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222 Cards in this Set
- Front
- Back
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What is the lumbosacral angle?
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Angle formed by longitudinal axis of L5 and S1
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Is the lumbosacral angle greater in males or females?
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males
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How many pairs of sacral foramina are there?
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4 pairs
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Caudal anesthesia is inserted into...
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sacral hiatus
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What attaches to the ASIS?
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inguinal ligament and sartorius muscle
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What attaches to the AIIS?
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rectus femoris
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What attaches to the PSIS?
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superiormost attachment for sacroiliac ligaments and superior portions of sacrotuberous ligaments
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At what level does the dural sac end?
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S2
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What closes the greater sciatic notch, making it a foramen?
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sacrospinous ligament
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What closes the lesser sciatic notch, making it a foramen?
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sacrotuberous ligament
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What are the boundaries of the false pelvis?
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anterolateral- abdominal wall
posterolateral- iliac fossae posterior- L5 & S1 vertebrae |
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What is contained within the greater pelvis?
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ileum, cecum, appendix, sigmoid colon
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What are the boundaries of the lesser pelvis?
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lateral- ischial bones and pelvic diaphragm
anterior- pubic bones and pubic symphysis posterior- sacrum inferior- pelvic diaphragm |
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What is contained within the true pelvis?
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urinary bladder and reproductive organs
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What makes up the pelvic brim?
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pectineal line of superior pubic rami, arcuate line of ilium, sacral promontory
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What makes the boundaries of the pelvic outlet?
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inferior border of pubic crest, ischiopubic rami, sacrotuberous ligaments, coccyx
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Limb buds grow from what?
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L2-S2 segments of trunk
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What rotation occurs in the limb bud during development?
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medial rotation and pronation
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What feature is the widest part of the iliac crest?
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iliac tubercle
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What attaches to the ischial tuberosity?
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hamstrings, adductor magnus, sacrotuberous ligament
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What attaches to the pubic tubercle?
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inguinal ligament
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What is the angle of inclination?
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longitudinal axis of the neck relative to the longitudinal axis of the shaft of the femur
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Which is the weakest of the SI joint ligaments?
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anterior
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Due to the fiber orientation of the posterior SIJ ligament, weight bearing causes ____________ of the sacrum.
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compression
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What ligaments provide the bulk of stability at the SIJ?
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interosseous SI ligament
posterior SI ligament |
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What type of joint is the SI joint?
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secondary cartilaginous
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The interpubic disc is generally _________ in females
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wider
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What are the ligaments of the pubic symphysis?
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superior and inferior pubic ligaments
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What is the subpubic angle? Describe the gender differences of the subpubic angle.
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angle between the inferior pubic rami. Angle is wider in females (>80 degrees vs <70 degrees in males)
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What do the sacrotuberous ligaments attach?
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inner surface of ischial tuberosities to sacrum and coccyx
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What neurovascular structures have a close relationship to the sacrospinous ligaments? What is this spacial relationship?
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pudental nerve and internal pudental vessels pas just inferior to the ligament near the ischial spine
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What structures are connected by the iliolumbar ligaments? What joints do they reinforce?
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connect L5 TPs to the ilia, reinforce lumbosacral joints
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What are the functions of the pelvic diaphragm?
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supports pelvic viscera
resists increases in intra-abdominal pressure involved with urinary and fecal continence separates pelvic and perineal cavities |
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The coccygeus is (superficial/deep) to the sacrospinous ligament
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deep
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What innervates the coccygeus?
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S4&S5 ventral rami
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What is the function of the coccygeus?
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flexes coccyx and supports viscera
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What innervates the perineal body?
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branches of S4, inferior rectal n, coccygeal plexus
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Which of the levator ani is responsible for fecal continence?
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puborectalis
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The pubococcygeus muscles merge midline to form...
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anococcygeal ligament (levator plate)
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What type of fascia covers intrapelvic muscles? organs?
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membranous fascia- parietal and visceral
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What type of fascia fills spaces within the pelvis?
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loose areolar fascia
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What type of fascia forms endopelvic fascial ligaments?
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fibroareolar fascia
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What fascia does the levator ani attach to?
