RCA: Pelvis

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RCA: Pelvis
2015-10-04 09:32:53

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Show Answers:

  1. What is meant by the "true" vs. "false" pelvis?
  2. Name the features of the pelvic inlet
    • Ala of the sacrum
    • S1 body (sacral promontory)
    • Sacroiliac joint
    • Anterior superior iliac spine
    • Ischial spine
    • Obturator foramen
    • Ischial tuberosity
    • Pubic symphysis
    • Pubic tubercle
    • Arcuate line
  3. Name the features of the pelvic outlet
    • Pubic symphysis
    • Pubic tubercle
    • Ischial tuberosity
    • Coccyx
    • Sacrum
    • Sacrotuberous ligament
    • Ischiopubic ramus
  4. Name the parts of the sacrum
    • Sacral promontory
    • Lumbosacral joints
    • Sacral canal
    • Sacral foramina
    • Median sacral crest
    • Coccyx
  5. Name the muscles and ligaments
    • Greater Sciatic foramen
    • Sacrospinous ligament
    • Sacrotuberous ligament
    • Lesser sciatic foramen
    • Piriformis
    • Obturator internus
  6. Give the function of the pelvic floor
    Name the features
    • Pelvic floor: separates pelvic cavity from perineum, and supports pelvic organs
    • Levator ani muscle; including
    • - Iliococcygeus muscle
    • - Puboccygeus muscle
    • - Puborectalis muscle
    • Coccygeus muscle
    • raphe
  7. Describe how the urogenital structures pass through the pelvis floor
    • Anterior ‘U’ shaped defect (for passage of urogenital structures); this defect is supported by the perineal membrane and muscles
    • Urethral opening
    • Vaginal opening
    • Perineum
  8. What is the perineum?
    • Perineal membrane
    • The perineum is the region below the pelvic floor and between the thighs
    • - It is bounded by the pelvic outlet and divided into two triangular regions
    • Urogenital triangle
    • Anal triangle
  9. Label the peritoneal reflections in the pelvis

    • Rectouterine pouch (of Douglas) in women
    • Vesicouterine pouches in women
    • Rectovesical pouch only in men
    • #
    • uterine tube
    • rectum
    • ovary
    • bladder
    • round ligament
  10. Name the
    • Fundus and body of uterus
    • Isthmus
    • Ampulla
    • Infundibulum
    • Fimbriae
    • Ureter
    • Cervix with canal
    • Broad ligament
    • Mesovarium
  11. Label the parts of the bladder & ureters
    • A pelvic organ in the adult, which expands into the abdomen when full but an abdominal organ in the infant.
    • Ureters
    • Apex
    • Base; faces posteroinferiorly
    • Median umbilical ligament
    • Opening of ureters
    • Trigone; smooth part
    • Internal urethral orifice
  12. Describe the differences between male and females in the bladder and ureters
    • Bladder neck supported by pubovesical ligament in women
    • Prostate supported by puboprostatic ligament in men
    • #
    • The ureter is crossed near the base of the bladder by the vas deferens in men and the uterine arteries in women (“water under the bridge”).
  13. Describe the male urethra (and differences to the female urethra)

    • There are 3 parts of the male urethra;
    • - Prostatic
    • - Membranous
    • - Spongy; bulbar and penile parts
    • #
    • Internal urethral sphincter
    • Urethral crest
    • Openings of prostatic ducts
    • Veru montanum; seminal colliculus
    • Ejaculatory ducts; either side of
    • prostatic utricle
    • Bulbourethral glands
    • External urethral sphincter; around membranous part of urethra
    • - not to be confused with orifice; i.e. on the tip of the penis = narrowest part of penis
    • Females: ~4cms long- opens into vestibule between labia minora
  14. Describe the anatomy of the rectum
    Rectum: ~15cms long, Extends from S3 to levator ani where the anorectal angle is formed (posterior to anterior)
  15. Blood supply of rectum (viewed from behind)

