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Anatomy > Pelvis > Flashcards

Pelvis Flashcards

1
Q

Pelvic Joints + Ligs

A
  • Secondary Cartilaginous
    • lumbosacral lig
    • IV disc
    • Iliolumbar lig
    • pubic symphysis
  • ZP (facet) plane synovial
    • sacroiliac
    • sacrococcygeal
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2
Q

pelvic diameters

A
  • Conj line = ant/post, sup PS -> mid sacral prom
  • true conj = back of PS -> prom, shorter than conj, narrowest btwn PS + prom, unaffected by pelvic lig relaxation
  • diagonal = bottom PS -> sacral prom, measured per vaginum, used to estimate true conj and to tell if wide enough for baby
  • oblique = sacroiliac joint -> iliopubic eminence
  • cant take conj/true conj w/o imaging
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3
Q

Pelvic Muscles

A
  • Floor = pelvic diaphragm = hammock - suspends viscera

- walls = obturator internus (lat ant wall) + piriformis (G. sciatic foramen -> femur)

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4
Q

Diaphragm + Innervation

A
  • diaphragm = levator ani + coccygeus
  • levator ani = levator ani n (S4), inf recta n. (from pudendal nerve, S3-S4), coccygeal plexus
  • Coccygeus = S3-S4
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5
Q

Levator Ani

A
  • puborectalis = from pubic bone, forms sling around GI tract
    • most medial, immediately lat to rectum -> maintains perineal flexure
    • relaxation = defecation
  • pubococcygeus = pubic bones -> coccyx at anococcygeal raphe (mid muscle)
  • iliococcygeus - ileum -> anococcygeal raphe (on outside)
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6
Q

Pelvic Borders

A
  • anterior wall = pubic bones, pubococcygeus, puborectalis
  • lat wall = obturator internus, piriformis
  • post wall = coccygeus
  • floor = pubococcygeus, puborectalis
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7
Q

Male Pelvic Cavity Spaces

A
  • Retropubic space = PS-bladder

- rectovesical space = rectum-bladder

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8
Q

Female Pelvic Cavity Spaces

A

• Rectopubic space (btwn pubis + rectum)
• Rectouterine pouch (of Douglas) = btwn uterus + rectum
• Vesicouterine pouch = btwn uterus + bladder
○ Paravesical space
○ Pararectal space
○ Retrorectal space

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9
Q

Thickened Pelvic Fascia

A
  • support viscera (in females)
  • pubovesical lig - from bone to bladder (thickened endopelvic lig)
  • transverse cervical lig (from uterus to wall)
  • uterosacral lig - from uterus back to sacrum
  • broad lig - peritoneal sheet, top of pelvic organs, from peritoneal cavity
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10
Q

Sacroiliac Lig

A
  • plane synovial + syndesmosis = compound joint
  • ant + post parts
  • blends w/2 other sacro-ligs
  • ossifies w/age
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11
Q

Pubic Symphysis

A
  • supported by sup/inf pubic arcuate ligs

- fibrocartilage + hyalin cartilage

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12
Q

Sacrotuberous + sacrospinous ligs

A
  • sacrotuberous lig (vertical) = sacrum -> ischial tuberosity
  • sacrospinous lig (horizontal) = sacrum -> ischial spine
  • prevent tilt up of sacrum
  • form G/L sciatic foramen
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13
Q

L5-S1

A
  • common disc herniation = spondylolisthesis, fracture of pars interarticularis)
  • forward sliding prevented by articular processes (ZP joints) + iliolumbar ligs
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14
Q

Transverse + Ant/Post (AP) diameter

A
  • transverse (inlet + outlet) - btwn ischial tuberosities = max diameter of inlet
  • AP diameter - lower border of PS + coccyx tip = max diameter of outlet
  • PS has inc mobility at end of pregnancy -> relaxing hormones to diameter + sacroiliac
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15
Q

urogenital diaphragm (UGD)

A

= deep perineal (DP) pouch

  • inf boundary = perineal mem (spans ischiopubic rami)
  • inferior to pelvic diaphragm
  • perineal body = central tendon
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16
Q

Pelvic Viscera

A
  • pelvic diaphragm + below peritoneum
  • ureters, urinary bladder, urethra, rectum
  • male: prostate, ductus deferens, seminal vesicles, ejaculatory ducts, bulbourethral glands (below pelvic diaphragm)
  • female: ovaries, uterine tubes, uterus, vagina
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17
Q

ureters

A
  • upper half in abs (retroperitoneal), lower half in pelvis
  • males: crossed by DD, btwn that and peritoneum
  • females: crossed by uterine art, post part of ovarian fossa
  • pierce post-lat edge of bladder, go oblique thru muscular wall
  • when ligating uterine tube, watch for ureter
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18
Q

