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GSSE Anatomy > Pelvis > Flashcards

Pelvis Flashcards

1
Q

What are the attachments of the capsule of the hip joint?

A
  • acetabular labrum
  • transverse ligament
  • intertrochanteric line where neck of femur joins greater trochanter

anterior surface of neck of femus is wholly intracapsular
p195 fig 3.9

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2
Q

What is the supracristal plane, where is it located and what does it signify clinically?

A
  • between highest points the left and right iliac crests
  • passes through the spine of L4 vertebra
  • it is a landmark for counting vertebral spines for lumbar puncture
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3
Q

Key sex differences between male and femal pelvises

A

females have

  • broader pelvis with drawn out ilial ala
  • wide subpubic angle
  • less indendtation of the pelvic inlet by sacral promontory more “oval” outline
  • greater sciatic notch at almost right angle (less than male)
  • obturator foramen is triangular (male oval)
  • distance from pubic tubercle to acetabular margin greater than diameter of acetabulum in female (equal or less in male)
  • sacral body narrower than ala
  • sacral auricular surface occupies 2 vertebra (2.5 in males)
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4
Q

Piriformis

  • location
  • nerve supply
  • surface marking
A
  • middle 3 pieces of sacrum through greater sciatic foramen into greater trochanter
  • anterior rami S1 & S2
  • surface marking: lower border is from midpoint of line between PSIS and tip of coccyx to tip of greater trochanter
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5
Q

What are some of the key relations of piriformis?

A
  • posterior to sacral plexus
  • upper border next to gluteus medius
  • lower border next to superior gemellus
  • superior gluteal artery and nerve above, inferior gluteal artery and nerve below
  • sciatic nerve and perineal branch of posteiror femoral cutaneous below
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6
Q

What passes through the greater sciatic foramen?

A
  • piriformis
  • inferior and superior gluteal vessels and nerves
  • sciatic nerve
  • pudendal nerve, internal pudendal artery and vein
  • posterior femoral cutaneous nerve
  • nerve to obturator internis
  • nerve to quadratus femoris
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7
Q

What passes through the lesser sciatic foramen?

What are its boundaries?

A
  • the tendon of the Obturator internus
  • internal pudendal vessels
  • pudendal nerve
  • nerve to the obturator internus

Anterior: the tuberosity of the ischium
Superior: the spine of the ischium and sacrospinous ligament
Posterior: the sacrotuberous ligament

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8
Q

Where are the superficial inguinal nodes?

What do they drain?

A
  • 20 notes in T shaped pattern in subcut fat of fermoal triangle

VERTICAL GROUP: drains lymphatics from deep fascia to skin of lower limb
LATERAL GROUP: buttock, flank, and back below level of waist
MEDIAL GROUP: below umbilicus and medial to line drawn up from ASIS including perineum, anal canal, urethra and external genitalia

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9
Q

What is a Richter hernia? What type of hernia does this usually occur with?

A

A Richter hernia describes a strangulated hernia with entrapment of portion of the circumference of the bowel within a hernial sac with a small opening from the peritoneal cavity. This classically occurs with femoral (not inguinal) hernias

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10
Q

What is the triangle of hesselbach? Why is it relevant?

A

Bounded by the inferior epigastric vessels laterally, the lateral edge of rectus medially and the inguinal ligament below

It is often the site of weakness of transversalis fascia through which a direct inguinal hernia enters the inguinal canal

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11
Q

What are the nerves of the lumbar plexus?
Which roots form them?
What are their relations to the psoas major?

A

I (twice) Get Laid On Fridays
2 from 1, 2 from 2, 2 from 3

  • iliohypogastric L1
  • ilioinguinal L1
  • genitofemoral (anteriorly) L1-L2
  • lateral cutaneous nerve of thigh L2-L3
  • obturator (medial) L2, L3, L4
  • femoral L2, L3, L4

All except genitofemoral and obturator nerve exit lateral
Lumbosacral plexus also exits medial

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12
Q

Describe the makeup, location and critical structures surrounding the lumbosacral trunk/sacral plexus.

A

Lumbosacral trunk: L4/L5
Sacral plexus: lumbosacral trunk + 4 sacral nerves

rests on pirriformis, covered anteirorly by strong fascia, anteriot o that are lateral sacral arteris and veins
Superiorly, common iliacs lie over lumbosacral trunk

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13
Q

What do the anterior/posterior branches of the obturator nerve supply?

A

ANTERIOR BRANCH

  • adductor longus
  • adductor brevis
  • gracilis
  • hip joint
  • cutaneous medial thigh

POSTERIOR BRANCH

  • adductor magnus
  • obturator externus
  • knee

these branches are separated by the obturator externus and adductor brevis

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14
Q

What structures are supplied by the genitofemoral nerve?

