Hs Week 5: Pelvic Cavity And Viscera

Front 1

Most structures that leave the pelvis traverse through which foramen?

Back 1

Greater sciatic foramen

Front 2

Which muscle passes over the sacrospinous ligament?

Back 2

Coccygeus M

Front 3

Name the 2 muscles of the pelvic diaphragm.

Back 3

1. Levator ani M
2. Coccygeus M

Front 4

The pelvic diaphragm is suspended from the __________ on the Obturator internus.

Back 4

Tendinous arch.
(Arcus tendineus levator ani)

Front 5

Name the 3 muscles of the Levator ani (from medial to lateral).

Back 5

1. Puborectalis
2. Pubococcygeus
3. Ileococcygeus

Front 6

Which muscle blends with the deepest portion of the external anal sphincter muscle?

Back 6

Puborectalis M

Front 7

Where does the Superior Rectal artery branch from?

The Middle Rectal artery?

The Inferior Rectal artery?

Back 7

Superior rectal A is the terminal branch of the Inferior mesenteric A

Middle rectal A is a branch from the Internal iliac A (via the inferior vesical A)

Inferior rectal artery is branch from the Internal pudendal A

Front 8

T or F.

Most of the anastomoses within the wall of the rectum occur b/w the superior and inferior rectal AA.

Back 8

TRUE!

Front 9

Which anal sphincter is supplied by somatic nerves (inferior rectal branches of the pudendal)?

Back 9

External anal sphincter

(this is why external hemorrhoids are VERY painful!)

Front 10

Which anal sphincter is supplied by autonomic nerves (splanchnics)?

Back 10

Internal anal sphincter

(this is why internal hemorrhoids don't really hurt)

Front 11

Which vaginal structure is close in proximity to the rectouterine pouch?

Back 11

Posterior fornix

Front 12

Which structure in the female body is equivalent to the gubernaculum in the male body?

Back 12

Round ligament of the uterus

Front 13

List the various parts of the uterine tube.

Back 13

1. Isthmus
2. Ampulla
3. Infundibulum
4. Fimbriae

Front 14

If a women has given birth before, would her cervix be multiparous or nulliparous?

Back 14

Multiparous

Front 15

Name the fold of the broad ligament that suspends the uterine tube.

Back 15

Mesosalpinx.

Front 16

Name the major part of the broad ligament below the mesosalpinx and the mesovarium.

Back 16

Mesometrium

Front 17

Name the fold of peritoneum that connects the anterior surface of the ovary with the posterior layer of the broad ligament

Back 17

Mesovarium

(not considered part of the broad ligament)

Front 18

The ureter crosses _________ (over/under) the Uterine artery.

Back 18

UNDER
("water under the bridge")

Front 19

Name the 3 portions of the male urethra.

Back 19

1. Prostatic urethra
2. Membranous urethra
3. Spongy urethra

Front 20

What ligament holds the prostate to the pubic bone?

Back 20

Puboprostatic ligament

Front 21

If a patient presents with signs of trauma, a full bladder, and is unable to urinate, what should you consider?

Back 21

Ruptured urethra

Front 22

Why are the origins of the Renal artery and Testicular artery close?

Back 22

Because the testicles develop from mesoderm near the kidney and moves anterior and over the ureters.

Front 23

Which prostate lobe can place pressure on the urethra?

Back 23

Middle lobe

Front 24

Which prostate lobe tends to be musculofibrous?

Back 24

Anterior lobe

Front 25

In the male body, what structure is equivalent to the female uterus?

Back 25

Prostatic utricle

Front 26

Which 3 areas of the body are supplied by the internal iliac artery?

Back 26

1. Posterior pelvic wall and buttock
2. Perineum
3. Pelvic organs

Front 27

The Superior gluteal artery passes above the ________ muscle and out the _________ foramen.

Back 27

passes above the PIRIFORMIS muscle and out the GREATER SCIATIC foramen

Front 28

Inferior gluteal and Internal pudenal arteries pass ________ the piriformis muscle to exit the greater sciatic foramen.

Back 28

BELOW

(Remember: the Superior gluteal A passes above the piriformis, while the Inferior gluteal A passes below)

Front 29

Which lymph nodes do pelvic organs drain into?

Back 29

Internal iliac nodes

Front 30

Which lymphatic channels do gonads drain toward?

Back 30

Towards the channels along the aorta

Front 31

The ilium, ischium, and pubs can all be found at which structure on the coxal bone?

