Pelvis Flashcards
pelvic inlet
aka brim
divided by pectineal line of pubis > arcuate line of ilium and sacral promontory
above line = greater pelvis/false pelvis
below line= lesser pelvis/true pelvis
joints
- sacroiliac (synovial)
- lumbosacral w/ IV disc
- sacrococcygeal w/ IV
- pubic symphysis
other joints are fibrocartilaginous or secondary cartilaginous
ligaments
- sacrotuberous
sacrum > IT - sacrospinous
sacrum > ischial spine
ligaments function
prevent anteroinferior displacement of superior sacrum
convert greater and lesser sciatic notches > foramina
differences
female
inlet = more round/oval
canal = short w/ parallel walls
IT and IS = everted
greater sciatic notch and pubic arch = broader
sacrum = short and broad
differences
male
inlet = heart shaped
canal = long and funnel shaped
IT and Is = not everted, in the way
greater sciatic notch and pubic arch = narrow
sacrum = long and narrow
muscles - lateral
1.obturator internus lined by** membrane** that forms medial tendinous arch
lesser pelvis > thru lesser sciatic foramen > femur greater trochanter
muscles - posterior
piriformis
sacrum in lesser pelvis> greater sciatic foramen > femur greater trochanter
bed for sacral nerve plexus
muscles - pelvic floor
aka pelvic diaphragm = levator ani + coccygeus
support viscera (esp when inc intraab pressure)
aid voluntary control of urination of fecal continence
levator ani
three parts:
1.puborectalis (medial)- sling from pubis around rectum, maintains fecal continence
2.pubococcygeus= pubis and teninous arch > cocyx
3.iliococcygeus - tendinous arch and IS > blends w/ pubococcygeus
coccygeus
ischiococcygeus
IS > occygeus/sacrum
urinary system
transport urine from kidneys to bladder
-store urine
-transfer urine to outside world
kidneys considered abdominal organs not pelvic
ureters
function
retroperitoneal muscular tubes transport urine from kidneys to posterosuperior bladder
enter bladder obliquely, flap valves form so contractions of bladder like sphincters to precent reflux
ureters
sex differences
female = ureters MEDIAL to uterine arteries origins,
male = ductus deferens b/t ureters and peritoneum
-ductus crosses ureter
ureters arterial supply
female= uterine arteries
male = inferior vesicular arteries
ureters innervation
nearby autonomic plexuses aka
renal, aortic, superior/inferior hypogastrics
bladder
temporary reservoir for urine
@ lesser pelvis in adults and extend to umbilicus
or in abdomen for children
bladder parts
apex- anterosuperior aspect
fundus- posterior wall
body- area b/t apex and fundus
neck- for constriction
trigone- triangle b/t ureteric and urethral openings (can project in older men = uvula)
walls made of detrusor muscle
bladder
sex differences
female: muscles of neck cont w/ urethra’s muscle
male: muscle of bladder neck cont w/ prostate fibromuscular tissue (fibers form involuntary internal urethral sphincter)
urethra
muscular tube from bladder to outside world
urethra female
descends anterior to vagina
urine exit via external urethral orifice
glands adj to urethra
urethra male
longer and more complex
2 curves in flaccid penis vs. 1 in erect
parts:
1. preprostatic: neck of bladder to prostate
2. prostatic: w/i prostate, gently curves
3. intermediate/membranous: short, narrow, least distensible, thru external sphincter, things get stuck
4. spongy; longest, ends at external orifice of glans penis
membranous and spongy in perineum not pelvis
prostatic urethra
urethral crest w/ median ridge
seminal colliculus= rounded eminence w/ utricle (cul de sac remnant of uterovaginal canal)
opening of ejaculatory (in seminal colliculus) and prostatic ducts (lateral to seminal colliculus)
reproductive system
female
ovaries + uterine tubes + uterus + vagina
ovaries
house glands
release ova
uterine tubes
parts:
1. infundibulum (funnel shaped w/ fimbrae)
2. ampulla (widest, longest)
3. isthmus (entering uterine horns)
4. uterine part (short segment in uterine wall)
uterus
body- upper 2/3
1. fundus- superior to uterine tube
2. uterine horns- entrance of tubes
3. isthmus- constricted region superior to cervix
