Pelvis Flashcards
Perineum - borders anatomical
Anterior - pubic symphysis Posterior - tip of coccyx lateral - inferior pubic rami/inferior ischial rami, sacrotuberous ligament roof - pelvic floor base - skin & fascia
Perineum - borders - surface
Anterior - mons pubis in females, base of penis
laterally - medial surface of the thigh
posteriorly - superior end of intergluteal cleft
Content - anal triangle
Posterior half of perineum
Anal aperture
External anal sphincter
two ischioanal fossa
Content - urogenital triangle
Anterior half of perineum
deep perineal pouch
perineal membrane - perforated by urethra, provides attachment to superficial external genitalia
Superficial perineal pouch
Deep perineal fascia
superficial perineal fascia - continuous to the abdominal wall
SKin
Content of deep perineal pouch
part of urethra
external urethral sphincter
bulbourethral glands
deep transverse perineal muscles
Content of Superficial perineal pouch
erectal tissue ischiocavernosus bulbocavernosus superficial transverse perineal muscles Greater vestibular gland
What is the Perineal body
Central point of perineum
attachment to pelvic floor muscles
Hip/pelvic bone
Ilium Pubis Ischium sacrum coccyx
Pelvic girdle
Sacroiliac joint
sacrococcygeal symphysis
pubic symphysis
Borders of Pelvic inlet
Posterior - sacral promontory
lateral - arcuate line on the inner surface of ileum, pectineal line on the superior ramus
anterior - pubic symphysis
Borders of Pelvic outlet
Posterior - tip of coccyx
lateral - ischial tuberosity & sacrotuberous ligament
anteiror - pubic arch/ischiopubic rami
Sacrum
Fused vertebrae
Pevic surface - transverse line & promontory, anterior sacral foramina
Dorsal surface - media sacral crest (fused SP), lateral sacral crest gives attachment to sacrotuberous ligament
Coccyx
Fused vertebrae
Caudal eminence
base has coccygeal cornu
attachment to levator ani
pelvic floor
Funnel shaped, attaches to the lesser pelvis and support abdominopelvic viscera
has 2 hiatus - urogenital and rectal
levator ani, coccygeus
Levator ani
3 paired muscles; S2-4
Pubococcygeus, Puborectalis, Iliococcygeus
Anterior - pubic body
Laterally - obturator internus/tendinous arch
Posterior - ischial spine
Puborectalis
U shaped sling
passed urogenital hiatus, around anal canal
Creates anorectal angle & anorectal junction
prevent defaecation
Pubococcygeus
Pubic to tendinous arch
travels around urogenital hiatus and attaches to coccyx and anococcygeal ligament
some loop around prostate/vagina, some terminate at perineal body
Iliococcygeus
ischial spine to tendinous arch
then attaches to coccyx and anococcygeal ligament
Coccygeus
Smaller posterior muscle
Ischial spine to sacrum/coccyx along sacrospinous ligaments
Ureter
25cm long, retroperitoneal
Starts at renal pelvis - uteropelvic junction
at SIJ, crosses pelvic brim & crosses CIA
Runs along the lateral wall and turn anteromedially at ischial spine
Enters ureter in oblique manner
Supplied by renal artery, CIA, vesical arteries
Urinary bladder
anterior organ in pelvic cavity
Apex - connected to umbilicus via median umbilical ligament (remnant of urachus)
Body
Fundus - trigone (smooth wall location where ureters & urethra are found)
Neck
Muscles of bladder
Detrusor muscles - smooth muscles
internal urethral sphincter - autonomic
external urethral sphincter - voluntary control
Neurovascular supply of bladder
Superior vesical artery - IIA Inferior vesical artery Sympathetic - hypogastric nerve (T12-L2) Parasympathetic - pelvic S2-S4 Voluntary control - pudendal nerve S2-S4 Bladder stretch reflex - primitive reflex, stretch in bladder wall in detected and detrusor muscle contract through parasympathetic nerve
urethra
lined with stratified columnar epithelium
Male:
preprostatic - internal urethral orifice to prostate
prostatic - has ejaculatory duct & prostatic duct
membranous - through pelvic flour and deep perineal pouch, has external urethral sphincter
spongy - through bulb and corpus spongiosum & external urethral orifice
Female - 4cm long, opens between labia minora (vestibule)
Penis
Root - superficial perineal pouch
Body
Glans
Muscles - bulbospongiosus, ischiocavernosus
ligaments - suspensory and fundiform
supplied by dorsal, deep and bulbourethral arteries (internal pudendal artery)
Erectile tissue
Corpora cavernosa x2 - root = crus
Corpus spongiosum - urethra passes through, root = bulb
Covered by deep fascia of penis and tunica albuginea
