Pelvis And Perineum

Front 1

Pelvic girdle (bones)

Back 1

-3 fused bones forming the os coxae bilaterally (ilium, ischium and pubis)
-right and left sides joined at symphisis pubis and connected to sacrum at SI joint

Front 2

Functions of pelvic girdle

Back 2

-bears weight in sitting/standing
-site of attachment for muscles of ambulation
-protect pelvic and lower abdominal viscera

Front 3

Subpubic angle

Back 3

-angle between pubic arch and inferior pubic rami (determines if a woman can have a large child)

Front 4

False/greater pelvis

Back 4

-superior to pelvic inlet
-think of this as "lower abdomen"
-bounded by iliac alae
-contains: ileum and sigmoid colon

Front 5

True/lesser pelvis

Back 5

-obstetric pelvis
-lateral walls of true pelvis: obturator internus muscle
-entrance at pelvic inlet: contains rectum, bladder and reproductive organs
-exit at pelvic outlet: exit of infant's head in a vaginal birth

Front 6

Pelvic outlet

Back 6

-Bounded by pubic arch, ischial tuberosities and coccyx
-Contains perineum
-Exit of true pelvis
-Babies exit the womb this way

Front 7

Pelvic diaphragm

Back 7

-aka pelvic floor
-levator ani: 3 regions (don't need to know them)

Front 8

Damage to levator ani

Back 8

may occur during childbirth (surgical, tear)
-often involves the pubococcygeous
-may result in partial loss of function of pelvic diaphragm (do keigel exercises!)

Front 9

Functions of coccygeus muscles

Back 9

-Support pelvic viscera
-Maintains urinary continence
-Assists in defecation
-Supports fetus (head) during delivery
-Separates pelvic cavity from perineum
-Dysfunction results in prolapse, incontinence

Front 10

Ligaments of pelvis

Back 10

-sacrotuberous ligament: sciatic notch to sciatic foramen
-sacrospinous ligament: divides sciatic foramen into greater and lesser sciatic foramena

Front 11

Sex variations in pelvis - female

Back 11

Lighter and thinner
Greater pelvis shallow
Lesser pelvis wide
Pelvic inlet oval
Pelvic outlet larger
Subpubic angle >80º

Front 12

Sex variations in pelvis - male

Back 12

More massive
Greater pelvis deep
Lesser pelvis narrow
Pelvic inlet heart-shaped
Pelvic outlet smaller
Supubic angle <80º

Front 13

Peritoneum of pelvis

Back 13

-parietal peritoneum lines pelvic cavity above pelvic floor
-pelvic organs only partially covered by peritoneum
-exception:ovaries and uterine tubes

Front 14

Folds of peritoneum

Back 14

-rectouterine pouch
-vesicouterine pouch
-rectovesical pouch

Front 15

Rectouterine pouch

Back 15

-in female
-pouch of Douglas, cul-de-sac
-fluid accumulation with intra-abdominal inflammation

Front 16

Vesicouterine pouch

Back 16

-in female
-between bladder and uterus

Front 17

Rectovesical pouch

Back 17

-in male
-also in female s/p hysterectomy

Front 18

Peritoneal reflections in female

Back 18

-broad ligament
-from uterus to pelvic wall and floor (mesosalpinx, mesovarium, mesometrium)

Front 19

Arteries of pelvis

Back 19

-mostly everything important branches off of iliac artery (LOTS of variation in branching)
-branches in pelvis from other arteries (gonadal arteries off abdominal aorta, superior rectal artery off IMA)

Front 20

Umbilical artery

Back 20

-branch off internal iliac artery
-obliterated after birth

Front 21

Arteries off anterior division of internal iliac artery

Back 21

-umbilical artery
-vesical artery (superior)
-obturator artery
-vesical artery (inferior, males)
-vaginal artery (female)
-middle rectal artery
-uterine artery
-internal pudendal artery
-inferior gluteal artery

Front 22

Arteries off posterior division of internal iliac artery

Back 22

-iliolumbar artery
-lateral sacral artery
-superior gluteal artery

Front 23

Obturator artery

Back 23

-Serves muscles and head of femur
-Many variations
-May see off interior epigastric artery (extrapelvic branch)
-Enters pelvis over brim
-Femoral hernia tissue

Front 24

Inferior vesical artery

Back 24

-In male only
-(vaginal continuing as uterine artery in female)
-Services inferior bladder, prostate, ductus, seminal vesicles

Front 25

Vaginal artery

Back 25

-Female only
-May arise from uterine artery
-Services inferior bladder, lower vagina
-(not seen in lab)

Front 26

Middle rectal artery

Back 26

-lots of variation
-services inferior rectum

Front 27

Inferior gluteal artery

Back 27

-terminal branch of anterior division
-services pelvic diaphragm, gluteal muscles

Front 28

Internal pudendal artery

Back 28

-terminal branch of anterior division
-with pudendal nerve, goes through both greater and lesser sciatic foramena
-services perineum

