Perineum & Pelvis 252-266

Front 1

Pelvis formed by...

Back 1

two hip bones, sacrum, coccyx

Front 2

Pelvic Brim

Back 2

AKA iliopectineal line; marks pelvic inlet; divides greater (false) pelvis above from lesser (true) pelvis below

Front 3

Pelvic Outlet

Back 3

closed by coccygeus & levator ani mm which form the floor of the pelvis

Front 4

In anatomic position, the following are in the same horizontal planes...

Back 4

1) ASIS & pubic tubercles
2) coccyx and upper margin of pubic symphysis
3) axis running through central point of inlet almost parallels curvature of sacrum

Front 5

Upper Pelvic aperture

Back 5

AKA pelvic inlet, pelvic brim; bound posteriorly by sacrum, laterally by arcuate line of ilium, anteriorly by pectineal line, pubic crest & pubic symphyses

Front 6

What crosses the pelvic inlet?

Back 6

ureter, gonadal vessels, middle sacral vessels, iliolumbar vessels, lumbosacral trunk, obturator nerve, spermatic cord, round lig of uterus, sympathetic trunk, suspensory ligament of ovary

Front 7

Lower Pelvic Aperture

Back 7

AKA pelvic outlet; diamond-shaped bounded posteriorly by sacrum & coccyx, laterally by ischial tub. and sacrotuberous ligs, anteriorly by pubic symphysis, arcuate pubic ligament and rami or pubic and ischium; closed by pelvic and urogenital diaphragms

Front 8

Sacroiliac joint

Back 8

synovial joint btw sacrum & ilium; covered by cartilage & supported by ant, post & interosseous sacroiliac ligaments;
TRASMITS WEIGHT OF BODY TO HIP BONE

Front 9

Pubic Symphyses

Back 9

cartilaginous joint btw pubic bones in the median plane

Front 10

Pelvic Diaphragm

Back 10

- forms pelvic floor, supports pelvic viscera
- formed by levator ani & coccygeus mm
- raises pelvic floor
- aids in defecation, micturition, parturition
- post to urogenital diaphragm, medial & deep to ischiorectal fossa

Front 11

Broad Ligament of Uterus

Back 11

consists of two layers of peritoneum; extends from lateral margin of uterus to lateral pelvic wall; holds uterus in position

Front 12

broad ligament - contents

Back 12

uterine tube, uterine vessels, round lig of uterus, ovarian ligament, ureter (lower part), uterovaginal nerve plexus, lymphatic vessels

Front 13

Mesovarium

Back 13

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

Front 14

Mesosalpinx

Back 14

fold of the broad ligament that suspends the uterine tube

grants 237

Front 15

Mesometrium

Back 15

major part of the broad ligament below the mesosalpinx and mesovarium

Front 16

Round ligament of the uterus

Back 16

attached to uterus in front of & below the attachment of the uterine tubes, represents the remains of the lower part of the gubernaculum

Front 17

round ligament (path, function)

Back 17

runs w layers of broad ligament, contains smoot m fibers, holds fundus of uterus forward;
enters inguinal canal at deep inguinal ring, emerges from superficial ring, becomes lost in subcu tissue of labium majus

Front 18

Ovarian Ligament

Back 18

fibromuscular cord that extends from ovary to uterus

Front 19

Suspensory ligament of ovary

Back 19

band of peritoneum that extends upward from the ovary to the pelvic wall and transmits the ovarian vessels, nerves, lymphatics

Front 20

Lateral/transverse cervial ligaments of the uterus

Back 20

AKA cardinal/Mackenrodt's ligaments; fibromuscular condensations of pelvic fascia from the cervix and vagina to pelvic walls, extend laterally below the base of the broad ligament, support the uterus

Front 21

Pubocervical ligaments

Back 21

firm bands of connective tissue that extend from the posterior surface of the pubis to the cervix of the uterus

Front 22

Pubovesical/Puboprostatic ligaments

Back 22

condensations of pelvic fascia that extend from neck of bladder (or prostate gland) to pelvic bone

