Anatomy Of Pelvis

Front 1

piriformis

Back 1

arises from anterior surface of sacral vertebrae 2-4; sacral plexus formed on the substance of muscle; almost fills the greater sciatic foramen; tendon passes thru and almost fills lesser sciatic foramen; attaches to greater trochanter; "pear-shaped"

Front 2

obturator internis

Back 2

arises from internal aspect of obturator membrane and almost total cirumference of the foramen; fleshy fibers converge to form a tendon which passes @ 90 deg angle between ischial spine and ischial tuberosity thru lesser sciatic foramen to attach posteriorly to greater trochanter; inferior part lies inferior to pelvic diaphragm so same muscle lies in the lateral wall of pelvis and perineum

Front 3

coccygeus (ischiococcygeus)

Back 3

arises from ischial spine and extends back towards the sacrum and coccyx; lies anterior to sacrospinous ligament

Front 4

pubococcygeus
(levator ani)

Back 4

arises from pubis, extends to posterior coccyx; circumscribes urethra, vagina, and rectum; 3 parts: pubourethralis, pubovaginalis, puborectalis

Front 5

iliococcygeus
(levator ani)

Back 5

arises from tendonous arch of levator ani

Front 6

tendonous arch of levator ani

Back 6

thickened part of obturator internus fascia

Front 7

puborectalis
(pubococcygeus)

Back 7

most medial and anterior fibers of pubococcygeus; attaches to one side fo pubis running posterior takin 90 deg bend around rectal/anal junction and attaches to the other side

Front 8

broad ligament

Back 8

double layered fold of peritoneum; anterior and posterior leaflets; anterior leaflet-comes over the top of the oviduct and passes posteriorly over ovarian ligament; 4 parts

Front 9

4 parts of broad ligament

Back 9

infundibulopelvic (suspensory ligament of ovary); mesoovarium; mesosalpinx; mesometrium <major part>

Front 10

uterus

Back 10

1)anteflexed (curved/bent forwards) at junction of uterine body & cervix; 2)anterverted (tilted forward) at junction of cervix & vagina; 3)muscular

Front 11

uterus

Back 11

cornu (horns); fundus (upper part); body; uterine cavity; internal os <about same position as isthmus>; cervix (lower 1/3); external os

Front 12

vagina

Back 12

smooth muscular tube; lower 1/4 innervated by pudendal n (n of perineum); fornices-surround lips of cervix, to reach rectouterine pouch <Douglas> go thru posterior fornix into most inferior part of peritoneal cavity/also important in infection (abortion)

Front 13

oviduct

Back 13

ampulla (2/3 of oviduct, where fertilization occurs); infundibulum (funnel)-distal end; fimbria-fingerlike processes on end of infundibulum

Front 14

urinary bladder

Back 14

surfaces: superior, anterior, posterior; subperitoneal (extraperitoneal); ligaments: pubovesical and pubocervical (female), and puboprostatic (male); lies in retropubiv space (space of Retsius)

Front 15

interior aspect of bladder

Back 15

detrusal muscle (smooth)-innervated by pelvic splanchnic nn (S2-S4), also called nervi erigentes, which also carry afferent and efferent limbs of bladder emptying reflex arc

Front 16

bladder trigone

Back 16

area of interior wall of bladder that is smooth-mucosa is so adherent to muscle tissue; bounded by ureters (ureteric orifices) and urethra

Front 17

prostate

Back 17

triangular shape with base superiorly and apex inferiorly(urogenital diaphragm); 4 lobes: two lateral, anterior, posterior; ejaculatory duct passes thru posterior lobe, dividing in into median and posterior lobe proper

Front 18

clinical assns: prostate

Back 18

median lobe is usually the lobe that enlarges in BPH (benign prostatic hypertrophy)-can occlude ureter/20% @ age 40, 90% @ age 80; posterior lobe proper is initial site for prostate cancer-2nd leading cause of death in men over 50.

Front 19

male urethra

Back 19

3 parts: prostatic, membranous, spongy portions

Front 20

prostatic urethra

Back 20

urethral crest-along posterior aspect; Seminal Colliculus (vernumontanum)-enlargement @ middle of crest where ejaculatory ducts open; prostatic utricle-blind opening <homologue to uterus>

Front 21

rectum

Back 21

begins @ junction of sigmoid colon where loses its mesocolon; @ vertebral level S3; ampulla-dilation lies inferior to 3 rectal shelves (shelves of Houston)

Front 22

anal canal

Back 22

4-5cm; 3 areas:cutaneous, transitory zones, and mucous membrane (5-10 vertical columns-Morgagni's)

Front 23

arterial supply of rectum

Back 23

superior rectal a (continuation of IMA); median sacral (aorta); middle rectal (internal iliac); inferior rectal (internal pudendal)

Front 24

internal iliac artery
(anterior and posterior divisions)

