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Anatomy Week 11 BT > Pelvis I > Flashcards

Pelvis I Flashcards

1
Q

What is the pelvic girdle held together posteriorly?

A

the sacroiliac joints

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2
Q

What two spaces are separated by the linea terminalis?

A

False (greater pelvis)

True (lesser pelvis)

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3
Q

What does the linea terminalis circumscribe?

A

Sacral Promontory (S1)
arcuate lines of the ilium
pectinal lines of the pubis
pubic symphysis

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4
Q

What marks the inlet of the true pelvis/pelvic brim/superior pelvic aperture?

A

Linea Terminalis

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5
Q

What makes up the pelvic outlet?

A

inferior margin of the pubic symphysis
inferior pubic rami
sacrotuberous ligaments
tip of coccyx

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6
Q

What marks the lateral boundaries of the false pelvis?

A

Iliac fossa

Note: this is really part of the abdominal cavity proper

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7
Q

What gender has a pelvis with the following features:

  • Circular pelvic inlet
  • angle of pubic arch wider than 80-85º
  • Ischial spines that don’t project as far into the pelvic cavity
  • Thinner, less massive bones of pelvic girdle
A

Female

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8
Q

What are some features of the male pelvis?

A
  • Heart shaped pelvic inlet

- angle of pubic arch less than 50-60º

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9
Q

What is the smallest anterior to posterior space the babies head must pass through when giving birth?
- How is this space measured?

A
  • True (obstetrical) conjugate

- Sacral Promontory to Pubic Symphysis

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10
Q

What prevents the true (obstetrical) conjugate from being measured in a pelvic exam?

A
  • The urinary bladder
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11
Q

A palpates the sacral promontory with the tip of her middle finger and usd the other hand to mark the inferior margin of the pubic symphysis, what is the measuring?

A

Diagonal Conjugate

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12
Q

What size of true conjugate ensure safe delivery?

A

11cm

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13
Q

How is true conjugate found if it can’t be directly measured?

A
  • After finding the distance of the diagonal conjugate using the middle finger, the true conjugate is estimated as the distance from the inferior pubic symphysis to the INDEX finger
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14
Q

Why would you measure the interspinous distance on a woman?

A
  • its the narrowest part of the pelvic canal from side to side
  • Measured between L and R ischial spines
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15
Q

How wide should the interspinous distance be for safe delivery?

A

should be able to stick in 3 fingers side by side

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16
Q

T or F: obstetric distance and interspinous distance may change in response to hormones during pregnancy.

A

True

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17
Q

What bones form the walls of the true pelvis?

A
  1. Sacrum
  2. Coccyx
  3. Pubis
  4. Inferior aspect of the ischium
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18
Q

What structures make up the anterior wall of the true pelvis?

A
  • pubic symphysis
  • body of pubic bone
  • superior ramus of the pubic bone
  • ischiopubic ramus

(mostly pubis w/ a little ischium)

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19
Q

What is the bony framework of the posterior wall of the true pelvis?

A
  • Sacrum

- coccyx

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20
Q

What is the framework of the lateral walls of the true pelvis?

A
  • pubis
  • ischium
  • Greater Sciatic Foramen
  • Lesser Sciatic Foramen
  • Obturator Foramina
  • *Think about nn. and vessels going through here
  • obturator membrane
  • sacrotuberous
  • sacrospinous ligaments
  • Piriformis
  • obturator internus
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21
Q

Pirifomis

  • origin
  • insertion
  • innervation
  • action
A

Origin - Pelvic surface of sacrum

Insertion - Greater trochanter or femur

action - lateral rotation

Innervation - n. to piriformis

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22
Q

Obturator internus

  • origin
  • insertion
  • innervation
  • action
A

Origin - Internal aspect of the obturator foramen and membrane

Insertion - Greater trochanter of the femur

Action - lateral rotation

Innervation - n. to the obturator int.

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23
Q

What forms the funnel-like pelvic floor?

