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Anatomy > Pelvis > Flashcards

Pelvis Flashcards

1
Q

Label these bony parts of the hip bone.

A
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2
Q

Label these parts of the ilium.

A
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3
Q

Label these parts of the ischium.

A
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4
Q

Label these parts of the pubis.

A
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5
Q

Label the ligaments of the pelvis.

A
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6
Q

What is the purpose of the sacrospinous and scarotuberous ligaments?

A

They ensure the inferior part of the sacrum is not pushed superiorly when weight is suddenly transferred vertically through the vertebral column (e.g. when jumping or during late pregnancy)

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7
Q

Which foraminae does the presence of the sacrospinous and sacrotuberous ligaments create in the pelvis?

A

The greater and the lesser sciatic foramen

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8
Q

What bones make up the pelvic inlet?

A
  • sacral promontory
  • ilium
  • superior pubic ramus
  • pubic symphysis
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9
Q

What structures make up the pelvic outlet?

A
  • pubic symphysis
  • ischiopubic ramus
  • ischial tuberosities
  • sacrotuberous ligaments
  • coccyx
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10
Q

What organs of the female reproductive system lie within the pelvic cavity?

A
  • Ovaries
  • Uterine tubes
  • Uterus
  • Superior part of vagina
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11
Q

What organs of the female reproductive system are found in the perineum?

A
  • Inferior part of vagina
  • Perineal muscles
  • Bartholin’s glands
  • Clitoris
  • Labia
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12
Q

Label these structures.

A
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13
Q

What is the broad ligament and where is it found?

A

A double layer of peritoneum that extends between the uterus and the lateral walls and floor of the pelvis

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14
Q

What structures are contained within the broad ligament?

A

Uterine tubes

Proximal part of the round ligament

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15
Q

Decribe the bony attachments of the sacrospinous ligament.

A

Sacrum to ischeal spine

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16
Q

Describe the bony attachments of the sacrotuberous ligament.

A

Sacrum to ischeal tuberosity

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17
Q

How does the male pelvis differ from the female pelvis?

A

More prominent sacral promontory

More curved coccyx

Narrower, taller pelvic cavity

Narrower pelvic inlet and outlet

Thicker, more robust bones

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18
Q

When may it be necessary to palpate bony landmarks of the pelvis?

A

Ischeal spines (internally) - landmark to guide pudendal nerve block (S2,3,4)

Pubic symphysis - to measure symphysis fundal height

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19
Q

Describe the relationship between the ischial spine and the pudendal nerve.

A

Travels from the sacrum through the greater sciatic formen, and loops around the sacrospinous ligament before reentering the pelvis through the lesser sciatic foramen

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20
Q

Which structures does the pudendal nerve innervate and which spinal cord levels does the nerve originate from?

A

S2, 3, 4

Supplies: clitoris and other perineal structures

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21
Q

How can fluid collection in the pouch of Douglas be drained?

A

Via needle aspiration passed through the posterior fornix of the vagina

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22
Q

What are the attachments of the round ligament?

A

Attaches to the lateral aspect of the uterus, and then passes through the deep inguinal ring to attach to the superficial tissue of the female perineum

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23
Q

What are the three layers of the uterus?

A

perimetrium

myometrium

endometrium

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24
Q

What are the three layers of support that hold the uterus in place?

A
  • ligaments (e.g. uterosacral ligaments)
  • endopelvic fascia
  • muscles of the pelvic floor (e.g. levator ani)
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25
Q

What is the most common position of the uterus?

A

Anteverted and anteflexed

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26
Q

What does anteverted mean?

A

Uterus tipped anteriorly relative to the axis of the vagina

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27
Q

What does anteflexed mean?

A

Uterus tipped anteriorly relative to the axis of the cervix (the mass of the uterus lies over the bladder)

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28
Q

Where do the ovaries develop and what structure moves them to their final position?

A

Develop on the posterior abdominal wall and move onto the lateral wall of the pelvis

Round ligament of the uterus

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29
Q

What is the nerve supply of the levator ani?

A

Nerve to levator ani, S3, 4, 5 sacral plexus

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30
Q

What is the perineal body?

A

A bundle of collagenous and elastic tissue into which the perineal muscles attach

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31
Q

What is this structure?

