Pelvis And Pelvic Organs Flashcards

1
Q

Pelvic cavity functions

A
  1. Bears wt upper body
  2. Transfers wt lower limbs
  3. Muscle attachment
  4. Contains and protects pelvic viscera and inf abdominal viscera
  5. Support abdominopelvic viscera
  6. Erectile body attachement
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2
Q

Os coxae

A

Fusion ilia, ischia, pubis, and sacrum during puberty

1. Right and left join ant at pubic symphysis

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3
Q

Lesser (true) pelvis

A

Between pelvic inlet and outlet

  1. Includes perineal compartment
  2. Houses reproductive and urinary structures
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4
Q

Greater (false) pelvis

A

Houses abdominal viscera

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5
Q

Pelvic diaphragm

A
  1. Levator ani

2. Coccygeus

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6
Q

Levator ani

A

Anterolateral wall pelvis

  1. Fxn: support abdominopelvic viscera and assist in maintaining urinary and fecal continence
  2. Innervation: S3-S4
  3. Puborectalis
  4. Pubococcygeus
  5. Iliococcygeus
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7
Q

Puborectalis

A
One of levator ani muscles
1. Fxn: support pelvic viscera 
2. Prox: sup pubic ramus 
3. Distal: anococcygeal lig
4. Innervation: 
  A. n. to levator ani (S4)
  B. Inf rectal n.
5. Forms u-shaped sling, maintain fecal continence
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8
Q

Pubococcygeus

A
One of levator ani muscles
1. Fxn: support pelvic viscera
2. Prox: pubis
3. Distal: anococcygeal lig, coccyx
4. Innervation: 
  A. N. To levator ani (S4)
  B. Inf rectal n.
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9
Q

Iliococcygeus

A
One of levator ani m.
1. Fxn: support pelvic viscera
2. Prox: internal obturator fascia of levator ani (tendinous arch)
3. Distal: anococcygeal lig, coccyx
4. Innervation: 
  A. N. To levator ani
  B. Inf rectal n.
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10
Q

Coccygeus

A
Part of pelvic diaphragm
1. Fxn: 
  A. Flexes coccyx
  B. Supports pelvic viscera
2. Prox: 
  A. Lateral surface coccyx
  B. S5 segment
3. Distal: ischial spine
4. Innervation: S3-S4 branches from sacral plexus
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11
Q

Internal iliac artery

A
1. Posterior trunk
  A. Iliolumbar a. 
  B. Lateral sacral a.
  C. Sup. Gluteal a. 
2. Anterior trunk
  A. Umbilical a. 
  B. Obturator a. 
  C. Inf vesicle/vaginal a. 
  D. Uterine a. 
  E. Middle rectal a.
  F. Internal pudendal a. 
  G. Inf gluteal a.
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12
Q

Iliolumbar artery

A

Branch off posterior trunk internal iliac a.

  1. Lumbar br. - supplies psoas major and quadratus lumborum
  2. Iliac br. - iliacus and ileum
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13
Q

Lateral sacral artery

A

Branch off posterior trunk internal iliac a.

  1. Spinal meninges
  2. Sacrum
  3. Skin overlying sacrum
  4. Erector spinae
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14
Q

Superior gluteal artery

A

Branch off posterior trunk internal iliac a.

1. Muscle and skin gluteal region

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15
Q

Umbilical artery

A

Branch off anterior trunk internal iliac a.
1. Superior vesicular a.
A. Sup bladder
B. Distal ureters

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16
Q

Obturator artery

A

Branch off anterior trunk internal iliac a.

  1. Pubic branch anastomose w/ contralateral branch and pubic branch IMA
  2. Accessory branch common
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17
Q

Inferior vesicle/vaginal artery

A

Branch off anterior trunk internal iliac a.

  1. Bladder
  2. Ureters
  3. Seminal vesicle and prostate
  4. Posterior surface vagina
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18
Q

Uterine artery

A
Branch off anterior trunk internal iliac a. 
1. Vaginal branch
  A. Cervix
  B. Vagina
2. Ascending branch
  A. Ovarian br.
  B. Tubal br.
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19
Q

Middle rectal artery

A

Branch off anterior trunk internal iliac a.

1. Rectum

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20
Q

Internal pudendal artery

A

Branch off anterior trunk internal iliac a.

  1. Perineum
  2. Perineal a.
  3. Dorsal a. Of penis/clitoris
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21
Q

Inferior gluteal artery

A

Branch off anterior trunk internal iliac a.

