Reproduction Week 1 Flashcards
Which features make up the pelvic inlet (pelvic girdle)?
Sacral promontory Ala of sacrum (wings) arcuate line of pelvis pectineal line (of superior pubic ramus) superior border of pubic symphysis,
How many vertebrae fuse together to create the sacrum?
5
What is the joint connecting the pelvic girdle?
The sacro-iliac joint.
Which 4 bones make up the pelvis?
- Ilium, ischium and pubis fused together
- sacrum
What is the female suprapubic angle?
The suprapubic angle sits between the two pubic arches
> 80 degrees
What is the suprapubic angle of males?
<70 degrees
What makes up the pelvic outlet?
(Inferior border of the pelvis)
- inferior border of pubic symphysis
- inferior rami of the pubis
- ischial tuberosities
- sacrotuberous ligaments
- tip of the coccyx
What is the position of the true pelvis/lesser pelvis?
In between the pelvic inlet and pelvic outlet.
What is the position of the false pelvis/greater pelvis?
- Superior to the pelvic inlet
- abdominal wall
- ala of the ilium
- L5 and S1 vertebrae
What type of joint is the sacroiliac joint?
Synovial plane joint.
What type of joint is the pubic symphysis?
Secondary cartilaginous joint.
What is the word used to describe the female pelvis?
Gynaecoid
What is the word used to describe the male pelvis?
Android
Describe the female pelvis?
- Thin and light
- suprapubic angle >80
- oval shaped pelvic inlet
- larger pelvic outlet
- oval shaped obturator foramen
- small acetabulum
- shorter and more curved sacrum (less pronounced sacral promontory)
- shallow greater pelvis
- wide and shallow lesser pelvis
Describe the male pelvis?
- thick and heavy
- suprapubic angle <70
- heart shaped pelvic inlet
- large acetabulum
- round shaped obturator foramen
- narrow and deep lesser pelvis
- deep greater pelvis
- smaller pelvic outlet
Which ligaments does progesterone and relaxin stretch?
Sacrotuberous
sacrospinous
What are the measurements of the female pelvic inlet?
- 13cm diameter
- 12cm top to bottom (sacrum to pubic symphysis)
Which hormones relax the pelvis during labour?
Progesterone and relaxin
What is the main reflection in the male pelvis?
rectovesicle pouch (between bladder +seminal vesicles and rectum)
What are the main reflections in the female pelvis?
- rectouterine pouch (between rectum and uterus) = pouch of Douglas
- vesicouterine
What is the difference between the inguinal ligament and inguinal canal?
The inguinal canal only begins at the midpoint of the inguinal ligament.
Where do the gonadal veins drain into?
- right = directly into IVC
- left = into the left renal vein
(This is for both testicular and ovarian veins)
Where do the gonadal arteries arteries arise from?
The abdominal aorta, below the renal arteries
L2
Where do the ovarian and testicular arteries arise from?
The abdominal aorta below the renal arteries
L2-L3
What are the measurements of the female pelvic outlet?
11cm diameter
12.5cm top to bottom
What is the obstetric conjugate?
The distance between the sacral promontory and the inner pubic arch 10cm
This is the narrowest diameter the foetus will need to fit through.
What is the diagonal conjugate?
The distance between the sacral promontory and the bottom of the pubic arch (its 2cm wider than the obstetric conjugate).
12cm
what is the true conjugate?
The distance between the sacral promontory and the top of the pubic arch.
11cm
what makes up the anterior-inferior wall of the pelvic cavity?
- the bodies and rami of the pubic bones
- pubic symphysis
What makes up the lateral walls of the pelvic cavity?
- obturator foramen
- obturator membrane
- obturator internus muscle
- piriformus
What are the layers of the obturator foramen?
-obturator fascia (lines the medial surface of obturator internus)
-obturator internus muscle
obturator foramen
-obturator membrane (closes the obturator foramen)
-obturator externes
What makes up the posterior pelvic wall?
- sacrum
- coccyx
- piriformis muscle
Where is the sacral plexus formed?
On the posterior wall of the pelvic cavity, the piriformis muscle serves as a muscular bed.
Which roots make up the sciatic nerve?
L4, L5, S1, S2, S3
Which roots make up the pudendal nerve?
S2, S3, S4,
Where does the piriformis leave?
the greater sciatic foramen.
What is the main muscle of the pelvic floor?
Levator ani:
- puborectalis
- pubococcygeus
- iliococcygeus
There is also the coccygeus muscle
What is the origin and insertion of puborectalis muscle?
originates at the pubis and goes to form a ring around the rectum. It is the most medial muscle of the elevator ani - it forms a kink between the rectum and anus and helps prevent faecal incontinence.
what is the origin and insertion of the pubococcygeus?
originates at the pubis and inserts at the coccyx (it is the middle of the elevator ani muscles)
What is the origin and insertion of the iliococcygeus muscle?