Front 29

Pelvic veins and lymphatic drainage

Back 29

-venous plexuses drain into internal iliac veins upward then drainage into internal vertebral plexus
-lymphatic drainage follows venous drainage

Front 30

Pelvic Nerves: Sacral Plexus

Back 30

L4-S4
-pudendal nerve
-sciatic nerve
-superior and inferior gluteal nerves

Front 31

Pudendal nerve

Back 31

S2-S4 anterior rami
Innervation of perineum and external genitalia
Leaves pelvis through greater sciatic foramen, enters perineum through lesser sciatic foramen

Front 32

Sciatic nerve

Back 32

L4-S3 anterior rami
Leaves pelvis through greater sciatic foramen into gluteal region
Branches into: tibial nerve and common peroneal nerve

Front 33

Superior and inferior gluteal nerves

Back 33

L4-S1 anterior rami
Superior: gluteus medius, minimus and tensor fascia lata
Inferior: gluteus maximus

Front 34

Obturator nerve

Back 34

From L2-4 anterior rami (lumbar plexus)
Leaves true pelvis through obturator foramen (with artery)
Supplies adductors of thigh

Front 35

Ureters

Back 35

Retroperitoneal tubes
Deliver urine to urinary bladder
Refered pain to ipsilateral lower abdomen and groin

Front 36

Urinary bladder

Back 36

Reservoir for urine prior to urination
Varies greatly in size depending on volume
Neck held firmly by pelvic fascia
Normally a pelvic muscle but can become an abdominal muscle depending on how much you drink

Front 37

Detrusor Muscle

Back 37

Relaxes to fill bladder
Contracts to empty bladder

Front 38

Internal urethral sphincter (smooth muscle)

Back 38

Prevents retrograde ejaculation in men
Assists in opening orifice
Deactivated on meds such as Cialis, Flomax etc

Front 39

Trigone and ureteric orifices

Back 39

Trigone is triangle between uretal orifices and urethral orifice
Sensitive to bladder filling
Signals to empty bladder

Front 40

Bladder obstruction

Back 40

Common in older men with benign prostatic hypertrophy. Will cause difficulty urinating and eventual bladder wall hypertrophy

Front 41

Urethra

Back 41

-muscular tube which conveys just urine in female and urine and semen in male

Front 42

Regions of male urethra

Back 42

Prosthetic – portion that goes through prostate
Membranous
Spongy – distance of penile shaft

Front 43

Ductus (Vas) Deferens

Back 43

Thick wall, small lumen conveys sperm
From epididymis-joins duct of seminal vesicle to form ejaculatory duct
Then joins urethra

Front 44

Seminal vesicles

Back 44

Glands which secrete fructose (food for sperm)
Superior to prostate

Front 45

Prostate

Back 45

2/3 glandular (exocrine, antigens, sugars, alkaline fluids)
1/3 fibromuscular

Front 46

Lobes of prostate

Back 46

-Inferoposterior (palpable during digital rectal, most common site of CA)
-Lateral lobes (right and left)
-Median lobe

Front 47

What is male prostate homologous to in female?

Back 47

paraurethral glands (Skene’s glands, lesser vestibular glands)

Front 48

Male: bulbourethral glands

Back 48

“Cowper’s gland”
Homologous to Bartholin’s (Greater vestibular) glands in female
Emit pre-ejaculate during sexual arousal

Front 49

Distensible tube of vagina

Back 49

Passage of menses
Acceptance of penis during intercourse
Passage of fetus during childbirth

Front 50

Fornices of vagina

Back 50

Posterior, anterior and lateral recesses

Front 51

Uterus (function and 4 parts)

Back 51

Region of embryo and fetal development
-body
-fundus
-isthmus (area between body and cervix)
-cervix

Front 52

3 layers of uterus

Back 52

Perimetrium: outer serous layer (peritoneum)
Myometrium: contraction during childbirth stimulates by prostaglandins
Endometrium: menstrual cycle

Front 53

2 anatomical variants of the uterus

Back 53

anteverted, anteflexed lies on urinary bladder
-retroverted (retroflexed) backward facing toward sacrum

Front 54

Female uterine tubes

Back 54

Tube for transmission of ovum to uterine cavity
Covered by broad ligament attached to mesosalpinx

Front 55

Ectopic pregnancy

Back 55

anatomically most common site is in ampulla of uterine tube. As fetus grows, this causes acute abdominal pain and may rupture the uterine tube resulting in peritonitis. Ectopic pregnancies are managed by surgical removal of the effected portion of the uterine tube

Front 56

Ovaries (general)

Back 56

Covered in broad ligament and attached to mesovarium
NAV conveyed via suspensory ligament of ovary
Attached to uterus via ovarian ligament (ovarian ligament starts out as gubernaculum)

Front 57

Ovaries arterial blood supply

Back 57

Double blood supply allows for viable ovaries after hysterectomy
-blood supply from
Internal iliac artery (via uterine arteries)
Abdominal aorta (gonadal arteries)

