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105 Cards in this Set

  • Front
  • Back
what devides the bony pelvis into greater(False) and lesser (true) pelves?
oblique surface of th epelvic inlet (superior pelvic apurture)

the pelvic inlet is bounded by the linea terminalis, and the bony rim is called the pevlic brim
what does the true pelvis contain?
pelvic viscera, such as unirnary bladder and preproductive organs
what ligament is a landmark for the pudental nerve?
sacrospinous and possibly the sacrotuberous
what ligement devides the siatic foramin?
sacrospinous and sacrotuberous
what ligament attaches to the ala, runs lateral to the ileum and brings some stability to the pelvis?
anterior sacroiliac ligament
what nerve peirces through the lesser siatic foramine?
obterator
what is the narrowest part of the pelvic canal (traversing pelvic inlet and pelvic outlet) ?
interspoinous distance- the babys head passes through here
What forms the pelvic floor?
the funnel shaped pelvic diaphram which consists of the levator ani and coccygeus
How does the levator ani attach to the pubic bones?

name the 3 parts of the levator ani
anteriorly

1. puborectalis- U muscular sling
2. pubococcygeus- forms part of the anococcygeal body
3. iliococcygeus
what is the perineal flexure?
90 degree turn in charge of rectal incontinence
what is the main and most medial part of the levator ani ?
(that is usally injured during child birth)
pubococcygyeus - because it encircles the urethra, vagina and anal canal.
whta connects the prostate to the pubis in the male?

what connects the fundus of the bladder to the pubis in females?
the anterior part of the tendinous arch of pelvic fascia

men= puboprostatic ligament
ladies= pubovisceral
what are potential spaces in the loose fatty tissue of the endopelvic fascia that accomodate the exspansion of the unrinary bladder and rectal ampulla as they fill?
retropubic and retrorectal spaces
what is a think band of condensened pelvic fascia that gives passage to essentially all vessels and nerves passing the lateral wall of hte pelvis to the pelvis viscera?
hypogastric sheath- which then devide into 3 lamina called
1. lateral ligament of the bladder
2. rectovescial septum/transverse cervical lig
3. posterior lamina
what spinal level is the rectum conected to the pelvic fascia?
s2-s4 (by the lateral rectal ligaments)
pelvic structures are innervated mainly by the:
sacral(s1-s4)coccygeal spinal nerves and th epelvic part of the ANS.

the lumbosacral trunk also joins up with the sacral plexus
where is the sacral plexus located?

what are the two main nerves of the sacral plexus?

most branches of the sacral plexus leave the pelvis through the?
posteriorlateral wall of the lesser pelvis. anterior to the surface of the piriformis.

siatic and pudental

greater siactic foramin
how does the siatic nerve (l4-s3) get to the ass?
passes through the greater siactic foramin inferior to the piriformous to enter the ass though the lesser foramin?
what is the main nerve of the perineum and the cheif sensory nerve or the external gentalia?
PUdental baby
what does the superior gluteal nevre supply?

what about inferior gluteal nerve?
glut med
glut mini
tensor fascia lata

glut MAX
the fascia white line is fused by:
obternator internus and levator ani
which siactic foramin does the pirifoormus go through to get to the femur?
greater
what muscle is good at helping you POOPY?
puborectalis
what is the segmental origen of the pudental nerve?
s2-s4
the hypogastric plexus (sup and inf) are networks of:

where is the main part of ther superior hypogastric plexus?

how does it terminate?
sympathetic and visceral afferents

inferior to the bifurcation of the aorta.


merges with parasympathetic pelvic splanchinics
what is aka the pouch of douglass?
the rectouterine pouch

-sometimes the exudate of uterine cancer builds up in here
discribe the pevlic pain line -
above the pelvic pain the the organs use the sympathetic pathways.

below the pelvic pain line, the organs use parasympathetic, pelvic splanchnic pathways.
retropubic space aka-
space of retzius...
The separation of transversalis fascia and peritoneum contains loose fatty tissue allowing for the filling of the bladder. This space is called the retropubic space of Retzius
the internal iliac passes over what to get to the pelvic cavity?
pelvic Brim
how does the obterator run on the pelvic wall?
anteriorinferiouly on the lateral wall
how does the uterine artery run on the levator ani?
medially
is the sigmoid colon and small bowel part of the pelvic viscera?
no- pg.224
where do the ureters pass over the pelvic brim?
bifurcation of the common iliac arteries
how do the ureters enter the bladder?
through the base (inferiormedially)
in males, the only structure that passes between the ureter and the perineum is the

in females?
ductus deferens


the ureter passes medial to the origen of the uterine A, and then inferior to it later on
The bladder is held freely within the extraperitoneal fatty tissue except for its NECK which is held by:
lateral ligaments of the bladder, tendonious arch of th epelvic fascia and (pubovesicla ligament in females)
where does the apex of the bladder point?
(anterior end) toward the superior edge of the pubic symphosis
What is the difference of the fundus Bladder in males and females?
FEM- the fundus is related to anterior wall of VAG

males- its by the rectum
where does the urethra enterthe bladder?