  1. Skin/muscle gluteal region
  2. Anastomose w/ vessels around hip jt.
  3. May arise from posterior trunk internal iliac a.
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22
Q

Ovarian artery

A
  1. Ovarian br.
  2. Tubal br. - uterine tube
  3. Anastomose w/ branches uterine a.
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23
Q

Medial sacral artery

A
  1. Anastomose lateral sacral -> lumbar a.
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24
Q

Superior rectal artery

A

Continuous w/ IMA -> internal anal sphincter

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25
Q

Internal iliac vein

A

Drains into common iliac v.

26
Q

Pelvic venous plexus

A

Surface of viscera

1. Part surrounding rectum and anal canal -> sup rectal v. -> middle and inf rectal v. -> hepatic portal system

27
Q

Inferior portion rectal plexus

A
  1. Internal rectal plexus: source internal hemorrhoids
  2. External rectal plexus: encircles external sphincter
    A. Source external hemorrhoids
  3. Single deep dorsal vein: drains erectile tissue
28
Q

Somatic innervation of pelvis

A
1. Anterior rami of sacral and coccygeal spinal n. + N. From lumbar plexus -> sacral + coccygeal plexuses (L2-L4)
  A. Ant surface of pisiformis
2. Sacral plexus (ant rami L4-S4)
3. Coccygeal plexus
4. Obturator n.
29
Q

Sacral plexus

A
Ant. Rami (L4-S4)
1. Sciatic n. (L4-S3): thru greater sciatic foramen -> gluteal region -> post thigh -> leg and foot
2. Pudendal n. (S2-S4): primary somatic n. Of perineum and sensory external genitalia 
3. Other branches
  A. Gluteal m.
  B. Pelvic wall
  C. Pelvic floor
  D. Skin inf gluteal region
  E. Skin post thigh and upper leg
30
Q

Coccygeal plexus

A

Ant rami S4-S5 and coccygeal n. -> anococcygeal n. ->

  1. Coccygeus
  2. Levator ani
  3. Sacrococcygeal jt
  4. Skin in anal triangle
31
Q

Autonomic innervation of pelvis

A
  1. Sympathetic
    A. Inhibit peristalsis rectum
    B. Stimulate ejaculation
  2. Parasympathetic
    A. Stimulate contraction rectum and bladder and erection
  3. Enter cavity 4 routes
    A. Sacral sympathetic trunks: cont lumbar trunks, send postsynaptic fibers to sacral plexus -> lower limbs
    B. Peri-arterial plexuses: post-synaptic symp, vasomotor fibers -> sup rectal a., ovarian a., and internal iliac a.
    C. Hypogastric plexus: primary route symp innervation pelvic viscera
    1. Sup: symp and visceral afferent fibers -> rt and lt hypogastric + pelvic splanchnic -> inf hypogastric
    2. Inf: symp + parasympathetic + visceral afferent
      A. Sub-plexus on
      1. Lateral rectum
      2. Inferolateral bladder
      3. Prostate and seminal glands
      4. Cervix and lateral fornices of vagina
        D. Pelvic splanchnic n.: presynaptic parasympathetic fibers + visceral afferent -> pelvic viscera and descending and sigmoid colon
32
Q

Visceral afferent fibers in pelvis

A
  1. Travel w/ autonomic
  2. Unconscious sensation travel w/ parasympathetic
  3. Pain
    A. Sup. Pelvic pain line -> symp thru abdominopelvic splanchnic n., lumbar symp trunks, white rami communicans-> spinal ganglia (T11-L2/3)
    B. Inferior pelvic pain line -> parasympathetic-> pelvic and inf hypogastric plexuses and pelvic splanchnic n. -> spinal sensory ganglia (S2-S4)
33
Q

Lymphatic drainage of the pelvis

A
  1. Nodes along internal and external iliac a. And br. -> common iliac nodes -> lateral aorta nodes -> lumbar trunks -> thoracic duct (T12)
  2. Ovaries, uterus, uterine tubes -> vessels w/ ovarian a. -> lateral aortic nodes or pre-aortic nodes
34
Q

Pelvic fascla

A
  1. Continuous w/ endoabdominal fascia between membranous peritoneum and muscular pelvic wall and floors
  2. Membranous pelvic fascia
  3. Endopelvic fascia
35
Q