What is the significance of this?

Back 31

Acetabular fossa

*This creates a point of weakness in the pelvic bone. A fractured pelvis is very dangerous due to the large blood vessels that pass over the sacroiliac joint. A fracture can lead to a bad hemorrhage, so be careful!

Front 32

Which bony structure separates the greater sciatic notch from the lesser sciatic notch?

Back 32

Ischial spine

Front 33

Which feature of the coxal bone can be found directly below the sacral iliac joint?

Back 33

Greater sciatic notch

Front 34

Which feature of the coxal bone is the "part you sit on?"

Back 34

Ischial tuberosity

Front 35

Arteries, nerves, and veins leaving the pelvis headed for the external genitals will first go out the greater sciatic foramen and then enter the ....?

Back 35

Lesser sciatic foramen

Front 36

Which pelvic ligament is part of the "pelvic outlet?"

Which bone is part of the pelvic outlet?

Back 36

Sacrotuberous L

Ischiopubic ramus

Front 37

The space above the sacrospinous L (or coccygeus M) is referred to as?

Back 37

Greater sciatic foramen

Front 38

Which ligament forms the inferior margin of the greater sciatic foramen?

Back 38

Sacrospinous L

(the Sacrotuberous L forms the medial margin)

Front 39

Through which foramen will the Internal pudendal N traverse?

Back 39

It will first traverse through the greater sciatic foramen and then enter the lesser sciatic foramen to reach the external genitalia.

Front 40

The pelvic diaphragm is held to the lateral wall of the pelvis by a thickening of the internal muscular fascia of the obturator internus muscle. This "thickening" is referred to as..?

Back 40

Arcus tendineus levator ani

Front 41

Which muscle of the pelvic cavity can be found over the greater sciatic foramen?

Back 41

Piriformis muscle

Front 42

Nerves of the sacral plexus cross over which muscle?

Back 42

Piriformis muscle

Front 43

The posterior wall of the pelvic cavity is formed by which muscle?

Back 43

Piriformis M

Front 44

The lateral wall of the pelvic cavity is formed by which muscle?

Back 44

Obturator internus M

Front 45

The floor of the pelvic cavity is formed by which muscles?

Back 45

1. Levator ani M
2. Coccygeus M

Front 46

Which "line" is found at the bottom of the anal valves in the anal canal?

What is the significance of this line?

Back 46

Pectinate line

Above this line, tissue was derived from endoderm, and below this line it was derived from ectoderm
*Above line = autonomic innervation (hemorrhoids NOT painful)
*Below line = somatic innervation (hemmorrhoids PAINFUL)

Front 47

The internal anal sphincter is controlled by which nerves?

Back 47

Pelvic splanchnics (parasympathetic)
Sacral splanchnics (sympathetic)

(involuntary control)

Front 48

The external anal sphincter is controlled by what nerve?

Back 48

Internal pudendal N (somatic fibers)

(voluntary control)

Front 49

Term for anterior bending b/w the cervix and body of uterus.

Back 49

Anteflexed

Front 50

Term for anterior angle be/w uterus and vagina.

Back 50

Anteverted

Front 51

How could you confirm an ectopic pregnancy/ ruptured uterine tube?

Back 51

1. Positive pregnancy test
2. Blood in rectouterine pouch (i.e. cul-de-sac of Douglas)
3. Pelvic pain

*The procedure used to perform this exam = Culdocentesis. Aspirate fluid from the rectouterine pouch by a needle puncture of the posterior vaginal fornix)

Front 52

Which part of the uterus does NOT change during pregnancy?

Back 52

Cervix

Front 53

What part of the bladder "senses" pressure?

Back 53

Trigone

Front 54

Ligament that represents peritoneal draping over the female pelvic structures.

Back 54

Broad ligament

Front 55

Which ligament transmits the ovarian vessels, nerves, and lymphatics?

Back 55

Suspensory ligament

Front 56

Which blood vessels contribute to the rich anastomosis along the vaginal and uterine walls?

Back 56

1. Ovarian A
2. Uterine A
3. Vaginal A

Front 57

Name the thickened endopelvic fascia (ligament) from the cervix and the vagina to the pelvic walls, that extends laterally below the base of the broad ligament, and supports the uterus

Which artery is transmitted within this ligament?

Back 57

Transverse cervical ligament of the uterus

Uterine artery

Front 58

Which angle should be used to measure the pelvic inlet of a woman?

