Mkgrady8 Chilton Lecture 1

Front 1

the symphasis pubis is

Back 1

a median cartilaginous joint between the bodies of the pubic bones

Front 2

the luboscaral joint is

Back 2

the L5 vertebra and the S1 vertebra articulate with one another by an anterior fibrocartilaginous joint between their bodies and by 2 posterior synovial joints between their articular processes

Front 3

the L5 vertebra is also attached to the ilium and sacrum by the

Back 3

iliolumbar ligaments that unite each thick transverse process of L5 vertebra to the internal lip of the iliac crest posteriorly; these ligaments help to stabilize the lumbosacral joint; they are important because they limit axial rotation of L5 vertebra on the sacrum and they assist the vertebral articular process by preventing forward gliding of L5 vertebra on the sacrum

Front 4

the sacroiliac joints

Back 4

very strong synovial joints between the articular surfaces oft he sacrum and the ilium; sting weight bearing joints which are responsible for transmitting the weight of the body of the ossa coxae or hip bones

Front 5

what are the accessory ligaments of the sacroiliac joints

Back 5

the sacrotuberous and sacrospinous ligaments; they bind the sacrum to the ischium and resist backward rotation of the inferior end of the sacrum; they convert sciatic notches into greater and lesser sciatic foramina

Front 6

position of the pelvis

Back 6

tipped anteriorly such that the pubic symphysis and anterior superior iliac spines lie in the same coronal plane

Front 7

the piriformis muscle origin

Back 7

anterior aspect of 2nd, 3rd, and 4th lateral masses of sacrum and sacrotuberous ligament

Front 8

piriformis muscle insertion

Back 8

greater trochanter of femur; leaves the pelvis via the greater sciatic foramen and passes posterior to the head of the femur to reach its insertion; forms a muscular bed for the sacral plexus

Front 9

piriformis muscle innervation

Back 9

S1, S2; aka nerve to piriformis

Front 10

piriformis muscle action

Back 10

laterally rotates thigh and abducts thigh (non-weight bearing); assists in holding the head of femur in acetabulum (weight bearing)

Front 11

obturator internus origin

Back 11

anteriolateral wall of pelvis minor including margins of obturator foramen and obturator membrane

Front 12

obturator internus insertion

Back 12

greater trochanter of femur; passes through the lesser sciatic foramen and makes a right angle turn around the lesser sciatic notch

Front 13

obturator internus innervation

Back 13

nerve to obturator internus (L5, S1, S2)

Front 14

obturator internus action

Back 14

laterally rotates thigh (non-weight bearing); assists in holding the head of the femur in acetabulum (weight bearing)

Front 15

what forms the funnel shaped pelvic diaphragm

Back 15

the 2 lavatories ahi muscles and the 2 coccygeus (ischiococcygeus) muscles

Front 16

where is the pelvic diaphragm and what does it do

Back 16

forms the fibromuscular floor of the confluent abdominopelvic cavities and supports the contents of the pelvis

Front 17

the 3 parts of the levator ani muscle

Back 17

pubococcygeus muscle which encircles the urethra, vagina, and anus and merges in the perineal body (fusion of the urorectal septum with the cloacal membrane); the puborectalis which arises from the pubis and the muscles from the 2 sides loop around the posterior surface of the anorectal junction forming a U shaped rectal sling; and the iliococcygeus which is the thin part of the levator ani that arises from the tendinous arch and the ischial spine, muscle on each side inserts into the coccyx and the anococcygeal ligament

Front 18

what is the urinary bladder

Back 18

a muscular vesicle for urine storage

Front 19

where does the bladder sit in the adult

Back 19

in the pelvis minor posterior to the pubic bones from which it is separated by the connective tissue space called the retropubic space

Front 20

where does the bladder sit in an infant

Back 20

in the abdomen

Front 21

the ligaments of the bladder

Back 21

the bladder is relatively free in the loose extra peritoneal fatty tissue except for its neck which is held firmly by the puboprostatic ligaments in the male and the pubovesical ligaments in the female

