
(piriformis, coccygeus, levator ani, coccyx, obturator internus, arcus tendoneus levator ani, pubococcygeus, puborectalis, urogenital diaphragm)
93
# female genitilia
what are the muscles in the second layer of the pelvic floor in female anatomy?
bladder
striated urogenital sphincter complex
vagina
ischipubic ramus
ischial tuberosity
deep transverse perineum
perineal body
vaginal canal
urethra
detrusor muscle
94
# female genitalia
what are the muscles in the first layer of pelvic floor in female anatomy?
urethral opening
bulvocavernosus
ischiocavernosus
superficial transverse perineum
external anal sphincter (EAS)
95
# male genitalia
for the male pelvic floor what is the role of layer one?
erection and ejaculation
helps stabilize perineal body
EAS function
96
# male genitalia
What are 3 common disorder of the pelvic floor occuring at layer one?
peyronies disease (penile fibrosis)
erectile dynfuction
**urinary incontenience
97
# male pelvic floor
what is the role of the plevic floor layer 2?
urinary control
support to perineal body
98
# male pelvic floor
what are 3 disorders associated with the 2nd layer of male pelvic floor?
post- void dribbling
difficulties fully emptying
stsream taht splits/sprays
99
# male pelvic floor
what is the role of the 3rd male pelvic floor layer?
suport of pelvic viscera
ex. urethral urinary sphincter control
maintains puborectalis angle (blowel control)
balance
load transfer
spine stabilization
100
# male pelvic floor
what are common disorders of the male pelvic floor 3rd layer?
- urinary/bowel incontinence and retention
- rectal prolapse
- LBP**
- hip pain**
- SI joint pain **
101
# muscles
what muscles consist of the levator ani
-iliococcygeus
- puborectalis
- pubococcygeus
102
# muscles
what is the musle action of the levator ani?
think= elevator
103
# muscles
is the coccygeus apart of the levator ani?
NO - it does not lift
104
# muscles
what shape is the levator ani?
bowl/hammack
105
# muscles
if the levator ani is hypertonic what is the new shape it takes?
flat tarp
106
label
107
# muscles
what is the action of obturator internus?
external hip flexor (or hip abductor when in hip flexion)
108
# muscles
what does the obturator internus help stabilize?
hip in socket
109
# muscles
every single pelvic diaphragm muscle connects the obturator internus via?
tendinous arch of levator ani
110
what are the muscles of the perineal body?
## Footnote
mneumonic: BELTS
bulbospngiosus
external anal sphincter
levator ani
transverse perineal muscles
sphincter urethrae (small, not seen often)
111
# muscles
112
# muscles
what is the role of puborectalis?
sling around the rectum
- puts a "kink" in the rectum to aid in resisting bowel movement
113
# muscles
114
# arteries, veins, nerves
the common iliac artery splits at what level of the intervertebral disc?
L5 and S1
115
# arteries, veins, nerves
What does the internal iliac artery bifurcate into?
anterior and posterior trunks
116
# female vaculature, arteries, veins, nerves
the anterior trunk of internal iliac artery has 8 -list them
## Footnote
Under Open Skies Unique Ideas Inspire Mighty Visions
1. umbilical artery
2. obturator artery
3. superior vesical arteries
4. uterine artery
5. internal pudendal artery
6. inferior gluteal artery
7. middle rectal artery
8. vaginal artery
117
# arteries, veins, nerves
What arteries are in the posterior trunk of internal iliac artery?
superior gluteal artery
118
# arteries, veins, nerves
119
# arteries, veins, nerves
what arteries are found of the anterior trunk of the internal iliac artery?
## Footnote
Unicorns Often Inspire Imagination Sparkling Magical Ideas Possibilities
1. umbilical artery
2. obturator artery
3. internal pudendal artery
4. inferior gluteal artery
5. superior vesical arteries
6. middle rectal rtery
7. inferior vesical arery
8. prostatic branch of inferior vesical artery
120
# arteries, veins, nerves
pelvic splanchnic nerve are what type of nerves?
parasympathetic
121
# arteries, veins, nerves
The hypogastric plexus is a mix of what?
parasympathetic and sympathetic
122
# arteries, veins, nerves
if the nerves are not parasympathetic, or sympathetic then they are?
somatic
123
# arteries, veins, nerves
Where are the pelvic splanchnic nerves located?
S2-S4
124
# arteries, veins, nervesarteries, veins, nerves
what does pelvic splanchnic nerves innervate?
pelvic organs
125
# arteries, veins, nerves
Fibers of the pelvic splanchnic nerve inter via ?
inferior hypogastric plexus to reach pelvic viscera
126
# arteries, veins, nerves
What is the action of the pelvic splanchnic nerve on organs via parasympathetic system?
- vasodilation for some organs
- contraction of detrusor (pee)
- relaxation of internal anal sphincter
- erection (point)
## Footnote
*think PPP - parasympathetic, pee, point
127
# arteries, veins, nerves
what is the action of sympathetic nerves in pelvic viscera?