Front 23

sacrocervical ligaments

Back 23

extend from lower end of sacrum to cervix and upper end of vagina

Front 24

Inferior Pubic (arcuate pubic) ligament

Back 24

arches across inferior aspect of the pubic symphysis and attaches to the medial borders of the inferior pubic rami

grants, 202, 232

Front 25

Rectouterine (sacrouterine) ligaments

Back 25

hold the cervix back and upward and sometimes elevate the rectouterine fold (sacrogenital fold in male)

Front 26

Rectouterine fold

Back 26

shelf-like fold of peritoneum; passes from the isthmus of the uterus to the posterior wall of the pelvis lateral to the rectum

grants 208, 233

Front 27

Rectouterine pouch

Back 27

AKA cul-de-sac of Douglas; sac or recess formed by a fold of the peritoneum dipping down btw the rectum and uterus; lies behind posterior fornix or vagina & contains peritoneal fluid and some of small intestine

grants 208, 233, 238, 250

Front 28

Rectovesical pouch

Back 28

peritoneal recess btw the bladder and the rectum in males

grants 217

Front 29

Vesicouterine pouch

Back 29

peritoneal sac btw bladder and uterus in females

grants 208

Front 30

Culdocentesis

Back 30

aspiration of fluid from the cul-de-sac of Douglass (rectouterine pouch) by a needle puncture of the posterior vaginal fornix near the midline btw the uterosacral ligaments; procedure done when pain occurs in the lower abdomen and pelvic regions and when ruptured ectopic pregnancy or ovarian cyst is suspected

Front 31

Ureter

Back 31

muscular tube that transmits urine

Front 32

three constrictions of ureter

Back 32

1) where renal pelvis joins ureter
2) where it crosses the pelvic brim
3) at its junction with the bladder

Front 33

path of ureter

Back 33

crosses the pelvic brim in front of the bifurcation of the common iliac artery; descends retroperitoneally on the lateral pelvic wall; runs medial to umbilical artery and obturator vessels and posterior to the ovary, forming posterior boundary of ovarian fossa

Front 34

in females, ureter is accompanied by...

Back 34

uterine artery, which runs above and anterior to it in the base of the broad ligament; *ureter is in danger during hysterectomy (water under the bridge = ureter under bridge of uterine artery)

grants 237

Front 35

in males the ureter...(pathway)

Back 35

passes posterior and inferior to the ductus deferens and lies in front of the seminal vesicle before entering the posterolateral aspect of the bladder in males

grants 217

Front 36

blood supply to ureter

Back 36

receives blood from aorta and renal, gonadal, common and internal iliac, umbilical, superior and inferior vesical, middle rectal arteries

Front 37

Urinary bladder (location)

Back 37

situated below the peritoneum and slightly lower in female than in male; extends upward above the pelvic brim as it fills

Front 38

Urinary bladder (anatomy)

Back 38

has APEX at anterior end and FUNDUS (base) at posteroinferor triangular portion; has NECK where fundus & inferolateral surfaces come together, leading into urethra

Front 39

Urinary bladder - UVULA & TRIGONE

Back 39

uvula = small eminence at apex of its trigone, projecting into orifice of urethra;
trigone = bounded by the two orifices of the ureters and the internal urethral orifice, surrounded by internal sphincter

Front 40

Detrusor muscle of bladder

Back 40

bundles of smooth mm fibers that surround urinary bladder

Front 41

blood supply to/venous drainage of urinary bladder

Back 41

receives blood from superior and inferior vesical arteries (and from vaginal a in xx); venous blood drained by prostatic/vesical plexus of veins which empty into internal iliac v.

Front 42

innervation of urinary bladder

Back 42

innervated by nerve fibers from vesical and prostatic plexuses; PARASYMPATHETIC nerve (pelvic splanchnics from S2-4) stimulates contraction of detrusor m, relaxes internal urethral sphincter, promotes emptying; SYMPATHETIC nerve relaxes detrusor & constricts internal urethral sphincter

Front 43

bladder cancer

Back 43

urually originates in cells lining inside of bladder; most common symptom hematuria; other symptoms are urinary frequency & painful urination

Front 44

Tenesmus

Back 44

constant feeling of desire to empty bladder or bowel, accompanied by pain, cramping and straining due to spasm of urogenital diaphragm

