Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
215 Cards in this Set
- Front
- Back
|
know difference b/w true pelvis and false pelvis
|
...they are both separate, no overlap
|
|
|
superior boundary of pelvis is the
|
pelvic inlet
|
|
|
inferior boundary of pelvis is the
|
pelvic outlet
|
|
|
This inferior outlet is closed by
|
the muscular pelvic diaphragm.
|
|
|
Passing through the pelvic diaphragm are the
|
rectum and urogenital structures
|
|
|
T or F: false pelvis part of abdominal cavity
|
true
|
|
|
true pelvis is related to which bones?
|
inferior pelvic bones, sacrum, coccyx
|
|
|
the pelvic organs, blood vessels, and nerves can be thought of as positioned how with respect to the peritoneum
|
retroperitoneal
|
|
|
which muscle and which nerve pass through the greater sciatic foramen?
|
piriformis; greater sciatic nerve
|
|
|
rectum is positioned how with respect to the peritoneum
|
retroperitoneal
|
|
|
prostate is about the size of what in a healthy male?
|
walnut
|
|
|
how many fused vertebrae in sacrum and coccyx respectively?
|
5-sacrum
4-coccyx |
|
|
joint b/w sacrum and pelvic bone is what type of joint?
|
synovial
|
|
|
what are the 2 major ligaments of the pelvic wall?
|
sacrospinous
sacrotuberous |
|
|
superior gluetal nerve is in what position relative to piriformis?
|
above it
|
|
|
inferior gluteal nerve is in what position relative to the piriformis
|
below it
|
|
|
what major structures pass through the lesser sciatic foramen?
|
tendon of obturator internus
pudendal nerve internal pudendal vessels |
|
|
pubic symphysis made up of what type of connective tissue?
|
fibrocartilage
|
|
|
in which direction is the sacrum angled towards, anteriorly or posteriorly?
|
posteriorly
|
|
|
what is the most common site of lumbar disc herniation?
|
the intervertebral disc b/w L5/S1
|
|
|
which spinal nerve would be affected by herniation of L5/S1 intervertebral disc?
|
S1
|
|
|
why does sacro-iliac joint have so many ligaments?
|
because so much force is being transmitted through the joint all the time
|
|
|
sacrospinous and sacrotuberous ligament serve what other fxn other than forming foramen?
|
preventing sacrum from tilting forward
|
|
|
general structure of male vs. female pelvis
|
male- thick and heavy
female - thin and light |
|
|
what is the easiest way to distinguish male vs. female pelvis?
|
look at pubic arch
|
|
|
pubic arch in male vs. female
|
male-narrow
female-wide |
|
|
female pelvis is adapted for
|
childbirth
|
|
|
pelvic inlet shape of female
|
circular
|
|
|
difference in ischial spine in female vs. male
|
in female, it does not project as far medially as in the male
|
|
|
what is the most common female pelvis type?
|
gynecoid
|
|
|
why is it important to know specific pelvis type/shape of a female?
|
to see if childbirth will be OK
|
|
|
how is capacity for woman's pelvis for vaginal delivery measured?
|
radiographically or manually
|
|
|
interspinous distance is
|
narrowest part of the pelvic canal
|
|
|
is the interspinous distance fixed?
|
No
|
|
|
by how much and under what influence can the interspinous distance increase?
|
10-15%, under influence of relaxin
|
|
|
obstetrical conjugate is
|
narrowest fixed distance through which the bay's head must pass in a vaginal delivery
|
|
|
is the obstetrical conjugate affected by relaxin during childbirth?
|
No
|
|
|
how many fingers indicate that ischial tuberosities are far enough apart to allow average full-term fetal head to pass during delivery?
|
3
|
|
|
obstetric conjugate has to be at least how long?
|
10 cm
|
|
|
anterior wall of true pelvis is
|
Bodies and rami of pubic bone and pubic symphysis
|
|
|
lateral walls of true pelvis formed by
|
Hip bones covered by obturator internus M
|
|
|
posterior wall of true pelvis formed by
|
Sacrum and coccyx, adjacent parts of ilia and sacroiliac joints
|
|
|
floor of true pelvis fromed by
|
Muscles of pelvic diaphragm:
Levator ani m and coccygeus m |
|
|
posterior wall of true pelvis is covered by what posterolaterally?
