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Gross Anatomy > Pelvis And Perineum (Jones) > Flashcards

Pelvis And Perineum (Jones) Flashcards

1
Q

What is the degree of inclination of the pelvic brim?

A

55 degrees

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2
Q

What structures exit through which foramina in the sacrum?

A

Anterior Sacral Foramina: Ventral Rami

Posterior Sacral Foramina: Dorsal Rami

Sacral Hiatus: Fat, Filum terminale, S5, and Coccygeal nerves

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3
Q

What is the average width of the pelvis?

A

10.5 cm

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4
Q

What is characteristic of the male pelvis?

A
  • Thick/heavy
  • Deep false pelvis
  • Narrow, deep, and tapering true pelvis
  • Heart shaped
  • Narrow pubic arch
  • Round Obturator foramen
  • Large acetabulum
  • Narrow sciatic notch
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5
Q

What is characteristic of the female pelvis?

A
  • Thin/light
  • Shallow False pelvis
  • Wide/shallow cylindrical true pelvis
  • Oval and rounded pelvic inlet
  • Large Pelvic outlet
  • wide pubic arch
  • Oval Obturator foramen
  • Small acetabulum
  • Wide greater sciatic notch (90 deg)
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6
Q

What connects the superior aspect of the pubic bone and the interpubic disc?

A

Superior pubic ligament

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7
Q

What are the boundaries of the pelvic outlet?

A
  • Coccyx
  • Ischial tuberosity
  • Inferior pubic ramus
    Pubic symphysis
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8
Q

What makes up the birth canal? How does the pelvic cavity pass?

A
  • Pelvic inlet
  • Deep pelvis
  • Pelvic outlet

Passes:

  • backward and downward
  • Longer posteriorly thananteriorly
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9
Q

What passes superiorly to the piriformis muscle?

A

Superior neurovascular bundle

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10
Q

What passes inferiorly to the piriformis?

A
  • Inferior gluteal bundle
  • sciatic nerve
  • Pudendal neurovascular bundle
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11
Q

What spinal roots innervates the Levator Ani? What are the three muscle of the levator ani?

A
  • S2-4 (Pudendal)
  • Iliococcygeus
  • Pubococcygeus
  • Puborectalis
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12
Q

Which muscle forms a rectal sling?

A

Puborectalis

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13
Q

what forms the walls of the pelvic outlets?

A

Lateral Wall: Oburator Internus

Posterosuperior wall: Piriformis

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14
Q

What pathologies are associated with the vesicouterine pouch?

A
  • Endometriosis

- retroverted uterus

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15
Q

What are the branches off the internal iliac artery?

A
  • Inferior Gluteal artery
  • Obturator artery
  • Umbilical artery ( —> Superior and Middle Vesical)
  • Uterine Artery
  • Deferential artery
  • middle rectal (HEmorrhoidal)
  • Inferior vesicular artery
  • Internal pudendal artery (—> Inferior rectal, Scrotal/labial, Perineal, and deep arteries of penis/Clitoris)
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16
Q

What are the Posterior branches off the internal iliac artery?

A
  • Iliolumbar
  • Lateral Sacral Artery
  • Superior Gluteal Artery
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17
Q

What are the anastomoses of the Internal iliac artery? What is the significance of them?

A
  • Lumbar (Aorta) —>Iliolumbar
  • Median Sacral (Aorta) —> Latreral Sacral
  • Superior rectal (IMA) —> Middle rectal

*Ligation of IIA will not stop blood flow, but will reduce it allowing hemostasis

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18
Q

Differentiate venous drainage from the uterus.

A

LOV —> Left Renal Vein —> IVS

ROV —> IVC

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19
Q

What are the lymph nodes of the pelvis and where do they drain?

A

External Iliac: Aling femoral vein

Internal Iliac: Perineum and gluteal

Sacral: Btwn pelvic organs and nternal iliac nodes

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20
Q

What are the three methods of anesthesia for childbirth?

A

Spinal: L3-L4 subarachnoid space (Waist down)

Pudendal: S2-S4 dermatomes

Epidural: Roots S2-4 Pain fibers from uterus and upper vagina; NO LOWER EXTREMITIES

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21
Q

What are the vertices and sides of the anal triangle?

