Pelvis Flashcards
Inguinal ligament
thickened external oblique aponeurosis; extends between the ASIS of ilium and pubic tubercle
Subinguinal space
inferior to the inguinal ligament; where flexors of the hip and neurovascular structure can be found.
Pelvis Artery Supply
primarily through internal iliac artery (aka hypogastric artery)
Pelvis Venous Drainage
pelvic venous plexuses ( made up of rectal, vesical, prostatic, uterine, and vaginal) that drain into–> internal iliac vein–>external iliac vein–> common iliac vein–> IVC
Some veins might drain into portal system (superior rectal vein–>IMV–> portal vein)
Internal (hypogastric) artery
made up of two branches:
Anterior & Posterior
Anterior contains umbilical artery, obturator artery, uterine artery (females), middle rectal artery, internal pudendal artery, and inferior gluteal artery. Anterior branch order can be variable but usually is in the order indicated above.
Posterior branch contains: superior gluteal artery, iliolumbar artery, and lateral sacral arteries
Umbilical artery
gives off superior vesicle arteries to the bladder
Obturator artery
gives off the pubic branch
males: inferior vesicle artery
females: vaginal artery (which can also branch off uterine artery)
Internal pudendal artery
goes to perineum & external genitalia
Inferior gluteal artery
goes to muscles and skin of butt & posterior thigh
Sacrum
helps to provide support to the spine by distributing the weight of the spine and upper torso; sacrum is concave and its concavity in women allows for fetus to fit during childbirth
Sacrospinous Ligament
attached to the ischial spine & lower part of the sacrum
Obturator canal
is where the obturator nerve goes through
Sacrotuberous ligament
attaches to the ischial tuberosity and middle of sacrum
Iliolumbar ligament
holds the spine laterally to the pelvis
Sacrococcygeal ligament (anterior & posterior, superficial, deep, & lateral)
hold the coccyx in place
Prepuce
penis foreskin that covers the head/glans of flaccid penis
Frenulum
located on posterior part of the penis; it is a small fold of tissue that connects the glans to the shaft
mons pubis
collection of fatty tissue that covers the pubic bone
perineum
area between the anus and scrotum/vulva
pudendum
aka external genitalia
Lesser (Skene) and Greater (Bartholin) Vestibular Gland openings
glands that secrete mucus to lubricate the vagina/ urethra; infections can occur in this glands which can obstruct the duct and cause a cyst which will need to be drained
Vestibule
the space that contains the labia minora, vaginal and urethral orifices, and vestibule ducts,
Vestibular bulbs
enlongated erectile tissue deep to labia minora, extending posteriorly from the glans of clitoris. These bulbs are covered by bulbospongiosus muscles
This is equiv to bulbs and corpus spongiosa of penis
Urogenital triangle
between the pubic sympphysis & ischial tuberosity
Anal triangle
between ischial tuberosity & coccyx
Tendinous arch of levator ani
weakness in this tendon might cause prolapse (slip down) of bladder & uterus
Levator Ani
consists of three muscles:
puborectalis m.
pubococcygeus m.
iliococcygeus m.
Urogenital Diaphragm
….
Spots where a kidney stone can get stuck in ureter
junction of renal hilum & ureter, as ureter passes over pelvic brim, and as ureter passes through muscular bladder wall
“Water under the bridge”
the ureter will always pass under the uterine artery (female) & ductus deferens (male)
Ureter blood supply
gets a rich source of blood supply from renal artery, gonadal artery, iliac arteries, superior vesical artery, etc.
