Pelvis And Perineum 1 Flashcards
Contrast true and false pelvis
- The iliac blades contribute to the abdominal cavity = “false pelvis”
- Below the pelvic inlet is the pelvic cavity =“true pelvis”
Contrast pelvic inlet and pelvic outlet
• Pelvic inlet - sacral promontory, sacral ala, arcuate line, pectineal line,
pubic crest
• Pelvic outlet - Anterior: pubic symphyses, ischiopubic ramus; Posterior: ischial tuberosities, sacrotuberous ligaments and sacrum
What does the pelvis consist of?
Funnel shaped muscle that reinforces the pelvic organs Anterior defect = urogenital hiatus Consists of : levator ani muscle • Iliococcygeus • Pubococcygeus \: Coccygeus (ischiococcygeus)
What the peritoneum and its pouches?
- Where the peritoneum folds over the organs it creates pouches where fluid may collect
- The rectouterine pouch (of Douglas) is the lowest point in the abdominopelvic cavity in the upright position
What is Culdoscopy/Culdoscentesis?
Culdoscope is an endoscopic instrument that can be inserted through the posterior part of the vaginal fornix to examine the ovaries or uterine tubes
Culdoscentesis: checks for abnormal fluid in the abdominal cavity behind the uterus
What are the make internal organs?
The testes are considered part of the internal organs
Their development, blood supply, innervation and lymphatic drainage is all connected to the lumbar region
What are the important ideas of the vascular supply?
Pelvic arteries are very variable, especially in regards to their origin. Name arteries for what they supply!
With the exception of the ovaries, all pelvic viscera are supplied by branches of the internal iliac arteries
Venous drainage follows the arteries and there is great difference between male and female
What are the veinous interconnections of the inner pelvis ?
The prostatic venous plexus drains into the Inferior vesicle veins and subsequently into the internal iliac vein The plexus may also drain into the sacral veins and into the internal vertebral plexus of Batson
What are the lymphatic drainage of the pelvic organs?
Male
• Testes drain to lumbar nodes
• Prostate, seminal vesicles, ductus deferens drain into internal iliac nodes
Female Uterine fundus (with ovaries and uterine tubes) drains to lumbar nodes
Body of uterus, cervix and upper vagina drain to external & internal iliac nodes
Lower vagina drain into superficial inguinal
What is the pelvic plane line?
Pelvic pain line (PPL)
imaginary line corresponds to the lower limit of the peritoneum
What happens above the pelvic pain line?
Above PPL - the visceral afferents (body of uterus, uterine tubes, peritoneal portion of bladder) for pain travel via the sympathetics
They travel in the inferior hypogastric plexus
Pain is referred to the T10-L2 areas
What happens below the pelvic pain line?
Below PPL - the visceral afferents (the cervix, the upper portion of vagina and majority of the urinary bladder) for pain travel via the parasympathetics
They travel in the inferior hypogastric plexus
Pain is referred to the S2-S4 areas
Note: the pelvic pain line in the GI tract is located at the midpoint of the sigmoid colon
Explain what is the perineum
- Area of the groin between the upper thighs, external to the pelvic diaphragm
- Perineal organs (external genitalia) are below the pelvic outlet
- Divided into two unequal triangles (approx. 45° to each other) • Urogenital anteriorly
- Anal posteriorly
- Their bases are formed by same line, midpoint = perineal body
What is the fascia of the urogenital triangle?
The membranous layer (Colle’s) of fascia is continuous with the fascia of the anterior abdominal wall
Fused to the inguinal ligament
Fused to the perineal membrane posteriorly
Fused to the ischiop
What are the perineal pouches?
The fascia of the inferior limits of the pelvic diaphragm, perineal membrane and superficial perineal fascia create 2 spaces where fluid may accumulate
• Deep perineal pouch; deep to the perineal membrane
• The superficial perineal pouch; superficial (external) to the perineal
membrane