|
piriformis
|
|
|
obturator internus origin
|
Deep surface of obturator membrane and adjacent bone
|
|
|
obturator internus insertion
|
Medial surface greater trochanter of femur
|
|
|
obturator internus innervation
|
L5/S1
|
|
|
obturator internus action
|
Laterally rotates extended hip joint
Abducts flexed hip |
|
|
specialization of obturator internus fascia helps form what within perineum?
|
pudendal canal
|
|
|
piriformis origin
|
Anterior surface of sacrum between sacral foramina
|
|
|
piriformis insertion
|
medial side of superior border of greater trochanter of femur
|
|
|
piriformis innervation
|
S1/S2 mainly
|
|
|
piriformis action
|
Laterally rotates extended hip joint
Abducts flexed hip |
|
|
coccygeus origin
|
ischial spine and pelvic surface of sacrospinous ligament
|
|
|
coccygeus insertion
|
Lateral margin of coccyx and related sacrum
|
|
|
coccygeus muscle also known as
|
ischiococcygeus muscle
|
|
|
coccygeus innervation
|
branches from anterior rami of S3 and S4
|
|
|
coccygeus action
|
Contributes to floor of pelvis, helps support pelvic viscera, pulls coccyx forward after defecation
|
|
|
Levator Ani origin
|
Posterior aspect of pubic bone, tendinous arch (thickening of obturator internus fascia), ischial spine via the tendinous arch
|
|
|
Levator Ani insertion
|
Anteriorly to superior surface of perineal body, posteriorly meets partner of other side and attaches along the anococcygeal ligament
|
|
|
Levator Ani innervation
|
direct branch of S4
inf. rectal branch of pudendal (S2-S4) |
|
|
Levator Ani action
|
Major part of pelvic floor, supports pelvic viscera, pulls coccyx forward after defecation
|
|
|
anorectal angle aka
|
perineal flexure
|
|
|
How many degrees is the anorectal angle?
|
80 deg.
|
|
|
what is the significance of the puborectalis muscle?
|
pulls on the anorectal junction, creating the anorectal angle
|
|
|
urogenital hiatus allows for passage of what structures in male vs female?
|
male-urethra
female-urethra AND vagina |
|
|
urogenital hiatus is
|
gap b/w medial borders of levator ani muscles on either side
|
|
|
significance of perineal membrane and associated muscles that fill urogenital hiatus
|
serve as sphincters
help support urogenital organs |
|
|
in general, the pelvic organs are positioned how with respect to the peritoneum?
|
retroperitoneal
inferior to parietal peritoneum of abd. cavity |
|
|
peritoneum is placed over organs like
|
a sheet
|
|
|
Transition from sigmoid colon to rectum is at the
|
S3 vertebral level
|
|
|
While the sigmoid colon is suspended in the abdominal cavity by a mesocolon, the rectum lies
|
retroperitoneally
|
|
|
is the rectum continuous with the anal canal?
|
yes
|
|
|
anal canal penetrates pelvic floor to enter perineum as the
|
anus
|
|
|
The anorectal junction is pulled forward by the puborectalis portion of the levator ani muscle to form the perineal flexure.
|
Know this.
|
|
|
upper part of anal canal has mucosa just like the
|
rectum
|
|
|
anal valve lies at
|
pectinate/dentate line
|
|
|
pectinate line marks site of
|
proctodeal membrane
|
|
|
signficance of proctodeal membrane
|
where embryonic endoderm and ectoderm meet
|
|
|
sensory afferents above vs. below pectinate line
|
above-visceral
below-somatic |
|
|
what type of epithelium before and after anocutaneous line?