where are common spots for stones?
at the fixed neck of the bladder

1. junciton of ureter and renal pelvis
2. at external iliax and brim
3. where they pass through wall of the bladder
what part of the bladder is covered by perineum?
superior part
the walls of the bladder are composed cheifly of-
detrusor muscles
what involuntary muscle prevents men from peeing during ejaculation?
internal urethral sphincter
in males, the bladder fibers are continous with...

and the females?
prostate

urethra
whats at the anlge of the trigone of the bladder?

what is the supior line of the trigone?
ureteric orfices and the internal urethra orifce


interurethric crest (between ureter orfices)
what arteries supply the bladder in males?

females?
superior vesicle A
inferior vesical A (get fundus and neck)

superior vesical a
vaginal arteries
what nerve gives motor to the ddetrusor muscle in the bladder?

but what is the bladder reflex?
parasympathetic fibers through pelvic splenchnic

visceral afferents are stimulated when the bladder is stretched/presure with allows pee to go into the urethra- but we can surpress this.
vas deferns are ____ to the male urethra
medial
Male urethra is devided into 4 parts...

which is the most longest part?

which part to urinary and reproducive tracts merge?
1. preprostetic (in bladder)
2. prostatic
3. membranous
4. penile

the penile spongy urethra

prostatic
where does the female urethra terminate?
extrenla urethra orfice in the vestibule of the VAG, anterior to the VAG
the female urethra gets blood from?

innervation?
internal pudental and vaginal artiers

pudendal N
what continues the epidydmus?
ductus deferens
it is medial to the ureter, and terminates as an ampulla as it joins the seminal gland- which is between the fundus and the rectum
the base of the prostate is near the...
neck of the bladder
what is the isthmus of the prostate?
superior continuation of the urethral shpincter muscle
the ducts of the bulbouurethral glands pass through the perneal membrane with the______ and open up the mini apertures in the proximal part of the _______
intermediate urethra

spongy urethra penis bulby
the ductus deferens, seminal vesciles, ejaculatory ducts and prostate are richly innervated by:
sympathetic nerve fibers from the intermediolateral cell column.
where is the cervix in the VAGigi
superior end
what is the vaginal fornix?

what is the posterior vaginal fornix?
recess around protruding cervix

deepest part closly related to the rectouterine pouch
4 muscles contract the vagina and act like sphinceters:
1. pubovaginalis
2. EUS
3. UVS
4. bulbosponge
anterior relations to the VAGIGI
fundus of the urinary bladder and urethra
name the 2 vaginal gutters
the ant and post fornix
because of the superior position of the distended bladder, it may be ruptured by injuiries to....
inferior part of the anterior abdominal wall

a superior rupture of bladder brings urinein into the peritoneum cavity

a posterior rupture of the bladder, brings urine into the perinuem.
what is the position in males of th ebulboiurethral glands?

how do the ducts pass trhough the perinueal membrane
posterior later to prostate gland. (one on each side)

with the intermediate urethra amnd open through minute apertures in the proximal part of the spongy urethra.
so discribe the erection and ejaculate innervation real quick
ejaculation- sympathetic
erection- parasymp
in most cases, where does prostate cancer usually develope?
postereoloateral region
The roof of the ischiorectal fossa is formed by which of the following?
levator ani
The ischiocavernosus muscle is found in the
superficial perenial space
The broad ligament of the uterus is a double layer of peritoneum which encloses:
ovarian ligament
uterine tube
round ligament
uterine artery
The prostate gland lies
at the neck of the bladder and above the pelvic diaphragm
The superior and inferior gluteal arteries arise from the
internal iliac artery
The internal iliac artery give rise to all of the following branches
superior gluteal
middle rectal
superior vesicle
internal pudendal

**not ovarian!
In the male, the membranous urethra:
is the part within the urogenital diaphram
In the male, during a rectal examination, each of the structures below can be palpated:
prostate
sacrum
coccyx
ischial tuberosity

*** NOT ductus deferens
The lateral wall of the ischiorectal fossa is the
obtorater internus
In the male, the pelvic diaphragm separates the
pelvis from the ischiorectal fossa
Which of the following leaves the pelvis by passing through the lesser sciatic foramen?
obterator internus

