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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
What is the perineal body and where is it located? What is the clinical significance?
- 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
Which structures attach to the perineal body?
- Superficial/Deep transversals perineal muscles - Bulbospingiosus Muscle - Levator Ani - Spincter Ani - SuperficialDeep perineal fascia
27
What are the boundaries of the anal triangle?
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
What are the contents of the Ischiorectal fossa?
- 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
What is a fourchette?
Membrane found in children under 5 YO located over posterior labial commisure
30
What is the blood supply and innervation for the external female genitalia?
Blood supply: Internal/external pudendal arteries Nerve Supply: Ilioinguinal nerve (L1) and Genitofemoral Nerve (L1-2)
31
What are the 7 surgical and anatomical spaces of the perineum?
- Prevesical (Space of retzius) - Vesicovaginal and vesicocervical - Paravesical rectovaginal - Pararectal - Retrorectal - Presacral
32
Describe the role of parasympathetic and sympathetic activity in male erectile tissue.
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
What are the two CT coats of the testes?
Tunica Vaginalis Tunica Albuginea
34
What is the blood supply of the scrotum?
- Internal/external pudendal - Testicular - Cremasteric
35
What are the Male-Female genital Homologues?
- 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
Which muscle forms part of the pelvic diaphragm is important in fecal continence?
Puborectalis of the Levator Ani
37
Which structures are palpable per rectum in men?
- Membranous urethra when distended - Prostate - Seminal vesicle when distended - Bladder when full - Bulbourethral gland when enlarged
38
What structures are palpable [er rectum in females?
- Cervix of Uterus - Vagina - Uterus when retroverted - Ovaries in pathology - Uterine tubes in pathology
39
What is the trigone?
Triangular space inside bladder Bounded by: - Internal urethral orifice inferiorly - Two ureteral orifices superiorly - Medial ridge called uvula vesicae
40
What are the main muscles of the Urinary bladder?
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
What is the role of the seminal vesicles?
- Produce Seminal Fluid | - DO NOT STORE SEMEN
42
How do the Vas Deferens Move positionally?
- 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
What is the Fornix?
Vaginal recess around the cervix and vaginal wall
44
What is Hegar’s sign?
Softening of the isthmus; early sign of pregnancy
45
How are the ovarian and round ligaments positioned within the broad ligament?
Ovarian ligament lies posterosuperiorly Round ligament lies anteroinferiorly
46
Laterally, the board ligament is prolonged superiorly over the ovarian vessels as the ________
Suspensory ligament of the ovaries
47
What are the three parts of the board ligament?
Mesovarium: To Ovary Mesosalpinx: Btwn ligament of ovary, ovary, and uterine tubes Mesometrium: Covers Body of Uterus
48
A pregnant patient comes in with an abnormally prominent spinous process of L5. What is the likely diagnosis?
Spondylolisthesis
49
What is the most commonly fractured part of the pelvis in anteroposterior compression?
Pubic Rami
50
Patient comes in with pelvic pain and a scan reveals large fibrous masses within the uterine wall. What is the likely diagnosis?
Leiomyomas (Fibroids)
51
Obese pregnant patient Patient comes in with pelvic pain, incontinence of urine and bowels, and a prolapsed vagina. What is the diagnosis?
Descending perineum syndrome
52
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?
Pelvic inflammatory Disease
53
What muscles are most often torn during childbirth?
Pubococcygeus Puborectalis
54
What is characteristic of inferior Gluteal Nerve lesions?
- Difficulty walking up stairs or standing from a a chair | - No positional pathological findings due to ischiocrural muscular compensation
55
What is characteristic o Superior gluteal nerve damage?
- Trendelenberg sign: Glut Med —> Healthy hip drops when walkinh (Duchenne Gait)
56
What is the approach for | I’m injections in the gluteal region?
- Recommeded site of injection is gluteus medius in upper outer quadrant (Hochstetter’s technique) *** Avoid damage to sciatic or sup gluteal nerve
57
What is the collateral circulation after Hypogastric (Internal Iliac) Ligation?
Iliolumbar: Lumbar Latearl Sacral: Middle Sacral Middle hemorrhoidal: Superior Hemorrhoidal
58
Which lobe of the prostate is most commonly affected by benign prostatic hyperplasia?
Middle
59
Which lobe of the prostate most commonly is affected by carcinoma?
Posterior Lobe
60
What is positioned close to the Uterine artery and must be avoided during cervical procedures?
Ureter
61
What are the most common referred pain sites in the hip and perineum?
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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