Front 45

Micturition

Back 45

urination/emptying of bladder; initiated by stretch receptors in the detrusor m

Front 46

Sympathetic involvement in micturition

Back 46

GVE fibers induce relaxation of the bladder wall and constrict internal urethral sphincter, INHIBIT emptying

Front 47

GVA impulses (micturition)

Back 47

arise from stretch receptors in bladder wall and enter spinal cord S2-S4 via pelvic splanchnic nerves

Front 48

Parasympathetic fibers (micturition)

Back 48

GVE fibers in pelvic splanchnic nerves synapse in pelvic (inferior hypogastric) plexus; postgang fibers to bladder musculature induce a reflex contraction of destrusor and relaxation of internal urethral sphincter, ENHANCE emptying

Front 49

GSE fibers (micturition)

Back 49

fibers in pudendal nerve cause voluntary relaxation of external urethral sphincter and bladder begins to void

Front 50

End of Micturition

Back 50

external urethral sphincter contracts, bulbospongiosus mm in male expel last drops of urine from urethra

Front 51

Testis

Back 51

covered by tunia albuginea which lies beneath tunica vaginalis; produces spematozoa and secretes sex hormones

Front 52

blood supply to testis/venous drainage

Back 52

supplied by testicular artery from abdominal aorta, drained by veins of pampiniform plexus

Front 53

lymph drainage of testis

Back 53

lymph vessels ascend with testicular vessela and drain into lumbar (aortic) nodes; lymphatic vessels in the scrotum drain into superficial inguinal nodes

Front 54

testicular torsion

Back 54

twisting of spermatic cord and testis within scrotum; results in blockage of blood supply to testis and produces sudden urgent pain, swelling, redness of scrotum; may be caused by trauma or spasm of cremaster mm and can be treated by surgery

Front 55

orchitis

Back 55

inflammation of the testis marked by pain, swelling, feeling of heaviness of testis; may be caused by mumps, gonorrhea, syphilis, tuberculosis; if spread to epidydymis, it is called epididymo-orchitis

Front 56

Testicular cancer

Back 56

develops from early state spermatogenic cells, Leydig cells, Sertoli cells; signs & symptoms include a painless mass or lump, testicular swelling, hardness, feeling of heaviness or aching in scrotum or lower abdomen

Front 57

Cryptorchidism

Back 57

congenital condition in which the testis fails to descend into the scrotum during fetal development; undescended testes are associated w reduced fertility, increased risk of testicular cancer, higher susceptibility to testicular torsion and inguinal hernias

Front 58

Epididymis

Back 58

consists of head, body, tail and contains CONVOLUTED DUCT; functions in MATURATION & STORAGE of spermatozoa in the head/body and PROPULSION of spermatozoa into the ductus deferens

Front 59

Ductus Deferens (anatomical pathway)

Back 59

enters pelvis at deep inguinal ring at the lateral side of the inferior epigastric artery; crosses medial side of umbilical artery and obturator nerve and vessels, passes superior to ureter near the wall of the bladder and is dilated to become the ampulla at its terminal part

Hint 59

grants 217-219

Front 60

Ductus Deferens (function)

Back 60

contains fructose which is nutritive to spermatozoa; receives innervation primarily from sympathetic nerves of hypogastric plexus and parasympathetic nerves of the pelvic plexus

Front 61

Vasectomy

Back 61

surgical excision of a portion of the vas deferens (ductus deferens) through the scrotum; stops the passage of spermatozoa but neither reduces the amount of ejaculate greatly nor diminishes sexual desire

Front 62

Ejaculatory ducts

Back 62

formed by the union of the ductus deferens with the ducts of the seminal vesicles; peristaltic contractions propel spermatozoa w/ seminal fluid into urethra

grants 216

Front 63

Ejaculatory ducts (connection to urethra)

Back 63

open into the prostatic urethra on the SEMINAL COLLICULUS just lateral to the blind PROSTATIC UTRICLE

grants 221

Front 64

Seminal Vesicles

Back 64

enclosed by dense endopelvic fascia, are lobulated glandular structures that are diverticula of the ductus deferens

Front 65

Seminal Vescicles (location)