cervix- neck
1. internal os- opening to uterus
2. external os- opening to vagina
ligaments
female reproduction
- ovarian (ovary-uterus @ posteroinferior to uterotubal junction)
- round/ ligamentum teres (uterus to labia majora @anteroinferior to uterotubal junction)
- broad (mesentary of uterus)
subdivisions of broad ligament
- suspensory- conveys ovarian vessels, lymphatics, nerves
- mesovarium- suspend ovary
- mesoalpinx- suspend uterine tube
- mesomentrium-suspend most of uterus
vagina
musculomembranous tube from cervix >vestibule
compressed via external urethral sphincter + bulbospongiosus
surrounds cervix so superior part called fornix (anterior, posterior, lateral)
vagina
innervation
lower 1/4 = deep perineal branch of pudendal, somatic
upper 3/4 = autonomic
male reproductive system
testes + epididymis + ductus deferens + seminal vesicles + ejaculatory duct + prostate + bulbourethral glands
ductus deferens
continuation of duct of epididymis
has ampulla
joins seminal vesicle = ejaculatory duct
seminal = paired glands secrete thick fluid into duct
ejaculatory ducts
seminal vesicle duct + ductus deferens
converge upon seminal colliculus of prostatic urethra > descend thru posterior prostate
prostate
accessory gland for male reprod
has prostatic urethra w/ lobes (ant, post, middle, lat) AND ducts that empty into sinuses on sides of colliculus
bulbourethral glands
small glands secrete during sexual arousal
@posterolateral to membranous urethra
ducts open into spongy urethra in bulb penis
semen is mix of testes, seminal vesicles, prostate, bulbo glands
periotenal reflections
- extraperitoneal/subperitoneal- outside or below peritoneal cavity, most pelvic viscera
- primarily retroperitonal (PRP)
- intraperitoneal
primarily retroperitoneal
kidneys, ureters, rectum, anal canal, male prostate, seminal vesicles, vas deferens
intraperitoneal
uterus, ovaries, uterine tubes
uterus could be secondarily IP
spaces
- retropubic/retzius- behind pubis, accom bladder distension
- retrorectal- behind rectum, accom rectal expansion
- rectovesical pouch- male, b/t bladder/prostate and rectum
- vesicouterine pouch- female, b/t bladder and uterus
- rectouterine pouch/douglas- b/t uterus and rectum
douglas easily accessed via posterior fornix
anterior vasculature
common iliac> internal iliac >
1. obturator
2. inferior gluteal
3. middle rectal
4. internal pudendal
5. inferior vesicular and superior
6. umbilical > superior vesicular
7. uterine > vaginal
O I MIIS U, UV
posterior vasculature
common iliac>internal iliac>
1. iliolumbar
2. lateral sacral
3. superior gluteal
PILS
vasculature general
- internal iliac
- external iliac
- gonadal arteries (testicular or ovarian) direct from aorta
lymphatics
inguinal nodes (superficial and deep) from lower limbs + lowest body wall and external genitalia
external/internal iliac nodes from pelvis and inguinal nodes
common iliac nodes from external/interal
lumbar nodes from common iliac
nerves general
- lumbosacral trunk (L4-5)
- obturator (L2-4)
- accessory obturator (L3-4)
- sacral plexus (L4-S4)
- coccygeal plexus (S4-5)
sacral plexus
- sciatic (L4-S3)
- pudendal (S2-4)
- superior gluteal (L4-S1)
- inferior gluteal (L5-S2)
sciatic nerve
L4-S3
-exits pelvis via greater sciatic foramen
-supplies lower limb
-anterior and posterior
pudendal
S2-4
-exit pelvis via greater sciatic then enters perineum via lesser sciatic
-supply skina nd muscles of perineum, main sensory for external genitalia
-anterior
superior gluteal
L4-S1
exit pelvis via greater sciatic
supply gluteus medius + minimus + tensor fascia latae
posterior division
inferior gluteal
L5-S2
exit pelvis via greater sciatic
supply gluteus maximus
posterior division
coccygeal plexus
small plexus from ventral rami of S4-5 + coccygeal nerves
sympathetics pathways
from T11-L2
4 ganglia bilaterally converge @ ganglion impar/end of trunk
-thru lumbar and sacral splanchnics
-synapse @ inferior mesenteric ganglion
-postsynaptics thru hypogastrics (superior, R/L, inferior)
-follow pelvic arteries to target organs