Front 22

the mucous membrane in the bladder

Back 22

if empty it is in numerous folds or rugae except in the trigone where the mucous membrane is smooth because here it is firmly attached to the muscular wall

Front 23

structure of the bladder

Back 23

wall composed chiefly of smooth m uncle called the detrusor urinae muscle; at neck these muscle fibers form the involuntary internal sphincter; the openings of the ureters and urethra form the angles of the thrigone; the ureters pass obliquely through the bladder wall in an inferomedial direction which helps prevent urine from backing up the ureters

Front 24

the male urethra does what and what are the names of its 3 parts

Back 24

conveys urine from the urinary bladder to the external urethral orifice and provides an exit for semen; the prostatic part, the membranous part, and the spongy part

Front 25

the prostatic male urethra

Back 25

the first part; begins at the internal urethral orifice at the apex of the trigone and descends through the prostate and ends at the superior layer of deep fascia of the sphincter urethrae muscle; the posterior wall of the prostatic part has- a urethral crest, prostatic sinus, seminal colliculus, prostatic utricle (vestigial homolog of uterus and vagina), and openings of ejaculatory ducts

Front 26

the membranous male urethra

Back 26

2nd part; shortest and least dilatable; traverses the sphincter urethrae muscle and the perineal membrane; bulbourethral gland is located on each side

Front 27

the spongy male urethra

Back 27

3rd part; longest segment; begins where the urethra passes into the corpus spongeosum of the penis and ends at the eternal urethral orifice

Front 28

the female urethra

Back 28

is a short (4 cm) muscular tube; the external urethral orifice is located in the vestibule of the vagina; passes with the vagina through the pelvic and urogenital diaphragm and the perineal membrane; is surrounded but he sphincter urethrae muscle; urethral glands are present

Front 29

the male genital organs comprise the

Back 29

testes, the deferent ducts, the seminal vesicles, and the ejaculatory ducts; prostate and bulbourethral glands are accessory or auxiliary genital glands

Front 30

the ductus deferens

Back 30

a thick walled muscular tube which begins in the tail of the epididymis and ends in the ejaculatory duct carrying sperm from one to the other; enlarges to form the ampulla then narrows to form the ejaculatory duct

Front 31

the seminal vesicles

Back 31

consist of long coiled tubes which form vesicle like masses on the base of the bladder; they do not store sperm; secrete a thick secretion which mixes with the sperm; are situated at the base of the bladder, anterior to the rectum; are separated from the rectum by the rectovesical pouch; the duct of each seminal vesicle joints the ductus deferens to form the ejaculatory duct

Front 32

the ejaculatory ducts

Back 32

open by slit like apertures into the prostatic urethra one on each side of the orific of the prostatic utricle

Front 33

the prostate

Back 33

the largest of the accessory glands of the male reproductive tract; surrounds the first part of the urethra; is enclosed by the fascial sheath of the prostate; the base of the prostate is related to the neck of the bladder; its apex is related to the superior fascia of the UG diaphragm and rests on the sphincter urethrae muscle

Front 34

what passes through the prostate

Back 34

the prostatic urethra and the ejaculatory ducts which divides the prostate into the median and lateral lobes (physicians may refer to a posterior lobe when palpating the prostate through the rectum but this isn't an additional area)

Front 35

the median lobe of the prostate

Back 35

in older men commonly produces a projection into the cavity of the bladder called the uvula of the bladder

Front 36

veins of the prostate

Back 36

form the prostatic venous plexus which drains into the internal iliac veins but also communicates with the vesicle plexus and the vertebral venous plexuses

Front 37

cancer of the prostate metastasizes via

Back 37

blood and lymph to the vertebral column and pelvis; valveless venous communications between the prostatic plexus of the veins and the vertebral plexuses are the basis of this metastasis; straining to urinate, necessary when the cancer impedes the flow of urine causes excess shunting of blood to vertebral plexuses

