Pelvis Clinical Supplement Flashcards
heart shaped pelvic inlet more commonly found in males
“android<div><br></br></div><div><img></img></div>”
rounded pelvic inlet shape more commonly found in males
“anthropoid<div><br></br></div><div><img></img></div>”
__________ shaped pelvic inlet heart shaped, more narrow, most common female
“gynecoid<div><br></br></div><div><img></img></div>”
_____________ shaped pelvic inlet oval, wide, uncommon
“platypelloid<div><br></br></div><div><img></img></div>”
extends from superior aspect of pubic symphesis to sacral promontory
“obstetric conjugate (pelvis diameter)<div><br></br></div><div><img></img></div>”
extends from the inferior aspect of the pubic symphesis to sacral promontory
“diagonal conjugate (pelvis diameter)<div><br></br></div><div><img></img></div>”
what pelvis diameter can be estimated during a manual pelvic exam
diagonal conjugate
-posterior aspect of the pubic symphesis to sacral promontory<br></br>-unaffected by relaxation of the pelvic ligaments
true conjugate (pelvis diameter)
___________ distance extends between the ischial spines
“interspinous distance<div><br></br></div><div><img></img></div>”
_____________ joint<br></br>plane synovial<br></br>articular surfaces are irregular to allow interlocking<br></br>commonly ossifies with age
“sacro iliac<div><br></br></div><div><img></img></div>”
secondary cartilaginous articulation<br></br>includes a fibro cartilaginous disc
“pubic symphysis<div><br></br></div><div><img></img></div>”
where is a common site to obtain red bone marrow for transplants/diagnostic purposes?
“crest of the ilium<div><br></br></div><div><img></img></div>”
what structures are in danger during marrow harvesting at the crest of the ilium?
superficial circumflex iliac artery, ilioinguinal n., lateral femoral cutaneous <br></br>(tensor fascia lata, external oblique, latissimus dorsi)
during what procedures is the ureter in danger of iatrogenic injury?
hysterectomy<br></br>ovarectomy
where does the ureter pass in respect to the uterine artery?
under
where does the ureter run in respect to the ovarian vessels?
run together (where they pass the pelvic inlet)
what artery is ligated to reduce blood flow in the pelvis during surgery
internal iliac
internal iliac anastomoses– 5
“uterine -> ovarian (aorta)<br></br>iliolumbar/circumflex iliac -> lumbar (aorta)<br></br>lateral sacral -> median sacral (aorta)<br></br>inferior rectal/middle rectal -> superior rectal (IMA)<br></br>inferior gluteal -> profunda femoris (femoral)<div><br></br></div><div><img></img></div>”
disruption of perineal body during episiotomy can result in dysfunction of the ______________ muscles and herniation of the pelvic contents
“levator ani<div><br></br></div><div><img></img></div>”
collapse of the bladder into the anterior wall of the vagina<br></br>may also occur with injury to the supportive structures of the vagina
“cystocele<div><br></br></div><div><img></img></div>”
anterior and inferior protrusion of the rectum into the posterior wall of the vagina
“rectocele<div><br></br></div><div><img></img></div>”
anterior and inferior protrusion of the rectovaginal pouch (with gut loops) into the posterior wall of the vagina
“enterocoele<div><br></br></div><div><img></img></div>”
what superficial fascia of the ab wall continues onto the penis and scrotum as dartos fascia
“scarpa’s”
what deep investing fascia extends over the shaft of the penis
“bucks fascia<div><br></br></div><div><img></img></div>”
what fascia covers the superficial perineal muscles?
external perennial fascia
“lacerations of the spongy urethra with an intact buck’s fascia will lead to urine spread _________(where?)”