The ischial spine is the origin and the coccyx is the insertion along with the anococcygeal ligament.
what is the opening of the rectum called in the pelvic floor?
Rectal hiatus
What is the opening of the ureter and vagina called in the pelvic floor?
urogenital hiatus.
which type of nerve innervates the pelvic floor muscles?
Somatic nerves
where are the anococcygeal body (ligament) and perineal bodies located?
anococcygeal - between rectum and coccyx
perineal - the central tendon of the perineum (between rectal hiatus and urogenital hiatus)
What is the innervation of the pelvic diaphragm/floor?
S2, S3, S4
what is a cystocele?
A prolapsed bladder - when part of it bulges into the vagina.
What is a rectocele?
A prolapsed rectum - part of the rectum bulges into the vagina.
What is a mediolateral episiotomy?
A cut from the vagina - which goes posterior and lateral towards the anus. This is better than a medial episiotomy because it is further away from the anus.
Which organs of the alimentary system are in the pelvic cavity?
- Colon
- anus
- rectum
What is the main branches of the pelvic arteries?
- abdominal aorta
- common iliac artery
- internal iliac artery
What are the branches of the anterior division of the internal iliac artery in males?
- superior vesicle artery (bladder, ureter)
- obturator artery (through obturator foramen to medial thigh)
- inferior vesicle arteries (seminal gland, prostate)
- Internal pudendal artery (continuation of the anterior division)
- inferior rectal artery (given off from the pudendal artery)
- Middle rectal artery
- inferior gluteal artery (goes out through the greater sciatic foramen)
What are the branches of the anterior division of the internal iliac artery in females?
- Superior vesicle arteries (bladder, ureters)
- obturator arteries (through obturator foramen to medial thigh)
- uterine artery (cervix and vagina)
- vaginal arteries (vagina, lower/fundus bladder)
- Internal pudendal artery (continuation of the anterior division)
- inferior rectal artery (given off from the pudendal artery)
- middle rectal artery
- inferior gluteal artery (goes out through the greater sciatic foramen)
Which arteries do the ovarian arteries anastomose with?
The ascending branches of the uterine arteries.
THIS IS THE ANASTAMOSES BETWEEN THE INTERNAL ILIAC ARTERY AND THE AORTA.
where does the ureter run?
Inferior to the uterine artery.
Where do the rectal arteries arise from?
Superior - inferior mesenteric artery
Middle - anterior division of internal iliac
Inferior - continuation of the internal pudendal artery (which is a continuation of the anterior division of the internal iliac artery).
What are the branches of the posterior division of the internal iliac artery?
- Iliolumbar branch (supplies iliac, psoas major, quadrates lumborum)
- Lateral sacral arteries (meninges, erector spinae)
- superior gluteal artery (runs through the greater sciatic foramen superior to the piriformis)
(The same for both male and female).
When does the femoral vein become the external iliac vein?
Once it runs underneath the inguinal ligament. It runs medial to the external iliac artery.
Which veins drain into the external iliac vein?
- inferior epigastric vein
- deep circumflex iliac veins
What does the internal iliac vein drain?
- superior gluteal vein
- inferior gluteal vein
- internal pudendal vein
- obturator vein
- middle rectal vein
- vesicle veins
- uterine and vaginal veins
(The same as the internal iliac artery but missing the iliolumbar vein).
Which parts of the rectum drain into the portal circulation?
Superior rectal vein
The middle and inferior rectal veins drain into the systemic circulation.
Due to portal system, liver cirrhosis can lead to venous backlog and dilatation (haemorrhoids)
What is the significance of the anastamosis between prostatic venous plexus and the internal vertebral venous plexus?
The two anastomose - which is why the first place for metastatic cancer of the prostate to travel to is the vertebrae of the spine.
What is another name for the prostatic venous plexus?
Santorinis plexus
Where do the ovarian and testicular veins drain into?
Right - directly into the inferior vena cava.
Left - into the left renal vein before going into the inferior vena cava.
Which male reproductive organ is very vascularised?
The prostate - prostatic venous plexus.
Which nerve supplies the skin at the root of the penis and the labia in females?
The ilioinguinal nerves - L1.
Enters the inguinal canal through superficial inguinal ring.
Which structures in the male does the genital branch of the genitofemoral nerve supply?
Scrotal skin
Cremaster muscle.
Which roots make up the genitofemoral nerve?
L1-L2.
Which roots does the pudendal nerve arise from?
S2, S3, S4.