|
before-strat. squamos non keratinized epithelium
after- strat squamos keratinized |
|
|
middle portion of anal canal ends where
|
at anocutaneous line (think about type of epithelium; its strat. squ. non-ker)
|
|
|
middle region of anal canal called
|
anal pectin
|
|
|
anocutaneous line also known as
|
white line of Hilton
|
|
|
three major arteries of the rectum and anal canal
|
superior rectal
middle rectal inferior rectal |
|
|
superior rectal artery branch of
|
inferior mesenteric
|
|
|
middle rectal aretery branch of
|
anteiror division of internal iliac artery
|
|
|
inferior rectal artery branch of
|
internal pudendal artery, which is branch of anterior division of internal iliac
|
|
|
the rectum/anal canal is a site of what type of venous anastomoses?
|
portal/caval
|
|
|
superior rectal vein drains into
|
portal system via inferior mesenteric vein
|
|
|
middle and inferiro rectal veins drain into
|
caval system
|
|
|
hemorrhoids
|
varicosities of the internal or external rectal plexuses
|
|
|
varicosities of rectal plexuses are called
|
piles (as opposed to being called hemorrhoids??)
|
|
|
external hemorrhoids are covered by
|
skin
|
|
|
which organ lies most anterioly in the pelvis?
|
urinary bladder
|
|
|
shape of bladder
|
3 sided pyramid
|
|
|
apex of bladder directed towards
|
pubic symphsis
|
|
|
median umbilical ligament is remnant of
|
emybrologic urachus
|
|
|
median umbilical ligament extends from
|
bladder to umbilicus
|
|
|
base of bladder shaped like
|
inverted triangle
|
|
|
ureturs enter bladder at
|
upper corners of base
|
|
|
urethra drain _____ from the lower corner of the base
|
inferiorly
|
|
|
urinary bladder is separated from the pubic bones by
|
retropubic space
|
|
|
as bladder fills, it ____ within the extraperitoneal fat
|
ascends
|
|
|
body of bladder is b/w
|
apex and fundus
|
|
|
what part of the bladder makes up the posterior wall?
|
fundus
|
|
|
fundus is related to what in male and what in a female?
|
male-rectum
female-vagina |
|
|
make sure to know relationship of ureters to the bladder
|
look at slide 61 of pelvic lecture
|
|
|
retropubic space and rectovescial pouch positioned how so relative to the bladder?
|
retropubic space - anterior
rectovescial pouch- posterior |
|
|
sympathetic innervation of bladder comes via
|
inferior thoracic and upper lumbar levels via hypogastric plexuses and nerves.
|
|
|
sympathetic innervation of bladder induces
|
contraction of internal sphincter during ejaculation in male to prevent reflux of semen in the male
|
|
|
pain afferents for the superior bladder, that part covered by peritoneum, travel with sympathetics to which vertebral levels?
|
T11 to L2 or L3
|
|
|
parasympathetics in pelvic splanchnics enter
|
inferior hypogastric plexus
|
|
|
afferents signaling stretch travel with
|
parasympathetics
|
|
|
pain afferents from inferior bladder travel w/
|
parasympathetics
|
|
|
parasympathetics of bladder cause relfexive contraction of
|
detrusor muscle and relaxtion of internal urethral sphincter
|
|
|
micturation occurs via
|
Detrusor reflex
|
|
|
detrusor reflex is
|
inhibition of sympathetics to allow internal sphincter to relax
|
|
|
external urethral sphincter is controlled by
|
motor neurons in Onuf's nucleus (S3,S4) in sacral cord
|
|
|
in normal adults, sensation of bladder fullness reaches what part of brain
|
sensory cortex
|
|
|
detrusor reflex is regulated by the
|
pontine micturation center
|
|
|
descending pathways from the medial frontal micturation centers activate the
|
detrusor reflex
|
|
|
ureters enter pelvic cavity by
|
crossing the pelvic brim at the bifurcations of the common iliac arteries
|
|
|
In the male, the ureter passes _____ the ductus deferens on its way to end in the ejaculatory duct.
|
beneath
|
|
|
in the female, ureter passes beneath the
|
uterine artery
|
|
|
in women, urethra is about how long
|
4cm
|
|
|
Skene's glands
|
are paired mucous glands which drain via ducts into the lateral margins of the urethral opening.
|
|
|
in males, urethra is how long
|
about 20 cm
|
|
|
divisions of male urethra?
|
preprostatic
prostatic membranous spongy |
|
|
is the male urethra muscular?
|
yes
|
|
|
location of preprostatic urethra
|
in bladder's neck
|
|
|
location of membranous urethra
|
passes through external urethral sphincter (voluntary)
|
|
|
location of spongy urethra
|
within corpus spongiosum of penis
|
|
|
which division of male urethra is most distensible?
|
prostatic
|
|
|
which division of the male urethra is the least distensible?
|
membranous
|
|
|
male reproductive organs consist of
|
Testes.