Front 38

the bulbourethral glands

Back 38

lie posterolateral to the membranous urethra; open by minute apertures into the proximal part of the spongy urethra; receive blood supply from the arteries to the bulb of the penis

Front 39

the internal female genitalia consist of

Back 39

the vagina, the uterus, the uterine tubes, and the ovaries

Front 40

the vagina

Back 40

the female organ of copulation is a musculomembranous tube; serves as the inferior end of the birth canal; descends anteroinferiorly from the rectouterine pouch; opens inferiorly into the vestibule of the vagina; communicates superiorly with the cavity of the uterus; tis posterior wall extends superior to the cervix of the uterus to the posterior fornix; the hymen membrane surrounds the entrance

Front 41

the vagina lies posterior to what and anterior to what

Back 41

posterior to the urinary bladder and anterior to the rectum

Front 42

the superior and inferior limit of the vagina

Back 42

the superior limit is usually covered by peritoneum thus injuries may involve the peritoneal cavity through the rectouterine pouch; the vagina is related inferiorly to the perineal body

Front 43

relations of the uterues

Back 43

anteriorly the body of the uterus is separated from the bladder by the vesicouterine pouch (is empty when the uterus is in its normal position); posteriorly lies the sigmoid colon; uterus separated from the rectum by the rectouterine pouch; the ureter is crossed superiorly by the uterine artery at the side of the cervix

Front 44

the orientation of the uterus

Back 44

bent anteriorly (ante flexed 170 degrees) between the cervix and the body; the body and the entire uterus is normally bent or inclined forward (anteverted 90 degrees)

Front 45

the body of the uterus is enclosed between the layers of the

Back 45

broad ligament and is freely moveable (as bladder is fully distended uterus becomes retroverted)

Front 46

the broad ligaments are

Back 46

folds of peritoneum with mesothelium on their anterior and posterior surfaces; they extend from the sides of the uterus to the side walls and the floor od the pelvis; they hold the uterus in relatively normal position; enclosed in the free edge of each broad ligament is a uterine tube; the ligament of the ovary lies posterosuperirly and the round ligament of the uterus lies anteroinferiorly within the broad ligament

Front 47

the 4 parts of the broad ligament

Back 47

the suspensory ligament of the ovary, mesosalpinx, mesovarium, and mesometrium

Front 48

the cervix of the uterus is held in position by

Back 48

the transverse cervical ligaments (cardinal ligaments) that extend from the cervix and the lateral fornices of the vagina to the side walls of the pelvis; the sacrocervical (uterosacral) ligaments that pass from the sides of the cervix toward the sacrum (they tend to hold the cervix in its normal relationship to the sacrum); and the pubocervical (pubouterine) ligemants that pass front he cervix to the pubic bone (continuation of the pubovesical ligaments)

Front 49

the principal supports of the uterus

Back 49

the pelvic floor (tone of levator ani muscles) and the structures surrounding the uterus (transverse cervical, sacrocervical, and pubocervical ligaments)

Front 50

the uterine tubes

Back 50

extend from the cornea or horns of the uterus; are designed to receive the oocytes discharged from ovarian follicles and to convey the zygote to the uterus; also convey sperm to the ampulla of the tube where the oocyte waits for fertilization; these tubes open at distal ends into the peritoneal cavity

Front 51

the ovaries

Back 51

located one on each side in the ovarian fossa (bounded anteriorly by the obliterated umbilical artery and posteriorly by the ureter an the internal iliac artery; each ovary is attached to the posterosuperior aspect of the broad ligament and is suspended from the posterior layer of this ligament by the mesovarium, through which the ovarian vessels pass)

Front 52

the ovaries are attached to the uterus by

Back 52

the ligament of the ovary which runs in the broad ligament

Front 53

near the pelvic brim the ovary it attached by

Back 53

*the suspensory ligament of the ovary which contains the ovarian vessels and nerves