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tendinous arch of the obturator fascia
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What are the attachments of the tendinous arch of the obturator fascia?
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posterolateral pubis to ischial spine
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The obturator fascia is continuous superiorly with...
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transversalis and iliopsoas layers of fascia
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Visceral pelvic fascia forms the _________ layer of each organ.
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adventitial
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What are the primary endopelvic fascial spaces?
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retropubic, retrorectal
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Give an example of an endopelvic fascial ligament in males and in females.
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rectovisical septum in males, cardinal ligaments in females
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What are the peritoneal pouches in females?
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vesicouterine pouch and pouch of douglas
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What is ascites?
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accumulation of peritoneal fluid in the peritoneal cavity
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What is the peritoneal pouch in males?
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rectovesical pouch
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What is the most gravity dependent region of the abdominopelvic cavity in the upright female?
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pouch of douglas
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The sacral plexus if formed by the anterior primary rami of...
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L4-S4
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What rami is the pudental nerve formed from?
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S2-S4
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What nerve is the chief sensory nerve to the external genitalia?
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pudental nerve
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Describe the course of the pudental nerve.
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accompanies the internal pudental vessels as it passes out of the pelvis via the greater sciatic foramen (btwn piri and coccygeus), passes just behind the sacrospinous ligament and then enters perineum via lesser sciatic foramen
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The pudental canal is a feature of...
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obturator fascia
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What branch of the pudental nerve arises while nerve is still in the Alcock canal?
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inferior rectal nerve
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What does the inferior rectal nerve innervate?
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GSEs to external anal sphincter and GSAs from perianal skin and anal canal inferior to pectinate line
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What does the dorsal nerve of the clitoris/penis innervate?
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GSAs from the clitoris/penis
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The posterior scrotal/labial nerve is a branch of...
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perineal nerve of the pudental nerve
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What does the perineal nerve innervate?
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most of the skeletal muscles and skin of the perineum
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What type of fibers are conveyed in the posterior scrotal/labial nerve?
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GSAs
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What are the 3 main branches of the pudental nerve?
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inferior rectal, dorsal nerve of the clitoris/penis, perineal nerve
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A pudental nerve block anesthetizes...
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majority of the perineum and inferior quarter of the vagina
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An ilioinginal nerve blook anesthetizes...
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anterior part of perineum
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From what ventral rami does the superior gluteal nerve arise?
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L4-S1
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What does the superior gluteal nerve innervate?
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gluteus medius and minimus, TFL
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What does the inferior gluteal nerve innervate?
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gluteus maximus
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From what rami does the inferior gluteal nerve arise?
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L5-S2
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From what rami does the obturator nerve arise?
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L2-L4
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What does the obturator nerve innervate?
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GSEs to medial thigh compartment and GSAs from medial thigh
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The coccygeal plexus contains fibers from...
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S4, S5 and coccygeal nerves
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Gray rami communicans span from...
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sacral sympathetic trunks to sacral and coccygeal ventral rami
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What travels from the sacral sympathetic trunks to the inferior hypogastric plexuses?
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sacral splanchnic nerves
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What arteries do the periarterial plexuses accompany?
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ovarian, superior rectal, internal rectal arteries
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What types of fibers are contained in the superior hypogastric plexus?
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sympathetic and parasympathetic
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The inferior hypogastric plexus is formed by...
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hypogastric nn, pelvic splanchnic nn, sacral splanchnic nn
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Pelvic splanchnic nerves arise from which spinal levels?
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S2-S4
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GVAs from viscera above the pelvic pain line accompany... GVAs from visceral below the pelvic pain line accompany...
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sympathetic GVEs, parasympathetic GVEs
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The anterior division of the internal iliac artery supplies... the posterior division...?
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anterior- primarily for visceral structures but some somatic
posterior- mainly somatic |
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Between which vessels does a porto-systemic anastomosis occur?
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internal rectal plexus (to superior rectal v)and external rectal plexus(to internal iliac system)
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What forms an anastomosis with the vertebral venous plexus?
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prostatic and vesical venous plexuses
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The internal iliac nodes drain lymph from the pelvic viscera, with the exception of... and what other structures?