Testes
In scrotum
suspended by spermatic cord
contains seminiferous tubules for spermatogenesis
has 2 coverings - tunica vaginalis (peritoneum) and tunica albuginea (fibrous capsule)
Describe sperm pathway
seminiferous tubules tubulus rectus rete testis efferent tubules epididymis vas deferens seminal vesicles add semen, passes through cowpers gland ejaculatory duct urethra
Scrotum layers
Skin Dartos - fascia/muscle external spermatic fascia cremasteric fascia internal spermatic fascia tunica vaginalis tunica albuginea
Spermatic cord - content
3 arteries - testicular, vas, cremateric
2 nerves - genitofemoral nerve, autonomic nerve
4 others - pampiliform plexus, lymphatics, vas deferens, processes vaginalis
Prostate gland
Anatomical lobes - anterior, posteiror, lateral, medial
Histological zone - central, transitional and peripheral
Covered by capsule
suppied by prostatic artery (IIA)
drained via protastic venous plexus (IIV but also connects to batson venous plexus/internal vertebral venous plexus)
Bulbourethral gland
Also known as Cowper’s
Located posterior to membranous urethra
Secretes mucus for neutralising urethra
Enclosed within the external urethral sphincter
Seminal vesicles
located between bladder fundus and rectum
Joins vas deferens to form ejaculatory duct
it has pseudostratified columnar epithelium
From mesonephric duct
supplied by internal pudendal/inferior vesicle and middle rectal arteries - IIA
Vulva
Mons pubis - anterior to vulva Labia majora - labioscrotal swellings Labia minora - urethral folds Vestibule - external vaginal orifice & urethra Bartholin's gland Clitoris
Neurovascular supply to vulva
Pudendal artery & veins
Anterior - ilioinguinal & genitofemoral nerve
Posteiror - pudendal nerve & posterior cutaneous nerve of thigh
Vagina
approx 9cm long Stratified squamous epithelium lining Elastic lamina propria Fibromuscular layer Adventitia supplied by uterine and vaginal artery uterovaginal plexus within broad ligament
Cervix
Lower portion of uterus
ectocervix - stratified non keratinising squamous epithelium
Endocervix - simple columnar epithelium
supplied by uterine artery
Uterus
Fundus, body and cervix
Fundus has 3 layers - peritoneum, myometrium, endometrium
5 ligaments
Endometrium
Deep stratum basalis - unchanged during menstruation
Superficial stratum functionalis - oestrogen & progesterone sensitive
5 ligaments of uterus
Broad ligament - peritoneum, acts as mesentery (mesometrium - proximal part of round ligament, mesovarium, mesosalpinx)
Round ligament - gubernaculum, from uterine horn to labia majora through inguinal canal
Ovarian ligament
Cardinal ligament - base of broad ligament, from cervix to lateral pelvic wall, contains uterine artery
Uterosacral ligament
Pubocervical ligament
Fallopian tubes
Transport and transfer ovum
inner mucosa - ciliated columnar epithelium & peg cells
Fimbriae - Infundibulum - Ampulla - Isthmus
Supplied by uterine and ovarian artery
Ovaries
Develop from mesonephric ridge
attached to posterior surface of broad ligament - mesovarium
Produce oocytes and sex hormones
3 surface - Surface (cuboidal epithelium), cortex, medulla
2 ligaments - suspensory ligaments (contains NV structures) and ovarian ligament
Internal iliac artery
bifurcates from CIA at L5/S1
Divides into anterior and posterior trunk at superior border of greater sciatic foramen
Anterior trunk
Obturator - adductors, passes through obturator foramen
Umbilical - gives off superior vesical
Inferior vesical - bladder, prostate, seminal vesicles
uterine - cardinal ligament, crosses uterer superiorly and 1cm laterally
vaginal
middle rectal - anastomoses with SRA & IRA
Internal pudendal - exits via greater sciatic foramen and enters again via lesser sciatic foramen
Inferior gluteal - leaves via greater sciatic foramen, inferior to piriformis, supplies gluteus maximus
Posterior trunk
Iliolumbar - posterior abdominal wall
Lateral sacral
Superior gluteal - greater sciatic foramen, superior to piriformis - gluteus minimus, medius
External iliac vein
Continuation of femoral vein
receives inferior epigastric and deep circumflex iliac veins
Joins IIV to become CIV
Internal iliac vein
Formed by Superior & inferior gluteal Internal pudendal - inferior rectal Obturator lateral sacral middle rectal - drains prostate vesical uterine and vaginal
Common iliac vein
Formed at L5
iliolumbar and middle sacral joins as well
