Practical class 1 Flashcards
What structures comprise the superior pelvic aperture
sacral promontory sacral ala pubic symphysis pubic crest pecten pubis arcuate line of ilium pubic tubercle
4 parts of inferior pelvic aperture
inferior margin of pubic symphysis
inferior pubic rami
tip of coccyx
sacrotuberous ligament
True pelvis
between pelvic inlet and outlet - pelvic viscera
false pelvis
superior to pelvic inlet and supports lower abdominal viscera
Main differences between the male and female pelvis
Female - shallow, wide, small acetabulum, oval and rounded inlet and wide angle of outlet
male - deep and narrow, heart shaped inlet and small outlet
sacroiliac joint type
posterior - syndesmosis (fibrous)
anterior - synovial
pubic symphysis joint type
secondary cartilaginous
Which muscle occupies the lateral pelvic wall
obturator internus
Muscle of posterior wall of pelvis
piriformis
Which nerve network lies on the posterior wall of pelvis?
sacral plexus
What muscles comprise the levator ani?
puborectalis
pubococcygeus
iliococcygeus
What 2 muscle groups form the pelvic floor?
levator ani and coccygeus
Functions of the pelvic floor
Urinary and faecal continence
support of abdominopelvic viscera
resist increased intra-abdominal pressure
support uterus
cystocoele
bladder drops into vagina due to weakening
rectocoele
bulging of front wall of rectum into the back wall of vagina
innervation of pelvic floor
S2-4
Injury to pelvic floor in childbirth
hormones and load –> muscles stretchy
poor blood supply for healing
Episiotomy advantages
prevent tearing of perineal body
Structures felt on PR examination
rectum - prostate - cervix - coccyx - ischial spines - vagina - vas deferens - sacral LN
Branches of which artery supply most of the pelvis?
internal iliac artery
5 pelvic veins
internal iliac superior rectal median sacral gonadal internal vertebral venous plexus
Which part of rectum drains into
A - portal circulation
B - systemic circulation
what is significance of this?
A - upper part - superior rectal veins
B - middle and inferior rectal veins
portal hypertension - enlarge superior rectal veins
Ilioinguinal nerve origin, where it enters inguinal canal and what It supplies
L1 - superficial inguinal ring
skin at root of penis and labia
genitofemoral nerve origin and where it enters inguinal canal
L1-2
deep inguinal ring
What structures in males is supplied by genital branch of genito-femoral nerve and importance of this
anterior scrotum and cremaster muscle
sensation –> testicular pain
Pudendal nerve course
follows pudendal artery
goes around sacrospinous
what does the pudendal nerve innervate?
skin and muscles of perineum
Bony landmarks used in pudendal nerve block during labour
ischial spines
ischial tuberosities
coccyx
Level of sympathetic fibres from hypogastric plexus and what does it innervate?
L1,2
vas deferens, seminal vesicles, prostate, epididymis
Autonomic innervation of female genital tract
sympathetic - ovarian and pelvic plexus
para - S2-4 pelvic splanchnic nerves
innervation of erectile structures in males and females
parasympathetic S2-4 via hypogastric plexus
What are the erectile strcutures?
penis, scrotum, testis, corpora cavernosa
clitoris, bulbs of vestibule
4 primary LN groups in pelvis
external iliac
internal iliac
sacral
common iliac
Male internal reproductive organs
testis ductus deferns/vas deferens seminal vesicle prostate epididymis bulbourethral glands
Purpose of testis being outside abdominopelvic cavity
thermoregulation for sperm production
Layers of inguinal canal
external oblique
internal oblique
transversus abdominis
fascia transversalis
main contents of spermatic cord
nerves
testicular artery
vas deferens/lymph vessels
Function of spermatic cord
ovoid testis are suspended in scrotum by these
Tough outer fibrous layer of testis
tunica albuginea
What is the tunica vaginalis?
peritoneal sac covering the testis
Hydrocoele
excess fluid In tunica vaginalis
Vertebral level of testicular artery
L2
2 structures the testicular arteries cross
ureters
inferior parts of external iliac arteries
8-12 anastomosing veins associated with testis name
pampiniform venous plexus
Right and left testicular vein drainage
right - IVC
Left - left renal vein
Varicocoele
pampniform plexus dilate due to defective valves
often seen when standing
2 LN groups receiving lymph from testis
right and left lumbar
pre-aortic
Vas deferens course
origi
How does the vas deferens terminate?
joining duct of seminal gland to form ejaculatory duct
seminal vesicles secretion
thick alkaline fluid - major constituent of semen
secretions of prostate
prostatic fluid = 15-30% semen
Where do the bulbourethral glands empty into?
spongy/penile urethra
bulbourethral gland secretion
mucus like secretion
scrotum and penis LN drainage
superficial inguinal
prostate LN drainage
internal iliac and sacral
seminal vesicle LN drainage
external or internal iliac
What travels through lesser sciatic foramen?
pudendal nerve
inferior pudendal artery and vein
Leydig cells
interstitial cells of testis which produce testosterone
Function of vas deferens
transport sperm from testis –> prostatic urethra
Function of vas deferens
transport sperm from testis –> prostatic urethra
Sertoli cells
testis - essential for spermatogenesis