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gonads and inferior rectum, deep perineum, gluteal and posterior femoral muscles
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What do the external iliac nodes drain?
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lower limb, infra-umbilical abdominal wall, penis or clitoris, membranous urethra, fundus of bladder, uterine cervix and upper vagina
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What viscera drain to both the internal and external iliac nodes?
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uterine cervic and upper vagina
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What drains to the superficial inguinal nodes?
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external genitalia, inferior anal canal and perianal region, uterine fundus
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The internal & external iliac nodes and the superficial inguinal nodes drain to...
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common iliac nodes to the para-aortic/lumbar nodes to the thoracic duct
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What is the lymphatic drainage of the gonads?
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para-aortic/lumbar nodes
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What are the layers of the uterine wall from superficial to deep?
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perimetrium, myometrium, endometrium (basal and superficial layers)
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What is the uterine cornu?
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Where the uterine tubes attach to the corpus of the uterus
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What is the flexion angle of the uterus? Is the uterus ante or retro flexed?
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angle between the longitudinal axis of the corpus and that of the cervix, anteflexed
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What is the version angle of the uterus/vagina? Is it usually ante or retro verted?
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angle between longitudinal axis of the cervical canal and the vaginal canal, anteverted
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What supplies most of the blood to the uterus? Describe the course of these vessels.
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Uterine arteries, descends along lateral pelvic wall before turning medially into the cardinal ligaments. Passes over ureter and ascends in the broad ligament along lateral uterus to anastomose with ovarian arteries. Also branches that descend along cervix to become or anastomose with vaginal arteries
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What drains the upper portion of the uterus? The lower portion?
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uterine veins, (vaginal portion) drains to internal pudendal veins
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What is the lymphatic drainage of the fundus?
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mainly lumbar nodes, some external iliac, some superficial inguinal
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What is the lymphatic drainage of the corpus?
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external iliac nodes
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What is the lymphatic drainage of the cervix?
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internal iliac and sacral nodes
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The uterovaginal nerve plexus is derived from the...
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inferior hypogastric plexus
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Describe the sympathetic innervation of the uterus.
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sympathetic fibers from lower thoracic spinal cord leave sympathetic chains as lumbar splanchnics to enter plexuses
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Describe the parasympathetic innervation of the uterus.
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From S2-S4 in pelvic splanchnic nerves to inferior hypogastric plexus
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Describe the afferent pain fibers from the uterus.
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pain from the fundus and body of uterus follow sympathetic pathways, pain (and all other afferent sensation) from cervix follows pelvic splanchnics to S2-S4
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What is anesthetized with spinal anesthesia?
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inferior to waist level
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What is anesthetized with caudal anesthesia?
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birth canal, pelvic floor, majority of perineum
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What mesentery connects the uterine tubes to the wall?
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mesosalpinx
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What are the parts of the uterine tube?
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infundibulum, ampulla, isthmus, uterine part
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What is the vascular supply to the uterine tubes?
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uterine and ovarian artery and vein
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What is the lymphatic drainage of the uterine tubes?
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lumbar lymph nodes
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Describe the parasympathetic innervation to the uterine tubes.
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lateral half from vagus nerve, medial half from pelvic splanchnic n
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Visceral pain fibers from the uterine tubes follow... visceral afferent reflex fibers follow...
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sympathetic pathways, parasympathetic pathways
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What is the mesentery of the ovaries?
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mesovarium
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What connects the ovary to the pelvic wall? to the uterus?
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suspensory ligaments, ovarian ligaments
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What is the vascular supply to the ovaries?
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uterine and ovarian arteries and veins
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What structures "bend" the vagina? How much?
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120 degrees because of the levator ani
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What supplies the vagina vascularly?
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uterine artery- upper portions
vaginal and internal pudendal arteries- middle and lower portions |
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What is the venous drainage of the vagina?
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vaginal plexus
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What is the lymphatic drainage of the vagina?
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superior- Int/Ext iliac nodes
middle- Int iliac nodes lower- sacral, common iliac, superficial inguinal nodes |
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What innervates the vagina?
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upper 3/4 from uterovaginal plexus (all visceral)
lower 1/4 from deep perineal branch of pudendal nerve |
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What muscles are associated with the vagina?