A

Vertices:

  • One vertex at the Coccyx bone
  • The two ischial tuberosities of the pelvic bone

Sides:

  • Posterior Perineal membrane (Anterior Wall)
  • The two Sacrotuberous ligaments
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22
Q

What are the bounds of the Ischioanal Fossa?

A

Laterally: Ischium and overlapping inferior part of the Obturator Internus covered with Obturator fascia

Medially: External anal sphincter, Sloping roof of levator Ani

Posteriorly: Sacrotuberous ligament and gluteus Maximus

Anteriorly: Bodies of pubic bone inferior to origin of Puborectalis

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23
Q

What are the contents of the Anal triangle?

A
  • Dense fat
  • Pudendal nerve and internal pudendal vessels
  • Inferior rectal vessels and nerve
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24
Q

Compare and contrast Urogenital sinus and the anal triangle

A
  • Share levator ani muscle
  • Share same innervation and blood supply (Ramus of S4 and branches of pudendal nerve)
  • Different special musculature
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25
Q

What is the perineal body and where is it located? What is the clinical significance?

A
  • Fibromuscular Central tendon
  • Provides Pelvic diaphragm with support
  • Located in the median plane between the anal canal and the vaginal bulb/bulb of urethra.

*** In Episiotomy, important to go LATERAL to perineal body

26
Q

Which structures attach to the perineal body?

A
  • Superficial/Deep transversals perineal muscles
  • Bulbospingiosus Muscle
  • Levator Ani
  • Spincter Ani
  • SuperficialDeep perineal fascia
27
Q

What are the boundaries of the anal triangle?

A

BOUNDARIES:
• THE TRANSVERSE DIAMETER OF THE
PELVIC OUTLET, AND LINES BETWEEN THE COCCYX AND ISCHIAL TUBEROSITIES.
• THE FLOOR IS FORMED BY THE LEVATOR
ANI (SUPERIORLY)
• THE WALLS ARE FORMED BY THE
OBTURATOR INTERNUS MUSCLE (ANTEROLATERALLY) AND THE SACROTUBEROUS LIGAMENT WITH THE OVERLYING GLUTEUS MAXIMUS MUSCLE

28
Q

What are the contents of the Ischiorectal fossa?

A
  • Fat
  • Inferior Rectal Vessels/Nerve
  • Posterior Femoral Cutaneous Nerve
  • Sphincter Ani Muscle
  • Pudendal Canal (Alcock’s) —> Pudendal nerve and internal pudendal vessels

*** Prone to “Horseshoe” Abcesses

29
Q

What is a fourchette?

A

Membrane found in children under 5 YO located over posterior labial commisure

30
Q

What is the blood supply and innervation for the external female genitalia?

A

Blood supply: Internal/external pudendal arteries

Nerve Supply: Ilioinguinal nerve (L1) and Genitofemoral Nerve (L1-2)

31
Q

What are the 7 surgical and anatomical spaces of the perineum?

A
  • Prevesical (Space of retzius)
  • Vesicovaginal and vesicocervical
  • Paravesical rectovaginal
  • Pararectal
  • Retrorectal
  • Presacral
32
Q

Describe the role of parasympathetic and sympathetic activity in male erectile tissue.

A

Parasympathetic: Straightening of Helicine AA. And compression of venous return leading to erectile tissue becoming engorged and erect

Sympathetic: Leads to ejaculation and return to flaccid state and recoiling

33
Q

What are the two CT coats of the testes?

A

Tunica Vaginalis

Tunica Albuginea

34
Q

What is the blood supply of the scrotum?

A
  • Internal/external pudendal
  • Testicular
  • Cremasteric
35
Q

What are the Male-Female genital Homologues?

A
  • Scotum: Labia Majorum
  • Glands Penis: Glan Clitoris
  • Corpus spongiosum: Vestibular bulb
  • Penile Urethra: Urogenital Sinus
  • Urethral glands: Lesser Vestibular glands
  • Bulbourethral glands: Greater vestibular glands
  • Prostate Gland: Paraurethtral
36
Q

Which muscle forms part of the pelvic diaphragm is important in fecal continence?

A

Puborectalis of the Levator Ani

37
Q

Which structures are palpable per rectum in men?

A
  • Membranous urethra when distended
  • Prostate
  • Seminal vesicle when distended
  • Bladder when full
  • Bulbourethral gland when enlarged
38
Q

What structures are palpable [er rectum in females?