“along shaft of penis<div><br></br></div><div><img></img></div>”
lacerations between _________ and ______________ urethra = urine spills into the true pelvis, inferior to the peritoneum
“prostatic, membranous<div><br></br></div><div><img></img></div>”
lacerations of _________ and ______________ urine leaks into the superficial pouch (scrotum) along the shaft of the penis and along the anterior wall, deep to scarpas fascia
“spongy urethra, Buck’s fascia<div><br></br></div><div><img></img></div>”
a condition where the foreskin cannot be retracted over the glans penis; can interfere with urinary/reproductive function
“phimosis<div><br></br></div><div><img></img></div>”
constriction of the glans penis by a tight band of foreskin; can lead to ischemia
“paraphimosis<div><br></br></div><div><img></img></div>”
“a buildup of scar tissue within the tunica albuginea of the penis resulting in an abnormal (painful) curvature during erection; associated with a family history of Dupuytren’s contracture”
“Peyronie’s disease<div><br></br></div><div><img></img></div>”
____________ - when the bladder is full or distended (or in children), it can be approached immediately superior to the pubic symphysis for drainage, avoiding entering the peritoneal cavity.
“Suprapubic cystotomy<div><br></br></div><div><img></img></div>”
Bladder infections are much more common in ___________. Their urethra is shorter, more distendableand opens to the vaginal vestibule
females
-herniation of the bladder along the anterior wall of the vagina<br></br>-occurs with injury or weakness of pelvic and urogenital diaphragm or vaginal support (transverse cervical ligament, uterosacral ligament)
“cystocele<div><br></br></div><div><img></img></div>”
the lowest point (in the upright position) of the female abdominal cavity; accumulates blood or ascites; can be drained through the posterior vaginal fornix (transvaginal paracentesis)
“rectouterine pouch (pouch of douglas)<div><br></br></div><div><img></img></div>”
__________ - region extending between pelvic diaphragm and skin<br></br>-anterior recess extends between pelvic diaphragm and UGD<br></br>-can be involved in the spread of an abscess from the anal canal (ischioanal abscess)<br></br>-spread is limited:<br></br>—-above by pelvic diaphragm<br></br>—-anterior and laterally by obturator internus muscle and pelvic wall
“ishioanal fossa<div><br></br></div><div><img></img></div>”
-the inferior rectal nerve traverses the adipose tissue in this fossa. damage to this nerve (due to draining an abscess) will result in fecal incontinence (anal seepage)
“ishioanal fossa<div><br></br></div><div><img></img></div>”
___________ abscess - infections involving the submucosa of the anal canal; may form an anal fistula when a tunnel is created by extension of the abscess and opens onto perianal skin (thus, pus andfeces ooze from the opening of the fistula)
Perinanal
provides a route for metastasis of cancerous cellsor spread of infections from pelvic organs to the vertebral column, skull and brain
“batson’s plexus<div><br></br></div><div><img></img></div>”
when does blood from pelvic veins goes into vertebral plexus?
“valsalva maneuver<div><br></br></div><div><img></img></div>”
Blood from the LL can reach the heart without traversing the IVC by going through _______________
“batson’s plexus<div><br></br></div><div><img></img></div>”
Signs of benign prostatic hypertrophy
“nocturia (frequent waking to void), dysuria (painful urination) and urgency<div><br></br></div><div><img></img></div>”
Prostate cancer arises most commonly from the __________ lobe
“posterior<div><br></br></div><div><img></img></div>”
Removal/ablation of the prostate endangers the prostatic nerve plexus which carries both sympathetic (via ____________ nerves) and parasympathetic axons (via __________________)to the penis
“hypogastric, pelvic splanchnic nerves (1)<div><br></br></div><div><img></img></div>”
A major concern after a radical prostatectomy is ___________________
“erectile dysfunction<div><br></br></div><div><img></img></div>”
protrusion of the cervix into the vaginal canal - the cervix may protrude all the way to the external vaginal orifice
“cervical prolapse<div><br></br></div><div><img></img></div>”
uterine prolapse usually results from weakness in the ______________
“pelvic diaphragm<div><br></br></div><div><img></img></div>”