**NOT piriformus
Each of the following crosses the pelvic brim
vas deferens
ureters
middle sacral artery
internal iliac artery

**** NOT uterine artery
The extension of the vaginal lumen around the intravaginal part of the uterine cervix is the
The cervix is the inferior end of the uterus that projects into the vagina. This means that the vagina comes up and wraps around the cervix, creating the vaginal fornix. There are multiple fornices at the top of the vagina: anterior, posterior, and lateral
Which of the following would be most likely to be damaged by a stab wound into the ischiorectal (ischioanal) fossa 2 cm lateral to the anal canal
The pudendal nerve is found about 2 cm lateral to the anal canal. Therefore, it is the structure most likely to be damaged by the stab wound.
The crus of the penis is the lateral part of the corpus cavernosum found at the
base of the penis

anterior to the anal canal
Who has a pernial body?
females ONLY
The inferior rectal artery is a branch of the internal pudendal artery that delivers blood to the
inferior part of the rectum
The pectinate line is the place where the
the lining of the anal canal changes from skin to mucosa. It is also a landmark that divides the lymphatic drainage, vascular supply, and innervation of the anal canal. Lymph coming from structures above the pectinate line drains to the inferior mesenteric lymph nodes or the internal iliac nodes. Lymph from structures below the pectinate line travels to the superficial inguinal lymph nodes.

As far as vasculature and nerves go... Superior to the pectinate line, arterial blood comes from the superior rectal artery and drains to the portal system through the superior rectal veins. This area is innervated by the inferior hypogastric plexus (autonomic innervation). Inferior to the pectinate line, blood comes from the inferior rectal arteries and is drained into the caval system. Innervation here comes from the inferior rectal nerves (somatic innervation).
The anorectal junction is the point where the rectal ampulla narrows due to
a U-shaped sling created by the puborectalis muscle. This area is superior to the pectinate line. The white line is a transitional area inferior to the pectinate line that represents some subtle changes as the mucosal lining becomes "regular" skin.
under normal conditions, where does fertilization take place ?
ampulla of the uterine tube- the longest and widest segment
what rectal structure is only found in males?
The rectovesicular pouch is a reflection of the peritoneum between the rectum and the bladder. It can only be found in males because females have the uterus sitting between the rectum and the bladder.
A 27-year-old woman is examined by her gynecologist. Upon rectal examination, a firm structure, directly in front of the rectum in the midline, is palpated through the anterior wall of the rectum. This structure is the:
The cervix of the uterus is anterior to the rectum. Since the cervix is the inferior part of the uterus that is protruding into the vagina, it should feel like a firm structure upon palpation. The bladder is the most anterior organ in the pelvis, in front of the uterus and rectum. So, the bladder would not be directly in front of the anterior wall of the rectum
is the prostate extraperitoneal?
yes
Structures within the lower gastrointestinal tract specialized for physical support of fecal material are the
There are usually three transverse rectal folds in the lower rectum. These are specializations of the circular layer of musculature that are designed to support fecal mass. Although circular folds is somewhat descriptive of the transverse rectal folds, this is not the best answer. Anal columns are longitudinal folds of mucosa over rectal vessels. They are found on the inner wall of the anal canal. Anal valves are the folds of mucosa that join the anal columns at their inferior ends.
Which of these features of the anal canal serves to indicate the point where the mucosal covering of the gastrointestinal tract ends and a skin-like covering begins?
The pectinate line is the line of transition between the mucosal lining of the anal canal and the skin lining of the anal canal. So, this is the point where the mucosal zone ends and the skin begins. The white line is a transitional zone between the pectinate line and "regular" skin where there are some more subtle changes in the epithelial lining of the anal canal. But the pectinate line is the line that demarcates the major transition from mucosal lining to skin.
A female patient is found to have an ectopic (tubal) pregnancy (embryo develops in the uterine tube). In order to gain access to the peritoneal cavity endoscopically to remove the embryo, the instrument can be passed into the vagina and through the:
This means that an incision made through the posterior fornix of the vagina will allow a surgeon to enter the rectouterine pouch of the peritoneal cavity and remove the embryo.
An elderly patient is having difficulty in voiding (urinating). He complains that after voiding, he still feels as though he needs "to go" again. You suspect that this patient suffers from benign prostatic hypertrophy, which has caused enlargement of the __________ of the bladder.
uvula
The part of the broad ligament giving attachment and support to the uterine tube is the:
mesosalpinx
is the femoral nerve in the true pelvis?
NNNOOOO

