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MD3002 post MSA > pelvis 2 walls and NV supply > Flashcards

pelvis 2 walls and NV supply Flashcards

1
Q

What is the false pelvis

A

from the iliac bones

posterior abdo wall and iliacus

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2
Q

what is the true pelvis

A

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

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3
Q

what muscle lines the pelvic lateral wall

A

obturator internus

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4
Q

what muscle lines the pelvic floor

A

levator ani

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5
Q

what is the perineum

A

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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6
Q

what organs lie on levator ani

A

bladder and prostate

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7
Q

what divides the perineum into deep and superficial compartments anteriorly

A

perineal membrane

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8
Q

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

A 
pubic symphysis and crest
superior pubic ramus 
pectineal line
arcuate line 
SI joint 
sacral ala and promontory
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9
Q

what are the borders of the pelvic outlet

A

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

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10
Q

what are the features of the female pelvis

A

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

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11
Q

what are the features of the male pelvis

A

heart shaped pelvic inlet
oval shaped outlet
smaller sub pubic angle

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12
Q

where is the sacrospinous ligament

A

from the ischial spine to the adjacent sacrum and coccyx

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13
Q

where is the sacrotuberous ligament

A

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

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14
Q

where is piriformis

A

sacrum to greater trochanter

forms the posterior pelvic wall and divides the greater sciatic foramen

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15
Q

where is obturator internus

A

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

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16
Q

what fascia gives origin to levator ani

A

obturator- tendinous arch

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17
Q

what muscles form the pelvic floor

A

coccygeus and levator ani

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18
Q

what is levator ani divided into

A

iliococcygeus

pubococcygeus

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19
Q

what is pubococcygeus divided into

A

rectalis,
vaginalis or prostaticus
urethralis

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20
Q

what is the nerve supply of iliococcygeus and pubococcygeus

A

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

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21
Q

what ligament does coccygeus overlie

A

sacrospinous and blends with levator ani posteriorly

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22
Q

what is the anococcygeal raphe

A

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

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23
Q

where is the perineal body aka central tendon of the perineum

A

anterior to the anal canal and posterior to the vagina

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24
Q

where are obturator lymph nodes found

A

on the lateral pelvic walls, alongside the obturator neurovascular bundle

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25
Q

what forms lumbosacral plexus

A

ventral rami of L4-5 and S1-4

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26
Q

what supplies the pelvic floor and voluntary sphincters

A

pudendal nerve S2-4

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27
Q

describe the course of the pudendal nerve

A

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

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28
Q

what forms the sacral splanchnics

A

sympathetic trunks extending into the pelvis

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29
Q

what does the superior hypogastric send branches to

A

pelvic plexus

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30
Q

what does the thoracic sympathetic trunk give

A

greater, lesser and least splanchnic nerves

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31
Q

what do the splanchnic nerves form

A

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

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32
Q

what do the sympathetic trunks form in the pelvis

A

fuse as the ganglion impar opposite the coccyx

33
Q

what is the value of the pelvic plexus

A

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

34
Q

what is the value of the pelvic splanchnics

A

parasympathetic fibres from S2-4

35
Q

what are the components of levator ani

A

puborectalis, pubococcygeus, iliococcygeus

36
Q

what are the components of pubococcygeus

A

puborectalis, pubovaginalis or prostaticus, true pubococcygeus

37
Q

what muscle divides the greater sciatic foramen

A

piriformis

38
Q

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

A

superior gluteal vessels and nerves

39
Q

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

A

sciatic nerve with inferior gluteal vessels

40
Q

what nerves go through the lesser sciatic foramen

A

the pudendal nerve with internal pudendal vessels

they recurve into the perineum, inferior to the pelvic floor

41
Q

what goes through the obturator canal

A

obturator nerves and vessels

42
Q

what muscle forms the posterior pelvic wall

A

piriformis

from the sacrum to the greater trochanter

43
Q

where is obturator internus

A

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

44
Q

what is the nerve supply of iliococcygeus

A

S3 and 4

45
Q

what is the nerve supply of pubococcygeus

A

S3 and 4

46
Q

what ligaments support the bladder

A

puboprostatic in the male

pubovesical in the female

47
Q

what is the blood supply of the bladder

A

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

48
Q

what is the venous drainage of the bladder

A

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

49
Q

what is the lymph drainage of the bladder

A

external iliac nodes

also internal iliac and common iliac nodes

50
Q

what is the nerve supply of the bladder

A

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

51
Q

what is the nerve supply of the internal sphincter

A

sympathetic T12, L1, L2 via the pelvic plexus

52
Q

what does scarpa’s fascia become

A

colle’s

53
Q

where is the male external sphincter

A

membranous urethra

54
Q

what is the veru montanum a landmark for

A

where the ejaculatory ducts enter the urethra

55
Q

what does the prostate secrete

A

acid phosphatase, amylase, PSA, fibrinolysin

56
Q

what part of the prostate is most susceptible to BPH

A

transitional zone

around urethra

57
Q

what part of the prostate is most susceptible to cancer

A

peripheral zone

58
Q

what structures are the seminal vesicles sandwiched between

A

rectum and bladder

59
Q

what is the blood supply to the prostate

A

inferior vesicle from internal iliac

60
Q

what is the blood supply of the female urethra

A

internal pudendal from internal iliac

61
Q

what does the venous drainage of the prostate communicate with

A

the valveless veins of the vertebral plexus which facilitates tumour spread

62
Q

what is the lymph drainage of the prostate

A

internal iliac nodes

63
Q

what nerves are responsible for the desire to micturate

A

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

64
Q

what nerves are responsible for micurition

A

relaxation of levator ani and external urethral sphincter via S2-4 via the pudendal nerve

sensation of urine maintains the reflex

65
Q

how do babies learn to control micturition

A

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

66
Q

what can cause urinary incontinence

A

cord transection above S2 or loss of cortical control following stroke

67
Q

what happens if sacral segments 2-4 are destroyed

A

detrusor is paralysed so bladder distends until there is overflow incontinence

68
Q

what are splanchnic nerves

A

nerves that innervate the organs

all carry sensory and sympathetic fibres except for the pelvic splanchnic which is parasympathetic

69
Q

what are the parts of the thoracic splanchnics

A

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

70
Q

what fibres does the inferior hypogastric plexus or pelvic plexus carry

A

fibres from lesser and least splanchnics so T10-12

additions from the pelvic splanchnics (nervi erigentes) which is p’sympathetic and sacral splanchnics

71
Q

where does the internal iliac artery branch from the common iliac

A

opposite the sacroiliac joint at L5

72
Q

what artery divides at L5

A

common iliac

73
Q

what artery divides at L4

A

the aorta into the common iliacs

74
Q

what does the internal iliac divide into

A

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

75
Q

what arteries may form a collateral circulation for the lower limb

A

gluteal branches of the internal iliac

76
Q

what is the internal pudendal artery a branch of

A

internal iliac

77
Q

name some branches of the internal iliac artery

A 
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)
78
Q

what are the tributaries of the internal iliac vein

A

superior gluteal
internal pudendal
inferior gluteal

middle rectal vein
vesical, vaginal, uterine from venous plexuses

MD3002 post MSA (66 decks)

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