A

Pelvic diaphragm

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24
Q

Levator Ani

  • origin
  • insertion
  • innervation
A

Origin - Pubis, tendinous arch of the levator ani, ischial spine

Insertion - midline connective tissue raphe

Innervation - inferior rectal n. and branches from S4

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25
Q

Coccygeus

  • origin
  • insertion
  • innervation
A

Origin - Ischial Spine

Insertion - Sacrum and coccyx

Innervation - Direct braches from s3 and s4

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26
Q

What are the two functions of the pelvic diaphragm?

A
  1. Support of Pelvic Viscera

2. Keeping the rectum and vagina closed

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27
Q

T or F: both men and women have structures that pass through the pelvic diaphragm.

A

True, these are the urethra and anal canal

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28
Q

What structure passes through the pelvic diaphragm in females?

A

Urethra
Anal Canal
Vagina (clearly nothing comparable to this in males)

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29
Q

How do structures pass through the diaphragm to enter the deep perineum?

A

Urogenital Hiatus

Anal Hiatus

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30
Q

What is the extremely important relationship between obturator internus the levator ani?

A

Obturator internus is BISECTED by the origin of Levator Ani from the Tendinous arch

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31
Q

What muscle has fibers both in the pelvis and perineum?

A

Obturator internus - its bisected by the structure that divides the two cavities (levator ani)

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32
Q

What spaces does the true pelvis communicate with?

A

Superiorly - abdomen

Laterally (and dorsally) - Lower limb and gluteal region via Greater sciatic foramen and obturator canal

Anteriorly - communicates with the perineum via a gap in the perineal membrane just posterior to the pubic symphysis and urogenital hiatus

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33
Q

What communicates via obturator canal, and what is contained in it?

A
  • Pelvis to medial compartment of the thigh

- Passageway for obturator nn. and vessels

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34
Q

What allows communication of the pelvis with the gluteal region?

A

Greater sciatic foramen

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35
Q

What two areas communicate via the lesser sciatic foramen?

A

Gluteal region to PERINEUM

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36
Q

What is the relationship between the pelvic diagphragm and the lesser sciatic foramen.

A

The lesser sciatic foramen is below

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37
Q

What passes through the anterior gap in the gap in the perineal membrane?

A

Dorsal vein of the Penis

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38
Q

What is the only direct communication between perineum and pelvis?

A

Anterior gap in perineal membrane

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39
Q

What is the boundary between the abdominal cavity and pelvic cavity?

A

Inferior Parietal Peritoneum

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40
Q

Can parietal peritoneum be found on the pelvic floor?

A

No

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41
Q

The bladder lies anterioly and the rectum lies posterioly to what structure?

A

The uterus in the femal

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42
Q

What is the draping of peritoneum spanning between rectum and bladder called?

A

Rectovesical Pouch

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43
Q

Where is the vesicouterine pouch located?

A

Between the bladder and uterus

*This is made by parietal peritoneum

44
Q

Where is the rectouterine pouch (POUCH OF DOUGLAS) located?

A

Between the rectum and uterus

*This is made by parietal peritoneum

45
Q

What is the importance of the POUCH OF DOUGLAS?

A
  1. Collection site for fluids and infection
  2. Risk of perforation in cystoscopic procedures using the vaginal approach
  3. Most common site for ectopic pregnancy
46
Q

What is the mesentery of the uterus?

A

Broad ligament

47
Q

Where does the rectum begin?

A

-Begins at S3

48
Q

When does the rectum become the anal canal?

A

As it pierces the pelvic floor

49
Q

If you put your fingers in the rectum and press posteriorly, what would you be feeling?

A

sacrum

50
Q

What is formed by the expansion of the lower part of the rectum?

A

Rectal Ampulla

51
Q

What is the function of the rectal ampulla?

A
  • Serves as a reservoir for fecal matter, allowing us to maintain fecal continence
52
Q

What is the perineal flexure and what maintains it?

A
  • At 90º flexure of the rectum
  • The levator ani (puborectalis) of the pelvic floor

*Note: this muscle must be relaxed for defecation

53
Q

What 3 muscles allow for rectal continence?

