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MRCS > Pelvis > Flashcards

Pelvis Flashcards

1
Q

How long are the ureters

A

25cm

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2
Q

The point where the renal pelvis narrows to form the ureter is known as what

A

Ureteropelvic junction

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3
Q

The ureters cross the bifurcation of which main arteries

A

Common iliac arteries

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4
Q

Which arteries does the ureters run under in the pelvis

A

Ovarian arteries in females

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5
Q

In men what structure crosses the ureters anteriorly

A

Vas deferens

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6
Q

Which embryological structure does the ureter develop from

A

The ureteric bud from the mesonephric duct

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7
Q

What is the blood supply to the abdominal ureter

A

renal artery, testicular/ovarian artery, and ureteral branches directly from the abdominal aorta

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8
Q

What is the blood supply to the pelvic ureter

A

Superior and inferior vesical arteries

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9
Q

Where are the 3 narrowings of the ureter

A

Uretopelvic junction
Pelvic brim
Where the ureter enters the bladder

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10
Q

What connects the bladder to the umbilicus

A

Median umbilical ligament - connects the apex of the bladder to the umbilicus
It is a remnant of the urachus

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11
Q

What is the trigone of the bladder

A

A triangular area located at the fundus of the bladder
Marks the orifices where the left and right ureter enter the bladder

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12
Q

What is the specialised smooth muscle that the bladder is composed of

A

Detrusor muscle

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13
Q

Describe the internal urethral sphincter in men

A

Smooth muscle fibres under autonomic control, prevents seminal regurgitation during ejaculation

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14
Q

Describe the internal urethral sphincter in women

A

Functional sphincter
Formed by the anatomy of the bladder neck and the proximal urethra

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15
Q

Describe the external urethral sphincter

A

Composed of skeletal muscle
Under voluntary control

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16
Q

What is the arterial supply of the bladder

A

Superior vesical artery - branch of the internal iliac artery
Supplemented in males - inferior vesical artery
Supplemented in females - vaginal arteries

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17
Q

What is the lymphatic drainage of the bladder

A

Superolateral aspect - external iliac lymph nodes
Neck and fundus - internal iliac, sacral, common iliac nodes

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18
Q

What is the sympathetic supply of the bladder and what is its action

A

Hypogastric nerve
Relaxation of the detrusor muscle, allowing urinary retention

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19
Q

What is the parasympathetic supply of the bladder and what is its action

A

Pelvic nerve
Contraction of the detrusor muscle, allowing micturition

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20
Q

What is the somatic innervation of the bladder and what is its action

A

Pudendal nerve
Innervates the external urethral sphincter, allowing control over micturition

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21
Q

Describe the bladder stretch reflex

A

Primitive reflex
Bladder wall stretch results in micutration - this is overridden in toilet training

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22
Q

What is the epithelial lining of the urethra

A

Stratified columnar epithelium

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23
Q

How long is the male urethra

A

15-20cm

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24
Q

What are the 3 sections of the male urethra

A

Prostatic
Membranous
Penile

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25
Q

The prostatic urethra has what 2 ducts opening into it

A

Ejaculatory ducts
Prostatic ducts

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26
Q

Which is the widest part of the male urethra

A

Prostatic urethra

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27
Q

In which part of the male urethra is the external urethral sphincter found

A

Membranous urethra

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28
Q

What ducts open into the penile urethra

A

Bulbourethral glands

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29
Q

What is the arterial supply of the prostatic urethra

A

Inferior vesical artery (branch of the internal iliac artery)

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30
Q

What is the arterial supply of the membranous urethra

A

Bulbourethral artery (branch of internal pudendal artery)

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31
Q

What is the arterial supply of the penile urethra

A

Branches of the internal pudendal artery

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32
Q

What is the lymphatic drainage of the penile urethra

A

Prostatic and membranous portions - drain to the obturator and internal iliac nodes
Penile portion - inguinal nodes

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33
Q

How long is the female urethra

A

4cm

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34
Q

Which glands mark the distal end of the female urethra

A

Skene’s glands

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35
Q

What is the arterial supply of the female urethra

A

Internal pudendal arteries
Vaginal arteries
Inferior vesical branches of the vaginal arteries

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36
Q

What is lymphatic drainage of the female urethra

A

Proximal urethra - Internal iliac nodes
Distal urethra - superficial inguinal lymph nodes

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37
Q

What are the 3 paired muscles that make up levator ani muscles

A

Pubococcygeus
Puborectalis
Iliococcygeus.