Back 58

Diagonal conjugate
(from pubic symphysis to sacral promontory)

Front 59

The ductus deferens cross ______ (medial/lateral) to the ureter to join with the seminal vesicle at the ejaculatory duct.

Back 59

MEDIAL

Front 60

.Which lobe of the prostate can be found b/w the entrance of the ejacultory duct and the prostatic urethra?

Back 60

Middle lobe

(prostate size increases with age, and this lobe can place pressure on the urethra).

Front 61

What structure can be found between the 2 ejaculatory ducts?

Back 61

Prostatic utricle.

Front 62

In general, the posterior division of the Internal iliac artery supplies...?

The anterior division supplies...?

Back 62

Posterior div--> Gluteal region

Anterior div --> pelvic organs and genitalia

Front 63

Which joint can be found directly behind the bifurcation of the internal iliac A?

Back 63

Sacroiliac joint.

Front 64

Which ligament in the female pelvic cavity enters the inguinal canal at the deep inguinal ring?

Back 64

Round ligament of the uterus

Front 65

A fibromuscular cord that extends from the ovary to the uterus below the uterine tube, running within the layers of the broad ligament.

Back 65

Ovarian ligament

Front 66

What forms the boundaries of the bladder trigone?

Back 66

2 orifices of the ureters and the internal urethral orifice

Front 67

Venous drainage above the pectinate line goes into the ______ system, and below the pectinate line goes into the _____ system.

Back 67

Above pectinate line = Portal venous system (via Superior rectal V)

Below pectinate line = Caval system (via middle, inferior rectal VV).

Front 68

Which artery usually runs b/w the lumbosacral trunk and the first sacral nerve?

Back 68

Superior gluteal artery

Front 69

Name the features of the coxal bone that define the pelvic inlet.

Back 69

1. Sacral promontory
2. Sacral ala
3. Arcuate line
4. Pectineal line (of superior pubic ramus)
5. Body of pubic bone
6. Superior margin of pubic symphysis

Front 70

Name the features of the coxal bone (and ligaments) that define the pelvic outlet.

Back 70

1. Sacrum
2. Coccyx
3. Sacrotuberous ligament
4. Ischial tuberosity
5. Inferior margin of pubic symphysis.

Front 71

Which part of the pelvis (true or false) is located above the pelvic brim?

Back 71

False pelvis.

Front 72

What is the most diagnostic characteristic of the bony pelvis when it comes to identifying a female pelvis versus a male pelvis?

Back 72

The intrapubic angle!
(This is the angle between the pubic symphysis and the ischiopubic ramus.)

*It is wider in the female

Front 73

Which muscles raise the entire pelvic floor upon contraction?

Back 73

Pelvic diaphragm MM
(Levator ani and coccygeus MM)

Front 74

List the 3 constrictions along the course of the ureter.

Back 74

1. Where the pelvis of the ureter joins the ureter
2. Were it crosses the pelvic brim
3. At its junction with the bladder

Front 75

Which lobe of the prostate is prone to benign hypertrophy?

Which lobe is prone to carcinomatous transformation?

Back 75

Benign hypertrophy --> middle lobe
cancer --> posterior lobe

Front 76

During defecation, does the puborectalis muscle relax or contract?

Back 76

It relaxes, which decreases the angle between the ampulla of the rectum and the upper portion of the anal canal.

Front 77

List the 3 branches of the posterior division of the internal iliac artery.

Back 77

1. Iliolumbar
2. Lateral sacral
3. Superior gluteal

Front 78

List the branches of the anterior division of the internal iliac artery.

Back 78

1. Umbilical
2. Obturator
3. Inferior gluteal
4. Internal pudendal
5. Inferior vesical
6. Middle rectal
7. Uterine

Front 79

Which artery supplies the iliacus M, ilium, Psoas major M, and quadratus lumborum M?

Back 79

Iliolumbar artery
(branch of posterior div of Internal iliac A)

Front 80

Which artery supplies the spinal meninges and muscles of the skin overlying the sacrum?

Back 80

Lateral sacral A
(branch of posterior div of Internal iliac A)

Front 81

Which artery usually runs between the lumbosacral trunk and the first sacral nerve?

Back 81

Superior gluteal A

Front 82

Which nerves make up the inferior hypogastric plexus?

Back 82

1. Hypogastric nerves
2. Pelvic splanchnic nerves
3. Sacral splanchnic nerves.