Membranous pelvic fascia

A
  1. Parietal: lines deep aspect m. Forming walls and floors
  2. Visceral: directly covers pelvic organs
  3. Parietal + visceral -> cont where organs penetrate pelvic floor
  4. Thickens -> tendinous arch pelvic fascia
  5. Ant portion
    A. Puboprostatic lig: pubis and prostate
    B. Pubovesical lig (females): pubis and fundus of bladder
  6. Post portion
    A. Sacrogenital lig: from sacrum, around rectum -> prostate/ vagina
    B. Paracolpium (female): connection visceral fascia vagina w/ tendinous arch pelvic fascia
    1. Assist wt bearing of fundus of bladder
36
Q

Endopelvic fascia

A
  1. Loose and condensed
  2. Subperitoneal fascia adjacent parietal and visceral membranous fascias
  3. Forms CT matrix for pelvic viscera
  4. Varies in density and content
    A. Loose Arsenal’s tissue: few lymphatics and nutrient vessels, potential spaces between pubis and bladder
    B. Condensed fibrous tissue (fasciae condensation/pelvic lig): collagen and elastic fibers, smooth m.
    1. Convey neurovascular structures
    2. Hypogastric sheath = thick band of condensed pelvic fascia that separates retropelvic and retrorectal spaces -> 3 lamina
      A. Ant: lat lig bladder
      B. Post: lat rectal lig
      C. Intermediate (males): rectovesicle septum
      D. Intermediate (females): cardinal lig
37
Q

Pelvic viscera

A
  1. Retroperitoneal
  2. Kidneys
  3. Ureters
  4. Suprarenal glands
38
Q

Kidney

A
  1. T12-L3 level
  2. Retroperitoneal
  3. Rt. Kidney lower
  4. Renal hilum
  5. Surrounded by perinephric fat
  6. Renal arteries: arise IVD between L1 and L2 vertebrae
  7. Innervation: from renal plexus
  8. Lymphatic drainage: lumbar lymph nodes
39
Q

Ureters

A
  1. Retroperitoneal
  2. Muscular
  3. Adhere closely to peritoneum
  4. Constrictions: potential sites of obstruction
    A. Ureter and renal pelvis
    B. Ureter and pelvic inlet
    C. Ureter and wall of urinary bladder
  5. Abdominal blood supply
    A. Renal a.
    B. Abdominal a.
    C. Common iliac a.
    D. Gonadal a.
  6. Venous drainage: into renal and gonadal v.
  7. Innervation:
    A. Renal n.
    B. Abdominal aortic n.
    C. Sup hypogastric plexus
  8. Lymphatic drainage -> lumbar and iliac lymph nodes
40
Q

Suprarenal glands

A
  1. Retroperitoneal
  2. Endocrine fxn
  3. Hilum
    A. Venous drainage: suprarenal v.
    1. Rt -> IVC
    2. Lt -> lt renal
      B. 50-60 arterial branches penetrate capsule
    3. Arise from sup, middle, and inf suprarenal a.
  4. Innervation:
    A. Celiac plexus
    B. Greater, lesser, and least splanchnic n.
  5. Lymphatic drainage: lumbar lymph nodes
41
Q

Urinary bladder

A
  1. Subperitoneal
  2. Neck held by lat lig, tendinous arch, and puboprostatic/pubovesicle lig
  3. Parts
    A. Apex
    B. Fundus
    C. Body
    D. Neck
  4. Walls composed of Detrusor m.
  5. Trigone = uterine + internal urethral orifices
  6. Blood supply: internal iliac a branches
  7. Venous drainage: internal iliac v branch
  8. Innervation:
    A. Symp: from inf thoracic/upper lumbar spinal cord levels -> pelvic plexuses via hypogastric plexus and n.
    B. Parasympathetic
    1. Sacral sp n. -> pelvic splanchnic and inf hypogastric plexus
    2. Motor detrusor and inhibitory internal urethral sphincter (males)
      C. Sensory = visceral
    3. Reflex follow parasympathetic
      A. Exception: sup bladder follows sympathetic
42
Q

Male urethra

A
  1. Muscular
  2. 4 parts
    A. Intramural (preprostatic)
    B. Prostatic
    C. Intermediate (membranous)
    D. Spongy
  3. Supply:
    A. Prostatic br inf vesicle
    B. Middle rectal a.
  4. Venous drainage: prostatic system
  5. Innervation: prostatic plexus
43
Q