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pubovaginalis, sphincter urethrae, bulbospongiosus
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Describe the path of the ductus deferens.
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Ascends in spermatic cord and passes through the inguinal canal and out the deep inguinal ring. Turns medially and crosses over obliterated umbilical artery, runs on lateral wall of pelvis medial to branches of II artery. Passes medially and superior to ureters and travels to the inferior
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The ductus deferens terminates...
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as the ampulla of the DD in the seminal vesicle
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The DD joins with the duct of the ___________ ______________ to form the ______________ duct.
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seminal vesicle, ejaculatory
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What vascular structures supply the DD?
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artery to ductus deferens from superior vesicle artery (anastomoses with testicular a)
papiniform venous plexus and testicular vein |
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Lymph from the DD drains to which nodes?
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external iliac nodes
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What percentage of ejaculate comes from the ejaculatory duct?
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70-80%
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What vascular structures supply the seminal vesicles?
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inferior vesicle and middle rectal a/v
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Lymph from the seminal vesicles drains to which nodes?
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internal and external iliac nodes
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Into what portion of what organ do the ejaculatory ducts empty?
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Prostatic portion of urethra
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Where are most neurovascular structures of the prostate located?
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fibrous capsule of prostate
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What is the relationship of the isthmus of the prostate to the urethra?
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Anterior to urethra
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The isthmus of the prostate is mainly (stroma/parynchyma)
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stroma
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Which lobe of the prostate is palpable by digital rectal exam?
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infero-posterior lobe
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Which lobe(s) make up the largest portion of the prostate?
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lateral
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What lobe of the prostate is involved urinary problems in benign prostatic hypertrophy?
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middle
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What zone corresponds to the central and transitional zones of the prostate? What percentage of cancers arise here?
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middle lobe, 30%
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What zone corresponds to the lateral and infero-posterior lobes of the prostate? What percentage of cancers arise here?
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peripheral zone, 70%
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What zone of the prostate is typically not associated with prostate cancer? Why?
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anterior, because of its fibromuscular structure
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The prostate receives arterial supply from where?
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prostatic arteries- arise from inferior vesicle a but also internal pudendal and middle rectal aa
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What drains blood from the prostate? What is this a tributary of?
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prostatic venous plexus, internal iliac vv and internal vertebral venous plexus
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Lymph from the prostate drains to which nodes?
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internal iliac nodes & some to sacral nodes
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What muscle are the bulbourethral glands closely associated?
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sphincter urethrae
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Ducts from the bulbourethral glands pass which membrane?
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perineal membrane
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What autonomic system causes erection? ejaculation?
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parasympathetic, sympathetic
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Where do preganglionic sympathetic GVEs to the male reproductive viscera originate? What nerves do they travel in?
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T12-L2/3 spinal cord segments and use lumbar and sacral splanchnic nerves
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Where do preganglionic parasympathetic GVEs to the male reproductive viscera originate? What nerves do they travel in?
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S2-S4 spinal cord segments and use pelvic splanchnic nerves
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What are the superior and inferior boundaries of the perineum?
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pelvic diaphragm, skin of perineum
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What are the A/M/L/P boundaries of the perineum?
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A- inferior margin of pubic symphysis & mons pubis
AL- ischiopubic rami L- ischial tuberosities & medial thighs PL- sacrotuberous ligaments & gluteus maximus P- tip of coccyx & intergluteal cleft |
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A transverse line through the ischial tuberosities divides the perineum into...
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urogenital triangle, anal triangle
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The ischioanal fossa is the ____________ portion of the _______ triangle of the perineum.
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lateral, anal
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What muscles connect to the perineal body?
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bulbospongiosus, external anal sphincter, superficial & deep transverse perineal muscles, levator ani, smooth and voluntary slips of the external urethral sphincter & muscular coats of the rectum
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What layer comprises the labia majora and mons pubis? What layer is this continuous with in the abdomen?
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superficial fatty layer, Camper's fascia
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What is the deep membranous layer of the perineum? What layer is this continuous with in the abdomen? In males, what is this continuous with inferiorly?