Ureter blood supply

A
  • any art they pass
  • renal, gonadal, common + internal iliac, vesical, uterine
  • variation from anastomoses
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19
Q

Ureter Innervation + lymphatics

A
  • innervation = ureteric nerves from renal, aortic, sup/inf hypogastric plexus (T10-L1), symp + parasymp
  • lymphatics => renal vessels, lateral aortic + lumbar nodes, common/int/ext iliac nodes
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20
Q

Bladder

A
  • urine storage
  • over pubic symph when full (suprapubic lithotomy)
  • prone to rupture in ab trauma + ant. pelvic fracture
  • young more prone (not protected)
  • cystitis = bladder infection, females more prone (short urethra)
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21
Q

Bladder Surface

A
  • apex, base/fundus/, int lat surface, neck
  • trigone -> appears smooth due to embryology, covered w/mucous layer
  • top = urethral crest
  • internal urethral orifice + sphincter (prevents backflow of semen into bladder)
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22
Q

Bladder stabilization

A
  • median umbilical lig -> attaches bladder to umbilicus
  • false ligs -> folds of peritoneum
  • thickening of endopelvic fascia (pubovescial = female, puboprostatic = male)
  • rectovesical lig = posterior
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23
Q

Internal Surface of Bladder

A
  • Internal mucous layer, folds when contracted

- muscle = detrusor (smooth) - expands when full, contracts by parasymp stim (pelvic splanchnics)

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24
Q

Blood Supply of Male Urethra

A

inf vesical, mid rectal, int. pudendal art

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25
Q

Prostatic Urethra

A
  • Urethral crest -> seminal colliculus vesicles (have ejaculatory ducts + prostatic utricle)
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26
Q

female urethra (3)

A
  • smaller than male (cystitis)
  • From bladder -> DP pouch/mem -> vestibule ant to vag opening
  • urethral glands + Paraurethral ducts -> external urethra margin
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27
Q

Male reproductive tract/path of semen (8)

A
  • testes -> seminiferous tubules -> epididymis -> ductus/vas deferens -> seminal vesicle -> ejaculatory duct -> urethra -> penis
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28
Q

Testes (4)

A
  • from post ab wall -> ab canal -> outside body
  • lymph drainage = lumbar lymph nodes
  • tissue covering = ext/int spermatic fascia, cremaster muscle
  • blood supply = testicular a/v, pampiniform plexus
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29
Q

Ductus (vas) deferens (5)

A
  • cont. w/epididymis, small lumen, thick walls, covered w/peritoneum
  • in scrotum, tortuous, then straight
  • traverses ing canal; at deep ring, separates from sperm cord, enters true pelvis
  • crosses over ureter btwn bladder (post to it) & rectum
  • enlarges (ampulla), joins seminal vesicle duct to form ejaculatory duct
30
Q

Seminal Vesicles (3)

A
  • coiled tube, prox end constricts, joins DD to form ejaculatory duct
  • Provides most semen, joins sperm from DD
  • Blood supply: inf vesicle + mid rectal arts (w/veins)
31
Q

Ejaculatory duct (2)

A

= union of seminal vesicle ducts + ductus deferens

- Terminal opening of seminal colliculus

32
Q

Bulbourethral glands (3)

A

= 2 glands in DP pouch

  • go thru perineal mem, drain to spongy urethra
  • Pre semen – cleans out leftovers in urethra before semen comes thru
33
Q

Prostate (6)

A

= glandular, fibromuscular, has lobes, makes 20% semen

  • urethral crest – down from trigone
  • seminal colliculus – bump in middle
  • prostatic utricle – from vaginal embryology
  • ejaculatory duct openings – below utricle, on each side
  • prostatic sinus – sides of colliculus; prost duct openings
34
Q

Prostate Blood Supply/Venous Drainage (2)

A
  • Blood supply: inf vesical, int pudendal, mid rectal arts

- Venous: prostatic venous, vesicular, internal vertebral plexus

35
Q

Prostatic Changes (5)

A
  • 45-50yrs -> BPH = urine flow blocked in prostatic urethra
  • malignant, nodular = prost cancer (= prostatectomy)
  • DRE + serum level test for PSA (inc in cancer)
  • Prostatectomy - preserve prost nerve plexus (impotence)
  • If resecting plexus, do sural n. grafts
36
Q

Female Viscera (6)

