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35 Cards in this Set
- Front
- Back
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The ligament bn right and left bodies of the pubi is the? The second ligament that is more posterior? |
suprapubic ligament; arctic pubic ligament |
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What clinical application does Relaxin have? |
relaxes the suprapubic and artic pubic ligaments for a wider opening for labor/birth |
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The joint connecting the pubi is the? |
pubic symphisis |
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The posterior wall of the pelvis skeletal trunk consists of? |
the sacrum and coccyx |
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The lateral wall of the pelvis consists of what three bones? What is the socket called? And what bone inserts there? |
ilium -10-2oclock, pubis- 2-5oclock, ischium-5-10oclock; socket is the acetabulum; the femur inserts in the socket |
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What muscle extends bilaterally off of the sacrum to insert on the greater trochanter of the femur? |
the piriformus muscle |
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What is the name of the largest gauge nerve in the body? and what plexus forms it? |
sciatic nerve; lumbosacral plexus |
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Which nerve "keeps the penis off the floor"? |
S2,3,4 the pudendal; this will have a key branch called the perineal; also the pudendal has somatic fibers to the rectum, allowing pinpoint pain presentation |
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What are the three dimensions of the female pelvic inlet? |
-Conjugate- (pubic symph to sacrum) -11cm -Transverse- (widest ilial line to opposing line) ~13cm -Oblique- (sacrum to ischial spine) ~ 12.5cm *Overall the distance between ths sacral promontory and the pubic symphisis is shorter than the lateral distance of the ileopectoneal lines *these planes are measured ultrasonically |
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What is the faux pelvis? |
Distance bn the wings of the ilial spines |
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What are the two planes associated with the female pelvic outlet? |
Conjugate- Tip of coccyx to pubic symphisis (9.5-11.5cm) Transverse- distance between ischial tuberosities (11cm) |
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What is the point of measuring the pelvic inlet and outlet planes of the female ultrasonically in the OB office? |
To determine if the woman can give an orthodox delivery or if she should be candidate for Caesarian section. |
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What features of the male pelvis give it a mechanical advantage compared to female pelvic physiology? |
Overall the measurments are more compact; The inlet is wider from anterior/posterior instead of right to left; the pubic symphisis is deeper/taller, and the arch is more narrow; the ischial tuberosities are closer; the ilial wings are less flared. *Overall the compact pelvis allows the legs/femurs to move strait forward for more economical movement and more potential speed |
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What two ligaments form the diaphragm and have the two 'windows' associated with their anatomy? |
1. Sacrospinous ligament, ischium spine to sacrum 2. Sacrotuberous ligament, sacrum to ischial tuberosity
*the two ligaments are in different planes and they sort of criss-cross. The sacrospinous ligament starts deeper and extends anteriorly and superiorly, while the sacrotuberous starts superiorly on the tuberosities and runs opposite down to the sacrum |
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What are the two "windows" called? and which is utilized by nerves going to the perineum? |
The greater and lesser sciatic foramen; nerves utilize the lesser sciatic foramen to reach the perineum; clinically, the pudendal inserts through here, so you have to stick a needle right through the sacrospinous ligament to utilize anesthetics on it |
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What two muscles cover teh inside and outside of the obturator foramen? |
the obturator internus and externus |
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What are the two key muscles that comprise the pelvic diaphragm? |
1. the levator ani; this muscle is the larger one and it originates anteriorly at the pubis and posteriorly at the ischial spine, and inserts at the arcus tendonous
2. Coccygeus muscle, also called the ischiococcygeus muscle, it originates at the sacrum and coccyx and runs to the ischium right adjacent and on top of the sacrospinous ligament |
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What is the "white arc" or the "white line" of the pelvis? |
this is where the levator ani attaches to the overlying fascia, creating a thickening of fascia that grossly appears to be a white arc |
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The levator ani can be divided into what two compnents? |
the pubococcygeous: originates from the pubis and arcus tendonosous and inserts at the midline int he perineal body and the anal-coccygeal body
the iliococcygeus originates form the psoterior arcus tendon. and the ischial spine and inserts into the perineal body |
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The pubococcygeus approaches the anus and what muscle runs posteriorly to it? and what does it help do? |
The puborectalis muscle; supports the fecal mass |
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The gap in the levator ani muscle is known as what? Where does it terminate? And what protrudes through these spaces in men and women, respectively? |
the urogential hiatus; terminates at the perineal body; the prostate in men, and the sphincter vaginae in women (palpable) |
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During labor/birth what muscle can tear? What can OBs do as a countermeasure? |
the pubrectalis muscle can tear away from the anococcygeal body making them incontinent; the OB can wisely make an incision of his choosing right at the midline in the anococcy. body to allow more space. Reconstruction will sew this anococc body back together very well. UAB doctors make transverse cuts across the muscles, like goons..... |
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The pelvic outlet is really diamond shaped and can be split into what two triangles? |
Anal triangle (apex is tip of coccyx and the other two tips are the ischial tuberosities) and the urogenital triangle(pubic symphisis at apex to the obturatir foramen) |
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Flanking the anal canal is are areas filled with Camper's fascia- what is this fascia also called? What three borders delineate this area? |
ischiorectal fascia; the levator ani medially, the obturator internus muscle laterally, and the skin of the butt cheek inferiorly |
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Area above the diaphragm is considered the ______, and the area below is considered the_______. |
above: pelvis below: perineum |
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What is the name of the channel that runs along the wall of the obturator internus? what does it contain? |
The pudendal canal, or the Alcox canal; the pudendal nerve, internal pudendal artery and internal pud. vein |
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Descibe the venous linkage from the inferior rectal vein to the inferior VC |
Inferior rectal vein drains into the internal pudendal vein, which empties into the internal iliac vein, which jons the external branch to form the common iliac vein which empties into the IVC |
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So the superior rectal vein empties into the inferior mesenteric vein and therefore the portal system, while the inferior rectal vein has systemic drainage.. What clinical opportunity does thsi present? |
If a pt suffered from portal hypertension (and had inflamed rectal veins/internal hemmorroids),a portal system anastamosis could be established here for portal to systemic venous drainage. |
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above/below the rectal column/anal valve areas are what type of innervation? |
above is autonomic pelvic splanchnic innervation, so referred pain only, below is pudendal, s2-4, somatic innervation, point pain |
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Describe the control of the internal anal sphincter. ANd then what are the three rings of the external anal sphincter? |
Internal sphinc is smooth muscle, which is controlled via splanchnic parasympathetic involuntary control
There are subcutaneous, superficial, and deep rings of the external anal sphinc, in that order from most superficial to deepest (yes the superifical ring is actually second). These are under voluntary control since they are somatically innervated by the pudendal nerve |
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The puborectalis is what type of muscle? And supports what? |
It is skeletal, so is somatic pudendal; the muscle pulls the anus toward the rectum; no pull results in incontinence. |
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The rectum is how long? How many folds does it have? What do they do? |
5-6 inches; three folds (a superior, medial, and inferior); the folds maintain the fecal mass |
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Between each anal column is an _________? And at the bottom of each of these is an_________? |
anal sinus anal valve *valves can potentially tear |
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Right below the valves is a pectinate line taht indicates what? What is this area referred to as? |
A transition from simple columnar cells to stratified squamous cells; Pecten |
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There is an overlap of the external and internal sphinx that makes a groove called what? |
Hilton's white line; not visible but its palpable, clinically, screenable for sphinx activity and anal incontinence. |
