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2012-06-19 02:07:05
Pelvis contents

Last lecture and a half
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  1. What does the urtethra pierce when entering the outside world?
    • the UG diaphragm: here it is surrounded by urethral sphincter
    • Under voluntary control through the somatic nervous system 
  2. WHat divides the greater and lesser pelvis?
    The pelvic brim
  3. what is the pelvic floor formed by?
    pelvic floor muscles- diaphragm- LA mm
  4. What marks the pelvic brim?
    top of S1 and the pubic symphesis
  5. What is on the floor of the pelvis?
    • - perineum lies within the flor
    • - diamond shaped between the pubic symphesis and coccyx
    • - this forms the anal and urogenital triangles 
  6. Male bits and pieces
  7. What are the contents of the lesser pelvis of a female?
    • - peritoneal reflections over the UG system- bladder, uterus, vagina, rectum
    • - recto- uterine space (space behind vagina and infront of the rectum)
    • - uterus on top of the bladder
    • - vagina, uterus and ligs can be palpated vis rectum
  8. What is the broad ligament?
    • - two layers of peritoneum sandwiched together outside the uterus
    • - round ligament runs through anterior part of broad ligament 
    • - suspensory ligaments of ovary contains ovarian vessels
  9. What are the structures that support the uterus?
    • - part of the broad ligament
    • - round ligament of the uterus
    • - - ligaments around the cervix 
  10. What is the position of the uterus normally?
    • - antiflexed
    • - antiverted  
  11. What are the ligaments around the cervix?
    • - cardinal ligament (transverse cervical)- at the base of the broad ligament- contains uterine artery and vein
    • - uterosacral ligament- from sacrum to uterus
    • - pubocervical- from the side of the cervix to the pubic symphosis 
  12. what are the components of the broad ligament?
    • Mesometrium - the mesentery of the uterus; the largest portion of the broad ligament
    • Mesosalpinx - the mesentery of the Fallopian tube
    • Mesovarium - the mesentery of the ovaries.
  13. What is the male equivalent of the round ligament of the uterus?
    spermatic cord
  14. Note/ decent of gonads explains termination of round lig in labia majoria
  15. What is the blood supply of the female pelvis?
    • - branches of the internal iliac crest
  16. What are the three division of the internal iliac artery?
    • - gluteal
    • - pelvic
    • - pudendal  
  17. What artery supplies the ureter?
    - uterine artery 
  18. Where does the pudendal artery supply blood to?
    - provides blood to the external genitalia
  19. Where does the gluteal division of the internal iliac artery supply blood to?
    • two branches
    • Superior and inferior branches:
    • - superior- largest branch, supplies glutes, piriformis etc
    • - inferior- (sciatic art), buttocks and back thigh 
  20. What does the pelvic arteries supply?
    - organs of the pelvis
  21. Ovarian artery connects with?
    uterine artery 
  22. Note/ during perganacy uterine artery pulse can be felt thru the vagina
  23. What does the ovary artery supply?
    • -ovaries
    • - ureter (ovary art turns into uterine art)
    • - apendix
  24. Where are the ext nodes of the lymphatic system?
    • - sit near the pelvic brim near common and external iliacas 
    • - they drain lower limb and genitals (superficial and deep)
  25. What are the two groups of nodes?
    • - external nodes 
    • - internal nodes 
  26. What are the internal nodes and where are they situated?
    - drain pelvic floor and viscera
  27. What lymphatic node does the ovaries drain into?
    -para- aortic node near renal arteries
  28. what lymphatic node do the fundus of uterus drain into?
    - para- aortic node
  29. What lymphnode does the body of uterus drain into?
    - generally to internal iliac node, some to superficial inguinal
  30. what lymphnode does the cervix drain into?
    • - internal iliac nodes
    • - also deep sacral nodes 
  31. Pelvis inlet and outlet
    • Inlet- is the pelvic brim
    • outlet- between ischial spine  
  32. Male genital/ UG system
    • - peritoneal reflections over male system
    •  - retropubic space- access to male UG system
  33. What sphincter is voluntary and involuntary of the bladder?
    • - internal urethral sphincter is involuntary- primary mm in control of the exit of urine- smooth mm 
    • -  external urethral sphincteris- located at the bladder's distal inferior end in females and inferior to the prostate in males- skeletal mm- voluntary
    • - female ext sphincter not very strong 
  34. Urethra in males
    • - longer than female
    • -  surrounded by lobes of prostate 
    • - prostate lobes develop as diverticula from prostatic urethra
    • - medial lobe (surrounds urethra) prone to BHP (begins at 45 yrs and by age 80- 80% of men have BPH)- hypertrophy