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Colles' fascia, Scarpa's fascia, Dartos' fascia
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What is the deep perineal (Gallaudet) fascia?
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deep investing fascia of ischiocavernosus, bulbospongiosus, superficial transverse perineal muscle
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What forms the superficial border of the superficial perineal pouch?
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perineal membrane
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What perforates the perineal membrane?
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urethra (M&F) vagina (F)
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What is the superficial perineal cleft?
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potential space between Colles' fascia and fascia of Gallaudet
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What is the superficial perineal pouch?
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potential space between perineal membrane and fascia of Gallaudet
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What is contained within the superficial perineal pouch in males?
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root of penis and associated muscles, proximal portion of spongy urethra, superficial transverse perineal muscles, deep perineal branches of the internal pudendal vessels and pudendal nerve
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What is contained within the superficial perineal pouch in females?
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clitoris and associated muscles, bulb of vestibule and associated muscles, greater vestibular glands, superficial transverse perineal muscles, deep perineal branches of internal pudendal vessels and pudendal nerve
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What is the deep perineal pouch?
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space between the perineal membrane and pelvic diaphragm
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What are the contents of the deep perineal pouch?
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part of urethra, inferior part of external urethral sphincter, anterior extensions of ischioanal fat pad, dorsal neurovasculature of clitoris/penis, bulbourethral glands (m), vestibular glands (f), deep transverse perineal muscles
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What contributes to the frequency of female UTIs vs male?
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short urethra
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What are the segments of the male urethra?
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intramural (pre-prostatic), prostatic, membranous, spongy
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What neurovascular structures are contained within the ichioanal fossae?
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inferior anal/rectal vessels and nerves, perforating branch of S2 & S3, perineal branch of S4 nerve
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The predominant tissue in the ischioanal fossae is...
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fat
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What does the pudendal canal transmit?
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internal pudendal vessels, pudendal nerve, nerve to obturator internus
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What neurovasculature arises within the pudendal canal?
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inferior rectal vessels and nerve
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At the anterior end of the pudendal canal the internal pudendal artery and pudendal nerve bifurcate into...
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perineal a/n and dorsal a/n of the penis/clitoris
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At what vertebral level does the sigmoid colon end and the rectum begin?
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S3
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What is the most orad flexure of the rectum?
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sacral flexure
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What causes the aborad flexure of the rectum? what is it called?
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pelvic diaphragm, anorectal flexure
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What portions of the rectum are covered by peritoneum?
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A/L surfaces of upper 1/3, A surface of middle 1/3, no peritoneum covering inferior 1/3
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What reflections form the pararectal fossae?
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reflection of peritoneum from lateral rectum onto posterior pelvic wall
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What are the superior limits of the pararectal fossae?
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sacrogenital folds (M) rectouterine folds (F)
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Through what fascia can you palpate the prostate via digital rectal exam?
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rectovesical/rectoprostatic fascia
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What septum may tear during vaginal delivery causing rectocele?
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rectovaginal septa
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From what artery does the superior rectal artery arise? The middle? The inferior?
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inferior mesenteric artery, internal iliac or inferior vesicular arteries, internal pudendal arteries
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Describe the venous drainage of the rectum.
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Internal rectal venous plexus empties to superior rectal vein to the IMV (portal)
External rectal venous plexus empties to middle and inferior rectal veins (systemic) |
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With what other venous plexuses do the rectal plexuses anastomose?
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vesical venous plexus (M) uterovaginal venous plexus (F)
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Describe the lymphatic drainage of the rectum.
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Pararectal nodes run along superior rectal vessels and drain superior 1/2 of rectum to lumbar lymph nodes, internal iliac lymph nodes drain the inferior 1/2
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Visceral afferent fibers from the rectum travel with which visceral efferents?
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parasympathetic
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What plexus/ganglia do the sympathetic fibers to the rectum travel through?
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inferior mesenteric
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Parasympathetic fibers innervating the rectum originate...
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S2-S4
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The longitudinal axis of the anal canal is angled slightly... the change in direction is due to...
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posterior (vs rectum slightly anterior), puborectalis muscle at anorectal junction
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Describe the difference in the internal and external anal sphincters.