A
  • puborectalis (of levator ani) to maintain the 90º flexure

- internal and external anal sphincters

54
Q

What do the anal columns overlie?

A

The terminal branches of the superior rectal VIENS

55
Q

What do the anal valves overlie?

A

Communicating veins

56
Q

How is the ano-rectal junction demarcated?

A

by the upper border of the anal columns

57
Q

How is the pectinate junction demarcated?

A

by the imaginary lines connecting anal valves

58
Q

What embryological feature was positioned at the pectinate line?

A

Anal membrane

59
Q

What is the anal pecten?

A
  • Transition zone inferior to pectinate line

- Stratified squamous epithelium

60
Q

What two zones are separated by the white line?

A
  • Separates cutaneous and transitional zones
61
Q

Describe the following features above the pectinate line:

  • Mucosa
  • Innervation
  • Blood Supply
  • Lymph Drainage
A

Mucosa:
endoderm

Innervation: Autonomic - HYPOGASTRIC PLEXUS
Sympathetic - Lumbar Splanchnics L1-L2
Parasympathetic - Pelvic Splanchanics S2-S4

Blood Supply:
Superior Rectal branches of IMA - PORTAL

Lymph Drainage:
Internal Iliac nodes

62
Q

Describe the following features below the pectinate line:

  • Mucosa
  • Innervation
  • Blood Supply
  • Lymph Drainage
A

Mucosa:
ectoderm

Innervation:
Somatic - inf. rectal n. via pudendal n.

Blood Supply:
Middle and Inferior rectal - CAVAL

Lymph Drainage:
Superficial inguinal nodes

63
Q

What is the difference between hemorrhoids above and below the pectinate line?

A
  • Above is not painful and below is

- above is related to INTERNAL venous plexus, below is EXTERNAL venous plexus

64
Q

What extends anterioly from the bladder?

A

Urachus - remnant of fetal allantois

65
Q

What enters the bladder posteriorly?

A

Ureters

66
Q

What muscles lie laterally to the bladder?

A

Obturator internus

Levator Ani

67
Q

What part of the bladder is fixed?

- ligaments involved?

A 
The neck 
Pubovesical ligaments (females)
Puboprostatic ligaments (males)
68
Q

Where is the prostate gland in relation to the bladder?

A

Immediately Inferior

69
Q

What space exists between the pubic bones and the apex of the bladder?

A

retropubic space (of Retzius) - can be used to retrieve urine via cystoscope

70
Q

What is the trigone of the bladder?

A
  • Smooth mucosal layer of the bladder
  • At the top L and R corners ureters enter
  • at the bottom the urethra begins at INTERNAL URETHRAL SPINCTER
71
Q

What muscle contracts to allow you pee?

A

Detrusor Muscle

72
Q

Describe the nerve activity during the filling phase of the bladder.

A

Detrusor Relaxed
Internal Urethral Sphincter Flexed

**sympathetic fibers from lumbar splanchnics L1-L4 are active causing flexion of sphincter

73
Q

Desribe the nerve activity of the emptying phase of the bladder.

A

Detrusor Flexed
Internal Urethra Sphincter Relaxed

**Paraympathetic pelvic splanchnics S2-S4 are active in Detusor contraction and sphincter relaxation

74
Q

What crosses the ureter “water under the bridge” in males and females.

A

Males: Vas Deferens = bridge

Females: Cardinal liagment containing uterine artery = bridge

75
Q

What are 3 sites where a kidney stone might get lodged?

A

Superior –> Inferior

  • Passing over pelvic brim
  • piercing bladder
  • Junction of ureter and renal pelvis
76
Q

Describe the course of the urethra in females.

A

From bladder to Vaginal Vestibule

  • Pelvic Diaphragm
  • UG Diaphragm
  • Superficial Space of Perineum
77
Q

Describe the course of the urethra in males.

A

Bladder to External orifice

  • Prostate Gland (PROSTATIC PT)
  • UG diaphragm (MEMBRANOUS PT)
  • Bulb of Penis (SPONGY PT)
  • Corpus Spongiosum (SPONGY PT)
78
Q

What are the two angles of the penis, which one is fixed?