Front 54

the oocyte is expelled into

Back 54

*the peritoneal cavity

Front 55

ovarian arteries arise from

Back 55

abdominal aorta at L1-L2 below the renal arteries and on reaching the pelvic brim they cross over the external iliac vessels internal to the ureter

Front 56

ovarian veins form

Back 56

a brace of vessels called the pampiniform plexus which communicates with the uterine plexus; 2 veins leaving the ovarian plexus form one ovarian vein; *the right ovarian vein ascends to the IVC whereas the left ovarian vein drains into the left renal vein

Front 57

the rectum is continous with

Back 57

the sigmoid colon superiorly and begins on the pelvic surface of the 3rd piece of the sacrum (S3); rectum ends by turning posteroinferirly to become the anal canal

Front 58

shape and flexures of the rectum

Back 58

terminal part bends sharply backward to join the anal canal; inferior part is distended into the rectal ampulla; rectum is S-shaped in the coronal plane; at the concavities there are folds called transverse rectal folds which partly close the lumen

Front 59

relations of the rectum

Back 59

posteriorly it rests on the inferior 3 sacral vertebrae, the coccyx, the anococcygeal ligament, the median sacral vessels, branches of the superior rectal artery and the inferior ends of the sympathetic trunks; anteriorly in male it is related to the bade of the bladder, terminal parts of ureters, deferent ducts, seminal vesicles, and prostate; in the female the anterior relation of the rectum is the vagina

Front 60

peritoneal covering of the rectum

Back 60

covers the superior 1/3 of the rectum (intraperitoneal); the middle 1/3 had peritoneum in front only (retroperitoneal); the inferior 1/3 has no peritoneal covering (extra peritoneal)

Front 61

the the male the peritoneum is reflected from

Back 61

anterior surface of rectum to posterior wall of the bladder where is forms the floor of the rectovesical pouch

Front 62

in the female the peritoneum is reflected from

Back 62

the rectum to the posterior fornix of the vagina where it forms the floor of the rectouterine pouch

Front 63

nerves of the lateral wall of the pelvis

Back 63

the obturator nerve, the lumbosacral trunk, the sacral plexus- the sciatic nerve and the pudendal nerve

Front 64

the obturator nerve

Back 64

arises from the lumbar plexus (not sacral plexus) in the substance of the psoas major muscle form the anterior branches of the ventral rami of L2, L3, L4; runs behind the common iliac vessels and crosses the sacroiliac joint to enter the pelvis minor; it then runs anteroinferiorly int he extra peritoneal fat medial to the fascia over the obturator interns muscle; it passes along the obturator groove superior to the obtuerator artery and vein where it divides into anterior and posterior divisions which leave the pelvis via the obturator foramen to supply the thigh

Front 65

the lumbosacral trunk

Back 65

formed by ventral nerve rami of L4 an L5; descends over the sacroiliac joint

Front 66

the sacral plexus

Back 66

this large plexus of nerves is located in the pelvis moor; is formed by the lumbosacral trunk an the ventral rami of the first 3 and the descending part of the 4th sacral nerves

Front 67

the sciatic nerve

Back 67

formed by ventral rami of L4, L5, S2, S2, and S3; the largest nerve in the body, passes through the greater sciatic foramen inferior to the piriformis muscle along with the inferior gluteal nerve; in the back of the thigh the sciatic nerve divides into the tibial and common perineal nerves

Front 68

the pudendal nerve

Back 68

arises from anterior divisions of the ventral rami S2, S3, S4; leaves the pelvis between the piriformis and coccygeus muscles (through the greater sciatic foramen), hooking around the sacrospinous ligament to enter the perineum through the lesser sciatic foramen; it is distributed to the muscles of the perineum including the external anal sphincter and ends as the dorsal nerve of the penis or clitoris; it is sensory to the external genitalia

