pelvic wall Flashcards
1
Q
pelvis function & loc
A
- connects trunk to lower ex
- beneath/below abd. region
1
Q
root word of pelvis
A
“basin” (bowl-shaped structure)
2
Q
pelvic orientation
mnemonic: Upper Box sa harap (sys) Din tai Fung sa likod (sac)
A
- tilted forward
- symph pub & ASIS same vertical plane
- symph pub UB
- sacrum (ant. surface) DF
mnemonic: Upper Box sa harap Din tai Fung sa likod
3
Q
pelvis function
A
- transmits weight of body downwards (vertebral column > femurs)
- support/protect pelvic viscera & lower parts of GI tract (keeps them inside)
- contains nerves, vessels, lymphatics
- attaches trunk to LE (muscles)
4
Q
pelvic wall boundaries (anterior & posterior walls)
A
front/anterior:
symphysis pubis
back/posterior:
sacrum/coccyx
(sacroiliac joint = ilium attaches to each side of sacrum)
5
Q
pelvic wall articulation (posterior & lateral walls)
A
posterior wall: sacrum/coccyx
lateral wall: hip bone (ischium, ilium, pubis)
6
Q
(2) parts of pelvis
A
1) true pelvis
2) false pelvis
7
Q
dividing partition of true & false pelvis
A
pelvic inlet/brim
8
Q
pelvic inlet/brim is formed by (3) / pelvic inlet boundaries
clue: SP, IL, SYS (mnemonic: SP/ILL mo na yan SyS!)
A
1) sacral promontory
2) iliopectineal lines
3) symphysis pubis
mnemonic: SP/ILL mo na yan SyS!
9
Q
true pelvis is located _____ of pelvic brim
above or below?
A
below
10
Q
false pelvis is located ____ of pelvic brim
above or below?
A
above
11
Q
false pelvis boundaries (APL)
A
anterior: abdominal muscles
posterior: LV
lateral: iliac fossa & iliacus muscle
12
Q
false pelvis function/support
A
- supports abdominal content
- supports gravid uterus at 3 months of pregnancy
- guides fetus down to the true pelvis during early stages of labor
13
Q
True/False:
false pelvis has lesser clinical significance than true pelvis
A
true
14
Q
True/False:
false pelvis is considered part of abdominal cavity
A
true
15
Q
true pelvis has (3) pelvic …
clue: IOC
A
1) pelvic inlet (brim)
2) pelvic outlet
3) pelvic cavity (between inlet & outlet)
mnemonic: In and Out of Cavite
16
Q
pelvic inlet function
A
- divides true and false pelvis
- serves as “entrance” going inside
17
Q
pelvic outlet shape
A
diamond-shaped
18
Q
pelvic outlet is best seen in this position
A
lithotomy position
19
Q
pelvic outlet boundaries (APL)
A
anterior: pubic arch (symphysis pubis)
posterior: coccyx
lateral: ischial tuberosities
20
Q
pelvic outlet (3) wide notches
A
1) pubic arch - anteriorly
2) greater & - lat.
3) lesser sciatic notches - lat.
21
Q
divides greater and lesser sciatic notches
clue: (2) “s” ligaments
A
1) sacrotuberous
2) sacospinous
22
Q
True/False:
sacrotuberous ligaments also form part of the margin of the pelvic outlet
A
true
23
Q
between pelvic inlet and pelvic outlet
A
pelvic cavity
24
pelvic cavity contents (3)
1) reproductive organs (especially that of female)
2) lower portions of intestines (sigmoid & rectum)
3) urinary bladder
25
known as the shallowest wall of true pelvis
anterior wall
26
anterior wall of true pelvis is formed by (3)
1) pubic bone
2) superior & inferior ramus of pubis/pubic rami
3) symphysis pubis
27
most extensive wall of true pelvis
posterior wall
28
True/False:
the posterior wall of the true pelvis is covered by parietal pelvic fascia
true
29
posterior wall of true pelvis is formed by (3)
1) sacrum
2) coccyx
3) piriformis muscle
30
posterior wall of true pelvis (3) openings
1) anterior sacral foramina
2) greater &
3) lesser sacral foramina
divided by sacrotub & and sacrospin ligaments
31
provides an EXIT from true pelvis
greater sciatic foramen
32
provides an ENTRANCE from gluteal region to perineum
lesser sciatic foramen
33
greater sciatic foramen (4) contents
clue/mnemonic: SPINS
1) sciatic nerve
2) pudendal nerve
3) superior &
4) inferior gluteal nerves and vessels
mnemonic: SPINS
34
5 rudimentary vertebrae fused to form a single wedge shape bone
sacrum
35
sacrum boundaries (SIL)
superior: 5th LV
inferior: fuses with coccyx
lateral: iliac bone (SI joint)
36
(4) significant sacrum parts
