Pelvis/Pelvic Floor Flashcards
The pelvis is divided into 2 regions by ___
pelvic brim
What are the two regions of the pelvis?
false pelvis (greater pelvis)
true pelvis (lesser pelvis)
Describe the borders of the false pelvis
false pelvis aka greater pelvis
bordered by iliac crest all the way down to pubic symphysis at sacroiliac joint
pelvic inlet is continuous with the abdominal cavity
Describe the borders of the true pelvis
pelvic outlet is closed off below by muscular pelvic floor
What are the pouches in the pelvic cavity male vs. female
Male: rectovesical pouch
Female: recouterine pouch and vesicouterine pouch
Are the viscera of the pelvic cavity retroperitoenal or intraperitoneal? Why?
Retroperitoneal
Because pelvic cavity is lined with continuum with the peritoneum from the abdominal cavity
The pelvis is made up of what bones?
1 sacrum (5 fused sacral vertebrae)
2 os coxae (ileum, ischium and pubis)
Describe the sexual dimophism of the pelvis
Female:
- Oval to rounded pelvic brim
- Wider pubic arch with subpubic angle >80
- obturator foramen is oval
- acetabulum is small
- flared iliac wings (alae)
- Ischial tuberosities farther apart
- Sacrum shorter and less curved
Male
- heart shaped pelvic brim
- greater pelvis is deeper
- lesser pelvis is narrow and deep
- pubic arch is narrow with subpubic arch <70
- obturator foramen is round/heart shaped
- acetabulum is large
What are the ligaments of the pelvis? 7
- Pubic symphysis
- Anterior sacroiliac lig
- posterior sacroiliac lig
- sacrotuberous lig
- sacrospinous lig
- obturator membrane
- interosseos lig
Describe the pubic symphysis
ligament of the pelvis
connects 2 pubic bones
Describe the anterior sacroiliac ligament
ligament of the pelvis
crosses sacro-iliac joint anteriorly
broad
Describe the posterior sacroiliac ligament
ligament of the pelvis
crosses sacroiliac joint posteriorly
broad
Describe the sacrotuberous ligament
ligament of the pelvis
From ischial tuberosity to sacrum/coccyx
lower border of the lesser sciatic foramen
seen best posteriorly
Describe sacrospinous ligament
ligament of the pelvis
from ischial spine to sacrum/coccyx
lower boundary of the greater sciatic foramen
seen best anteriorly
Describe the obturator membrane
ligament of the pelvis
closes off obturator foramen
becomes lower border of obturator canal
Describe interosseous ligament
ligament of the pelvis
between the sacrum and iliac in the sacroiliac joint
lies interosseous (bw bone) and between anterior and posterior sacroiliac ligaments so we cannot see it.
What are the muscles of the pelvic walls?
- Obturator internus muscle
2. Piriformis muscle
Describe the location of the piriformis muscle
muscle of the pelvic wall
runs from anterior sacrum to greater trochanter of the femur
passes behind the greater sciatic notch and thru greater sciatic foramen
closes off the posterior/superior pelvic outlet
Describe the location of the obturator internus muscle
muscle of the pelvic wall
runs from obturator foramen to greater trochanter
covered with thick fascia and attaches to levator ani as a tendinous arch
passes through greater sciatic foramen
What is the innervation for the pelvis wall muscles?
obturator internus = L5/S1 innervation
piriformis muscle =S1/S2 innervation
Do both obturator internus and pitiformis muscle act on hip joints?
yes.
What are the apertures in the pelvic wall?
greater and lesser sciatic notches are subdivided by pelvic wall muscles/ligaments
sacriospinous ligament greaters lesser border of greater sciatic foramen
piriformis thru greater sciatic foramen creates space superior/inferiorto piriformis
sacrotuberous ligament creates inferior border of lesser sciatic foramen
obturator internus muscle creates space superior and inferior
What does the pelvic diaphragm separate?
the pelvic cavity from the perineum
What are the two components to the pelvic diaphragm?
Levator Ani muscles and Coccygenus muscles
^these are both bilateral
What are the 3 components to the levator ani muscles?
Iliococcygenus
Pubococcygeus
Puborectalis
The coccygenus portion of the pelvic diaphragm covers what?
sacrospinous ligament
Do other muscles assist the muscles of the pelvic diaphragm?
yes.
pelvic diaphragm assisted by pitiformis and obturator internus m
between 2 thighs there are 2 triangular regions. What are they?
urogenital triangle
anal triangle
What is the passageway in the urogenital triangle?
passageway of urinary and genital system
What is the passageway of the anal traingle?
passage of rectum and anus
What is the perineum?
a membrane beneath the pelvic muscles
What is the perineal body?
the connection between the anal triangle and the urogenital triangle
What is the perineal membrane?
