pelvis 2 walls and NV supply Flashcards by Susannah Bath

What is the false pelvis

from the iliac bones

posterior abdo wall and iliacus

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what is the true pelvis

inferior to the arcuate lines on the iliac bones - pelvic brim/ inlet

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what muscle lines the pelvic lateral wall

obturator internus

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what muscle lines the pelvic floor

levator ani

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what is the perineum

the region below the pelvic floor and it contains the genitalia and urethra anteriorly and the anal cancal and ischio anal fossae posteriorly

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what organs lie on levator ani

bladder and prostate

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what divides the perineum into deep and superficial compartments anteriorly

perineal membrane

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what are the borders of the true pelvis or pelvic inlet/brim

pubic symphysis and crest
superior pubic ramus 
pectineal line
arcuate line 
SI joint 
sacral ala and promontory

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what are the borders of the pelvic outlet

pubic symphysis and ischiopubic ramus
ischial tuberosity
sacrotuberous ligament and sacram and coccyx

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what are the features of the female pelvis

lighter, rounder, wider, greater subpubic angles, oval shaped inlet, circular shaped outlet

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what are the features of the male pelvis

heart shaped pelvic inlet
oval shaped outlet
smaller sub pubic angle

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where is the sacrospinous ligament

from the ischial spine to the adjacent sacrum and coccyx

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where is the sacrotuberous ligament

external to the sacrospinous ligament from the ischial tuberosity to the ilium, sacrum and coccyx

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where is piriformis

sacrum to greater trochanter

forms the posterior pelvic wall and divides the greater sciatic foramen

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where is obturator internus

from obturator membrane and adjacent bone, passing to the greater trochanter, forms the lateral pelvic wall, with overlying obturator fascia

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what fascia gives origin to levator ani

obturator- tendinous arch

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what muscles form the pelvic floor

coccygeus and levator ani

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what is levator ani divided into

iliococcygeus

pubococcygeus

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what is pubococcygeus divided into

rectalis,
vaginalis or prostaticus
urethralis

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what is the nerve supply of iliococcygeus and pubococcygeus

S 3,4 via the pudendal nerve which is s2-4

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what ligament does coccygeus overlie

sacrospinous and blends with levator ani posteriorly

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what is the anococcygeal raphe

where each side of muscle meets in the midline, also forming the perineal body

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where is the perineal body aka central tendon of the perineum

anterior to the anal canal and posterior to the vagina

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where are obturator lymph nodes found

on the lateral pelvic walls, alongside the obturator neurovascular bundle

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what forms lumbosacral plexus

ventral rami of L4-5 and S1-4

what supplies the pelvic floor and voluntary sphincters

pudendal nerve S2-4

describe the course of the pudendal nerve

passes out of the greater sciatic foramen and into the buttock then curves posterior to the ischial spine, sacrospinous ligament and coccygeus then runs forward into the perineum, below levator ani

what forms the sacral splanchnics

sympathetic trunks extending into the pelvis

what does the superior hypogastric send branches to

pelvic plexus

what does the thoracic sympathetic trunk give

greater, lesser and least splanchnic nerves

what do the splanchnic nerves form

pre aortic vertebral plexus and synapse in ganglia at the coeliac trunk, SMA and IMA the pre aortic plexus passes into the pelvis as the superior hypogastric plexus that becomes the pelvic plexus

what do the sympathetic trunks form in the pelvis

fuse as the ganglion impar opposite the coccyx

what is the value of the pelvic plexus

T10- 12 as it is carrying fibres from the lesser and least splanchnic nerves

what is the value of the pelvic splanchnics

parasympathetic fibres from S2-4

what are the components of levator ani

puborectalis, pubococcygeus, iliococcygeus

what are the components of pubococcygeus

puborectalis, pubovaginalis or prostaticus, true pubococcygeus

what muscle divides the greater sciatic foramen

piriformis

what nerves and vessels go through the greater sciatic foramen above piriformis

superior gluteal vessels and nerves

what nerves and vessels go through the greater sciatic foramen below piriformis

sciatic nerve with inferior gluteal vessels

what nerves go through the lesser sciatic foramen

the pudendal nerve with internal pudendal vessels they recurve into the perineum, inferior to the pelvic floor