A
  • ovaries, uterine tubes, uterus, cervix, vagina, greater vestibular glands
37
Q

Ovaries (3)

A
  • in true pelvis, develop like testes, ovulate oocytes into peritoneal cavity
  • Oocytes -> uterine tube -> uterus
  • Held in place by:
    ○ ovarian lig
    ○ suspensory lig – holds ovary to wall
    ○ Mesovarium – part of broad lig
38
Q

Ovaries Blood Supply/Nerves (2)

A
  • Blood Supply: ovarian arts + veins (R to vena cava, L to renal vein, drainage same as testicular vein)
  • Nerves: pelvic splanchnics -> parasymp
39
Q

Uterus (3)

A
  • in true pelvis
  • Blastocytes implant here -> when fertilized, implant in wall
  • Enlarges in preggos, atrophies in old age (dec hormones)
40
Q

Uterus Parts (4)

A

○ Fundus - top, above opening of uterine tubes
○ Body - btwn layers of peritoneum
○ Isthmus - btwn body and cervix
○ Cervix - Surrounds internal opening

41
Q

3 layers of Uterus Wall

A
  • Perimetrium: peritoneum + areolar tissue
  • Myometrium: most of wall, smooth muscle
  • Endometrium: inner mucous coat, epithelium
42
Q

Cervix, External Os, Fornix (5)

A
  • Cervix - surrounds int os (near isthmus)
  • External os -> vagina
  • Fornix - recess around protruding cervix
  • Uterus anteverted + anteflexed = on top of bladder
  • If retroverted + retroflexed uterus => implantation + fertility problems
43
Q

Uterus Support (5)

A
  • thickenings of endopelvic fascia (transverse cervical + uterosacral ligs)
  • Levator ani
  • UGD
  • Other pelvic organs (esp. bladder)
  • Uterine ligs
44
Q

Transverse cervical (cardinal) ligs, uterosacral ligs (3)

A
  • transverse cervical (cardinal) ligs: cervix & lat fornices of vagina to lat pelvic wall
  • uterosacral ligs (supportive): sides of cervix to mid sacrum; palpable on rectal exam
  • Homologues of gubernaculum
    ○ Round Lig: uterus -> labia majora
    ○ Ovarian Lig: ovary -> uterus
45
Q

Broad Lig (5)

A
  • peritoneum over uterus + adnexa in pelvis
  • Mesosalpinx = suspends uterine tube
  • Mesovarium = suspends ovary
  • Mesometrium = main part below ovary + uterine tube
  • Suspensory lig of ovary: ovarian vessels covered w/peritoneum
46
Q

Blood Supply/Venous Drainage to Uterus (3)

A
  • uterine art (some from ovarian + vaginal a.)
  • Uterus gives blood to fetus (needs a lot) -> inc blood in preggos
  • Venous Drainage: -> uterine plexus -> internal iliac veins
47
Q

Uterus Lymphatics (4)

A
  • Fundus - lumbar, external iliac
  • Body - external iliac
  • Cervix - internal iliac, sacral
  • Area where uterine tubes join uterus has lymph drainage -> follows round lig, drains to superficial ing. nodes
48
Q

Uterus Innervation (3)

A
  • uterovaginal plexus
  • parasymp from S2-S4
  • symp from T12-L2 lumbar splanchnics, intermesenteric, hypogastric plexuses)
49
Q

Vagina (3)

A

= fibromuscular tube from cervix to vestibule (btwn labia minora), walls in contact w/each other

  • sup end of vagina surrounds cervix, extends sup = ant/post/lat fornix
  • post. fornix related to rectouterine pouch
50
Q

Pt w/peritonitis infection (3)

A
  • do culdocentesis to check for abnormal fluid in pouch of Douglas
  • Inferiorly -> somatic info from pudendal nerve – feel pain
  • Superiorly -> viscera, don’t feel pain – don’t need anesthesia when removing fluid
51
Q

Vaginal Sphincters (4)

A
  • Pubovaginalis (part of levator ani)
  • urethrovaginal sphincter (smooth muscle)
  • Bulbospongiosus
  • external urethral sphincter
52
Q

Vaginal Blood Supply + Venous Drainage (2)

A
  • Blood supply: Uterine + Vag a. (overlap), mid rectal & int pudendal a.
  • Drainage: internal iliac vein
53
Q

Vaginal lymphatics + nerves of upper 2/3 (2)

A
  • lymph - int/ext. iliac

- visceral innervation: uterovaginal plexus (from inf. Hypogastric plexus) -> parasymp/symp & afferent fibers

54
Q

Uterine Tubes (4)