    • Superior rectal artery: from the inferior mesenteric artery (singular)
    • Middle rectal artery: from internal iliac artery (x2)
    • Inferior rectal artery: from internal pudendal artery from internal iliac artery (x2)
    • #
    • Superior rectal vein: from the inferior mesenteric vein
    • Middle rectal vein: to
    • internal iliac vein
    • Inferior rectal vein: to internal pudendal vein to internal iliac vein
  16. Describe the anatomy of the anal canal
    • External anal sphincter: is smooth muscle (autonomic innervation).
    • Internal anal sphincter: is skeletal muscle (pudendal nerve)
    • Puborectalis part of levator ani
    • Submucosal venous plexus; origin of haemorrhoids
    • Anal column
    • Anal valve
    • Dentate (pectinate) line
    • Anal verge
  17. Describe the anatomy of the following
    • Perineum & external genitalia: the region below the pelvic floor and between the thighs, which are bounded by the pelvic outlet and divided into two triangular regions
    • Perineal membrane: A triangular membrane attached to the pubic arch with a free posterior border
    • - Has a thin region immediately above it called the deep perineal 'pouch'
    • - Provides attachments for perineal muscles and the roots of the external genitalia
    • - Perforated by urethra in both sexes and by vagina in females
    • Levator ani
    • Perineal body: small fibromuscular region at the centre of the perineum where the posterior border of the perineal membrane, perineal muscles & levator ani muscles converge
  18. Describe the perineal muscles