To answer this question, you need to understand what the true pelvis is. The true pelvis is the area beneath the pelvic brim (pelvic inlet), where the pelvic viscera are located. The false pelvis is the area above the pelvic brim, bounded by the iliac blades. Now, you just need to think about the structures listed and determine which ones are in which location. The femoral nerve is the structure that is not in the true pelvis. After coming off the lumbar plexus with contributions from L2, 3, and 4, the femoral nerve runs along the border between the psoas major muscle and the iliacus to travel into the lower limb. It never descends below the pelvic brim, so it is not in the true pelvis.
A structure which is homologous to the male scrotum
The labia majora and scrotum are homologous structures. The labia minora is the female counterpart of the pentscrotal raphe. The glans of the clitoris and glans of the penis are homologous structures. Finally, the shaft of the corpus cavernosum in the female is the shaft of the clitoris, which is homologous to the shaft of the penis.
4 major differences between the male and female pelvis
There are four major differences between the male and female pelvis. First, the subpubic angle and pubic arch are greater in the female pelvis than in the male pelvis. This is why A is correct-- females often have a subpubic angle of 90 degrees or greater. A second difference between the female and male pelvis is that the pelvis inlet for females is rounded, while for males it is heart shaped. Third, the pelvic outlet for females is larger than in males. Finally, the female pelvis has iliac wings that are more flared than in males.
You are observing a doctor perform an abdominal hysterectomy. He notes that it is vital to protect the ureter which is found in the base of the:
The mesometrium is the part of the broad ligament of the uterus that attaches the body of the uterus to the pelvic wall. The ureters pass through the base of the mesometrium as they travel to reach the bladder.
rectouterine pouch is the lowest extent of the female peritoneal cavity. At its lowest, it provides a coat of peritoneum to a portion of the
In females, the rectouterine pouch is a peritoneal fold reflecting from the rectum to the posterior fornix of the vagina. At its lowest extent, the rectouterine fold is draped over the posterior fornix of the vagina. This means that surgeons can make an incision in the posterior fornix of the vagina and enter the rectouterine pouch to harvest eggs from the ovaries or remove an ectopic pregnancy. Take a look at Netter Plate 337 for a picture of this relationship
In a CT scan of the pelvis, the uterus is located:
In the female pelvis, the bladder is the most anterior organ; the uterus is posterior to the bladder, and the rectum is posterior to the bladder and uterus.
rectouterine pouch is the lowest extent of the female peritoneal cavity. At its lowest, it provides a coat of peritoneum to a portion of the
In females, the rectouterine pouch is a peritoneal fold reflecting from the rectum to the posterior fornix of the vagina. At its lowest extent, the rectouterine fold is draped over the posterior fornix of the vagina. This means that surgeons can make an incision in the posterior fornix of the vagina and enter the rectouterine pouch to harvest eggs from the ovaries or remove an ectopic pregnancy. Take a look at Netter Plate 337 for a picture of this relationship
In a CT scan of the pelvis, the uterus is located:
In the female pelvis, the bladder is the most anterior organ; the uterus is posterior to the bladder, and the rectum is posterior to the bladder and uterus.
is the prostate extraperitoneal?
yes
Structures within the lower gastrointestinal tract specialized for physical support of fecal material are the
There are usually three transverse rectal folds in the lower rectum. These are specializations of the circular layer of musculature that are designed to support fecal mass. Although circular folds is somewhat descriptive of the transverse rectal folds, this is not the best answer. Anal columns are longitudinal folds of mucosa over rectal vessels. They are found on the inner wall of the anal canal. Anal valves are the folds of mucosa that join the anal columns at their inferior ends.
Which of these features of the anal canal serves to indicate the point where the mucosal covering of the gastrointestinal tract ends and a skin-like covering begins?
The pectinate line is the line of transition between the mucosal lining of the anal canal and the skin lining of the anal canal. So, this is the point where the mucosal zone ends and the skin begins. The white line is a transitional zone between the pectinate line and "regular" skin where there are some more subtle changes in the epithelial lining of the anal canal. But the pectinate line is the line that demarcates the major transition from mucosal lining to skin.
A female patient is found to have an ectopic (tubal) pregnancy (embryo develops in the uterine tube). In order to gain access to the peritoneal cavity endoscopically to remove the embryo, the instrument can be passed into the vagina and through the:
This means that an incision made through the posterior fornix of the vagina will allow a surgeon to enter the rectouterine pouch of the peritoneal cavity and remove the embryo.
An elderly patient is having difficulty in voiding (urinating). He complains that after voiding, he still feels as though he needs "to go" again. You suspect that this patient suffers from benign prostatic hypertrophy, which has caused enlargement of the __________ of the bladder.
uvula