Back 24

posterior division (hypogastric): 3 parietal br-iliolumbar (iliacus m), lateral sacral (sacral foramina), superior gluteal (passes out btwn lumbosacral trunk and S1); Anterior division: 3 parietal-obturator, inferior gluteal, and internal pudendal/ 4 visceral br-umbilical (gives rise to superior vesical), middle rectal, inferior vesical and vaginal, uterine (runs with cardinal lig @ base of cervix)

Front 25

obturator nerve

Back 25

only nerve found in pelvis that is branch of lumbar plexus

Front 26

sacral plexus

Back 26

formed on piriformis muscle; formed by lumbosacral trunk joining with S1-S5

Front 27

sciatic nerve

Back 27

largest nerve, formed by L4-S4

Front 28

pudendal nerve

Back 28

almost sole somatic nerve supply of perineum; passes out of greater sciatic foramen (beteen piriformis and coccygeus muscles)then run deep to sacrospinous lig and thru lesser sciatic foramen to give off inferior rectal nerves, then continues into pudendal canal (ischiorectal fossa), gives off posterior scrotal and labial nerves and perineal nerve continues deep to perineal membrance and becomes the dorsal nerve of penis or clitoris

Front 29

pelvic splanchnic nerves

Back 29

from S2-S4; causes erection (parasympathetics); carry afferent and efferent limbs (bladder reflex arc fibers)

Front 30

points @ which structures may enter or leave pelvis

Back 30

1)enter pelvis by passing across pelvic brim into true pelvis from abdomen;2)greater sciatic foramen-connects pelvis to buttock;3)lesser sciatic foramen-pelvis to perineum;4)obturator canal-medial thigh

Front 31

ischium

Back 31

L-shaped, has body and ramus;greater and lesser sciatic notches lying in between ischial tuberosity and ischial spine

Front 32

pubis

Back 32

body lies medially; pubic crest; superior ramus; inferior ramus, which joins with the single ramus of ischium (ischiopubic ramus), one of the most frequently fractured sites of oscoxy

Front 33

pectineal line

Back 33

lies in superior and posterior aspect of superior ramus (pubis); pectineus attaches here

Front 34

1) sacrospinous lig
2) sacrotuberous lig

Back 34

1) is anterior to 2); both help to convert greater and lesser sciatic notches into foramina; extrinsic ligs of SI joint; 1) attaches to ischial spine and coccygeus muscle lies anterior to it.

Front 35

Peritoneum related to pelvis (male)

Back 35

comes off the anterior abdominal wall and passes onto superior aspect of vesicle of bladder then passes deeply in the interval of the vesicle and rectum and back over anterior and lateral surfaces of rectum--forms most inferior, dependent protion of male peritoneal cavity <rectovesical pouch>; excess liquid in peritoneal cavity called ascites

Front 36

Peritoneum-continued
(female)

Back 36

comes off ant abdominal wall down to superior surface of bladder, hits uterus; change is the intervention btwn urinary bladder and rectum with vagina and cervix; anterior layer runs over ant aspect of uterus and runs over top part (fundus) and is located posteriorly as well; relationship to rectum is similar to in male; 2 spots that are most dependent: 1)rectouterine pouch <pouch of Douglas or cul-de-sac>--inferior to 2)vesicouterine pouch

Front 37

Pelvic fascia

Back 37

Parietal-a continuation of abdominal transversalis fascia; more or less equal to deep fascia enveloping muscles; visceral-Endopelvic or extraperitoneal fatty tissue; acts as a cushion,and supports and lies adjacent to organs

Front 38

2 thickenings of parietopelvic fascia-used to suture uterus or bladder to lateral wall

Back 38

1) tendinous arc of levator ani-condensation of obturator interin fascia, lies against wall of pelvis; 2) tendinous arc of pelvic fascia-thickening of fascia covering pelvic diaphragm

Front 39

divarication

Back 39

Separation of normally joined parts, such as the separation of certain abdominal muscles during pregnancy.

Front 40

dehiscence

Back 40

A bursting open or splitting along natural or sutured lines

Front 41

pudendal artery

Back 41

gives rise to inferior rectal aa then on to posterior labial aa and on to deep artery of clitoris <homologous structures in male>

Front 42

pectinate line

Back 42

point where voluntary muscle in external anal sphincter, and involuntary muscle in internal anal sphincter; internal area supplied by pelvic sympathetics and parasympathetics, external by somatic nerves

Front 43

suspensory lig of ovary
(infundibulopelvic lig)

Back 43

part of broad ligament; fold of peritoneum convering anterior aspect of ovarian vessels as cross the pelvic brim

Front 44

ovarian ligament

Back 44

connects other end of ovary to uterus; the distal portion of gubernaculum ovary, or round lig--artery of round lig <Artery of Samson>

Front 45

cardinal ligament

Back 45

represents 90% of ligamentous support; NOT part of peritoneum