Front 69

the pelvic autonomic nerves include the

Back 69

sympathetic trunks, the branches of the sacral sympathetic trunks, the hypogastric plexuses, the visceral plexuses

Front 70

the sympathetic trunks

Back 70

the sacral sympathetic trunks are directly continuous with the lumbar sympathetic trunks; the trunks descend on the pelvic surface of the sacrum just medial to the pelvic sacral foramina; the 2 trunks converge as they pass along the sacrum and unite in the small median ganglion impair on the coccyx

Front 71

branches of the sacral sympathetic trunks

Back 71

the sympathetic trunks send gray rami communicantes (post-gangalionic fibers) to each of the ventral rami of the sacral and coccygeal nerves; they also send branches to the median sacral artery and to the inferior hypogastric plexus

Front 72

the hypogastric plexuses

Back 72

the superior hypogastric plexus descends into the pelvis and lies just below the bifurcation of the aorta; is is the downward prolongation of the inter mesenteric plexus joined by L3 and L4 splanchnic nerves; branches from the superior hypogastric plexus enter the pelvis and descend anterior to the sacrum as the right and left hypogastric nerves, which descend, mingle with the pelvic splanchnic nerves and form the right and left inferior hypogastric plexuses

Front 73

the pelvic splanchnic nerves are

Back 73

parasympathetic and are derived from S2, S3, and S4 hence the inferior hypogasstric plexus contains both sympathetic and parasympathetic fibers

Front 74

each plexus surrounds the corresponding

Back 74

internal iliac artery

Front 75

branches from the hypogastric plexuses are distributed to the pelvic viscera along

Back 75

the branches of the internal iliac artery

Front 76

the visceral plexuses

Back 76

are extensions of the inferior hypogastric plexuses on the walls of the pelvic viscera and include the middle rectal plexus (branches to rectum, sigmoid, and descending parts of the colon), the vesicle plexus (branches to bladder, seminal vesicles, ejaculatory ducts, urethra, bulbourethral glands, and penis), the uterovaginal plexus (branches to vagina, cervix, uterus, uterine tubes, urethra, vestibular bulbs, greater vestibular glands, and clitoris) - the uterovaginal plexus is homologous with the prostatic plexus

Front 77

the 3 types of splanchnic nerves

Back 77

thoracic (greater, lesser, and lowest)-sympathetic-originate from branches of thoracic sympathetic ganglia 5 to 12; lumbar-sympathetic-originate from branches of the 4 lumbar sympathetic ganglia; pelvic-parasympathetic-originate from branches of ventral rami of sacral spinal nerves S2, S3, S4

Front 78

the proximal 2/3 of the colon are innervated by

Back 78

the vagus nerve and beginning at the left colic flexure, the distal 1/3 of the oclon is innervated by parasympathetic pelvic splanchnic nerves via the inferior mesenteric artery to the marginal artery of Drummond

Front 79

the 4 different arteries that enter the pelvic minor

Back 79

the internal iliac (paired), median sacral, superior rectal, and ovarian (paired)

Front 80

the internal iliac artery

Back 80

supplies most of the blood to the pelvic viscera; branch of the common iliac artery which arises medial to the psoas major muscle and anterior to the sacroiliac joint; arrangement of its visceral branches is variable

Front 81

the anterior branches of the internal iliac artery

Back 81

the umbilical artery, the obturator, the inferior vesical, the uterine, the middle rectal, the internal pudendal, and th inferior gluteal

Front 82

the umbilical artery

Back 82

crosses the pelvis to the dome of the bladder; gives off superior vesical arteries to the bladder then becomes obliterated and forms the medial umbilical ligament of the anterior abdominal wall; NOTE in the male the ductus deferens can arise front he superior vesical artery, the inferior vesical artery, the internal iliac artery, or the umbilical artery