Extends inferiorly posteriorly and anteriorly to hold the deep transverse perinneal mm in the deep perineal pouch
this is the urogenital diaphragm
What muscles are present in the male deep perinneal pouch?
deep transverse perinneal mm
external urethral sphincter
What muscles are present in the female deep perinneal pouch?
deep transverse perinneal mm
external urethral sphincter
compressor urethrae mm
sphincter urethrovaginalis mm
What are the pelvic viscera?
Ureters, Bladder, Urethra, Rectum, Anal Canal, Uterus (women), external genitalia
What does the deep transverse perineal mm blend with?
sphincter mm of urethra in vagina (female)
How do the ureters get into the pelvis? How to get to bladder?
cross the external iliac vessels and descend into pelvis
Travel to posterolateral aspect of urinary bladder
How does ureter get to bladder in females?
“water under the bridge”
Ureter runs posterior (“under”) the uterine artery
How does ureter get to bladder in males?
ductus deferens crosses ureter
What is the muscle in urinary bladder?
smooth muscle
detrusor urinae
What is detrusor urinae?
smooth muscle in the urinary bladder
What is inferior extend of female bladder?
perineum and pubivesical ligament
What is inferior extend of male bladder?
pubovesical ligament, perineum and prostate
Where is the prostate found?
between the bladder and perineum
What is the passageway of the urethra in relation to the prostate?
The urethra passes through the prostate
think: prostatic urethra
The female urethra pierces the anterior portion of the _____ between what?
pierces anterior portion of urogenital diaphragm
between the bladder and external urethral orifice
What is periurethral gland?
lubricating opening of urethra and protecting epithelium against the urine itself
aka skene’s gland
What are the portions of the male urethra?
pre-prostatic portion
prostatic portion
membraneous portion
spongy/penile urethra
Pre-prostatic part of male urethra?
very small
What part of the male urethra is where the urogenital tracts combine?
prostatic portion
What portion of the male urethra passes through the perineum?
the membraneous urethra
What portion of the male urethra goes to the external urethral orifice?
spongy/penile urethra
Rectum is normally constricted by ____
puborectal sling
(which is the puborectalis muscle of the levator ani)
“u shaped”
What is the puborectal sling?
part of the puborectalis muscle of the levator ani that contsributs the rectum
“u shaped”
What is the anal rectal flexure created by?
puborectalis mm (the most medial portion of this mm)
anal rectal flexure is when it turns from rectal to anal
Anal canal emerges in ___, ____ to pelvis floor
emerges at anal triangle inferior to pelvic floor
Anal canal is continuous with ___ at ____.
rectum at anorectal junction
curvature of perineal junction forms anorectal flexure
What are the 3 male reproductive galnds?
- seminal vesicles
- prostate galnd
- bulbourethral (cowper’s) gland
Where are seminal vesicles?
join the vas deferens and empties into prostatic urethra
forms ejaculatory ducts
How big is the prostate gland and where is it located?
walnut sized
between bladder and urogenital diaphragm
Where are bulbo-urethral gland? How big? Where does it empty?
in deep perinneal pouch, within urogenital diaphragm
empties into penile urethra
2 pea sized balls
Uterine tubes are an open channel from ____ to ____
peritoneal cavity to uterus
What are the 4 parts of the uterine tube?
fimbriae, infundibulum, ampulla, isthmus
The uterus is ___ long and enlarges ___x during pregnancy
7cm
20x
How is the uterus oriented in the pelvic cavity?
anteverted
at right angle to vaginal canal
What is the uterine cervix?
inferior neck of uterus protruding into vaginal canal
External os is opening of ___ into the ____
opening of cervix into vagina
Internal os is opening of ___ into the ___
opening uterus to cervical canal
What is the vaginal fornix? What is it’s orientation?
circular gutter surrounding cervix
deeper posterior than anterior
What are the uterine ligaments?
- suspensory ligament
- broad ligament
- ovarian ligament
- round ligament of the uterus
What is the suspensory ligament of the ovary?
peritoneum covering OVARIAN VESSELS and NERVES
What is the broad ligament?
peritoneum covering uterus and adnexa (adnexa = tubes and ovaries)
What is adnexa?
tubes and ovaries
What is the ovarian ligament? What is embryological derivative?
anchors ovary to uterus
aka ovarian ligament proper
gubernaculum derivative
What is the round ligament of the uterus?
continuation of the ovarian ligament
passes through inguinal canal to fuse with labia majora
What is the mesovarium?
posterior extension of the broad ligament