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38
Q

Which muscle is the most important in maintaining faecal incontinence

A

Puborectalis

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39
Q

How does puborectalis maintain faecal incontinence

A

Creates the anorectal angle which contributes to faecal continence
It is voluntarily inhibited during defecation.

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40
Q

What is the nerve supply to levator ani muscle group

A

Nerve to levator ani
Pudendal nerve

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41
Q

Which muscle creates the bulk of the levator ani

A

Pubococcygeus

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42
Q

Which muscle form the posterolateral part of the levator ani

A

Iliococcygeus

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43
Q

What is the action of pubococcygeus

A

Stability and support of abdominal and pelvic organs

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44
Q

What is the action of iliococcygeus

A

Elevates the pelvic floor and anorectal canal

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45
Q

Where is coccygeus located

A

Posterior to the levator ani muscle group
A small triangular muscle

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46
Q

What is the function of the pelvic floor

A

Support of abdominopelvic viscera
Resistance to increase intra-pelvic/abdominal pressure
Urinary and faecal incontinence

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47
Q

What are the 2 holes in pelvic floor

A

Urogenital sinus
Rectal hiatus

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48
Q

What are the anatomical borders of the perineum

A

Anterior - pubic symphysis
Posterior - tip of coccyx
Lateral - inferior pubic rami and inferior ischial rami
Roof - pelvic floor
Base - skin and fascia

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49
Q

The perineum is split into which two spaces

A

Anterior urogenital triangle
Posterior anal triangle

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50
Q

What are the boundaries of the anal triangle

A

Coccyx
Sacrotuberous ligaments
A theoretical line between the ischial tuberosities

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51
Q

What are the contents of the anal triangle

A

Anal arpeture - opening of the anus
External anal sphincter
Ischioanal fossae (2, located either side of the anus)

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52
Q

What do the ischioanal fossa allow

A

Allow for expansion of the anal canal during defecation

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53
Q

Which nerve is found in the anal triangle

A

Pudendal nerve

54
Q

What are the boundaries of the urogenital triangle

A

Pubic symphysis
Ischiopubic rami
A theorectical line between the two ischial tuberosities.

55
Q

From deep to superficial what are the layers of the urogenital triangle

A

Deep perineal pouch
Perineal pouch
Superficial perineal pouch
Perineal fascia
Skin

56
Q

What is the deep perineal pouch

A

A potential space between the deep fascia of the pelvic floor superiorly and the perineal membrane inferiorly

57
Q

In females what is contained in the deep perineal pouch

A

Urethral
External urethral sphincter
Vagina

58
Q

In males what is contained in the deep perineal pouch

A

Bulbourethral glands
Deep transverse perineal muscles

59
Q

What is the function of the perineal membrane

A

Provide attachments for the muscles of the external genitalia

60
Q

What is the superficial perineal pouch

A

A potential space between the perineal membrane superiorly and the superficial perineal fascia inferiorly

61
Q

What is contained in the superficial perineal pouch

A

Erectile tissues that form the penis and clitoris, and three muscles – the ischiocavernosus, bulbospongiosus and superficial transverse perineal muscles.

62
Q

What are the two components of the perineal fascia

A

Deep fascia
Superficial fascia

63
Q

What does the deep perineal fascia cover

A

The superficial perineal muscles and protruding structures (penis and clitoris)

64
Q

How many layers of superficial perineal fascia is there

A

2

65
Q

What is the superficial layer of the superficial perineal fascia continuous with

A

Camper’s fascia of the anterior abdominal wall

66
Q

What is the deep layer of the superficial perineal fascia continuous with

A

Scarpa’s fascia of the abdominal wall

67
Q

What attaches to the perineal body

A

Levator ani
Bulbospongiosus muscle.
Superficial and deep transverse perineal muscles
External anal sphincter muscle
External urethral sphincter muscle fibres

68
Q

What is the neurovascular supply to the perineal body

A

Pudendal nerve
Internal pudendal artery

69
Q

What travels in Alcock’s canal

A

Pudendal nerve, artery and vein

70
Q

What separates the greater and lesser sciatic foramen

A

Sacrospinous ligament

71
Q

What are the borders of the greater sciatic foramen

A

Superior - anterior sacroiliac ligament
Posteromedial - sacrotuberous ligament
Anterolateral - greater sciatic notch of ileum
Inferior - sacrospinous ligament and ischial spine

