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98 Cards in this Set
- Front
- Back
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Ala of sacrum
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Wings articulating with ilium at sacroiliac joint
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What enters pelvis at sacroiliac joint
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Obturator nerve and lumbosacral trunk
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Sacral promontory
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Anterosuperior aspect, connected to L5 through lumbosacral joint
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Coxal bones
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Ilium, ischium, pubis
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Ilium
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-ASIS, AIIS, PSIS
-Tubercle --> lateral aspect of iliac crest -Greater and lesser sciatic notches |
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Ischium
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-Ischial spine
-Ischial tuberosity --> posterior, what we sit on |
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Ischiopubic rami
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location of urogenital diaphragm
form subpubic angle |
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Sacrotuberous ligament
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Between sacrum and ischial tuberosity
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Greater sciatic foramen
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Formed both by sacrotuberous and sacrospinous ligaments
-piriformis muscle goes through greater sciatic foramen to femur |
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Sacrospinous ligament
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Between sacrum and ischial spine
-anterior to sacrotuberous ligament |
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Pathway of pudendal canal
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Passes out the greater sciatic foramen, over the ischial spine, and back into lesser sciatic foramen, to travel on medial aspect of ischial ramus
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Orientation of pelvis
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It is tilted forward so that ASIS and pubic tubercle are on the same frontal plane
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Genital hiatus
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Hole in the pelvic diaphragm, where there is no muscle, just fascia.It overlies superior part of urogenital diaphragm. Urethra and vagina go through it
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Levator ani muscles
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Attach to tendinous arch of levator ani
-ileococcygeus -pubococcygeus -puborectalis |
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Function of puborectal sling
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It creates an angle between the rectum and anal canal, which allows you to retain fecal matter. The angle is almost 90, and the anal canal points down and posteriorly
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Is ureter located in abdomen or pelvis
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Upper half of ureter in abdomen, lower part in pelvis
Abdominal part is retroperitoneal |
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Relation of ureters
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Male - relation to ductus deferens
Female - relation to uterine artery |
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Describe pathway of ureters
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Ureters pierce posterolateral edge of bladder and run obliquely through muscular wall of bladder
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Blood supply of ureters
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Arteries supplying ureters arise from renal, gonadal, common and internal iliac, visceral and uterine
A lot of variation, many anastomose |
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Innervation of ureters
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Ureteric nerves are derived from renal, aortic, superior and inferior hypogastric plexuses (T10-L1), both sympathetic and parasympathetic
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Lymphatics of ureters
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from upper part may join renal vessels, aortic nodes (lumbar), common, internal or external iliac
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Describe bladder
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Bladder is muscular sac for urine storage, approximately pyramid shaped.
Appearance of bladder depends on contents and surrounding viscera Average bladder can be approached over pubic symphysis |
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Parts of bladder
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Fundus
Neck Apex Superior surface Two inferolateral surfaces |
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Stabilization of bladder
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Neck of bladder is held in place by ligaments, thickenings of endopelvic fascia, posteriorly held by rectovesical ligaments
-Median umbilical ligament attaches bladder to umbilicus -There are also folds of peritoneum that serve to steady bladder (false ligaments) |
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Internal structure of bladder
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Internal mucous layer is loosely attached to muscular layer - can fold when contracted. Over the trigone mucous layer is tightly bound and is always smooth.
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What is muscular coat of bladder
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Detrusor muscle, has 3 layers- external and internal longitudinal layers and middle circular layer
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Internal urethral sphincter is derived from
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middle circular layer
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Which innervation contracts bladder
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parasympathetic
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Blood supply of bladder
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superior and inferior vesical - male
vaginal - female |
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Venous supply of bladder
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Follow accompanying arteries and contribute to vesical venous plexus and prostatic venous plexus
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Lymphatics of bladder
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drain to external and internal iliac nodes
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Male urethra has 4 parts. Name them
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1.Preprostatic
2.Prostatic - widest, most dilatable, has ejaculatory and prostatic ducts 3. Membranous - surrounded by sphincter urethra 4. Spongy - within corpus spongiosum, receives openings of bulbourethral glands |
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Blood supply of male urethra
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Inferior vesical
Middle rectal Internal pudendal |
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Describe female urethra
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Female urethra is much shorter then male. It courses from bladder anterior to anterior wall of vagina and opens directly anterior to vagina and posterior to clitoris
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Which glands empty to terminal portion of female urethra
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Paraurethral
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Where does ductus deferens go through
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Inguinal canal to deep inguinal ring to back side of prostate and bladder
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Ductus deferens is directly continuous with
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epidydymis
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In pelvis ductus deferens
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is covered with peritoneum
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Posterior to bladder ductus deferens
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crosses over ureter, lies between bladder and rectum
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Seminal vesicles
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Single coiled tube
-Proximal end of tube is constricted, straight duct that joins ductus deferens to form ejaculatory duct -provides bulk of volume to semen |
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Blood supply of seminal vesicles
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Inferior vesical
Middle rectal |
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Ejaculatory ducts
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Commence at base of prostate and courses between median and right lobe
Terminates by opening on seminal colliculus |
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Describe prostate
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Partly glandular and partly fibromuscular, secretions make up 20% of semen volume
-It is situated between neck of bladder and urogenital diaphragm, conical in shape |
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Parts of prostate
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Base - adjacent to bladder
Apex - inferior Lobes - anterior, posterior, lateral (R + L), middle |
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Prostatic sheath
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derived from pelvic fascia and is continuous with puboprostatic ligaments, has prostatic veins
Important is stopping spread of cancer |
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Name features of posterior wall of prostatic urethra
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Urethral crest - crest extends down from trigone