A

Bartholins gland

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32
Q

What are the muscles labelled?

A
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33
Q

What is the rectus sheath?

A

A strong fibrous layer immediately deep to the superficial fascia, consisting of the combined aponeuroses of anterolateral abdominal wall muscles

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34
Q

What muscles does the rectus sheath surround?

A

Rectus abdominis muscles

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35
Q

What is the difference in the rectus sheath above and below the umbilicus?

A

Above the umbilicus there is an anterior and posterior rectus sheath

Below the umbilicus there is only anterior

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36
Q

Which level do the iliohypogastric and ilioinguinal nerve come from and in which direction do they travel?

A

L1

Travel in plane between internal oblique and transversus abdominis

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37
Q

Which artery is the suprior epigastric artery a continuation of and where can it be found?

A

Internal thoracic artery

Lies posterior to rectus abdominus

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38
Q

Which artery is the inferior epigastric artery a branch of?

A

External iliac artery

39
Q

What layers must be opened to perform a lower section cesarean section (LSCS)?

A
  • Skin and fascia
  • (anterior) Rectus sheath
  • Rectus abdominis – separate the muscles laterally
  • Fascia and peritoneum
  • Retract bladder (a urinary catheter is usually already inserted)
  • Uterine wall
  • Amniotic sac
40
Q

What layers must be stitched closed following an LSCS?

A
  • Uterine wall with visceral peritoneum
  • Rectus sheath
  • (Fascial layer if increased BMI)
  • Skin
41
Q

What artery must be avoided when inserting a lateral port during laparoscopy?

A

Inferior epigastric artery

42
Q

How can the inferior epigastric artery be avoided during laparoscopy?

A

Artery emerges just medial to the deep inguinal ring (located half way between ASIS and pubic tubercle)

Insert port laterally to this

43
Q

What kind of nerve supply does the pelvis have?

A

Sympathetic, parasympathetic and visceral afferent

44
Q

What kind of nerve supply does the perineum have?

A

Somatic motor and somatic sensory

45
Q

What is the sensory supply to the superior part of the pelvis, and what defines this?

A

Superior part defined as ‘touching the peritoneum’

Visceral afferents run alongside sympathetic fibres

46
Q

What level of the spinal cord do the visceral afferents from the superior pelvis enter?

A

T11-L2

47
Q

What is the sensory nerve supply of the inferior aspect of the pelvic organs?

A

Visceral afferents running alongside parasympathetic fibres

48
Q

Which level of the spinal cord do the visceral afferents supplying the inferior part of the pelvic organs enter?

A

S2, S3 and S4

49
Q

At what level does the subarachnoid space end?

A

S2

50
Q

At what level does the spinal cord become the cauda equina?

A

L2

51
Q

What level is the anaesthetic injected in a spinal/epidural procedure?

A

Subarachnoid space of L3-L5

52
Q

What structures does the needle pass through to administer a spinal anaesthetic??

A
  • supraspinous ligament
  • interspinous ligament
  • ligamentum flavum
  • epidural space (fat and veins)
  • dura mater
  • arachnoid mater
53
Q

How may a mediolateral episiotomy reduce the risk of faecal incontinence developing after a difficult vaginal delivery?

A

Tear can be directed away from the anus

54
Q

What is the mahjor structure incised during a median episiotomy and what potential issues are faced if further tearing occurs?

A

Perineal body

Urgence, flatulence, faecal incontinence

55
Q

Which nerve block could be performed to abolish sensation from the anterior aspect of the perineum?

A

Ilioinguinal

Posterior cutaneous femoral nerve

56
Q

How does a spinal anaesthetic differ from an epidural anaesthetic?

A

Epidural injected into epidural space and acts on the rootlets passing through rather than the cord itself

Spinal anaesthetic injected into the subarachnoid space

57
Q

What are the potential side effects of a spinal or epidural anaesthetic?

A

Temporary paralysis/immobility

Dural headache

Hypotension

58
Q

What is the pudendal canal?

A

A passageway within the obturator fascia

Contains the pudendal nerve, internal pudenal artery and vein and the nerve to obturator internus

59
Q

Into which structure is an episiotomy incision made?

A

Ischioanal fossa

60
Q

What are the three layers of the pelvic floor?