72
Q

What passes through the greater sciatic foramen

A

Superior gluteal artery and vein
Superior gluteal nerve
Sciatic nerve
Pudendal nerve
Inferior gluteal artery and vein
Inferior gluteal nerve
Posterior femoral cutaneous nerve
Nerve to obturator internus
Nerve to quadratus femoris

73
Q

What are the borders of the lesser sciatic foreman

A

Superior - sacrospinous ligament and ischial spine
Anterior - ischial spine, lesser sciatic notch and ischial tuberosity
Posterior - sacrotuberous ligament

74
Q

What passes through the lesser sciatic foramen

A

Internal pudendal artery and vein
Pudendal nerve
Obturator internus tendon
Nerve to obturator internus

75
Q

Which nerve leaves the great sciatic Forman and re-enters the lesser sciatic foramen

A

Pudendal nerve

76
Q

Which nerve leaves the great sciatic Forman and re-enters the lesser sciatic foramen

A

Pudendal nerve

77
Q

Which nerve roots form the sacral plexus

A

Anterior rami of S1-S4

78
Q

What are the 5 main main branches of the sacral plexus

A

Sciatic nerve
Pudendal nerve
Superior gluteal nerve
Inferior gluteal nerve
Posterior femoral cutaneous nerve

79
Q

What are the nerve roots of the pudendal nerve

A

S2, S3, S4

80
Q

What is the sensory function of the pudendal nerve

A

Innervates the external genitalia of both sexes and the skin around the anus, anal canal and perineum

81
Q

What is the motor function of the pudendal nerve

A

Bulbospongiosus
Ischiocavernosus
Levator ani muscles (including the iliococcygeus, pubococcygeus and puborectalis)
External urethral sphincter
external anal sphincter

82
Q

The inferior rectal nerve is a branch of which nerve and what does it innervate

A

Branch of pudendal nerve
Innervates the perianal skin and lower third of the anal canal

83
Q

The perineal nerve is a branch of which nerve and what does it innervate

A

Branch of pudendal nerve
Inervates the skin of the perineum, labia minora and majora or posterior scrotum.

84
Q

The dorsal nerve of the penis/ dorsal nerve of the clitoris is a branch of which nerve and what does it innervate

A

innervates the skin of the penis or clitoris. Thus, responsible for the afferent component of penile and clitoral erection.

85
Q

What is the major artery of the pelvis

A

Internal iliac artery

86
Q

Where does the internal iliac artery divide into anterior and posterior trunks

A

At the superior border of the greater sciatic foramen

87
Q

What are the branches of the internal iliac artery

A

Obturator artery
Umbilical artery
Inferior vesical artery
Vaginal artery
Uterine artery
Middle rectal artery

88
Q

What are the branches of the anterior trunk of the internal iliac artery

A

Obturator artery
Umbilical artery
Inferior vesical artery
Vaginal artery
Uterine artery
Middle rectal artery
Internal pudendal artery
Inferior gluteal artery

89
Q

What are the branches of the posterior trunk of the internal iliac artery

A

Iliolumbar artery
Lateral sacral arteries
Superior gluteal artery

90
Q

What are the minor arteries of the pelvis

A

Gonoadal arteries
Median sacral arteru
Superior rectal artery

91
Q

The external iliac vein is a continuation of which vein, and what veins drain into it

A

Continuation of the femoral vein - from the point of the inguinal ligament
Receives the inferior epigastric and the deep circumflex iliac veins

92
Q

Which veins drain into the internal iliac veins

A

Superior and inferior gluteal veins
Internal pudendal vein
Obturator vein
Lateral sacral veins
Middle rectal vein
Vesical veins
Uterine and vaginal veins

93
Q

Which vessels drain directly into the common iliac vein

A

Iliolumbar veins
Middle sacral vein

94
Q

At what level do the common iliacs combine to form the IVC

A

L5

95
Q

What is pelvic congestion syndrome

A

Intense pain in the pelvis secondary to venous congestion following valve failure, usually occurs in ovarian veins

96
Q

What 3 bones make up the hip

A

Ilium
Pubis
Ischium

97
Q

What forms the pelvic girdle

A

The 2 hip bones
Sacrum
Coccyx

98
Q

What are the 4 articulations of the pelvis

A

Sacroiliac joints
Sacrococcygeal symphysis
Pubic symphysis

99
Q

What are the functions of the pelvis

A

Transfer weight from axial skeleton
Provides attachment for muscles and ligaments
Contains and protects the abdominopelvic viscera

