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MRCS > Pelvis anatomy > Flashcards

Pelvis anatomy Flashcards

1
Q

Obturator internus

A

Supplied by L5 and S1, attaches to GT of femur

Lateral rotation of femur and abduction of flexed hip

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2
Q

Piriformis

A

Supplied by S1 and S2, attaches to GT of femur above obturator internus
Lateral rotation of femur and abduction of flexed hip
Separates greater sciatic foramen into two regions (one above and one below)

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3
Q

Obturator canal

A

Bordered by obturator membrane, associated obturator muscles and superior pubic ramus. Obturator nerve and vessels pass from pelvic cavity to the thigh through this canal.

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4
Q

Greater sciatic foramen

A

Formed by greater sciatic notch, sacrotuberous and sacrospinous ligaments and spine of ischium.
Superior gluteal nerves and vessels passes through foramen above piriformis
Inferior gluteal nerves and vessels, sciatic nerve, pudendal nerve, internal pudendal vessels, posterior femoral cutaneous nerves and nerves to obturator internus and quadratus femoris muscle passes below piriformis

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5
Q

Lesser sciatic foramen

A

Formed by lesser sciatic notch, ischial spine, sacrospinous ligament, sacrotuberous ligament.
Tendon of obturator internus passes through this foramen to enter gluteal region.
Below attachment of pelvic floor, act as route of communication between perineum and gluteal region.
Pudendal nerve and internal pudendal vessels pass through here as well + greater sciatic foramen

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6
Q

Pelvic floor

A

Formed by pelvic diaphragm, perineal membrane and muscles in deep perineal pouch
Greater sciatic foramen above pelvic floor
Lesser sciatic foramen below pelvic floor

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7
Q

Pelvic diaphragm

A 
Levator ani (iliococcygeus, pubococcygeus and puborectalis) and coccygeus muscles from both sides
Innervated by branches of anterior ramus of S4 and branches of pudendal nerve S2-S4
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8
Q

External urethral sphincter

All muscles in deep perineal pouch

A

Innervated by perineal branches of pudendal nerve

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9
Q

Ureters

A

Enters pelvic cavity anterior to bifurcation of common iliac artery and joins base of bladder.
Crossed by
uterine artery in women
ductus deferens in men

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10
Q

Bladder

A

Retroperitoneal structure
apex, two inferolateral surfaces, base and superior surface
Neck is most fixed part of the bladder. Anchored onto posteroinferior aspect of pubic bone by pubovesical ligaments (women) or puboprostatic ligaments (men)

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11
Q

Deep perineal pouch

A

Space between pelvic diaphragm (superior) and perineal membrane at the bottom

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12
Q

Bladder cancer spreads via

A

internal iliac lymph nodes

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13
Q

Urethra in women

A

Short, about 4cm.

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14
Q

Urethra in men

A

Long, about 20cm, bends twice along its course.

Preprostatic, prostatic, membranous and spongy.

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15
Q

Preprostatic part of urethra

A

1cm long, associated with internal urethral sphincter

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16
Q

Prostatic part

A

3-4cm long, site of connection between reproductive and urinary part of men

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17
Q

membranous part

A

passes through deep perineal pouch.

Surrounded by external urethral sphincter

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18
Q

Spongy part

A

longest part of urethra

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19
Q

Sacral plexus

A

formed by anterior rami of S1-S4 and lumbosacral trunk (L4 and L5).
Plexus formed in relation to anterior surface of piriformis muscle.

20
Q

Lumbosacral trunk

A

part of L4 and all of L5.

Passes into pelvic cavity anterior to sacroiliac joint

21
Q

Sacral splanchnic nerves

A

Contribute to inferior hypogastric plexus

22
Q

Branches of sacral

A

Sciatic nerve - tibial part, common fibular part
Pudendal S2-S4
Superior gluteal L4-S1
Inferior gluteal L5-S2
Nerve to obturator internus and superior gemelli L5-S2
Nerve to quadriceps femoris and inferior gemelli L4-S1
Posterior femoral cutaneous nerve S1, S3
Perforating cutaneous nerve
Nerve to piriformis S1-S2
Nerves to levator ani, coccygeus and external anal sphincter S4
Pelvic splanchnic nerves S2-S4

23
Q

Branch of coccygeal plexus

A

Anococcygeal nerves

24
Q

Sciatic nerve - tibial part

A

L4 to S3
Forms on anterior surface of piriformis and leaves through greater sciatic foramen inferior to piriformis
Motor:
posterior compartment of thigh (including hamstring of adductor magnus) except for short head of biceps
All muscles of posterior compartment of leg
All muscles in sole of foot
Sensory:
Skin on posterolateral and lateral surface of foot and sole of foot