Seminal colliculus- large bump in middle, has prostatic utricle and openings of ejaculatory ducts Prostatic sinus - openings of prostatic ducts |
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Prostatic utricle is a remnant of
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vagina
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Age changes in prostate
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At age 45-50 prostate may undergo benign hypertrophy, resulting in blockage of urine flow. Median lobe can act as valve - more pressure more completely urethra is blocked
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Prostate cancer is diaagnosed by
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PSA blood test and/or palpation through rectum
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Blood supply of prostate
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Inferior vesical
Internal pudendal Middle rectal |
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Venous supply of prostate
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Prostatic venous plexus
communicates with vesicular plexus and internal vertebral plexus |
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Lymph of prostate
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Internal iliac and sacral nodes
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Bulbourethral glands
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Two small, round glands situated within deep perineal pouch. Duct of each gland penetrates perineal membrane and passes obliquely forwards to spongy urethra
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Lowest point of peritoneum in males
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rectovesical space
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Pararectal fossa
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depressions in pelvic floor, just lateral to rectum
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Where is ovary located
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True pelvis, ovarian fossa
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What holds in place ovary
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Ovarian ligament
Suspensory ligament Mesovarium |
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Ovarian fossa boundaries
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Anterior - obliterated umbilical artery
Posterior - ureter and external iliac artery |
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Blood supply ovaries
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Ovarian artery
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Ovarian veins empty into
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Right - vena cava
Left - renal vein |
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Ovary lymph drains to
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Lumbar nodes
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Uterine tubes
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Hollow tubes that open to peritoneal cavity and empty into uterus, convey oocyte toward uterus and sperm towards oocyte
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Uterine tubes have 4 parts . What are they
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Infundibulum - part with fimbriae
Ampulla Isthmus Uterine portion |
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Fertilization occurs at
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ampulla of uterine tubes
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Three layers of uterine tube
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Serosa, muscle and epithelium
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Part of broad ligament attached to uterine tube is called
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Mesosalpinx
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Blood supply of uterine tubes
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Ovarian + uterine arteries
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Lymph drainage of uterine tubes
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Lumbar nodes
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Why does peritonitis occur more often in females
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Due in large part to continuity of vagina/uterus with abdominal cavity
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Ectopic pregnancy
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Implantation outside of uterus
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Uterus
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Hollow, thick muscular organ that allows implantation of fertilized oocyte and provides nourishment for developing embryo
Uterus is shaped like inverted pear and contained entirely in pelvis. In old age atrophies |
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Uterus has 4 parts - what are they
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Fundus - top rounded part, lies above opening of uterine tubes
Body - movable part above internal os of cervix, between layers of peritoneum, anterior part is in contact with urinary bladder, posterior part is in contact with rectum Isthmus - between body and cervix Cervix - part that surrounds internal openign |
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External os of cervix opens in
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anterior wall of vagina
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Fornix
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Lateral side of cervix
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Normal position of uterus
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Anteverted
Anteflexed |
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Wall of uterus consists of 3 layers
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Perimetrium - peritoneum + thin layer of areolar tissue
Myometrium - most of substance of uterus Endometrium - nutritional layer, epithelium |
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Endometriosis
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Endometrium in areas other then uterus
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Homologues of gubernaculum
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Round ligament
Ovarian ligament |
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Ligaments that hold uterus in place
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Transverse cervical and uterosacral
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Structures most important in uterine support
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Levator ani
Urogenital diaphragm Other pelvic organs Uterine ligaments |
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Blood supply of uterus
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Mostly uterine artery with some of vaginal and ovarian
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Venous drainage of uterus
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Uterine plexus --> internal iliac veins
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Lymphatic drainage of uterus
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Fundus - drains to lumbar and external iliac
Body - external iliac Cervix - internal iliac and sacral Regions where uterine tubes joins uterus has lymphatic drainage following roung ligament and drains to superficial inguinal nodes |
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Innervation of uterus
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Uterovaginal plexus
parasympathetic - S2-S4 sympathetic - T12 - L2 |
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2 parts of broad ligament
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Mesosalpinx and mesovarium
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Vagina
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Collapsed fibromuscular tube that extends from cervix to vestibule
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4 muscles serve as vaginal sphincters
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1. Pubovaginalis
2. External urethral sphincter 3. Urethrovaginal sphincter 4. Bulbospongiosus |
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Blood supply of vagina
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Uterine and vaginal
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Venous drainage of vagina
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internal iliac
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Lymphatic drainage of vagina
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Upper 2/3 drain into internal and external iliac
Lower 1/3 drains to superficial inguinal |
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Innervation of vagina
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Upper 2/3 - visceral innervation
Lower 1/3 - somatic innervation |
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Rectum
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Continuous with sigmoid colon at level of S2, indicated by lower end of sigmoid mesocolon
Continuous with anal canal by passing through pelvic diaphragm |
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Rectum differs from descending colon
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1. Haustra
2. Mesentery 3. Epiploic appendages 4. Ampulla 5. Teniae coli |
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What is the name of position for examination of perineum
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Lithotomy position
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Transverse line divides pelvis into two parts - what are they
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Urogenital and anal triangle
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Urogenital triangle contains
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bulb of penis
scrotum in male vestibule, vaginal + urethral orifices in female |
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Urogenital diaphragm
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Sits in urogenital triangle
Strengthens genital hiatus |
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Homologous structure of penis
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Clitoris
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