Back 65

inferior and lateral to the ampullae of the ductus deferens against the fundus (base) of the bladder

Front 66

Seminal Vescicle (function)

Back 66

produce the alkaline constituent of seminal fluid, which contains fructose and choline; have lower ends that become narrow and form ducts, which join the ampullae of the ductus deferens to form the ejaculatory ducts

Front 67

Prostate gland (location, anatomy)

Back 67

located at the base of the urinary bladder; has five lobes:
1) anterior lobe
2) middle lobe - prone to benign hypertrophy
3) posterior lobe - prone to carcinomatous transformation
4) R & L lateral lobes

Front 68

Prostate gland (function)

Back 68

secretes a fluid that produces the characteristic odor of semen; secretes PSA (prostate-specific antigen), prostaglandins, citric acid and acid phosphatase and proteolytic enzymes

Front 69

Prostatic Sinus

Back 69

a groove on either side of the urethral crest

grants 221

Front 70

hypertrophy of prostate

Back 70

benign enlargement of prostate that occurs most often in middle lobe leading to nocturia, dysuria & urgency

Front 71

Prostate Cancer

Back 71

occurs particularly in the posterior lobe; usually asymptomatic in early stages; spreads via vertebral venous plexus; metastasizes to heart and lungs through prostatic venous plexus, internal iliac veins into IVC

Front 72

Prostatectomy

Back 72

surgical removal of prostate gland;

Front 73

Urethral Crest

Back 73

located on the posterior wall of the prostatic urethra & has numerous openings for the prostatic ducts on either side

grants 221

Front 74

Seminal colliculus

Back 74

ovoid-shaped enlargement on which the two ejaculatory ducts and prostatic utricle open

Front 75

Erection

Back 75

depends on stimulation of PARASYMPATHETICS from pelvic splanchnic nerves, which dilates the arteries and causes engorgement of corpora cavernosa & corpus spongiosum, compressing veins

Front 76

Erection maintained by contraction of...

Back 76

bulbospongiosus and ischiocavernosus muscles which compress the erectile tissues of the bulb and crus

Front 77

"point & shoot"

Back 77

Point (erection by Parasympathetic)
Shoot (ejaculation by Sympathetic)

Front 78

Ejaculation

Back 78

friction to glans penis and other stimuli result in EXCITATION OF SYMPATHETICS; leading to contraction of smooth m of epididymal ducts, ductus deferens, seminal vesicles, prostate

Front 79

Ejaculation (role of bladder)

Back 79

during ejaculation, sphincter of the bladder contracts, preventing the entry of urine into the prostatic urethra and the reflux of semen into the bladder

Front 80

Ovaries

Back 80

lie on posterior aspect of broad ligament; not covered by peritoneum; attached to posterior layer of broad ligament by MESOVARIUM; surface covered by germinal epithelium

Front 81

Ovaries (blood supply)

Back 81

blood supply primarily from ovarian arteries, which are contained in the suspensory ligament and anastomose w branches of uterine arter

Front 82

Ovaries (venous drainage)

Back 82

drained by ovarian veins; the right ovarian vein joins the IVC and the left joins the left renal vein

Front 83

Ovarian Cancer

Back 83

develops from germ cells that produce ova or eggs, stromal cells that produce estrogen & progesterone and epithelial cells; symptoms include feeling of pressure on pelvis or changes in bowel/bladder habits; metastasis via lymph and blood vessels to nearby structures

Front 84

Uterine tubes

Back 84

extend from uterus to uterine end of the ovaries and connect uterine cavity to peritoneal cavity

Front 85

Uterine tube (parts)

Back 85

1) uterine part
2) isthmus
3) ampulla (longest/widest)
4) infundibulum (funnel-shaped termination formed of fimbrae)

Front 86

uterine tube (function)

Back 86

convey the fertilized or unfertilized oocytes to the uterus by ciliary action and muscular contraction; transport sperm toward eggs; fertilization takes place w/in tube usually in infundibulum or ampulla

Front 87

Uterus

Back 87

organ of gestation in which fertilized oocyte becomes embedded and developing organism grows until birth

Front 88

Uterus (position)

