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Flashcards in Chapter 10 Deck (38)
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1
Q

bony landmarks of the hip bones

A
1. ilium
body iliac crest iliac tubercle
ASIS AIIS PSIS PIIS
auricular surface (for SI joint)
arcuate line
iliopectineal line
greater sciatic notch
2. Ischium
body
ischial spine
lesser sciatic notch
ischial tuberosity
ramus
3. Pubis 
superior pubic rami
inferior pubic rami
pubic symphysis, pubic crest, pubic tubercle
pectin pubis (pectineal line)
iliopectineal line
obturator canal
2
Q

bony landmarks of the sacrum

A
base (superior)
apex (inferior)
medial sacral crest
lateral sacral crest
ala
promontory
sacral cornu 
sacral hiatus
3
Q

describe the two pelvis apertures

A
  1. superior pelvic aperture (pelvic inlet/brim)
    -boundaries: sacrum ilium pubis
    Post: promontary and ala
    Lateral: iliopectineal line of ilium
    Ant: pubic symphysis, pectin pubis, pubic crest
  2. Inferior pelvic aperture (pelvic outlet) diamond shape
    post: sacrum coccyx
    lat: ischial tuberosities, sacrotuberous ligament
    ant: pubic symphysis, arcuae ligament, rami of pubis, ischium
4
Q

describe the regions of the pelvis

A
  1. pelvis major/false
    pelvic space above pelvic brim/iliopectineal line
    contains abdominal viscera: ileum of SI and sigmoid colon
    boundaries: abdominal wall, iliac fossa and L5/S1
  2. Pelvis minor/true
    below the pelvic brim but above the pelvic outlet/floor
    contains viscera: urinary and reproductive organs
    boundaries: pelvic surfaces of hip bones, sacrum, coccyx
5
Q

describe the acetabulum and obturator foramen

A

acetabulum
-formed by junction of 3 hip bones
acetabular notch, lunate, margin
ROUND IN MEN

obturator foramen
-formed by ramis of pubis and ischium
large and fibrous with obturator canal opening
obturator nerve and BV pass thru

6
Q

ddx male vs female in pelvis

A

men: heart shaped inlet, narrow true pelvis cavity, pubic angle is narrow, round obturator foramen
women: oval pelvic inlet, wide true pelvis, pubic angle is wide, oval obturator foramen

7
Q

describe the joints of the pelvis

A
  1. Sacroiliac joint- iliac bone (articular surface) and sacrum (lateral spine??)
    • Sacroiliac Ligament*
  2. Pubic symphysis - fibrocartilaginous joint
    (idt we need to know this: bony compartments- 2 pubic bones, articular surfaces R/L pubic bones, interpubic disc-fibrocartilage, thicker in females)
    –Ligaments:
    a. superior pubic ligament (connects superior pubic bones and R/L pubic tubercles
    b. inferior pubic ligament (arcuate ligament[looks like upside down u])
8
Q

List the ligaments of the pelvis

A
  1. superior pubic ligament
  2. inferior pubic ligament
  3. sacroiliac ligament (post, interosseous, anterior)
  4. iliolumbar ligament (l4/5-iliac crest)
  5. sacrotuberous ligament (lateral sacrum/coccyx to ichial tuberosity)
  6. sacrospinout ligament (sacrum to ischial spine)
  7. Iliolumbar ligament (lower spine- sacrum - pelvis for stability)
9
Q

describe the walls of the pelvis

A
  1. anterior wall
    - bodies and rami of pubic bones
    - obturator internus and fasica
    - pubic symphysis
  2. lateral wall
    - obturator internus
    - obturator nerves and vessels and branches of the internal iliac vessels
  3. posterior wall
    - sacrum and adjacent ilium
    - sacroiliac joints and ligaments
    - piriformis muscle
    - sacral plexus and internal iliac vessels and branches
10
Q

OINA obturator internus

A

O: pelvic surfaces of ilium and ischium, obturator membrane
I: greater trochanter of femur
N: nerve to obturator internus
A: ER femur, stabilize head of femur

11
Q

OINA piriformis muscle

A

O: pelvic sacral segments, greater sciatic notch, sacrotuberous ligament
I: greater trochanter of femur
N: ventral rami
A: ER, ABduct femur, stabilize head of femur
(myofascial trigger points, potential for entrapment of sciatic nerve** piriformis syndrome”)

12
Q

describe the floor of the pelvis

A
  1. pelvic diaphragm:
    A. Levator Ani muscles:
    -puborectalis (u shaped, lasso around anorectal junction)
    -pubococcygeus (main part of levator ani)
    -iliococcygeus
    ->attachments: body of pubis, obturator membrane, ischial spine, coccyx, walls of prostate or vag, rectum, anal canal
    ->action: RAISE pelvic floor and compress abdominal/pelvic content
    (cough, sneeze, forced expiration, vomit, stabilizing trunk during lifting)
    –voluntary control of urination, fecal incontinence
    *clinical= women’s health (urinary incon.), SCI, Cauda equinaB. Coccygeus muscle:
    –Ishiococcygeus
    –>attachments: ischial spine to coccyx and lower sacrum
    (small portion of pelvic floor)
    –>action: assists in supporting pelvic viscera, flex coccyx
13
Q