Female urethra

A
  1. Muscular
  2. Para-urethral glands
  3. Arterial supply:
    A. Internal pudendal
    B. Vaginal a.
  4. Veins: follow arteries
  5. Innervation: branch from vesical plexus and pudendal n.
44
Q

Rectum

A
  1. Rectosigmoid junction
    A. Ant S3 vertebrae
    B. Teniae coli -> longitudinal layer smooth m.
    C. Fatty omental appendices end
  2. Lateral flexures
    A. Sup (lt)
    B. Inf (lt)
    C. Intermediate (rt)
  3. Supply:
    A. Sup rectal - proximal
    B. Rt and lt middle rectal a. : middle and inf
    C. Inf rectal: anorectal jxn and anal canal
  4. Venous drainage: sup, middle, and inf rectal v.
    A. Portal and systemic anastomoses in wall of anal canal
  5. Innervation
    A. Sympathetic
    1. Lumbar splanchnic
    2. Hypogastric/pelvic plexuses
    3. Peri-arterial plexuses of IMA and sup rectal a.
      B. Parasympathetic: S2-S4 sp n. -> pelvic splanchnic and lt and rt inf hypogastric plexuses -> rectal plexus
      C. Visceral afferents: follow parasympathetic-> S2-S4 spinal sensory ganglia
    4. Inf pelvic pain line
45
Q

Male internal genitalia

A
  1. Testes and epididymis
  2. Ductus deferens
  3. Seminal glands
  4. Ejaculatory ducts
  5. Prostate
  6. Bulbo-urethral (Cowper’s) glands
  7. Innervation: sympathetics
    A. Presynaptic T12-L2 -> synapse w/ paravertebral ganglia -> hypogastric and pelvic plexuses -> internal genitalia
46
Q

Ductus deferens

A

Muscular duct

  1. Spermatozoa epididymis -> ejaculatory duct
  2. Supply: from sup vesical a. And anastomoses w/ testicular a.
  3. Venous drainage: testicular vein
47
Q

Seminal glands

A
Duct and vas deferens -> ejaculatory duct
1. Secretes fluid for semen 
2. Supply: 
  A. Inf vesical a. 
  B. Middle rectal a. 
3. Veins follow arteries
48
Q

Ejaculatory ducts

A
Seminal ducts + vas deferens
1. Supply: from sup vesical a. And anastomoses w/ testicular a. 
2. Venous drainage: 
  A. Prostatic venous plexus
  B. Vesical venous plexus
49
Q

Prostate

A
  1. Produces thin fluid for semen
  2. Fibrous capsule covered by prostatic plexus of v. And n.
  3. Prostatic sheath = visceral layer prostatic fascia
    A. Cont w/ puboprostatic lig and rectovesical septum
    B. Supply
    1. Inf vesical
    2. Internal pudendal
    3. Middle rectal
  4. Venous drainage: prostatic venous plexus -> internal iliac v.
50
Q

Bulbo-urethra (Cowper’s) glands

A

Produce mucus secretion for semen

51
Q

Female internal genitalia

A
  1. Ovaries
  2. Uterine tubes
  3. Uterus
  4. Vagina
52
Q

Ovaries

A
  1. Suspended by mesovarium
  2. Tethered superolateral suspensory lig
    A. Nerve, artery, and vien run through them
  3. Tethered medially to uterus ovarian lig
  4. Innervation: ovaries and uterine tubes
    A. Ovarian and uterine plexuses
    B. Visceral pain afferents follow sympathetic -> T11-L1 spinal sensory ganglia
    C. Visceral afferent reflex follow parasympathetic-> pelvic and inf hypogastric plexuses and pelvic splanchnic n. -> S2-S4 spinal sensory ganglia
53
Q

Uterine tubes

A
  1. Suspended by mesosalpinx
  2. Parts:
    A. Infundibulum (fimbrae)
    B. Ampulla
    C. Isthmus
    D. Uterine
  3. Supply: ovarian a. And ascending uterine anastomose -> collateral circulation for abdominal and pelvic sources
  4. Venous drainage
    A. Overian veins -> pampiniform plexus -> ovarian v.
    1. Rt ovarian v. -> IVC
    2. Lt ovarian v. -> lt renal v. And uterine venous plexus
  5. Innervation: ovaries and uterine tubes
    A. Ovarian and uterine plexuses
    B. Visceral pain afferents follow sympathetic -> T11-L1 spinal sensory ganglia
    C. Visceral afferent reflex follow parasympathetic-> pelvic and inf hypogastric plexuses and pelvic splanchnic n. -> S2-S4 spinal sensory ganglia
54
Q