Front 58

Rectum

Back 58

Teniae coli converge to form smooth wall
Rectum ends at levator ani

Front 59

Anorectal flexure

Back 59

-marks end of rectum and beginning of anal canal
-important in fecal continence

Front 60

Anorectal junction

Back 60

-superior line across upper limit of anal columns
-juncture of rectum and anus

Front 61

Anal canal

Back 61

-inferior GI tract
-Distal colon
-Internal (involuntary) and external (voluntary, S4) anal sphincters
-if you do a digital rectal exam and there’s atony (no tone), suggests damage at S4
-Pectinate line: inferior border of anal columns

Front 62

Lymphatic drainage of anal canal

Back 62

Above line to preaortic, internal iliac nodes
Below line to inguinal nodes

Front 63

Innervation of anal canal

Back 63

Above line= visceral (insensitive)
Below line= somatic (sensitive)

Front 64

Internal hemmorhoids

Back 64

venous dilatation of internal rectal plexus that causes out pouching of rectal mucosa above the pectinate line. These are insensate (non-painful) unless incarcerated.

Front 65

External hemmorhoids

Back 65

thrombosis of external rectal venous plexus below the pectinate line. These are sensate- OUCH

Front 66

Perineum

Back 66

-Diamond shaped region inferior to pelvic diaphragm, between legs
-Diamond is formed by two triangles: urogenital triangle and anal triangle

Front 67

Urogenital triangle

Back 67

-continuation of abdominal fascia (Scarpa’s)
-becomes Colle’s fascia
-superficial perineal space
-deep perineal space
-perineal body

Front 68

Superficial perineal space contains:

Back 68

Crura of clitoris, bulbs of the vestibule, greater vestibular glands
Root and crura of penis, spongy urethra
Both: superficial transverse perineal muscles and associated nerves and vessels

Front 69

Deep perineal space contains:

Back 69

Membranous portion of urethra
Part of the vagina (female)
Bulbourethral glands (Cowper’s; male)
Vessels and nerves (branches of pudendal)
Ischioanal fossa
Bulbourethral glands of male

Front 70

Perineal body

Back 70

Central point of perineum
Episiotomy and tear
-median episiotomy: incision through perineal body
-allows for delivery
-minimizes tearing? (some argue there are better ways to cut for an episiotomy)

Front 71

Anal triangle contains:

Back 71

-ischioanal fossa
-pudendal nerves and vessels
-anal canal

Front 72

Ischioanal fossa

Back 72

Fat filled regions which support distal colon
Fat easily compresses to permit evacuation (pooping)

Front 73

3 parts of penis

Back 73

root, body and glans

Front 74

Erectile tissue made up of 3 vascular muscles

Back 74

-corpora cavernosum
-corpus spongiosum
-ischiocavernosus muscles

Front 75

Corpora cavernosum

Back 75

-bun of hotdog
-crura of penis

Front 76

Corpus spongiosum

Back 76

-hotdog
-contains urethra
-bulb (root) of penis covered in bulbospongiosus
-glans of penis

Front 77

Ischiocanvernosus muscles

Back 77

-Surround crura of penis
-Help to maintain erection and complete urination
-Pudendal nerve

Front 78

Bulbospongiosus

Back 78

It's a muscle
Assist in erection maintenance
-compresses dorsal vein
Pudendal nerve

Front 79

Hypospadias

Back 79

-external urethral orifice ventrally placed

Front 80

Vulva includes:

Back 80

-mons pubis
-labia minora
-labia majora (posterior labial commisure)
-clitoris

Front 81

Clitoris

Back 81

-analogous to male penis
-Glans
-Crura (corpora cavernosa)
-Prepuce formed by labia minora
-Ischiocavernosus m overlies

Front 82

Vestibule

Back 82

-opening of vagina, accepts penis
-space between labia minora
-orifices for urethra, vagina

Front 83

Bulbs of the vestibule

Back 83

Erectile tissue, covered by bulbospongiosum hold penis in vagina during intercourse

Front 84

Glands of the vestibule

Back 84

Greater vestibular gland ( AKA: Bartholin’s Gland): secrete mucous for lubrication
Lesser vestibular gland (Skene’s Glands) : secrete mucous for lubrication

Front 85

Bartholin's Gland Cyst

Back 85

A mucinous accumulation in the Barthonlin’s glands may form a cyst and is at risk for infection. This would be very painful to the patients especially during intercourse and urination and might require incision and drainage as well as antibiotics.

Front 86

Homologous structures: female: labia majora

Back 86

male: scrotum

Front 87

Homologous structures: female: clitoris

Back 87

male: penis

Front 88

Homologous structures: female: bulb of the vestibule

Back 88

male: bulb of the penis

Front 89

Homologous structures: female: glans clitoris

Back 89

male: glans penis

Front 90

Homologous structures: female: clitoral hood

Back 90

male: foreskin

Front 91

Homologous structures: female: Bartholin's glands

Back 91

male: bulbourethral glands

Front 92

Homologous structures: female: Skeene's

Back 92

male: prostate