- sacral promontory
- sacral hiatus
- sacral canal
- sacroiliac joint
37
important landmark when measuring the pelvis/level of S1
sacral promontory
38
level of S5
sacral hiatus
39
contains anterior and posterior roots of lumbar, sacral and coccygeal spinal nerves/opening where nerves passes through before they exit
sacral canal
40
connection of sacrum to ilium
clue: joint
sacroiliac joint
41
True/False:
sacrum is usually wider in length in female than male
true
42
lumbosacral angle
- between L5 (lower body) and S1 (upper body
- 30 degrees
- decreased angle > instability
43
coccyx
- four vertebrae fused to form small triangular bone/sometimes 3 or 5
- also known as "tail bone"
- articulates with S5 (base of sacrum)
44
True/False:
1st coccyx attaches to S5 and has a rudimentary transverse process and cornua
true
45
remains of pedicles and superior articular processes
cornua
46
pelvic floor/diaphgram
- forms the inferior wall of true pelvis/inferior boundary of pelvic cavity
- divides true pelvis into main pelvic cavity (above) and perineum (below)
- perineum > inferior wall > cavity
- supports pelvic viscera
47
significance of true pelvis of women
true pelvis is where the baby grows and developes
48
gynecoid pelvis characteristics
(frequency, percentage, shape of inlet, subpubic arch, delivery presentations)
- "classic" female pelvis/most common type of pelvis
- 41%
- oval at inlet
- generous capacity/wide subpubic arch (makes delivery of baby easy)
49
anthropoid pelvis characteristics
(frequency, percentage, shape of inlet, subpubic arch, delivery presentations)
- 24% white, 41% black
- oval at inlet
- subpubic arch narrowed and has long axis "flipped gynecoid"
- favors occiput posterior presentations/cephalic delivery
50
android pelvis characteristics
(frequency, percentage, shape of inlet, subpubic arch, delivery presentations)
- most common pelvis seen in males "male pelvis" "funnel-shaped pelvis"
- 33% white, 16% black
- triangular shape in the inlet
- subpubic arch narrowed
- small babies pass than larger babies
51
platypelloid pelvis characteristics
(frequency, percentage, shape of inlet, subpubic arch, delivery presentations)
- least common type of pelvis
- 2 %
- flattened at inlet
- has a prominent sacrum/sacral promontory pushed forward
- subpubic arch is wide but ischial spines are prominent
- favors transverse (sideway) presentations IN BOOK
but in real life scenarios, CS delivery is opted
52
most common to least common pelvis
clue: GAAP
gynecoid - anthropoid - android - platypelloid
53
female pelvis characteristics
false pelvis
pelvic outlet
pelvic inlet
pelvic cavity
ischial spine
sacrum
pubic arch
false pelvis: shallower
pelvic inlet: oval shape (transversely narrower)
pelvic outlet: larger
pelvic cavity: roomier (more spacious)
ischial spine: everted
sacrum: shorter, wider & flatter
pubic arch: wider and more rounded
54
formed by anterior rami of l4-l5, s1-s4
sacral plexus
55
largest nerve in your body
sciatic nerve
56
roots of
superior gluteal n./ n. to quadratus femoris
inferior gluteal n. /n. to obt internus
sciatic nerve
nerve to piriformis
posterior cutaneous n. of thigh
pudendal nerve
superior gluteal n./ n. to quadratus femoris (L4-S1)
inferior gluteal n. /n. to obt internus (L5-S2)
sciatic nerve (L4-S3)
n. to piriformis (S1-S2)
posterior cutaneous n. of the thigh (S1-S3)
pudendal nerve (S2-S4)
57
true pelvis blood supply (4)
mnemonic: SOMI
arteries that enter the pelvic cavity:
- internal iliac
- superior rectal
- ovarian
- median sacral
mnemonic: SOMI
58
artery that supplies all of the organs within the pelvis
internal iliac artery
59
after passing over the pelvic brim, the internal iliac artery divides into (2) trunks
anterior & posterior trunks
60
anterior trunk (internal iliac artery) branch & what they supply
umbilical*
vaginal*
middle rectal*
uterine artery*
inferior gluteal
internal pudendal
inferior vesical
obturator artery
- umbilical (sup ves/upper part of bladder)*
- vaginal (inf ves/vagina & base of bladder)*
- middle rectal (inf ves/lower rectum)*