A
  • 3-layered structure (serosa, muscle and epithelium).
  • hollow tubes -> peritoneal cavity -> uterus
  • convey oocyte to uterus and sperm to oocyte
  • fimbria brings floating oocyte into uterine tube and thru it via peristalsis
55
Q

Uterine Tube Parts (4)

A
  1. infundibulum – has fimbriae
  2. ampulla
  3. isthmus
  4. uterine portion
56
Q

Uterine Tube Blood Supply/drainage/lymph (2)

A
  • Blood supply/drainage: ovarian + uterine arteries/veins

- Lymph: lumbar nodes

57
Q

Peritonitis

A

more in females due to continuity of vagina/uterus w/ab cavity

58
Q

Ectopic pregnancy (5)

A
  • outside of uterine cavity if oocyte fertilized
  • Tubal – in uterine tube (not viable -> insufficient space + blood supply)
  • Abdominal – in ant. ab wall = “stone baby” = Lithopedion
    ○ Ectopic fetus detected by immune sys
    ○ Sometimes viable, present as normal
  • Ovarian – ovary itself
  • Cervical – moves too far, in cervix
59
Q

Rectum (3)

A

= Cont w/sigmoid colon at S2/S3 (lower end of sigmoid mesocolon) + w/anal canal (passes thru pelvic diaph)

  • Anorectal junction in front of tip of coccyx; 80 degree turn
  • Lower part dilated (ampulla) -> no sacculation/appendices/mesentery (only sup front/sides covered in peritoneum)
60
Q

Rectum Blood Supply (3)

A
  • Sup (inf mesentery)/mid. (inf vesical-male; uterine-female)/inf. (int pudendal a) rectal arts + veins
  • portal (sup) + caval (mid./inf) systems
61
Q

Rectum Innervation

A
  • Hindgut innervation
  • Symp: lumbar splanchnics/sup. hypogastric plexus
  • Parasymp: pelvic splanchnics/inf. hypogastric plexus
62
Q

Failure of Hammock: Prolapse of Pelvic Viscera

A
  • potential from childbirth or trauma
  • Cystocele = bladder prolapse via vagina
  • Uterine prolapse = end of cervix, prolapse via vagina
  • Rectocele = rectal prolapse
63
Q

Perineum

A
  • inf to pelvic diaphragm + urogenital hiatus
  • same boundaries as pelvic outlet, btwn legs externally, shallow compt. internally
  • floor = skin & fascia; roof = pelvic diaphragm + fascia
  • divided into ant urogenital triangle + post anal triangle
64
Q

Deep perineal pouch (aka UGD)

A
  • Superior to perineal mem
  • Reinforces pelvic diaphragm, supports pelvic viscera
  • Further outside = superficial perineal pouch
65
Q

Contents of Perineal Pouches

A
  • Superficial Pouch
    ○ 2 Erectile Bodies = corpus cavernosum/crus + corpus spongiosum/bulb
    ○ 3 Muscles = bulbospongiosus, ischiocavernosus, superficial transverse perineal m.
  • Deep Pouch
    ○ Muscles = deep transverse perineal, external urethral sphincter (M/F), urethrovaginal sphincter (F), compressor urethrae (F/M)
66
Q

Male Urethra: Preprostatic

A

short, from base of bladder, surrounded by internal urethral sphincter

67
Q

Male Urethra: Prostatic

A
  • length of prostate, widest/most dilatable part
  • closer to ant prostate
  • gets ejaculatory/prostatic duct openings
68
Q

Male Urethra: Membranous

A
  • in DP pouch (UGD), surrounded by external urethral sphincter
69
Q

Male Urethra: Spongy

A
  • in corpus spongiosum, longest, widens => navicular fossa
  • openings of bulbourethral glands
  • out to external urethral orifice, surrounded by erectile tissue
70
Q

Prostate Innervation/Lymph

A
  • Innervation: pelvic splanchnic nerves (parasymp) + inferior hypogastric plexus (symp)
  • S2-S4 (also to bladder, rectum, penis)
  • Lymph: internal iliac + sacral nodes
71
Q

Vaginal lymphatics + nerves of lower 1/3 (3)

A
  • Lymphatics: superficial inguinal
  • Innervation: somatic innervation: from deep perineal branch of Pudendal n. -> symp + somatic afferent fibers
  • NO parasymp (only part of vagina sensitive to touch and temperature)
72
Q

Rectum Cont

A
  • Teniae coli – spread out to form single layer
  • 3 perm transverse rectal folds/valves of Houston
  • Upper part of rectum = fecal reservoir

Anatomy (10 decks)

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