A
  • Cervix of Uterus
  • Vagina
  • Uterus when retroverted
  • Ovaries in pathology
  • Uterine tubes in pathology
39
Q

What is the trigone?

A

Triangular space inside bladder Bounded by:

  • Internal urethral orifice inferiorly
  • Two ureteral orifices superiorly
  • Medial ridge called uvula vesicae
40
Q

What are the main muscles of the Urinary bladder?

A

Detrusor muscle: Smooth muscle wall of bladder

Sphincter Vessicae: Guard internal urethral orifice part of detrusor muscle

Sphincter urethrae: Skeletal muscle; Part of Levator Ani

41
Q

What is the role of the seminal vesicles?

A
  • Produce Seminal Fluid

- DO NOT STORE SEMEN

42
Q

How do the Vas Deferens Move positionally?

A
  • Descend anterior to external iliac artery over the posterior aspect of the bladder where it joins the duct of the seminal vesicle to form ejaculatory duct
43
Q

What is the Fornix?

A

Vaginal recess around the cervix and vaginal wall

44
Q

What is Hegar’s sign?

A

Softening of the isthmus; early sign of pregnancy

45
Q

How are the ovarian and round ligaments positioned within the broad ligament?

A

Ovarian ligament lies posterosuperiorly

Round ligament lies anteroinferiorly

46
Q

Laterally, the board ligament is prolonged superiorly over the ovarian vessels as the ________

A

Suspensory ligament of the ovaries

47
Q

What are the three parts of the board ligament?

A

Mesovarium: To Ovary

Mesosalpinx: Btwn ligament of ovary, ovary, and uterine tubes

Mesometrium: Covers Body of Uterus

48
Q

A pregnant patient comes in with an abnormally prominent spinous process of L5. What is the likely diagnosis?

A

Spondylolisthesis

49
Q

What is the most commonly fractured part of the pelvis in anteroposterior compression?

A

Pubic Rami

50
Q

Patient comes in with pelvic pain and a scan reveals large fibrous masses within the uterine wall. What is the likely diagnosis?

A

Leiomyomas (Fibroids)

51
Q

Obese pregnant patient Patient comes in with pelvic pain, incontinence of urine and bowels, and a prolapsed vagina. What is the diagnosis?

A

Descending perineum syndrome

52
Q

Patient comes into clinic with Hx of gonorrhea. She is complaining of pelvic pain, has vaginal discharge, and states that it is painful during sex. What is the likely diagnosis?

A

Pelvic inflammatory Disease

53
Q

What muscles are most often torn during childbirth?

A

Pubococcygeus

Puborectalis

54
Q

What is characteristic of inferior Gluteal Nerve lesions?

A
  • Difficulty walking up stairs or standing from a a chair

- No positional pathological findings due to ischiocrural muscular compensation

55
Q

What is characteristic o Superior gluteal nerve damage?

A
  • Trendelenberg sign: Glut Med —> Healthy hip drops when walkinh (Duchenne Gait)
56
Q

What is the approach for

I’m injections in the gluteal region?

A
  • Recommeded site of injection is gluteus medius in upper outer quadrant (Hochstetter’s technique)

*** Avoid damage to sciatic or sup gluteal nerve

57
Q

What is the collateral circulation after Hypogastric (Internal Iliac) Ligation?

A

Iliolumbar: Lumbar

Latearl Sacral: Middle Sacral

Middle hemorrhoidal: Superior Hemorrhoidal

58
Q

Which lobe of the prostate is most commonly affected by benign prostatic hyperplasia?

A

Middle

59
Q

Which lobe of the prostate most commonly is affected by carcinoma?

A

Posterior Lobe

60
Q

What is positioned close to the Uterine artery and must be avoided during cervical procedures?

A

Ureter

61
Q

What are the most common referred pain sites in the hip and perineum?

A

Anterior superolateral waist: Enthesitis (ASIS)

Along inguinal ligament to perineum and innermost thigh: True hip pain —> Iliopsoas bursitis

Lateral thigh: Meralgia parenthetical

Posterior just medial to midline above buttocks: Sacroiliac pain

Buttock pain: Lumbosacral spine

Lower Latearl quadrant buttock pain: ISchiogluteal bursitis

Lateral hip: Trlchanteric bursitis

Gross Anatomy (24 decks)

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