Front 83

the obturator artery

Back 83

usually arises close to the umbilical artery; crossed by the ureter; passes between the obturator nerve and vein and then through the obturator foramen to supply muscles of the thigh and the ligament of the head of the femur; gives off a nutrient artery to the ilium, some muscular branches, and a pubic branch which anastomoses with the inferior epigastric artery of the external iliac (may be large- accessory obturator); a medially placed obturator artery is vulnerable to injury during repair of femoral hernia

Front 84

the inferior vesical artery

Back 84

corresponds to the vaginal artery in the female; passes forward to base of bladder and supplies the seminal vesicle, the prostate, and the posteroinferior part of the bladder

Front 85

the vaginal artery

Back 85

to the vagina

Front 86

the uterine artery

Back 86

homolog of artery of ductus deferens; may arise from umbilical of internal iliac; descends on the side wall of the pelvis anterior to the internal iliac artery to enter the broad ligament; *the uterine artery passes anterior to and above the ureter near the lateral fornix of the vagina and this point of crossing lies about 2 cm superior to the ischial spine and anastomoses with the ovarian artery

Front 87

the middle rectal arteru

Back 87

to the middle of the rectum

Front 88

the internal pudendal artery

Back 88

leaves the pelvis between the piriformis and coccygeus muscles by passing through the greater sciatic foramen then enters the ischiorectal fossa through the lesser sciatic foramen; passes through the pudendal canal and divides into the deep and dorsal arteries of the penis or the clitoris; also gives off inferior rectal artery

Front 89

the inferior gluteal artery

Back 89

usually passes between S2 and S3 and leaves the pelvis through the inferior part of the greater sciatic foramen below the piriformis muscle

Front 90

posterior branches of the internal iliac artery

Back 90

the superior gluteal artery, the iliolumbar artery, the lateral sacral arteries

Front 91

the superior gluteal artery

Back 91

runs between the lubosacral trunk and the ventral rams of the 1st sacral nerve; leaves the pelvis through the superior parts of the greater sciatic foramen above the piriformis muscle

Front 92

the iliolumbar artery

Back 92

separates the obturator nerve from the oumbosacral trunk; divides into an laic branch and a lumbar branch

Front 93

the lateral sacral arteries

Back 93

descend anterior to the sacral ventral rami giving off spinal branches that pass through the pelvic sacral foramina and supply the contents of the sacral canal

Front 94

the median sacral artery

Back 94

the final unpaired branch of the abdominal aorta; runs anterior to body of sacrum

Front 95

the superior rectal artery

Back 95

direct continuation of the inferior mesenteric artery; anastomoses with middle rectal, a branch of the internal iliac and with the inferior rectal, a branch of the internal pudendal

Front 96

the ovarian arery

Back 96

paired; these arise from abdominal aorta inferior to the renal arteries; passes inferiorly internal to the ureter; anastomoses with the uterine artery

Front 97

lymphatics - in general the pelvic organs drain through the

Back 97

external and internal iliac lymph nodes and the sacral lymph nodes; from these nodes lymph drains to the common iliac and lumbar lymph nodes

Front 98

exceptions

Back 98

the upper and middle parts of the oviduct, funds of the uterus, the ovaries and the testes drain directly into the lumbar lymph nodes; the lowest part of the oviduct, the uterine body via the round ligament of the uterus, the vagina below the hymen, the anal canal inferior to the pectinate line, the scrotum (labia majora), and the skin and most of the penis (or clitoris) drain into the horizontal group of superficial inguinal nodes

Front 99

just in case anyone ever asks - as the ureters and the ductus deferens come in on the bladder what are their positions

Back 99

the ductus deferens runs superior and then dives down into the prostate to connect with the urethra; the ureters come in at an angle and attach so the ductus deferens slings on top of this connection as it comes in

Front 100

I don't care what netters says there are no BLANK arteries in the female

Back 100

inferior vesicle branches from obliterated umbilical (they could come off of vaginal)