uterosacral ligament provides minimal assistance in preventing prolapse.<br></br>-it is derived from endopelvic fascia and carries sympathetic and parasympathetic axons to<br></br>the __________
“uterus<div><br></br></div><div><img></img></div>”
“____________________ (aka cardinal, Mackenrodt’s lig) ligament provides minimal assistance in preventing prolapse.<br></br>-it is derived from pelvic fascia”
“transverse cervical<div><br></br></div><div><img></img></div>”
postmenopausal bleeding is a sign of potentially having _____________
uterine cancer
Implantation site anywhere outside the body of the uterus; tubal implantation is the most common ectopic site and poses the risk of rupture and bleeding
“Ectopic pregnancy<div><br></br></div><div><img></img></div>”
3 sites of anesthesia for child birth
Spinal, Caudal epidural, Pudendal nerve block
______________ anesthesia<br></br>-Anesthesia is injected into the subarachnoid space<br></br>-spinal anesthesia results in anesthesia of: _____(4)_______<br></br>-Impedes sensory relay along sympathetic, parasympathetic and lumbosacral nerves
spinal, uterus, vagina, pelvic floor, and lower extremities
______________ anesthesia<br></br>-Anesthesia is injected into the sacral canal<br></br>- Results in anesthesia of: _____(4)______<br></br>-Impedes sensory relay along sacral nerves (i.e. pudenal nerve, pelvic splanchnic nerves)
caudal epidural, cervix, vagina, pelvic floor and lower extremity (same as spinal
Pudendal nerve block<br></br>-Anesthesia is injected at the iliac spine<br></br>-Results in anesthesia of ____(2)_____ <br></br>-Impedes sensory relay along the pudendal nerve only
lower vagina and pelvic floor
“Blood supply to the uterus is via the ________ artery branching off of the internal iliacs (the ureter crosses inferior to the uterine artery - ““water under the<br></br>bridge””)”
“uterine<div><br></br></div><div><img></img></div>”
collateral supply to the uterus is from the ___________ artery (from abdominal aorta)
ovarian
derived from remnants of the mesonephric duct, found lateral to vagina
“Gartner’s duct cyst<div><br></br></div><div><img></img></div>”
____________ situated between layers of the broad ligament
“Epoophoron (““above the egg basket””)<div><br></br></div><div><img></img></div>”
a surgical incision that begins at the posterior aspect of the vagina (posterior fourchette) through the vaginal wall and skin to expand the birth canal; major complications are bleeding and incontinence
Episiotomy
___________ episiotomy<br></br>incision begins posteriorly and extends laterally at 45-90°; permits wide expansion but may involve the ischioanal fossa<br></br>-spares the perineal body but damages the bulbospongiosus and transverse perineal muscles; <br></br>-more likely to have bleeding (from perineal and/or posterior labial arteries)
“mediolateral<div><br></br></div><div><img></img></div>”
___________ episiotomy<br></br>damages the perineal body (+ perineal membrane) and insertions of the bulbospongiosus and transverse perineal muscles > external anal sphincter»_space; puborectalis/pubovaginalis<br></br>-during repair care must be taken to avoid suturing into the rectal/anal mucosa
“median<div><br></br></div><div><img></img></div>”
“above the pectinate line, the anal canal has ________ innervation (endoderm derived!) <br></br>-it has autonomic innervation (distention, but no ““pain”” innervation!) <br></br>-lymph: internal iliac nodes <br></br>-arterial: inferior mesenteric artery + internal pudendal artery<br></br>-venous drainage: portal system”
visceral
“above the pectinate line, the anal canal has visceral innervation (endoderm derived!) <br></br>-it has autonomic innervation (distention, but no ““pain”” innervation!) <br></br>-lymph: ______________ nodes <br></br>-arterial: inferior mesenteric artery + internal pudendal artery<br></br>-venous drainage: portal system”
“internal iliac<div><br></br></div><div><img></img></div>”
“above the pectinate line, the anal canal has visceral innervation (endoderm derived!) <br></br>-it has autonomic innervation (distention, but no ““pain”” innervation!) <br></br>-lymph: internal iliac nodes <br></br>-arterial: __________+____________<br></br>-venous drainage: portal system”
“inferior mesenteric artery, internal pudendal artery<div><br></br></div><div><img></img></div>”
“above the pectinate line, the anal canal has visceral innervation (endoderm derived!) <br></br>-it has autonomic innervation (distention, but no ““pain”” innervation!) <br></br>-lymph: internal iliac nodes <br></br>-arterial: inferior mesenteric artery and internal pudendal artery<br></br>-venous drainage: ____________”