A

pelvic diaphragm

muscles of perineal pouches

perineal membrane

61
Q

What muscles make up the levator ani?

A

Puborectalis

Pubococcygeus

Iliococcygeus

62
Q

Label these muscles.

A
63
Q

What nerves innervate the levator ani?

A

Pudendal nerve

Nerve to levator ani

64
Q

What is this structure?

A

Tendinous arch of levator ani

65
Q

What muscle forms the tendinous arch of levator ani?

A

Obturator internus

66
Q

What is the origin and insertion of the piriformis muscle?

A

Origin: pelvic surface of sacrum

Insertion: superior aspect of greater trochanter

67
Q

What is the origin and insertion of the obturator internus muscle?

A

Origin: ischiopubic ramus & obturator membrane

Insertion: medial aspect of the greater trochanter

68
Q

What is the obturator membrane?

A

The obturator membrane is a thin fibrous sheet, which almost completely closes the obturator foramen

69
Q

Label these structures.

A
70
Q

Where is the deep perineal pouch located?

A

Lies below the fascia covering the inferior aspect of the pelvic diaphragm

Lies above the perineal membrane

71
Q

What is contained in the deep perineal pouch?

A

Contains part of the urethra and vagina in females

Bulbourethral glands in male

Neurovascular bundle for penis/clitoris

Extensions of the ischioanal fat pads and muscles

72
Q

What is the difference between the deep transverse perineal muscle in males and females?

A

In females this is smooth muscle

In males this is skeletal muscle

73
Q

Label these structures.

A
74
Q

What structures are the last passive support for the pelvic organs?

A

Perineal body

Perineal membrane

75
Q

What is the perineal membrane?

A

Thin sheet of touch, deep fascia located superficially to the deep perineal pouch

76
Q

Where does the perineal membrane attach laterally?

A

Pubic arch

77
Q

What structures are contained in the superficial perineal pouch of the male?

A

Root of penis:

Bulb – corpus spongiosum

Crura – corpus cavernosum

Associated muscles – bulbospongiosus and ischiocavernosus

Proximal spongy (penile) urethra

Superficial transverse perineal muscle

Branches of internal pudendal vessels and pudendal nerve

78
Q

Label these structures.

A
79
Q

Label these structures.

A
80
Q

Label these structures.

A
81
Q

Label these arteries.

A
82
Q

The majority of arteries of the pelvis and perineum arise from the internal iliac, with the exception of which two arteries?

A

Gonadal

Superior rectal

83
Q

What arteries arise from the posterior division of the internal iliac artery?

A

Gluteal

84
Q

What arteries arise from the anterior divison of the internal iliac artery?

A

Obturator artery

Superior vesical arterie

Inferior vesical artery/vaginal artery

Internal pudendal artery

85
Q

Most arteries in the male perineum arise from the internal pudendal artery, with the exception of which artery?

A

Anterior scrotal artery - comes from external iliac

86
Q

What is the significant anastamosis in the female pelvis and why?

A

Anastamosis between uterine and ovarian artery

Uterine artery comes from internal iliac

Ovarian artery comes from abdominal aorta

87
Q

Why might prostate cancers spread to the cranial cavity?

A

Venous drainage of prostate occurs through lateral sacral veins, which have no valves

88
Q

Describe the venous drainage of the pelvis.

A

Drain mainly to internal iliac vein:

  • some will drain via superior rectal into hepatic portal system
  • some will drain via lateral sacral veins into internal vertebral venous plexus
89
Q

What is the drainage of the gonadal veins?

A

Right - drains directly into IVC

Left - into left renal vein

90
Q

Why does ureter damage in females during surgery more commonly occur on the left than the right?

A

The right usually crosses the external iliac, the left is more medial and crosses common iliac

91
Q

Where does lymph from the superior pelvic viscera drain?

A
  • external iliac nodes
  • common iliac, aortic, thoracic duct
  • ,venous system
92
Q

Where does lymph from the inferior pelvic viscera drain?

A
  • deep inguinal
  • internal iliac nodes
  • common iliac, aortic, thoracic duct, venous system
93
Q

Where does lymph from the superficial perineum drain??

A

Superficial inguinal nodes

Anatomy (22 decks)

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