What is the course of the pudendal nerve?
passes between the piriformis and ischiococcygeus muscles.
Leaves pelvis through greater sciatic foramen
re-enters through lesser sciatic foramen.
What does the pudendal nerve innervate?
Motor: pelvic muscles, external urethral sphincter, external anal sphincter.
Sensory: external genitalia of both sexes, skin around anus, anal canal, perineum.
Responsible for afferent part of penile and clitoral erection.
What should be done before a pudendal nerve block?
Aspiration - because pudendal nerve runs next to pudendal artery - vital to put the anaesthetic into the nerve and not the artery.
What bony landmarks are used when performing a pudendal nerve block?
Ischial spine is palpated transvaginally
Patient lies in lithotomy position
What is the roots of the sympathetic nerves of the pelvis?
L1, L2 - via hypogastric nerve and terminal sympathetic trunk.
Where do the parasympathetic nerves of the pelvis originate from?
S2, S3, S4.
From splanchnic nerves.
Also innervate erectile tissue in males and females.
What are the 4 lymph node groups in the pelvis?
External iliac
Internal iliac
Sacral
Common iliac
Where do the testis pass through during development?
The inguinal canal.
What are the fascial layers of the spermatic cord?
- External spermatic fascia
- Cremaster muscle and fascia
- Internal spermatic fascia
How is the cremaster muscle described?
Striated muscle orientated longitudinally.
Which nerves are responsible for the cremaster reflex?
sensory - ilioinguinal nerve
motor - genital branch of genitofemoral nerve (innervates the cremaster muscle).
What are the contents of the spermatic cord?
Papers don’t contribute to a good specialist level.
- pampiniform plexus
- ductus deferens
- cremasteric artery
- testicular artery
- artery of ductus deferens
- genital branch of genitofemoral nerve
- sympathetic nerve fibres
- lymphatic vessels.
What are the fibrous layers of the testis called?
- Outer - tunica vaginalis (tough fibrous)
- inner - tunica albiginea
What are the two layers of the tunica vaginalis?
- visceral (overlies tunica albuginea)
- parietal (lines scrotal cavity)
Which problems can arise in the tunica vaginalis?
Hydrocoele
Haematocoele
Which structures do the testicular arteries cross?
They travel retroperineally near the pelvic brim before they travel through the inguinal canal.
- anterior to psoas major
- anterior to IVC on the right
What is the pampiniform plexus?
8-12 anastomosing veins associated with the testis.
They drain testis and epididymis.
What is a varicocele?
enlargement of the veins of the testis usually caused by incompetent valves.
What is a testicular torsion?
An emergency.
When the blood supply to the testes has been completed cut off.
Requires orchidopexy.
Which lymph nodes receive lymph from the testis?
Lumbar and para-aortic lymph nodes
What secretions are produced by the seminal vesicles?
Alkaline fluid
Fructose
Prostaglandins
Clotting factors
What secretions are produced by the prostate?
Proteolytic enzymes (they break down clotting factors in the ejaculate)
What are the bulbourethral glands?
Cowpers glands.
They secrete an alkaline mucus like secretion - it is secreted prior to ejaculation.
What is the round ligament of the liver a remnant of?
The umbilical vein.
What is the pectineal line?
Also known as pecten pubis - its a ridge on the anterior surface of the superior pubic ramus.
What are the 4 main ligaments which have attachments to the sacrum?
- Sacrotuberous
- Sacrospinous
- Anterior sacroiliac
Posterior sacroiliac.
Which ligaments does progesterone cause to stretch in the female?
Sacrotuberous
Sacrospinous
What are the layers regarding the obturator membrane, muscles, fascia etc?
The obturator membrane in the middle is covered by obturator membrane, the obturator externes muscle sits externally, the obturator internus muscle sits internally, and the obturator fascia sits internal to the obturator internus muscle
Which two lateral pelvic muscles are also lateral hip rotators? where do they pass through and where do they insert?
the piriformis (passes through the greater sciatic foramen) The obturator internus (passes through the lesser sciatic foramen)
They both insert onto the greater trochanter of the hip.
What is the branch level of coeliac trunk, SMA, renal arteries, gonadal arteries, IMA, common iliac splitting?
Coeliac trunk = T12 SMA = L1 Renal = L1-L2 Gonadal = L2-L3 IMA = L3 Common iliac split = L5
Which ligament stretches between the anus and the coccyx?
The anococcygeal ligament.
What is the perineal body?
The central tendon of the perineum
What muscle is most often torn during childbirth?
Levator ani - pubococcygeus.
What is the significance of the tendinous arch of the obturator fascia? Where does it originate and insert?
Originates on pubic bone
Inserts at ischial spine
Its where some parts of the elevator ani muscle originate.