    • External urethral sphincter
    • Deep transverse perineal muscle
    • Ischiocavernosus
    • Bulbospongiosis muscle
    • Superficial transverse perineal muscle
  19. Describe the anatomy of the roots of external genitalia
    • Crus of clitoris: attached part of corpus cavernosum
    • Bulb of vestibule
    • Bartholin’s glands
    • #
    • Crus of penis: attached part of corpus cavernosum
    • Bulb of penis: attached part of corpus spongiosum
  20. Describe the anatomy of the external female genitalia
    • Glans clitoris
    • Labium majus
    • Urethral opening
    • Labia minora surrounding
    • the vestibule
    • Vaginal opening; introitus
    • Hymen
    • Fourchette
  21. Describe the anatomy of the external male genitalia
    • Corona of glans
    • Prepuce (foreskin)
    • Urethral meatus; external urethral orifice
    • Frenulum
    • Glans penis
  22. Pelvic vessels and nerves: describe the internal iliac artery and its branches
    • Posterior trunk: giving rise to the
    • - Superior gluteal artery
    • Umbilical artery; giving rise to
    • - Superior vesical artery
    • Anterior trunk: giving rise to
    • - Obturator artery
    • Uterine/vaginal artery (women) or
    • Inferior vesical artery (men): supplies branches to the prostate (in men), bladder, ureter, seminal vesicle
    • Inferior gluteal artery
    • Middle rectal artery
    • Internal pudendal artery
  23. Describe the pelvic venous and lymphatic drainage
    • Pelvic veins: rich venous plexuses surround the bladder, rectum, prostate, uterus & vagina
    • - NB bleeding with pelvic trauma
    • #
    • Pelvic lymph nodes: alongside iliac arteries draining to pre- and para-aortic nodes
    • External iliac lymph nodes: receive vessels from the inguinal nodes, external genitalia, vagina, and cervix; they drain into the common iliac nodes.
    • Internal iliac and sacral lymph nodes: receive afferents from all the pelvic viscera (e.g., cervix, prostate, and rectum) and from the perineum, buttock, and thigh; they drain into the common iliac nodes.
    • Common iliac lymph nodes drain the two preceding groups and send their efferents to the lumbar group of aortic nodes, which also receives the afferents of the testis and ovary.
  24. Describe the Sacral Plexus, including what nerve rami contribute to it
    • Sacral plexus: consist of somatic nerves which are formed from anterior rami of S1-4 with contributions from L4,5
    • - supplies lower limbs, pelvis & perineum
    • - lies on piriformis
    • Lumbosacral Trunk
    • Pudental nerve
    • Coccygeus
    • Levator ani
    • Tendinous arch
    • Obturator internus
    • Sciatic nerve
    • Inferior gluteal nerve
    • Piriformis
    • Obturator nerve (from lumbar plexus)
    • Superior gluteal nerve
  25. Name this nerve and its functions
    • Pudendal nerve: THE nerve to the perineum
    • - supplies the external sphincters and levator ani
    • - supplies perineal muscles
    • - sensory to perineum
    • Inferior rectal nerve
    • Perineal nerve
    • Dorsal nerve of clitoris/penis
  26. What nerves supply these dermatomes?
  27. Anatomy of autonomic innervation: What is the Inferior hypogastric plexus?
    • Superior hypogastric plexus
    • Hypogastric nerves
    • Inferior hypogastric plexus: an autonomic plexus of parasympathetic and sympathetic nerves
    • Pelvic splanchnic nerves: parasympathetic nerves from S2,3,4
    • - ascend to hindgut via hypogastric nerves and descend to rectum, prostate, vagina, uterus, bladder, perineum (penis/clitoris)
    • Sympathetic nerves come directly from sacral sympathetic trunk and descend from superior hypogastric plexus via the hypogastric nerves
  28. Describe the innervation of Micturition (urinating)
    • Pelvic splanchnic nerves (S2,3,4) convey visceral sensation from bladder and motor to detrusor smooth muscle (the outer largely longitudinally arranged musculature of the bladder wall called also detrusor muscle)
    • - External urethral sphincter (voluntary control - pudendal nerve S2,3,4)
    • Voiding: abdominal muscles contract, detrusor contracts, urethral sphincters relax
    • Initially reflex emptying but later under higher CNS control
    • Female urethra empties by gravity; male assisted by bulbospongiosus contraction.
  29. Describe the innervation involved in sexual function
    • Parasympathetics: from pelvic splanchnic nerves (S2,3,4) enter inferior hypogastric plexus and pass through deep perineal pouch to erectile tissues.
    • - Produce vasodilatation of branches of internal pudendal artery & erection (penis/clitoris)
    • Sympathetic nerves: via inferior hypogastric plexus produce emission and contraction of internal urethral sphincter
    • Pudendal nerve (S2,3,4): sensation from penis/clitoris
    • - cyclical contraction of ischiocavernosus and bulbospongiosus muscles (orgasm)
  30. Which lymph nodes does the cervix drain to?
    • The cervix drains to internal iliac lymph nodes (lymphatics passing with uterine vessels),
    • external iliac nodes (via lymphatics in the broad ligament) and
    • presacral lymph nodes
  31. What structures can be felt on rectal examination in males and females?
    • Anteriorly: in males, Prostate and seminal vesicles (if they are diseased)
    • - vagina, cervix of uterus and rectouterine pouch of douglas
    • Laterally: ischial spine and tuberosity
    • Posteriorly: anterior surface of sacrum and Coccyx
  32. What structures can be felt on vaginal examination?
    • Anteriorly: cervix and uterus
    • - posterior surface of bladder and urethra
    • Laterally: ischial spine and enlarged ovaries
    • Posteriorly: rectum and rectouterine pouch of douglas
  33. What is the nerve supply to the anal sphincter?
    • The internal anal sphincter is supplied by sympathetic nerves (contraction) and parasympathetic nerves (S2-4, relaxation) from the inferior hypogastric plexus on the side wall of the pelvis overlying the iliac vessels.
    • The external anal sphincter is supplied by the inferior rectal branch of the pudendal nerve (S2-4).
  34. Which nerves supply the urethral sphincters?
    • The external urethral sphincter in both sexes is innervated by the perineal branch of the pudendal nerve (S2-4).
    • The internal urethral sphincter in the male (poorly developed in females) is supplied mostly by sympathetic nerves from the inferior hypogastric plexus