Reproductive System (Pelvis) Flashcards
Label diagram
Recap: State the 3 types of joints and name examples for each type of joint.
Fibrous joint –> dense connective tissue, immobile (skull)
Cartilaginous joint –> little bit of movement (sacroiliac joint)
Synovial joint –> most movement (hip and shoulder joints)
Regarding the SACRUM,
- Spinal cord ends at ____
- ____ - ____ is the cauda ____
- Sacrum is formed by the fusion of the ____ sacral vertebrae
- Sacral ____ = anterior lip of the ____
- Anterior sacral ____ gives exit to anterior rami of the sacral ____
Regarding the SACRUM,
- Spinal cord ends at L1
- L1 - S1 is the cauda EQUINA
- Sacrum is formed by the fusion of the 5 sacral vertebrae
- Sacral PROMONTORY = anterior lip of the S1
- Anterior sacral FORAMINA gives exit to anterior rami of the sacral NERVES
Regarding the COCCYX,
- Spinal column’s last ____ - ____ vertebrae fuse to form coccyx
- Tailbone is an anchor for muscles and ligaments
- Coccyx injury = ____ (due to ____, ____, ____)
Regarding the COCCYX,
- Spinal column’s last 3 - 4 vertebrae fuse to form coccyx
- Tailbone is an anchor for muscles and ligaments
- Coccyx injury = COCCYDYNIA (due to TRAUMA, OBESITY, CHILDBIRTH)
State 3 functions of the PELVIC GIRLDLE
- transmits weight from axial skeleton to lower limb and helps in body’s movements
- protects abdominal and pelvic organs
- female pelvis is wider for childbearing purposes
Label the TRUE PELVIS and FALSE PELVIS.
State the type of organs found in each type of pelvis.
Red = false pelvis –> intestinal organs
Blue = true pelvis –> pelvic organs
State the boundaries of PELVIC INLET and PELVIC OUTLET
PELVIC INLET
- anteriorly = pubic symphysis
- posteriorly = sacral promontory
- laterally = iliopectineal (arcuate) lines
PELVIC OUTLET
- anteriorly = pubic symphysis
- posteriorly = coccyx
- anterolaterally = ischiopubic ramus
- posterolaterally = sacrotuberous ligaments
Regarding the ANTERIOR TILT OF THE PELVIS,
- State the 2 points in the same vertical plane
- State the purpose of the anterior tilt
ANTERIOR TILT OF PELVIS
- ASIS and PUBIC SYMPHYSIS are in the same vertical plane
- Purpose = prevent collapse of the true pelvic organs in the lesser pelvis
State the differences in FEMALE PELVIS and MALE PELVIS
Name the 2 ligaments coloured in red and blue. State the origin and insertion of each ligament.
Red = Sacrospinous ligament (sacrum - ischial spine)
Blue = Sacrotuberous ligament (sacrum - ischial tuberosity)
Label any MUSCLES, LIGAMENTS, STRUCTURES in the diagram
State the 3 lateral rotators of the thigh.
- obturator internus
- obturator externus
- piriformis
PELVIC FLOOR/DIAPHRAGM
- Muscular partition formed by ____ and ____
- Supports visceral contents of pelvis
- 2 openings in pelvic floor:
- Divides pelvic cavity from ____ below
PELVIC FLOOR/DIAPHRAGM
- Muscular partition formed by LEVATOR ANI (PUBOCOCCYGEUS, PUBORECTALIS, ILIOCOCCYGEUS) and COCCYGEUS
- Supports visceral contents of pelvis
- 2 openings in pelvic floor: UROGENITAL HIATUS + ANAL/RENAL HIATUS
- Divides pelvic cavity from PERINEUM below
Regarding the LEVATOR ANI, state the
- Anterior/Lateral/Posterior origins:
- Insertion of each muscle:
- Innervation of muscles:
LEVATOR ANI:
- Anteriorly = pubic body of hip bone
- Laterally = tendinous arch (continuation of deep fascia of obturator internus)
- Posteriorly = ischial spine of hip bone
Puborectalis insertion = pubis on contralateral side (u-shaped sling)
Pubococcygeus + Iliococcygeus insertion = coccyx, perineal body, anococcygeal ligament
Innervation = pudendal nerve (S2-S4), perineal branch of S4
Are the pelvic diaphragm muscles SMOOTH MUSCLES or SKELETAL MUSCLES?