Uterus

A
  1. Variable positioning
  2. Parts
    A. Body
    B. Uterine cavity
    C. Fundus
    D. Isthmus
    E. Cervix
    F. Cervical canal
    G. Internal and external Os
    H. Vaginal fornix
  3. Layers uterine wall
    A. Perimetrium
    B. Myometrium
    C. Endometrium
  4. Ligaments
    A. Ovarian lig
    B. Round lig: remnant ovarian gubernaculum
    C. Broad lig
    D. Support uterus
    1. Active = pelvic diaphragm
    2. Passive = resting on top of bladder
  5. Cervix: least mobile part, attached by endopelvic fascial lig
    A. Cardinal lig
    B. Uterosacral lig
  6. Supply: uterine a.
55
Q

Vagina

A
1. Fxns
  A. Canal for menstrual fluid
  B. Receives penis and ejaculate
  C. Communicates w/ cervical canal and vestibule vagina
2. Vaginal fornix: recess around cervix
  A. Ant
  B. Lat
  C. Post: deepest and related to recto-uterine pouch
3. Muscles that act as sphincters
  A. Pubovaginalis
  B. External urethral sphincter
  C. Urethrovaginal sphincter
  D. Bulbospongiosus
4. Supply and drainage
  A. Sup vagina: uterine a.
  B. Middle and inf: vaginal and pudendal a. 
  C. Vaginal v. -> vaginal plexus cont w/ uterine plexus -> uterovaginal plexus -> uterine v. -> internal iliacs
56
Q

Innervation uterus and vagina

A
  1. Inf 1/4 vagina
    A. Somatic: deep perineal n.
    B. Sympathetic: pudendal n. (S2-S4)
    C. Visceral afferent: pudendal
    D. Sensitive to touch and temp
  2. Sup 3/4 vagina and uterus
    A. Visceral: uterovaginal n. Plexus
    1. Sympathetic
    2. Parasympathetic
    3. Visceral afferent
  3. Sympathetic: inf thoracic spinal cord -> lumbar splanchnic n. And intermesenteric-hypogastric pelvic series of plexuses
  4. Parasympathetic: S2-S4 -> pelvic splanchnic n. -> inf hypogastric-uterovaginal plexus
  5. Visceral afferent
    A. Pain from intraperitoneal uterine fundus and body (sup pain line) follows symp -> inf thoracic- sup lumbar spinal ganglia
    B. Pain inf pain line follow parasympathetic-> uterovaginal and inf hypogastric plexuses and pelvic splanchnic -> S2-S4 sensory ganglia
    C. Clinically sig: several routes anesthesia during childbirth
57
Q

Female internal genitalia lymphatic drainage

A
  1. Follows venous -> internal iliac v. -> sacral nodes -> internal nodes
  2. Exception: structures sup in ant pelvis -> external iliac nodes
  3. External and internal iliac nodes -> common iliac and lumbar lymph nodes -> lumbar lymph nodes -> lumbar lymphatic trunks -> cisterns chyli
58
Q

Sacral sympathetic trunks

A

Postsynaptic fibers -> sacral plexus -> innervate lower limbs
A. Vasomotor, pilomotor. Sudomotor

59
Q

Peri-arterial plexuses in the pelvis

A

Post-synaptic sympathetic (vasomotor) -> sup rectal, ovarian, and internal iliac a. And branches

60
Q

Hypogastric plexuses

A
  1. Most imp symp route into pelvic region
  2. Superior
    A. Network (mostly post-synaptic) symp, and visceral afferents, prolongation intermesenteric plexus inf aortic bifurcation
    B. Receives 2 lower lumbar splanchnic
    C. Enters pelvis and divides -> lt and rt n.
    D. Carries pre-synaptic from lumbar splanchnic
  3. Inferior
    A. Network symp (most post-synaptic) parasympathetic (pre and post), and visceral afferents
    B. Formed by: hypogastric + pelvic splanchnic (parasympathetic) + sacral splanchnic (symp)
    1. Sacral splanchnic mostly postsynaptic
    2. Subplexuses = pelvic plexuses assoc w/
      A. Inferolat bladder
      B. Lat rectum
      C. Prostate and seminal glands
      D. Cervix and lat vaginal fornices
61
Q

Pelvic splanchnic n.

A

Ant rami S2-S4

1. Carry pre-synaptic parasympathetic and visceral afferents