what goes through the obturator canal

obturator nerves and vessels

what muscle forms the posterior pelvic wall

piriformis from the sacrum to the greater trochanter

where is obturator internus

from the obturator membrane and bone to the greater trochanter forms the lateral pelvic wall and gives origin to levator ani

what is the nerve supply of iliococcygeus

S3 and 4

what is the nerve supply of pubococcygeus

S3 and 4

what ligaments support the bladder

puboprostatic in the male | pubovesical in the female

what is the blood supply of the bladder

anterior trunk of the internal iliac artery > superior vesical and inferior vesical/ vaginal artery

what is the venous drainage of the bladder

vesical plexus which drains to the internal iliac veins via vesical veins also prostatic plexus and internal iliac (and internal vertebral venous plexus)

what is the lymph drainage of the bladder

external iliac nodes | also internal iliac and common iliac nodes

what is the nerve supply of the bladder

anterior part of pelvic plexus that passes from the rectum to the bladder (surgical risk) mainly p'symp to detrusor from pelvic splanchnics s2-4 via pelvic plexus

what is the nerve supply of the internal sphincter

sympathetic T12, L1, L2 via the pelvic plexus

what does scarpa's fascia become

colle's

where is the male external sphincter

membranous urethra

what is the veru montanum a landmark for

where the ejaculatory ducts enter the urethra

what does the prostate secrete

acid phosphatase, amylase, PSA, fibrinolysin

what part of the prostate is most susceptible to BPH

transitional zone around urethra

what part of the prostate is most susceptible to cancer

peripheral zone

what structures are the seminal vesicles sandwiched between

rectum and bladder

what is the blood supply to the prostate

inferior vesicle from internal iliac

what is the blood supply of the female urethra

internal pudendal from internal iliac

what does the venous drainage of the prostate communicate with

the valveless veins of the vertebral plexus which facilitates tumour spread

what is the lymph drainage of the prostate

internal iliac nodes

what nerves are responsible for the desire to micturate

sensory afferents to the spinal cord then M center in pons stimulates preganglionic sympathetic neurones at S2-4

what nerves are responsible for micurition

relaxation of levator ani and external urethral sphincter via S2-4 via the pudendal nerve sensation of urine maintains the reflex

how do babies learn to control micturition

afferents ascend up the spinal cord to trigger cortical inhibition in the frontal lobe this superimposes cortical control on the M center in the pons which controls the bladder

what can cause urinary incontinence

cord transection above S2 or loss of cortical control following stroke

what happens if sacral segments 2-4 are destroyed

detrusor is paralysed so bladder distends until there is overflow incontinence

what are splanchnic nerves

nerves that innervate the organs | all carry sensory and sympathetic fibres except for the pelvic splanchnic which is parasympathetic

what are the parts of the thoracic splanchnics

greater- t5-9- foregut lesser -T10-11- midgut least- T12- hindgut

what fibres does the inferior hypogastric plexus or pelvic plexus carry

fibres from lesser and least splanchnics so T10-12 | additions from the pelvic splanchnics (nervi erigentes) which is p'sympathetic and sacral splanchnics

where does the internal iliac artery branch from the common iliac

opposite the sacroiliac joint at L5

what artery divides at L5

common iliac

what artery divides at L4

the aorta into the common iliacs

what does the internal iliac divide into

the anterior and posterior trunks to supply the buttock, medial thigh, pelvic walls, viscera and perineum

what arteries may form a collateral circulation for the lower limb

gluteal branches of the internal iliac

what is the internal pudendal artery a branch of

internal iliac

name some branches of the internal iliac artery

``` internal pudendal middle rectal inferior vesicle vaginal artery uterine umbilical artery which forms the artery to vas superior vesicle inferior gluteal iliolumbar artery (muscles- PM, QL, iliacus) ```

what are the tributaries of the internal iliac vein

superior gluteal internal pudendal inferior gluteal middle rectal vein vesical, vaginal, uterine from venous plexuses