A
  1. Anterior bend after passing through UG into bulb (FIXED)

2. inferior bend where unattached flacid penis is flopped over

79
Q

What 3 things open into the prostatic urethra in males?

A
  • Ejaculatory Ducts
  • Prostatic Ducts
  • Prostatic Utricle
80
Q

What marks the lumen of the prostatic urethra?

A

Urethral Crest

NOTE: there are depressions on either side = SINUSES

81
Q

What is the seminal colliculus and what opens here and on either side?

A
  • Circular elevation of the urethral crest
  • Prostatic Utricle opens on top (male vagina)
  • Ejaculatory ducts open on either side
82
Q

Where are Cowper’s glands located in relation to the prostate?

A

Below, inside the deep space of the UG triangle

83
Q

T or F: the vulva is a collective term for the external female genitalia

A

True

84
Q

What is the job of the broad ligament?

A

To keep the uterus properly positioned

85
Q

What are the 3 parts of the broad ligament and what do they span?

A

Mesometrium - lateral pelvic wall and BODY OF THE UTERUS

Mesovarium - Ovary and Mesometrium

Mesosalpinx - Uterine tube to mesometrium

86
Q

What is the superior extension of the mesovarium?

A
  • suspensory ligament
87
Q

T or F: the round ligament and ligament of the ovary are enclosed in the broad ligament.

A

True

88
Q

What part of the uterus lies above the uterine tubes?

A

The fundus

89
Q

What are the uterine and vaginal openings to the cervical canal?

A

internal os - uterine

external os - vaginal

90
Q

What part of the cervix projects into the vaginal canal and what does this form?

A
  • Infravaginal portion

- Forms the Fornices

91
Q

What is the Lowest point of the abdominopelvic cavity in a supine patient?

A

Pouch of Douglas

92
Q

During a procedure the physician accidentally pierces the area posterior to the posterior fornix, what area did he penetrate into?

A

Pouch of Douglas

93
Q

What forms the angle of ANTEVERSION?

A

Axis of Vagina and Axis of Cervix

(V for Vagina and anteVersion)

Normally 100-110º

94
Q

What forms the angle of ANTEFLEXION?

A

Axis of Uterine body to Axis of Cervix

Normally 100-110º

95
Q

What causes uterine prolapse?

A

Weakening of supporting structures in the Vagina

96
Q

Which would be more detrimental, a cut infudibulopelivic ligament (IPL / suspensory ligament) or ovarian ligament and why?

A
  • Cut IPL = BAD

- Contains ovarian a. and v. as well as nerve supply

97
Q

What uterine ligaments are a remnants of the gubernaculum?

A
  • ovarian ligament

- Round ligament

98
Q

What are the boudaries of the ovarian fossa?

A
  • Anteriolaterally by the external iliac vessels

- Posteriomedially by the ureter

99
Q

A surgeon slips and cuts posteriomedially to the ovary, fluid starts coming out. What kind of fluid is this?

A

Urine, the ureter was cut

100
Q

What is the most common site of conception in the uterine tube?

A

The ampulla

101
Q

What is the most common site of ectopic pregnancy?

A

Uterine tube, specifically the ampulla

102
Q

A Dr. sticks his fingers in a vagina and presses forward then back. What structures does she press on in the two different positions?

A
  • Forward: Uterus

- Back; Rectum

103
Q

A Dr. sticks his fingers in a rectum of a female and presses forward then back. What structures does she press on in the two different positions?

A
  • Forward: Vagina

- Back: Sacrum

104
Q

What ligament could be pierced by puncturing the posterior fornix?

A

Cardinal ligament

**Note Water under the bridge occurs here at the base of the round ligament, you also risk puncturing a ureter

105
Q

What is blood supply to the vagina?

A
  • Vaginal Aa. –> internal iliac a.
106
Q

Where is a culdoscopy typically done?

A

in the pouch of douglas

Anatomy Week 11 BT (8 decks)

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