  35. What are the layers of the perineum? 
    • - superficial perineal space (three muscles and root of penis)- outside
    • - Inferior fascia of UG diaphragm (aka perineal membrane)
    • - UG diaphragm- sphincter urethral and transverse perinel mm, bulbourethral glands. Vol sphincter
    • - Superior fascia of UG diaphragm
    • -Levator ani- three mm- puborectalis, pubococcygeous, iliococygeous
  36. What mm is responsible for the bend in rectum?
    - puborectalis
  37. Scrotum
    • - pouch that develops from ant abdominal wall
    • - testis have superior retroperitoneal orgin
    • - drags layers with it and these form various coverings (tunics) or spermatic cord and testies
    • - vessels, nerves and vas within fascia that surrounds spermatic cord
  38. WHat is the anatomical position for the penis
    - erect 
  39. Anatomy of the penis
    • - 3 cylinders of erectile tissue 
    • - two corpora cavernosum- crus attached to pubic arch
    • - corpora spongeosum expands to form glans and transmits urine and ejaculate
    • - each cylinder is surrounded by elastic sheath
    • - three cylinders invested by deep fascia of penis
    • - suspensory and fundiform ligament suspend penis
    • - when errect the  ANS controls
    • - when errect, stays errect by the compression of the vein
  40. What is the blood supply of the penis?
    • - two arteries: dorsal and deep arteries of penis
    • - most venous drainage into dorsal vein of penis
  41. Female genitalia
    • - peritoneal reflects over female UG system
    • - recto- urterine space
    • - uterus bent anteriorly over bladder (antiverted/antiflexed)
    • - vaginal fornices- intercourse  
  42. What are the parts of the external female genitalia?
    • - located in perineum  
    • - the vulva
    • - labia majora (outer hair)
    • - labia minora
    • - vestibule or urogenital sinus-between labia minora
    • - clitoris
    • - urethal orifice
    • - vagina
    • - has 3 layers of erectile tissue- but one uretral tube in the middle
  43. Vagina
    • - fibromscular tube- from vestible to uterus
    • - for elimination of menstrual fluids
    • - recieves penis during sexual intercourse and holds sperm
    • - forms birth canal for expulsion of fetus
    • - fornices (singular fornix)
    • - interesting wall- four layers 
  44. What are the four layers of the vagina?
    • - epithelium
    • - lamina propria
    • - fibromuscular
    • - adventitial (nerves and skeletal mm)
  45. What are the layers of perioneum in a female?
    • - three mm, root of clitoris, bulb of vestibule, greater vestibular gland 
    • - inferior fascia of UG diaphragm (perineal membrane)
    • - UG diaphragm- sphincter urethral & deep transverse perinel mm
    • - Levator ani
  46. Male and female structures
  47. WHat supplies most of the peritoneum?
    • - pudendal artery
  48. What nerve innervates the perineum?
    • branches of pudendal nerve supplies most. S 2-4 
    • - micturition
    • - defectation
    • - erection
    • - parturtion 
  49. What is the sexual response mediated by?
    • - sexual response mediated by coordinated activity of autonomic and somatic NS in both genders 
  50. WHat are the autonomic effects of the sexual function?
    • - vascular dilation- causes penile or clitoral erection (parasympathetic) 
    • - stimulation of prostatic or vaginal secretions
    • - smooth mm contractioon of vas deferns in ejaculation (sympatheitc) and rhythmic vaginal contractions during orgasm 
    • - contraction of somatic pelvic mm (BS and IC) during orgasm 
  51. WHat are the four nerve pathways of the sexual act?
    • - sensory afferents
    • - somatic (voluntary) efferents
    • - sympthetic and para efferents 
  52. What is sexual function usually driven by?
    • - psychic and reflex mechanisms that generate sexual sensations
    • - erection- emission- ejaculation- resolution.  
  53. physiology of sexual function
    • - reflexs arcs throughthe spinal cord important
    • - both motor and sensory nerve fibres involved
    • - dual projections from thoracolumbar (T10-L2) and lumbosacral (S2-S4) segments in splanchnic nerves and autonomic plexi
    • - sexual responses are mediated by the coordinated activity of somatic (sensory and motor), sympathetic, parasympathetic divisions of the nervous systems (four pathways)
  54. Somatic afferent branch involved in sexual sensations?
    • - glans richly inervated in both genders
    • - afferents travel in pundenal nerve (S2,3,4), sacral plexus, sacral cord then up to somatosensory cortex
    • - labia, scrotum, and anal perineal region stimulation adds to sexual sensation
  55. Visceral afferent for sexual sensations
    • - sexual sensations also originate in internal structures
    • - urethral, bladder, prosate, testes, seminal vesicles and vas deferens
    • - inflammation and aphrodisiac drugs can lead to sexual sensation by their action inside the above organs