## Footnote
*think SSS
- internal urethral and internal anala sphincter smooth muscle control (store)
- moving secretions from epididymis during ejaculation (shoot)
## Footnote
* think SSS - sympathetic, store, shoot
128
# arteries, veins, nerves
where is the sacral plexus located with respect to piriformis muscle?
anterior to
129
# ANS: hypogastric plexus
the superior hypograstric plexus (L5) feeds into
inferior hypogastric plexus
130
# ANS: hypogastric plexus/infeiror hypogastric plexus
what level of the spine is the inferior hypogastric plexus?
S2-S4
131
# ANS: hypogastric/inferior hypogastric plexus
the HG and IHG plexus has sympathetic innervations via? how does it connect between the plexuses?
sympathetic trunk
- bidirectional communication between superior and inferior hypogastric plexus via hypogastric nerve
132
# ANS: hypogastric/inferior hypogastric plexus
these plexuses have parasympathetic contributions via?
pelvic splanchnic nerves
133
# somatic nerves
the sacral plexus runs what level of the spine? and has contributions from what 2 levels?
S1-S4
L4/L5 contributions
134
# somatic nerves
the coccygeal plexus runs what level(s) of spine?
S5
S4 contributions
135
# sacral plexus
what levels of spine is the sacral plexus? what nerves run with which level?
L4-S4
- superior gluteal (L4-S1)
- inferior gluteal (L5-S2)
- sciatic (L4-S3)
- pudendal (S2-S4)
136
# sacral plexus
what are the portions of sciatic nerve?
fibular portion
tibial portion
posterior femoral
137
# sacral plexus
pudendal nerve exits pelvis via?
greater sciatic foramen (inferior to piriformis)
138
# sacral plexus
pudendal nerve passes over which ligament lateral to ischial spine?
sacrospinous ligament
139
# sacral plexus
the pudendal nerve enters the pelvis via _________ lateral to obturator internus
lesser sciatic foramen
140
# sacral plexus
the pudendal nerve passes through what canal?
alcocks canal
141
# sacral plexus
what can occur at the sacral plexus to cyclists or those with ED ?
they can crush their pudendal nerve via alcocks canal
142
# sacral plexus
What are the 3 branches of the pudendal nerve?
- dorsal nerve of clitoris or penis
- the perineal branch
- the inferior rectal nerve
143
# sacral plexus
what are the 3 functions of the pudendal nerve?
- innervates pelvic floor musculature
- assists in external urethral sphincter tone
- assists in maintaining erection of clitoris or penis
144
145
# clinical pearl
if someone metions the toilet seat is the most comfortable seat in the house, what is the likely cause?
pudendal neuralgia
## Footnote
does not put pressure on alcocks canal
146
# pelvic organs
what level of Delancey pelvic floor support is in direct fusion of the vagina with levator ani muscles, perineal membrane and body?
level 3
147
# embryology
waht embryonic tissuedevelops into the reproductive system? where do the germ cells come from?
intermediate mesoderm
- germ cells come from endoderm lining of the yolk sac to the urogenital ridges
## Footnote
- the intermediate mesoderm condenses to become the urogenital ridge and gives rise to gonads and ductal systems
- the primordial germ cells will give rise to gametes
148
# embryology
which duct system gives rise tos the uterus and fallopian tubes? which duct system gives rise to the ductus deferens?
- the paramesonehpric (mullerian) ducts
- The mesonephric (wolffian) duct
149
# embryology
What structure is derived from the labioscrotal swellings in females? what about males?
- labia major
- scrotum
150
# embryology
sometime the paramesonephric ducts fail to fuse together completely in female development. What is the name of the resulting condition?
the paramesonephric ducts will duplicate the uterus also known as bicornate uterus
151
# autonomic nerves of the pelvis
what spinal cord levels give rise to the parasympathetics for the pelvis viscera? what is another name for these nerves?
S2, S3, S4 bilaterally
pelvic splanchnic nerves
152
# autonomic nerves of the pelvis
what important somatic nerve to the perineum also arises from S2,3,4?
pudendal nerve
153
# autonomic nerves of the pelvis
waht is the name of the plexus taht gives rise to the postganglionic sympathetics to the pelvic viscera? What are the name for the preganglionic sympathetics that synapse there?
- inferior hypogastric pelxus
- sacral splanchnic nerves
154
label
155
label
156
157
158
159
160
161
the mons pubis contains which ligament?
round ligament
162
163
in the penis the urethra passes through which structure?
corpus spongiosum
164
what part of the broad ligament covers the ovary?
mesosalpinx
165
role of ovary
produce oocyte for fertilization
responsible for estrogen and progestrone produciton
166
the oocye enters the fallopian tube via?
fimbriae
167
what are the 4 parts of the fallopian tubes?
1. infundibulum
2. ampulla
3. isthmus
4. uterine part
## Footnote
from lateral to medial
168
what 3 muscles make up the levator ani
- puborectalis
- pubococcygeus
- iliococcygeus