trigone
in the bladder, it is a triangular area of the bladder wall that contains ureteric orifice
Internal urethral sphincter muscle
under involuntary controls, ANS, sympathethic
external urethral sphincter
under voluntary control, it is the muscle that you squeen when you want to stop your urine/ do kegal exercises
male urethra
is much longer than female urethra; it has four parts:
- intramural (preprostatic), prostatic, membranous, and spongy
Glands of Lettre
mucus secreting urethral glands
Bladder Arterial Supply
Superior vesical artery (supplies top of bladder; artery is extension off umbilical artery)
Inferior vesical artery (males; supplies prostate)
Vaginal arteries (female)
Bladder venous drainage
vesical venous plexus; varies a bit per gender
female: plexus is continuous with uterovaginal plexus & receives blood from the dorsal vein of clitoris
male: plexus continuous with prostatic plexus and the deep dorsal vein of penis
Bladder innervation
autonomic via hypogastric plexuses and pelvic splanchnic nerves;
exception: parasympathetic innervates the detrusor muscle and internal urethral sphincter (in males)
Pelvic splanchnic nerves
travel with parasympathetic input as well as afferent input
pudendal nerve
gives off motor, sensory, and autonomic innervation
submucosal space (internal venous plexus)
where internal hemorrhoids occur
perianal space (external venous plexus)
external hemorrhoids occur
pudendal (alcock) canal
contains pudendal vessels & pudendal nerve, as well as perineal nerve
Valves of Houston
the ridges in the anal canal, there are three parts:
superior, middle, and inferior. These valves tend to act as stop gates as stool comes down and fills the rectum
Surgical Anal Canal
relates to hemorrhoids and certain types of cancers
Anal glands
makes mucus that secretes into the anus so that the stool can pass easier; sometimes these glands can become infected
Rectal arterial supply
- Superior rectal artery (branch off IMA)
- middle rectal artery (branch of anterior internal iliac artery)
- inferior rectal artery (branch of pudendal artery)
Round ligaments
attach to the anterior surface of the uterus and terminates in the labia majora; provides little support in preventing prolapse but does help to keep uterus anteverted (inclined forward)
Vesicouterine Pouch
potential space located in front of uterus; can be a site of fluid collection during certain pathological conditions
Rectouterine Pouch (aka Cul de sac of Douglas)
potential space located behind the uterus; can be a site of fluid, blood, pus collection during pathological conditions
Rectouterine Fold (uterosacral ligament)
attaches uterus to the sacrum; most important ligament that resists uterine prolapse
Broad ligament
name given to party of the peritoneum that drapes over the ovaries, uterine tubes, and superior uterus. There is vascularity embedded in it.
there are three parts:
-mesovarium= folds over the ovary and ovarian vessels
-mesosalpinx= fold over the uterine tube
-mesometrium=layers of peritoneum hanging lateral to the uterus itself
Uterine tube (aka fallopian tube) parts
4 parts (in order from ovary to uterus):
- fimbria
- infundibulum
- ampulla
- isthmus
internal os (uterus)
internal gatekeeper that keeps pregnancies in uterus
endometrium
the inner mucous layer that regularly builds up during the month cycle and sheds during menstruation; if conception occurs, the embryo will implant into this layer
myometrium
middle smooth muscle layer that is the majority of the uterus; very thick; majority of neurovascular structures found in this layer
perimetrium
simply peritoneum and a thin layer of connective tissue around uterus (superficial layer)
uterus arterial supply
primarily from uterine arteries with collateral supply from vaginal arteries and ovarian arteries
uterus venous drainage
uterine venous plexus located on either side of cervix–>drains to uterine & vaginal veins–> internal iliac veins
uterus innervation
entirely autonomic via uterovaginal nerve plexus
uterine adnexa
consists of uterus, fallopian tubes & ovaries structures
Ovarian arterial supply
ovarian arteries (branch off aorta)
ovarian venous drainage
ovarian veins (off IVC on right, off renal vein on left)
Cardinal (transverse cervical/ Mackenrodt’s ligament)
STRONGEST pelvic ligament extending from lateral pelvic walls to lateral portions of cervix & vagina; also convey uterine artery, uterine vein, and uterovaginal nerve
Pubocervical ligament
party of the pelvic floor that helps form a sling from pubic symphysis to help maintain continence by compressing vagina and urethra against bone
Vagina artery supply
Superior vagina supplied by uterine artery
Middle and inferior vagina supplied by vaginal and internal pudendal artery
Vagina venous drainage
uterovaginal plexus and drain into the internal iliac veins
vagina innervation
superior vagina is innervated by uterovaginal nerve plexus , which conveys sympathetic, parasympathetic, and visceral afferent innervation
inferior vagina is innervated by deep perineal nerve (somatic, sensitive to touch and temp)
vagina lymph drainage
superior and middle vagina lymph drains to internal and external iliac nodes
inferior vagina lymph drains into superficial and deep inguinal nodes
uterus anastomoses
consists of ovarian vessels, uterine vessels, vaginal vessels, and pudendal vessels. They all anastomose
suspensory ligament of penis
penis is suspended from pubic symphysis & overlying fascia by this ligament
penis artery supply
- internal pudendal artery
- superficial & deep branches of external pudendal artery
penis venous drainage
- venous plexus within penis to deep dorsal vein to prostatic venous plexus
- superficial dorsal vein to superficial external pudendal vein
penis innervation
- dorsal nerve of penis
- ilioinguinal nerve supplies the skin at root of penis
benign hypertrophy of prostate (BHP)
common in old age; prostate will enlarge and project into the bladder which can cause partial urethral obstruction
seminal colliculus vesicle
in prostate; where liquid semen is deposited before ejaculation
seminal vesicles (glands)
produce an alkaline fluid that is high in fructose to provide energy for sperm; these vesicles connect to the vas deferens to form a right & left ejaculatory duct near the neck of bladder
prostate
accesssory gland in male reproduction that produces prostatic flud (thin, milky fluid that activates sperm)