Epididymis. Ductus deferens or vas deferens. Seminal vesicles. Ductus Deferens. Bulbourethral glands. Penis. |
|
|
testis develop where?
|
in abdomen
|
|
|
where and when do testis descend?
|
to the scrotum, before birth
|
|
|
testis innervation (spinal segments)
|
T10-T11
|
|
|
lymphatics of testis drain to
|
lateral aortic and preaortic nodes
|
|
|
testicular arteries arise from
|
aorta inferior to the renal arteries
|
|
|
left testicular vein drains into
|
left renal vein
|
|
|
right testicular vein drains into
|
IVC
|
|
|
does the tunica vaginalisis contain fluid?
|
yes
|
|
|
epididymis is
|
Long, coiled duct on posterolateral aspect of testis.
|
|
|
efferent ductules of epididymis form
|
head of epididymis.
|
|
|
true epidydmis is
|
a single coiled duct made up of the body and the tail along the posterolateral aspect of the testis.
|
|
|
epididymis serves what type of fxn
|
storage site for sperm and place where they acquire motility
|
|
|
ductus deferens is
|
Long tubular structure with a thick, smooth muscle wall.
|
|
|
ductus deferens extends from
|
the tail of the epididymis to the ejaculatory duct.
|
|
|
ductus deferens is enclosed within the
|
spermatic cord (distal to superficial inguinal ring)
|
|
|
what happens to ductus deferens as it passes throug hte deep inguinal ring?
|
turns medially around the inferior epigastric vessels and passes over the ureter on its way to join the duct of the seminal vesicle to form the ejaculatory duct.
|
|
|
b/w the ureter and ejaculatory duct, the ductus deferens does what
|
expands to form the ampulla of the ductus deferens
|
|
|
Seminal vesicle develops as an outgrowth of
|
ductus deferens
|
|
|
seminal vesicle lies b/w
|
bladder and the rectum
lateral to ductus deferens |
|
|
seminal vesicle is the duct that joins the
|
ductus deferns to form the ejaculatory duct
|
|
|
prostate lies
|
inferior to the bladder and anterior the rectum
|
|
|
fibrous capsule of prostate contains a plexus of veins and nerves which do what fxn?
|
innervate the rectile tissue of the penis
|
|
|
urologists often refer to the seminal colliculus as
|
the verumontanum
|
|
|
cancer typically occurs where in the prostate
|
periphery (inferolateral lobule)
|
|
|
benign prostatic hypertrophy (BPH)
|
hypertrophy blocks urethra
|
|
|
symptoms of BPH
|
Nocturia – most common symptom
Dysuria – difficult or painful urination |
|
|
prostate carcinoma typically occurs in
|
70% involve peripheral zone
|
|
|
gold standard treatment of prostate carcinoma?
|
radical prostectomy
|
|
|
why is nerve sparing radical prostectomy performed sometimes?
|
to preserve erectile function
|
|
|
female reproductive organs are
|
Ovaries.
Uterus. Vagina. Greater vestibular (Bartholin) glands |
|
|
ovaries descend similar to the
|
testis
|
|
|
ovaries lie where
|
adjacent to lateral pelvic wall, just below pelvic brim
|
|
|
ovaries are suspended by
|
mesentary from broad ligament of uterus
|
|
|
suspensory ligament of the ovary contains
|
nerves and blood vessels of the ovary (know this)
|
|
|
the broad ligament is
|
a sheet-like fold of peritoneum that extends from the lateral pelvic wall to the uterus.