all skeletal muscles –> under voluntary control
State the 3 functions of the pelvic floor muscles
- supports pubic viscera
- resists rise in intra-abdominal and pelvic pressure (during coughing, weightlifting, chronic constipation) by counteracting the appropriate contraction of the levator ani wholly or in part
- sphincteric actions (puborectalis swings around the anorectal junction and some fibres join deeper part of external anal sphincter to play crucial role in voluntary control of defecation)
PELVIMETRY = diagnostic technique used to evaluate the dimensions of a woman’s pelvis
- Predicts her potential to deliver vaginally
- State how the diameters of PELVIC INLET and PELVIC OUTLET are taken
PELVIC INLET
- Anteroposterior = from midpoint of sacral promontory to midpoint of upper margin of pubic symphysis
- Oblique = from sacroiliac joint of 1 side to iliopectineal eminence of other side
- Transverse = max transverse diameter of pelvic inlet
PELVIC OUTLET
- Anteroposterior = from tip of sacrum to lower margin of pubic symphysis
- Oblqiue = from middle of sacrotuberous ligament of one side to junction of ischiopubic ramus of opposite side
- Transverse = between inner aspects of both ischial tuberosities
What is cephalopelvic disproportion? What is its implication?
Cephalopelvic disproportion = clinically significant mismatch between the size/shape of presenting part of fetus and size/shape of maternal pelvis and soft tissue
- Implication = cesarean section instead of natural delivery
State the test used to measure an estimated diagonal conjugate to prepare for birth.
Insert two fingers into vagina until sacral promontory - distance should be ~12.5cm (>10cm)
State the 3 accessory glands of the MALE REPRODUCTIVE SYSTEM
- seminal vesicles
- prostate gland
- bulbourethral gland
State the 4 histological divisions of PROSTATE.
State any clinical conditions related to each division.
- fibromuscular stroma
- transitional zone –> BPH
- central zone
- peripheral zone –> PROSTATE CANCER
EJACULATORY DUCTS
- Each duct is formed by the union of ____ with duct of ____
- Passes through the ____ and opens into ____ urethra
EJACULATORY DUCTS
- Each duct is formed by the union of VAS DEFERENS with duct of SEMINAL VESICLE
- Passes through the PROSTATE and opens into PROSTATIC urethra
PROSTATIC URETHRA
- Broadest and most ____ portion of urethra (length = ____)
- Midline ridge also known as urethra ____ is where ____ open
- Prostatic ____ = homologue of female uterus, cervix and vagina (derived from ____ duct)
- Prostatic ____ = openings of ducts of prostatic gland
PROSTATIC URETHRA
- Broadest and most DILATED portion of urethra (length = 3-4CM)
- Midline ridge also known as urethra CREST is where EJACULATORY DUCTS open
- Prostatic UTRICLE = homologue of female uterus, cervix and vagina (derived from PARAMESONEPHRIC duct)
- Prostatic SINUSES = openings of ducts of prostatic gland
State the ARTERIAL SUPPLY and VENOUS DRAINAGE of PROSTATE GLAND
PROSTATE GLAND
(1) Arterial supply = branches of internal iliac A
- Inferior vesical A
- Middle rectal A
- Internal pudendal A
(2) Venous drainage = internal iliac V
- Via prostatic plexus
State the difference between INTERNAL OS and EXTERNAL OS in the female reproductive system.
Internal os = opening between cervix and uterus
External os = opening between cervix and vagina
ISTHMUS UTERI
- Part between the ____ and upper 1/5th of cervix
- ____ dilates and is taken up into uterus during pregnancy
- Clinical application - Lower segment caesarean section (LSCS) is conducted here
ISTHMUS UTERI
- Part between the INTERNAL OS and upper 1/5th of cervix
- ISTHMUS dilates and is taken up into uterus during pregnancy
- Clinical application - Lower segment caesarean section (LSCS) is conducted here
State the position of the UTERUS with reference to axes of uterus and relevant axes.