100
Q

What is the greater pelvis

A

Also known as the false pelvis
Located superiorly
Gives support to the lower abdominal viscera - the sigmoid and the ileum

101
Q

What is the lesser pelvis

A

Also known as the true pelvis
Located inferiorly
Forms the pelvic cavity and holds the pelvic viscera

102
Q

What is the pelvic inlet

A

The junction between the greater and lesser pelvis

103
Q

What is the pelvic brim

A

The outer bony edges of the pelvic inlet

104
Q

What are the borders of the pelvic inlet

A

Posterior - sacral promontory and sacral wings (ala)
Lateral - arcuate line on the inner surface of the ileum and the pectineal line on the superior pubic ramis
Anterior - pubic symphysis

105
Q

What is the linea terminalis of the pelvis

A

The combined pectineal line, arcuate line and sacral promontory

106
Q

What does the iliopectineal line represent

A

This represents the lateral border of the pelvic inlet.

107
Q

What is the iliopectineal line

A

The combined arcuate and pectineal lines

108
Q

What are the borders of the pelvic outlet

A

Posterior - tip of the coccyx
Lateral - The ischial tuberosities and inferior margin of the sacrotuberous ligament
Anterior - the pubic arch

109
Q

How is the gynaeoid pelvis different from the android pelvis

A

Wider and broader structure, with an oval shaped inlet - compared to a heart shaped inlet
A greater angled sub-pubic arch

110
Q

What are the 6 surfaces of the sacrum

A

Base - articulates with L5
Apex - articulates with the coccyx
2 x Auricular surfaces - lateral surfaces which articulate with the posterior surface of the ilium
Anterior and posterior surfaces

111
Q

How many crests are found on the dorsal surface of the sacrum

A

Median sacral crest
2 x intermediate sacral crest
2 x lateral sacral crest

112
Q

What attaches to the median sacral crest of the sacrum

A

Supraspinous ligament

113
Q

What forms the median sacral crest of the sacrum

A

Formed by the fusion of the spinous processes of the first 3 sacral vertebrae

114
Q

What attaches to the intermediate sacral crest

A

Posterior sacroiliac ligaments

115
Q

What attaches to the lateral sacral crest

A

Posterior sacroiliac ligaments
Sacrotuberous ligament

116
Q

At what age does fusion of the sacral vertebrae begin

A

20

117
Q

In which sex is the sacral promontory less prominent

A

Females

118
Q

Which muscles attach to the anterior surface of the sacrum

A

Piriformis
Coccygeus
Iliacus

119
Q

Which muscles attach to the posterior surface of the sacrum

A

Multifidus lumborum
Erector spinae

120
Q

At what level does the dural sac terminate

A

S2

121
Q

What is the blood supply to the sacrum

A

Median sacral artery - posterior branch of the aorta
Lateral sacral arteries - bilateral vessels from the internal iliacds

122
Q

What embryological structure does the coccyx arise from

A

Caudal eminence

123
Q

What is the sacrococcygeal symphysis

A

The fibrocartilaginous joint where the coccyx articulates with the sacrum

124
Q

Which 5 ligaments support the sacrococcygeal symphysis

A

Anterior sacrococcygeal ligament
Deep posterior sacrococcygeal ligament
Superficial posterior sacrococcygeal ligament
Lateral sacroccygeal ligament
Interarticular ligaments

125
Q

The anterior sarcococcygeal ligament is a continuation of which ligament

A

Anterior longitudinal ligament of the spine
Connects the anterior aspect of the vertebral bodies

126
Q

Which muscles attach to the coccyx

A

Gluteus maximus
Levator ani muscle
Anococcygeal raphe

127
Q

What is a sacrococcygeal teratoma

A

Tumour of the coccyx
most common presenting tumour of a newborn

128
Q

What type of joint is the sacroiliac joint

A

Synovial

129
Q

Which 3 main ligaments reinforced

A

Interosseous sacroiliac ligament
Posterior sacroiliac ligament
Anterior sacroiliac ligament

130
Q

Which is the strongest of the sacroiliac ligaments

A

Interosseous sacroiliac ligament

131
Q

What is the arterial supply of the sacroiliac joint

A

Iliolumbar arteries
Median and lateral sacral arteries

132
Q

What is the nervous innervation of the sacroiliac joint

A

Sacral spinal nerves

MRCS (17 decks)

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