25
Q

Sciatic nerve - common fibular part

A

L4 to S2
Motor:
Short head of biceps
All muscles in anterior and lateral compartment of leg
Extensor digitorum brevis in foot
Sensory:
Skin on anterolateral surface of leg and dorsal surface of foot

26
Q

Pudendal nerve

A

S2-S4
Motor:
Skeletal muscles in perineum including urethral and anal sphincters and levator ani
Sensory:
Most skin of perineum, penis and clitoris

27
Q

Superior gluteal

A

L4 to S1

Motor: gluteus medius, gluteus minimus and tensor fasciae latae

28
Q

Inferior gluteal

A

L5 to S2

Motor: gluteus maximus

29
Q

Pelvic splanchnic nerves

A

Motor visceral:
erection, mobility in GI system distal to left colic flexure, inhibitory to internal urethral sphincter
Sensory visceral:
Pelvic viscera and distal parts of colon.

30
Q

Obturator nerve

A

L2 to L4 - branch of lumbar plexus.
Passes posterior to common iliac artery and medially to the internal iliac artery at the pelvic inlet and along lateral pelvic wall.
Travel through obturator canal and supplies adductor region of thigh

31
Q

Pelvic prevertebral plexus hypogastric nerves

A

Enters pelvis as two hypogastric nerves, cross the pelvic inlet medial to internal iliac vessels.
Formed by splitting of superior hypogastric plexus into right and left bundles.

32
Q

Inferior hypogastric plexus

A

Formed when hypogastric nerves joined by pelvic splanchnic nerves S2 to S4.
Course medially to major vessels and somatic nerves
Gives rise to:
rectal, uterovaginal, prostatic and vesical plexus
Innervate erectile tissue of penis and clitoris in perineum.

33
Q

Sympathetic fibers of inferior hypogastric plexus

A 
Mainly T10 to L2 
Innervate blood vessels
Contraction of internal anal/urethral sphincters
Contraction of reproductive tract
Ejaculation
34
Q

Parasympathetic fibers of pelvic plexus

A 
From pelvic splanchnic nerves S2-S4
Generally vasodilatory
Stimulate bladder contraction
Stimlate erection 
Modulate activity of enteric nervous system of colon distal to left colic flexure
35
Q

Major artery supply to pelvis and perineum

A

Internal iliac artery

36
Q

Site of origin of internal iliac artery

A

Level of L5-S1, anteromedial to sacro-iliac joint

Divides into anterior and posterior trunk at superior border of greater sciatic foramen

37
Q

Branches of posterior trunk of internal iliac artery

A

Supply lower posterior abdominal wall, posterior pelvic wall and gluteal region
Iliolumbar artery, lateral sacral artery and superior gluteal artery

38
Q

Branches of anterior trunk of internal iliac artery

A

Pelvic viscera, perineum, gluteal, adductor of thigh, placenta
Superior vesical artery, umbilical artery, inferior vesical artery/vaginal, middle rectal artery, uterine artery, obturator artery, internal pudendal and inferior gluteal

39
Q

Obturator artery

A

In between obturator nerve (above) and obturator vein (below) enters and supplies adductor region of thigh

40
Q

internal pudendal artery

A

Leaves pelvic cavity through greater sciatic foramen inferior to piriformis muscle
With pudendal nerve on its medial side, passes laterally to ischial spine and through lesser sciatic foramen to enter perineum.
Main artery of the perineum.

41
Q

Inferior gluteal artery

A

Passes through greater sciatic foramen beneath piriformis to enter gluteal region

42
Q

Pelvic veins

A

Follow course of arteries except for umbilical and iliolumbar artery
Drain into internal iliac veins which leave the pelvic cavity to join common iliac veins just superior and lateral to the pelvic inlet

43
Q

Deep dorsal vein

A

Drains erectile tissues of clitoris and penis, joins prostatic plexus in men and vesical plexus in women.
Superficial veins that drain skin of penis and corresponding regions of clitoris drain into external pudendal veins (tributaries of saphenous vein in thigh)

44
Q

Lymphatics in pelvis

A

Lymphatics from most pelvic viscera drain mainly into lymph nodes distributed along internal iliac and external iliac arteries and their associated branches

45
Q

Internal iliac nodes

A

Also receive drainage from gluteal region and deep areas of perineum

MRCS (28 decks)

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