- uterine artery (ovar/uterine & fallopian tube)*
- inferior gluteal (gsc foramen/post gluteal region)
- internal pudendal (muscles of anal canal & skin/muscle of perineum)
- inferior vesical (base of bladder, prostrate, & seminal vesicles)
- obturator artery (obt. n./medial compartment of thigh)
61
posterior trunk (internal iliac artery) branch & what they supply
superior rectal*
ovarian*
median sacral*
iliolumbar
lateral sacral
superior gluteal
- superior rectal (inf mes/rectum & upper anal canal)*
- ovarian (abd aorta L1/ovary for female, testicles for men)*
- median sacral (bifurcation of aorta/sacrum and coccyx anterior surface)*
- iliolumbar (passes laterally/pelvic inlet, psoas, iliacus)
- lateral sacral (terminates as post. gluteal/sacrum)
- superior gluteal (gluteal region)
62
(3) veins of true pelvis (from what/joins what)
1) external iliac
- from post. of gluteal region (legs)
- continuation of femoral vein
- receives from inferior epigastric and deep circumflex
2) internal iliac
- from pelvis
- joins external iliac v. to become common iliac
3) median sacral
- from sacrum
- joins (L) common iliac vein
63
(3) lymphatics of true pelvis
1) external iliac nodes
2) internal iliac nodes
3) common iliac nodes
64
True/False:
lymph nodes and vessels are arranged in a chain along the main blood vessels
true
65
sacroiliac joint characteristics
- synovial (glides)
- formed by sacrum and ilium
- supported by: post, ant, & interosseus sacroiliac ligaments
- transmits weight of body downwards
66
symphysis pubis joint characteristics
- cartilaginous (minimal to no movement)
- surrounded by ligament that extend from 1 pubic bone to the other
67
sacrococcygeal joint characteristics
- cartilaginous (minimal flex/ext.)
- between body of sacrum & 1st coccyx
68
surface anatomy
iliac crest
asis
psis
urinary bladder
bladder neck
uterus
iliac crest (L4)
- top part of ileum
- landmark used by anesthesiologist for spinal needle
ASIS (end of iliac crest)
- start of inguinal ligament
- anterior end of iliac/lateral end of fold of groin
PSIS (S2/level of middle of SI joint)
- dimple in posterior back
- lower limit of subarachnoid space
urinary bladder (posterior of symphysis pubis)
- children under 6 (abd organ)/adults (joins pelvis)
bladder neck (level of upper border of symphysis pubis)
uterus (lower anterior abdomen 2 months preg./xiphoid process 9 months)
69
at the SI joint divides into external and internal iliac arteries
common iliac artery
70
leaves false pelvis passing the inguinal ligament to become a femoral artery
inferior epigastric & deep circumflex artery
71
levator ani (3) fibers
1) anterior
2) intermediate
3) posterior
72
levator ani anterior fibers
- form a sling around prostate/vagina (levator prostate/sphincter vaginae)
- insertion: perineal body
- supports prostate (male)/constricts or expands vagina (female)
- stabilizes perineal body
73
levator ani intermediate fibers (puborectalis)
- form a sling around junction of rectum & anal canal
- prevents feces to get out, relax & support release of feces
74
levator ani intermediate fibers (pubococcygeous)
pass posteriorly to insert the anoccygeal body
75
True/False:
pubococcygeus muscle pass posteriorly to insert the anococcygeal body
true
76
levator ani posterior fibers (ileococcygeus)
- insertion: anococcygeal body/coccyx
- support pelvic viscera/sphincter to anorectal junction & vagina/helps in valsalva
77
innervation of levator ani
s4 & pudendal n. (perineal branch)
78
innervation of coccygeous
s4-s5
79
(2) pelvic fascia
1) parietal - covers wall
2) visceral - covers organs
80
sacral plexus motor & cutaneous innervation
check table
81
autonomic nerves
check trans
82
moina
check table
82
moina
check table
83
lateral wall
- formed by hip bone
- below pelvic inlet, obt. mem., obt. int. muscle, 2 "s" ligaments & fascia
84
what nerve is L2, 3, 4
obturator nerve
85
covered by obturator membrane for passage of obturator nerve
obturator foramen
86
(2) groups of muscles in pelvic diaphragm
1) levator ani
2) coccygeus