|
|
|
uterine tube is within
|
fold of peritoneum
|
|
|
portion of the broad ligament b/w the origin of the mesovarium and the uterine tube called
|
mesosalpinx
|
|
|
uterine artery lies in
|
lateral ligament
|
|
|
uterus is
|
thick walled muscular organ
|
|
|
uterus lies
|
posterior to bladder, anterior to rectum (usually lies on top of the bladder)
|
|
|
fundus of uterus
|
superior, rounded end above the uterine tubes
|
|
|
body of uterus is continuous inferioly with
|
cervix
|
|
|
view the cervix with a
|
speculum
|
|
|
lumen of uterine tube connects what to what
|
peritoneal cavity to lumen of uterus
|
|
|
uterine tube is enclosed in
|
upper margin of mexosalpinx
|
|
|
expanded end of the uterine tube is the
|
infundibulum
|
|
|
infudibulum has finger like projections called
|
fimbriae
|
|
|
which division of uterus is closest to uterus?
|
isthmus
|
|
|
ligament of ovary and round lig. of uterus are remnants of the
|
gubernaculum
|
|
|
ligament of ovary extends from
|
ovary to uterus
|
|
|
round ligament of uterus extend from
|
uterus to labia majora
|
|
|
round ligament of uterus passes through
|
inguinal canal
|
|
|
broad ligament is
|
Sheet-like fold of peritoneum that extends from the lateral pelvic wall to the uterus.
|
|
|
three divisions of broad ligament
|
mesometrium
mesosalpinx mesovarium |
|
|
largest part of the broad ligament is
|
mesometrium
|
|
|
what occurs between uterine and ovarian vessels
|
anastomosoes
|
|
|
what is hysterosalpingogram
|
procedure to see if uterine tubes get blocked with mucus
|
|
|
to perform hysterosalpingogram
|
use a water soluble radiopaque dye to visualize uterus and uterine tubes.
Dye should fill tubes and enter peritoneal cavities through the abdominal os. |
|
|
INFECTIONS IN THE VAGINA AND UTERUS CAN SPREAD INTO THE PERITONEAL CAVITY AND THEREBY CAUSE PERITONITIS.
|
KNOW THIS.
|
|
|
ostium of vagina is surrounded by a ring like fold of membrane, the
|
hymen
|
|
|
during development, _______ separates vagina from urogenital sinus
|
hymen
|
|
|
within anterior wall of vagina is
|
urethra
|
|
|
upper end of vagina surrounds
|
cervix
|
|
|
rectouterine pouch aka
|
pouch of douglas
|
|
|
does vagina have muscularis mucosa?
|
No
|
|
|
culdoscopy
|
view rectouterine pouch via posterior formix of the vagina
|
|
|
ovaries drain lymph to
|
lumbar nodes
|
|
|
Middle and upper vagina, cervix and body of uterus drain to nodes along the
|
internal iliac arteries.
|
|
|
Ostium of the vagina, below the hymen and the vulva drain to the
|
superficial inguinal nodes.
|
|
|
pelvic fascia is continuation of
|
extraperitoneal connective tissue of the abdomen
|
|
|
most important ligament derived from pelvic fascia in female is
|
transverse cervical or cardinal ligament
|
|
|
kegel exercises were devised to strengthen
|
pelvic floor muscles
|
|
|
do ligaments of pelvic diaphragm provide weightbearing support for organs?
|
No, simply act as moorings
|
|
|
pelvic floor exercises are important in preventing
|
prolapse
|
|
|
stress incontinence
|
neck of the bladder slips through the pelvic diaphragm, moving it below the effects of
intraabdominal pressure. |
|
|
does childbirth weaken pelvic diaphragm?
|
Yes
|
|
|
cavenous nerves are important in
|
erection
|
|
|
divisions of internal iliac artery
|
Anterior division – mainly to viscera
Umbilical artery Obturator artery Inferior vesical artery (only in males) Middle rectal artery Vaginal artery (female equivalent of inferior vesical) Uterine artery Internal pudendal artery Inferior gluteal artery Posterior division – mainly body wall Superior gluteal artery Iliolumbar artery Lateral sacral arteries |
|
|
superior rectal artery comes from
|
inferior mesenteric artery
|
