Pelvis and Perineum Flashcards
Borders of the anterior abdominal wall x3
Superior: costal cartilages 7-12, xiphoid process
Inferior: pelvic bone and iliac crest
Lateral: mid axillary line
Layers of the abdominal wall x8
Skin
Superficial fascia
External oblique muscle
Internal oblique muscle
Transverse abdominis
Transversalis fascia
Extraperitoneal fat
Parietal peritoneum
Two types of superficial fascia and their contents
Campers - fatty layer
Scarpas - membranous
Superficial arterial supply x3 to the abdominal wall and which artery do they come from
They branch from the femoral artery
Superficial epigastric
Superficial circumflex iliac
Superficial external pudendal
State 5 deep arteries of the abdomen
Superior epigastric
Musculophrenic
Inferior epigastric
Deep circumflex artery
Branches of 10th and 11th intercostal arteries
Which 2 branches supply the deep upper abdominal wall and which artery do they come from
Superior epigastric
Musculophrenic
Branches of the internal thoracic artery
Which 2 branches supply the deep lower abdominal wall and which artery do they come from
Inferior epigastric
Deep circumflex iliac
Branches of the external iliac
State 3 veins which drain into the femoral vein
Superficial epigastric vein
Superficial external pudendal
Superficial circumflex iliac
Where does superior epigastric vein drain
Brachiocephalic vein
Which veins drain into the external iliac veins x2
Inferior epigastric vein
Deep circumflex iliac
State 3 lymph nodes that drain the abdominal wall
Axillary
Parasternal
Superficial inguinal
Nerve supply to the abdominal wall x4
Thoracoabdominal aka Lower intercostal T7-T11
Subcostal T12
Ilioinguinal L1
Iliohypogastric L1
Functions of the anterior abdominal wall x5
- Move trunk and maintain posture
- Stabilize the pelvis during movement
- Compress abdominal contents
- Protect abdominal viscera
- Maintain intraabdominal pressure
State 4 bones of the pelvic skeleton
2 hip bones
Sacrum
Coccyx
Name 3 bones make up the hip bone and the cartilage between them
Ilium
Pubic
Ischium
Triradiate cartilage
Name the 4 pelvic joints
Lumbosacral
Sacroiliac
Sacrococcygeal
Pubic symphysis
State 3 boundaries of the pelvic inlet
Ant- pubic symphysis
Post- promontory of sacrum
Lat- ileopectineal/arcuate lines
4 borders of the pelvis outlet
Ant- pubic symphysis
Post- coccyx
Anterolat- ischiopubic ramus
Posterolat- sacrotuberous ligament
3 boundaries of the greater pelvis
Ant- abdominal wall
Post- L5 and S1 vertebrae
Lat- iliac fossa
What makes the inferior part of the lesser/true pelvis
Musculofascial pelvic diaphragm
4 types of pelvises
Gynecoid
Android
Anthropoid
Platypelloid
State and describe 4 pelvic measurements
- True conjugate- from promontory of sacrum to sup border pubic symphysis
- Obstetric conjugate- promontory to most bulging point of pubic symphysis
- Diagonal conjugate- promontory to inf border of pubic symphysis
- Sub pubic angle- between inferior rami of pubic bones
State 4 pelvic muscles
Levator ani
Coccygeus
Piriformis
Obturator internus
State 3 muscles making up the levator ani
Puborectalis
Ilicoccygeus
Pubococcygeus
Where does the internal iliac artery arise and where it divides
Arises in front of sacroiliac joint
Divides into ant and post at upper border of greater sciatic foramen
Arterial supply to the pelvis x4
Internal iliac artery
Median sacral
Superior rectal
Ovarian
Vein draining the pelvis
Internal iliac vein
Lymph nodes of the pelvis x3
Internal, external and common iliac nodes
Nerve supply to the pelvis x3
Pudendal
Sympathetic
Parasympathetic
5 boundaries of the perineum
Ant- pubic symphysis
Post- tip of coccyx
Lat- inf pubic rami, inf ischial rami, sacrotuberous ligament
Sup- pelvic floor
Base- skin and fascia
Name 2 triangles of the perineum and their position
Anterior urogenital triangle
Posterior anal triangle
3 boundaries of the anterior urogenital triangle
Ant- pubic symphysis
Lat- ischiopubic ramus
Post- line joining the ischial tuberosities
3 boundaries of the anal triangle
Ant- line joining the ischial tuberosities
Lat- sacrotuberous ligament
Post- tip of coccyx
3 contents of the anal triangle
Anal aperture
Ischioanal fossa
External anal sphincter muscle
Boundaries (2) of the deep perineal pouch
Sup- deep fascia of the pelvic floor
Inf- perineal membrane
Contents(5) of the deep perineal pouch
Parts of urethra
External urethral sphincter
Bulbourethral glands
Vagina
Deep transverse perineal muscles in males
2 boundaries of the superficial perineal pouch
Sup- perineal membrane
Inf- superficial perineal fascia
Contents of the superficial perineal pouch x6
Penis
Clitoris
Batholin glands (F)
Ischiocarvenous muscle
Bulbocarvenous muscle
Superficial transverse perineal muscles
Describe the 4 degrees of vaginal tearing
I - tear of the perineal skin
II- tear of the perineal muscles
III- anal sphincter complex
IIIa- <50% of EAS
IIIb- >50% of EAS
IIIc- both EAS and IAS
IV- all above plus rectal mucosa
Indications of episiotomy x3
- Increased risk of third degree tear from previous history
- Breech delivery to obtain more space
- Fetal distress in second stage of labor
State 5 ligaments of the pelvis
Sacrotuberous
Sacrospinous
Iliolumbar
Iliofemoral
Pubofemoral
3 advantages of the Joel Cohen incision
Minimal blood loss
Good pain control
Cosmesis- skin covers the scar