Back 88

anteverted & anteflexed, supported by pelvic diaphragm, urogenital diaphragm, round, broad, lateral or transverse cervical ligaments, pubocervical, sacrocervical, rectouterine ligaments

Front 89

blood supply to uterus

Back 89

primarily from uterine artery, secondarily from ovarian artery

Front 90

Fundus of uterus

Back 90

the rounded part of uterus located superior and anterior to the plane of the entrance of the uterine tube

Front 91

Body of uterus

Back 91

main part of uterus located inferior to the fundus and superior to the isthmus

Front 92

uterine cavity

Back 92

triangular in the coronal section and is continuous with the lumina of the uterine tube and with the internal os

Front 93

Isthmus of Uterus

Back 93

constricted part of the uterus located btw the body and cervix of the uterus; corresponds to internal os

Front 94

Cervix

Back 94

inferior narrow part of the uterus that projects into the vagina and divides into regions:
1) internal os
2) cervical canal
3) external os

Front 95

Uterine prolapse

Back 95

protrusion of the cervix into the lower part of the vagina close to the vestibule and causes bearing-down sensation in womb and increased frequency of and burning sensation on urination; results from weakness in mm & ligaments

Front 96

Fibromyoma

Back 96

(leiomyoma); most common benign neoplasm of the female genital tract; may cause urinary freq, dysmenorrhea, abortion or obstructed labor

Front 97

Fibroid

Back 97

benign uterine tumor made of smooth m cells and fibrous connective tissue in the wall of the uterus

Front 98

Endometriosis

Back 98

benign disorder in which a mass of endometrial tissue occurs aberrantly in various locations, including the uterine walls, ovaries; frequently forms cysts containing altered blood

Front 99

Endometrial cancer

Back 99

most common type of uterine cancer and develops from endometrium of uterus; main symptom is vaginal bleeding

Front 100

Cervical cancer

Back 100

slow-growing cancer that develops from epithelium covering the cervix; major risk factor is HPV infection

Front 101

Papanicolaou (Pap) smear

Back 101

cervical smear test effective in detecting cervical cancer early; cancer metastasizes to extrapelvic lymph nodes, liver, lung and bone and can be treated by surgical removal

Front 102

Hysterectomy

Back 102

surgical removal of the uterus, may result in injury to the ureter

Front 103

Vagina

Back 103

extends btw vestibule and cervix of the uterus; serves as excretory channel; has a FORNIX that forms the recess btw the cervix and wall of vagina; opens into vestibule & is partially closed by the hymen

Front 104

Vagina supported by...

Back 104

levator ani, transverse cervical, pubocervical, sacrocervical ligaments; urogenital diaphragm, perineal body

Front 105

blood supply to vagina

Back 105

from vaginal branches of uterine artery and of the internal iliac artery

Front 106

lymph drainage of vagina

Back 106

two directions:
1) lymphatics from the upper 3/4 drain into the internal iliac nodes
2) lymphatics from lower 1/4 drain downward to perineum and into superficial inguinal nodes

grants 245

Front 107

innervation of vagina

Back 107

innervated by nerves derived from the uterovaginal plexus for the upper 3/4;
deep perineal branch of pudendal for lower 1/4

Front 108

Vaginismus

Back 108

painful spasm of the vagina resulting from involuntary contraction of the vaginal musculature, preventing sexual intercourse

Front 109

Mediolateral episiotomy

Back 109

surgical incision through the posterolateral vaginal wall, just lateral to the perineal body; enlarges birth canal and prevents uncontrolled tearing during parturition

Front 110

Median episiotomy

Back 110

incision is carried posteriorly in the midline through the posterior vaginal wall and the central tendon (perineal body); relatively bloodless and painless but provides limited expansion

Front 111

Gonorrhea

Back 111

infectious disease caused by bacteria Nisseria gonorrhoeae; symptoms include painful or burning sensation while urinating & a yellowish-white discharge from vagina or penis; treated with cephalosporin or quinolone types of antibiotics

Front 112

Chlamydia

Back 112

STD caused by Chlamydia trachomatis; usually no symptoms but if they do occur, the consist of a discharge from penis or vagina and burning sensation when urinating; women may experience painful intercourse