UTERUS
- anteroflexed (long axis of uterus bent forward in relation to long axis of cervix)
- anteroverted (long axis of uterus bent forward in relation to long axis of vagina)
State the ligaments involved in UTERINE SUPPORT for female internal genital organs
- FIBROMUSCULAR ligaments - pubocervical, cardinal, uterosacral ligaments
- PERITONEAL LIGAMENT
- ROUND LIGAMENT of uterus
- OVARIAN LIGAMENT
State the origin and insertion of each of the FIBROMUSCULAR LIGAMENTS of uterus.
(1) PUBOCERVICAL LIGAMENT
- pubic bone - cervix (wraps around the bladder)
(2) CARDINAL/TRANSVERSE CERVICAL LIGAMENT
- cervix - lateral pubic wall (wraps around cervix)
(3) UTEROSACRAL LIGAMENT
- uterus - sacrum (wraps around rectum)
BROAD LIGAMENT OF UTERUS
- ____ layered fold of ____
- Extends from sides of ____ to lateral walls of pelvis
- Content between the layers:
- Vestigial remnants of ____ tubules: (2)
- 3 parts:
BROAD LIGAMENT OF UTERUS
- 2 layered fold of PERITONEUM
- Extends from sides of UTERUS to lateral walls of pelvis
- Content between the layers: UTERINE VESSELS, LYMPHATICS, OVARIAN LIGAMENT
- Vestigial remnants of MESONEPHRIC tubules: (2) EPOOPHORON + PARAOOPHORON
- 3 parts: Mesometrium (ard uterus) + Mesosalpinx (ard fallopian tubes) + Mesovarium (ard ovaries)
CARDINAL LIGAMENT
- Condensation of ____ (just below ____)
- Thick connective tissue at the base of ____ ligament that extend betweenthe lateral sides of cervix and side of pelvic wall
- Provides major support to uterus
- ____ A travels to uterus through ligament
CARDINAL LIGAMENT
- Condensation of PELVIC FASCIA (just below PERITONEUM)
- Thick connective tissue at the base of BROAD ligament that extend betweenthe lateral sides of cervix and side of pelvic wall
- Provides major support to uterus
- UTERINE A travels to uterus through ligament
State the 5 parts of the fallopian tube.
- infundibulum
- fibriae
- ampulla (widest section - common site of fertilisation)
- isthmus (narrow section)
- uterine part/interstitium
How does TUBECTOMY act as a form of birth control?
TUBECTOMY = ligation or binding of fallopian tubes
- Each ovary releases ovum however passage of ovum through fallopian tube is blocked
- Sperm is unable to pass through fallopian tube to fertilise the ovum
- Unfertilised ovum is absorbed by body
Name the blood vessels that supply blood to the UTERUS, OVARIES and FALLOPIAN TUBE. (State any anastomoses that occur)
UTERUS
- Uterine A (branch of internal iliac A)
- 2 uterine A anastomose extensively with each other across midline
OVARIES
- Internal iliac A –>* uterine A*
- Uterine A anastomoses with ovarian A
- Uterine A anastomoses with vaginal A
- Aorta –> ovarian A (travels with infundibulopelvic ligament/suspensory ligament of ovary - continuation of broad ligament of uterus)
FALLOPIAN TUBE
- Tubal branches of ovarian A
- Ovarian A anastomoses with Uterine A
State the innervation of UTERUS
Sympathetic - INFERIOR HYPOGASTRIC PLEXUS, T12-L1 (uterine contractions + vasoconstrictions)
Parasympathetic - PELVIC SPLANCHNIC N (S2-S4) (uterine inhibition and vasodilation)
PELVIC PAIN LINE
- Structues above/in contact with ____ peritoneum –> visceral pain sensation via ____ N
- Structures below ____ peritoneum –> visceral pain sensation via ____ N
PELVIC PAIN LINE
- Structues above/in contact with INFERIOR peritoneum –> visceral pain sensation via SYNMPATHETIC SPLANCHNIC N
- Structures below INFERIOR peritoneum –> visceral pain sensation via PARASYMPATHETIC SPLANCHNIC N
Explain CYSTOCELE and RECTOCELE
Cystocele = anterior vaginal wall prolapse (due to weakening of pelvic floor muscles and connective tisseus that support the baldder and front wall of vagina)
Rectocele = posterior vaginal wall prolapse(due to weakening of pelvic flor muscles and connective tissues in between the back wall of vagina and rectum)