“portal system<div><br></br></div><div><img></img></div>”
below the pectinate line, the anal canal has _________ innervation (ectoderm derived!) <br></br>lymph: superficial inguinal nodes <br></br>arterial: pudendal <br></br>venous: caval system
“somatic<div><br></br></div><div><img></img></div>”
below the pectinate line, the anal canal has somatic innervation (ectoderm derived!) <br></br>lymph: ________________ nodes <br></br>arterial: pudendal <br></br>venous: caval system
“superficial inguinal<div><br></br></div><div><img></img></div>”
below the pectinate line, the anal canal has somatic innervation (ectoderm derived!) <br></br>lymph: superficial inguinal nodes <br></br>arterial: ___________ <br></br>venous: caval system
“pudendal<div><br></br></div><div><img></img></div>”
below the pectinate line, the anal canal has somatic innervation (ectoderm derived!) <br></br>lymph: superficial inguinal nodes <br></br>arterial: pudendal <br></br>venous: ________________
“caval system<div><br></br></div><div><img></img></div>”
nerve injury - injury affecting the pudendal nerve or autonomics; spinal stenosis, cauda equina<br></br>syndrome, conus medullaris syndrome, stroke, trauma, abscess in ischioanal fossa<br></br>-will lead to ______________
fecal incontinence
muscle weakness - damage to external anal sphincter, perineal body and/or levator ani (especially<br></br>puborectalis)<br></br>-will lead to ______________
“fecal incontinence<div><br></br></div><div><img></img></div>”
“-related to internal rectal venous plexus and breakdown of muscularis mucosa<br></br>-prolapse of mucosa and dilated veins which can become strangulated or ulcerated<br></br>-involves visceral part of canal and are not painful (““visceral”” innervation)”
“internal hemorrhoids<div><br></br></div><div><img></img></div>”
-involve blood clots within veins of the external rectal plexus<br></br>-covered by skin (somatic innervation–painful!)
“external hemorrhoids<div><br></br></div><div><img></img></div>”
the retroperitoneal (superior) segment of the rectum drains to ______________ nodes
“inferior mesenteric<div><br></br></div><div><img></img></div>”
”"”sub”“peritoneal segment of the rectum drains to ____________ and ____________ nodes”
“pararectal, sacral<div><br></br></div><div><img></img></div>”
the superior portion of the bladder drains to _________ nodes
external iliac
the inferior portion of the bladder drains to _________ nodes
internal iliac
most of the lymph from the prostate drains to _________ nodes
internal iliac
most of the lymph from the penis drains to _________ nodes <br></br>(except distal corpus spongiosum and glans)
internal iliac
distal corpus spongiosum of the penis and glans both drain to __________ nodes
deep inguinal
lymph from the testes drains to _________ nodes
lumbar (para-aortic)
lymph from the perennial skin drains to _________ nodes
superficial inguinal
lymph from the scrotum drains to _________ nodes
superficial inguinal
lymph from the uterine tube/ovary drains to _________ nodes
lumbar
lymph from the fundus of uterus drains to _________ and ___________ nodes
lumbar, external iliac
lymph from the body of uterus drains to _________ and ___________ nodes
lumbar, external iliac
lymph from the cervix of uterus drains to _____(4)_____ nodes
external iliac, internal iliac, obturator, sacral
lymph from the upper 2/3 of vagina drains to __________ nodes
external iliac, internal iliac
lymph from the upper 1/3 of vagina + vulva drains to __________ nodes
superficial inguinal
the anterior aspect of the scrotum receives its main cutaneous innervation from the ___________ nerve<br></br>(L1) and _____________________ nerve (L1 & L2)
ilioinguinal, genital branch of the genitofemoral
the posterior aspect of the scrotum receives cutaneous innervation from the _________ nerve (S2-4)
pudendal
Lower extremity <br></br>(Symp. levels T10-L2) preganglionic in IML. post ganglioic cell bodies _______
sympathetic chain
Testes/Ovary <br></br>(Symp. levels T10-T11) preganglionic in IML. post ganglioic cell bodies _______
prevertebral
Large intestine <br></br>(hindgut)(Symp. levels L1-L2) preganglionic in IML. post ganglioic cell bodies _______
Inferior mesenteric ganglia
Pelvic organs <br></br>(Symp. levels L1-L2) preganglionic in IML. post ganglioic cell bodies _______
hypogastric plexus