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Internal surrounds the upper 2/3-3/4 of anal canal, separated from external by intersphincteric groove. External anal sphincter overlies inf 1/2 of internal
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What provides autonomic innervation to the anal canal?
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parasympathetic GVEs from pelvic splanchnics and sympathetic GVEs from hypogastric plexuses
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What branch of autonomics maintain fecal continence?
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sympathetic
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The superior tips of the anal columns defines what line?
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anorectal junction
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The serrated appearing band in the orad anal canal is called...
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pectinate line
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What structures are above anal valves and between anal columns?
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anal sinuses (crypts)
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What is the pectinate line?
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top edge of anal valves
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Describe the neurovasculature above the pectinate line.
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A- superior rectal a of IMA
V- superior rectal v N- GVAs sensitive to stretch |
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Describe the neurovasculature below the pectinate line.
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A- inferior rectal aa
V- external rectal venous plexus N- inferior rectal n contains GSAs sensitive to temp, pain, light touch |
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In what pouch is the root of the penis located?
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superficial perineal pouch
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What covers the R&L crura of the penis?
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ischiocavernosus muscles
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What covers the bulb of the penis?
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bulbospongiosus muscle
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Each cylindrical mass of the penis is covered by...
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tunica albuginea
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What do the crura of the penis attach to proximally?
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ischiopubic ramus and perineal membrane
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What structure houses the spongy urethra?
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corpus spongiosum
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The fundiform ligament is continuous with what structure?
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linea alba
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From what does the suspensory ligament arise?
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pubic symphysis
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What are the layers of the penis from superficial to deep?
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skin, superficial penile fascia, deep penile fascia (Buck's fascia), tunica albuginea
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The superficial penile fascia is continuous with what layer of the abdomen? The thigh? The scrotum?
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superficial fascia of abdomen, fascia lata of the thigh, dartos muscle of the scrotum
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Buck's fascia is continuous with what layer of the perineum? The abdomen?
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deep perineal fascia, deep investing fascia of abdominal muscles
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Rupture of the intermediate part of the urethra causes accumulation of urine into what pouch?
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deep perineal pouch
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Rupture of the corpus spongiosum or the spongy urethra causes accumulation of urine into what pouch?
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superficial perineal pouch
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The major arteries to the penis are derived from...
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internal pudendal artery
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What artery supplies the skin of the penis? What is its origin?
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external pudendal artery, external iliac artery
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What is the lymphatic drainage of the penis?
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skin- superficial inguinal
glans- deep inguinal & EI erectile- II |
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What is the course of parasympathetic GVEs to the penis?
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from S2-S4 through pelvic splanchnic nerves to the prostatic plexus. Terminate here and give postsynaptic GVEs to the arteriorlar and urethral smooth muscle.
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The scrotum is a developmental homolog of what female structure?
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labia majora
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What developmental structure links the testes from its initial location near the kidneys to the scrotum?
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gubernaculum
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What structure creates the inguinal ligament?
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processus vaginalis
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The processus vaginalis is what structure after development is completed?
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tunica vaginalis
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What are the layers of the testes?
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skin, superficial fascia (dartos muscle), external spermatic fascia, cremasteric muscle/fascia, internal spermatic fascia, parietal layer of tunica vaginalis, cavity of tunica vaginalis, visceral layer of tunica vaginalis, tunica albuginea
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What structures are conveyed in the spermatic cord?
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testicular artery, papiniform venous plexus, cremasteric artery, deferential artery, nervous tissue
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What innervates the muscles associated with the external genitalia?
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pudendal nerve
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A pudendal nerve block provides relief to...
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most of the perineum and inferior quarter of vaginal canal.
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Why is a pudendal nerve block not sufficient to ease all pain from childbirth?
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superior birth canal is not anesthetized by pudendal block
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What innervates the mons pubis?
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ilioinguinal nerve
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What fibers are carried in the genital branch of the genitofemoral nerve? from where?
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GSAs from labia majora and upper medial thigh
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What do parasympathetic GVEs to the external female genitalia do?
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erect clitoris, engorge erectile tissue of bulbs, increase secretions of greater vestibular glands
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