A

best remembered as the FEMOROGENITAL (p. 529)

  • L1 femoral: skin below inguinal ligament
  • L2 genital: spermatic cord/round ligament, sensory to tunica vaginalis and spermatic fasciae, small area of anterior labial skin, motor to cremaster
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15
Q

What is the supply of the lateral femoral cutaneous nerve?

A

p 530

  • iliac fascia
  • peritoneum of iliac fossa
  • lateral side of thigh to knee
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16
Q

What is the anatomical course of the femoral nerve?

A

p 530

  • crosses iliac fossa in cutter between psoas and iliacus
  • beneath inguinal ligament lateral to femoral sheath
  • divided by lateral femoral circumflex artery into superficial and deep
17
Q

What is Heyde’s syndrome?

A

PR bleeding in the setting of angiodysplasia in association with aortic stenosis

18
Q

What do the superficial and deep branches of the femoral nerve supply?
What are their distal branches?

A

SUPERFICIAL

  • pectineus
  • sartorius
  • intermediate femoral cutaneous nerve (skin and fascia lata over thigh)
  • medial femoral cutaneous nerve (medial thigh and front of knee)

DEEP

  • rectus femoris
  • vastus lateralis
  • vastus intermedius
  • vastus medialis
  • saphenous nerve
19
Q

What are the nervei erigentes and what do they do?

A

pelvic splanchnic nerves

  • detrusor
  • smooth muscle of internal sphincter of bladder
  • smooth muscle of internal sphincter of anal canal
  • parasympathetics to hindgut
  • sensory to derivatives of the cloaca (prostate, bladder, rectal ampulla, cervix, vagina)
20
Q

Which muscles make up the urogenital diaphragm? Where is it located?

A

p 518
mass of muscles above urogenital diaphragm
- sphincter urethrae (external urethral sphincter)
- deep transverse perineal muscles

located in deep perineal pouch

21
Q

What makes up the edges of the trigone of the bladder?

What structures stabilise it in the male/female

A
  • internal urethral orifice centrally
  • two urethral orifices above and laterally

MALE: fixed to prostate
- pelvic fascia at front of vagina

22
Q

What is the blood supply of the bladder? What is its drainage?

A
  • superior and inferior vesical arteries
  • small contributions from obturator, inferior gluteal, uterine and vaginal arteries

Vesicoprostatic plexus in groove between bladder/prostate. Similar in females in communications with veins at the base of the broad ligament

23
Q

What is the autonomic nerve supply to the pelvic viscera?

Which is responsible for distension, which are responsible for pain?

A

MOTOR

  • parasympathetic pelvic splanchnic nerves: motor
  • L1/L2 sympathetics via superior hypogastric and pelvic plexi : inhibit detrusor and supply superficial trigonal muscle and internal sphincter (in males)

SENSORY

distension: parasympathetic
pain: parasympathetic and sympathetic

24
Q

Name from top to bottom the structures passed by the ureter in the pelvis?

A
  • OVER internal iliac artery
  • BEHIND ovary
  • OVER obturator nerve
  • OVER obliterated umbilical (superior vesical) artery
  • OVER obturator artery and vein

only two structures cross in front

  • uterine artery in females
  • ductus deferens crosses IN FRONT to run medial
  • enters base of bladder at the upper lateral angle
25
Q

What is the fascia of DenonVillier’s?

What is the fascia of Waldeyer?

A

Denonvilliers: the rectovesical fascia connecting rectum to bladder separating anterior wall of rectum from seminal vesicles p483

Waldeyer: fascia anchoring rectum to sacrum p. 480 Pelvic fascia

https://www.researchgate.net/publication/324917352/figure/fig3/AS:622214420393987@1525358886954/Locations-of-the-rectum-in-the-pelvic-cavity-and-of-the-normal-fascia-structures-around.png

26
Q

The most constricted part of the male urethra is …?

A

at the external meatus

27
Q

What are the muscles of the pelvic floor?

What are their nerve supply?

A

Coccygeus - S4/S5
- from ischial spine to coccyx

LEVATOR ANI S3/S4

  • iliococcygeus from posterior white line of obturator fascia to anococcygeal raphe
  • pubococcygeus from anterior white line of obturator fascia and body of pubis to tip of coccyx and anococcygeal raphe

PUBOCOCCYGEUS split into

  • pubococcygeus proper
  • puborectalis
  • levator prostatae/pubovaginalis

GSSE Anatomy (7 decks)

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