Blood supply of pelvis

email him might need to add more to this

A
  1. common iliac artery (bifurcates at L4)
  2. External iliac artery (passes thru false pelvis only*)
    - -medial border of psoas
    - -branches into:
    a. inferior epigastric artery
    b. deep circumflex artery
    - -exits false pelvis DEEP to inguinal ligament and becomes the femoral artery!
  3. Internal lliac artery
    - -descends in pelvis to greater sciatic foramen** and divides into:
    a. anterior division (supplies structures inside of cavity)
    b. posterior division (supplies outside of cavity
14
Q

describe the nerves of the pelvic region

*email him might need to add more

A
  1. lumbar plexus (ventral rami of L1-4)
    - -roots split into anterior and posterior divisions in psoas muscle
    - -terminal branches:
    a. Ilioinguinal - passes thru inguinal canal, inferolateral and anterior to quadratus lumborum, supplies skin to suprapubic and inguinal regions, and motor to abdominis
    b. femoral nerve- supplies hip flexors and extensors of knee, lateral the BV as it enters the thigh DEEP to inguinal canal
    c. Obturator nerve- supplies adductors of thigh
  2. Sacral plexus
    –formed by lumbosacral trunk L 4/5 and ventral primary rami s1-4
    -passes thru greater sciatic forament inferolaterally into gluteal region
    –supplies muscles and skin of but, posterior thigh, everything below knee
    A. Sciatic nerve:
    1. common fibular/peroneal nerve = posterior division
    2. tibial nerve = anterior division
15
Q

describe the urinary bladder

A

temp storage of urine
in the true pelvis (Can extend up if full)
-anterior surface (posterior to pubic symphysis)
-superior surface (men:inferior to peritoneum of abdominal cavity and women: inferior to uterus and vesicouterine pouch)
-posterior surface (men: anterior to rectovesical pouch, rectum, seminal vesicles, ampulla of ductus deferns and females: anterior to vagina)

landmarks of bladder:
apex (anterior)
fundus (posterior)
neck (inferior leading to urethra- male: prostate gland inferior to neck, women have urogenital diaphragm inferior to neck)
trigone (posterior wall triangle of two ureter openings and opening of urethera with smooth muscle)

muscles:
detrusor (smooth)
internal urethral sphincter- smooth at junction of bladder and urethra
external urethral sphincter - skeletal as it passes thru the urogenital diaphragm

16
Q

list the male reproductive organs

A
testes
epididymis
ductus deferens
seminal vesicle
prostate gland
bulbourethral gland/cowpers gland
external genitilia (testes, scrotum, penis)
17
Q

define rectovesical pouch, rectouterine pouch, vesiouterine pouch

A

rectovesical (men - peritoneal space btwn bladder and rectum)
rectouterine (women - peritoneal space btwn uterus and rectum)
vesicouterine (women - peritoneal space btwen bldder and uterus)

18
Q

describe testes

A
develop retroperitoneal then descend into scrotum
produce sperm (in seminiferous tubules) and sex hormones
19
Q

external genitalia men

A

testes, scrotum, penis

20
Q

describe the epididymis

A

head, body, tail
stores and matures sperm in the head
propel sperm into ductus deferens
convoluted duct = 20 ft long

epididymis contains fructose for nutrition for sperm!!

21
Q

describe the ductus deferens

A

arises from epididymis
travels up thru spermatic cord and inguinal canal*
enters pelvis via DEEP inguinal ring* lateral to the epigastric artery
passes posterior* to the bladder and ends at the ampulla of the ductus deferens
-merges with seminal vesicle into the ejaculatory duct which passes thru the prosatic urethra

epididymis contains fructose for nutrition for sperm!!

**vasectomies

22
Q

describe the seminal vesicle

A

posterolateral portion of the bladder lateral to the ductus deferns*
produces seminal fluid with fructose and choline
sperm is NOT stored here

*fructose is not produced anywhere else in body so used to tell if sex assualt occured- look for presence of choline crystals (florence test ) to see if semen is present

23
Q

describe the prostate gland

A

base of urinary bladder and surrounds urethra

  • fluid, psa, acid phosphate
  • the fluid comes out of prostatic utricle and combines with sperm and seminal vesicle fluid and bulbourethral gland fluid to form SEMEN

prostate consists of 5 lobes:
Anterior-isthmus, no glandular tissue, only muscle and fibrous
Middle- btwn urethra and ejaculatory ducts (BPH) obstructs urine flow
Posterior- CA site, posterior to urethra and inferior to ejaculatory duct
R/L lateral - each side of urethra and represent major portion of gland

venous return ???? idk if we need to know:
two pathways
1. prostatic venous plexus drains into internal iliac-ivc-heart
2. vertebral venous plexus drains into cranial dural sinuses
*might be way prostate CA metastasizes to heart lungs vertebral column and brain

24
Q

describe bulbourethral gland

A

two small glands posterior to membranous urethra (located in the membranous urethra i think but the ducts open up in the spongy cavernous urethera)
-secrete mucus like secretion into urethra

25
Q

describe the scrotum

A

cutaneous (no fat tho) pouch for maintaining low temp
contains testes and epididymis
layers are continuous with abdominal wall!!!!
-Cremaster muscle–> continuation of the internal oblique muscle

pulled up by sexual arousal and cold

26
Q

describe the penis

A

body- (1 corpus sponginosum, 2 corpous cavernosa 90% blood fill)
root- (2 crura, 1 bulb of penis)
head/glans penis- (terminal part of corpus sponginosum
urethera: passes thru the corpus sponginosum
-prostatic urethera (surrounded by prostate gland, urethral crest** is on posterior wall, SEMINAL COLLICULUS = oval raised portion with openings to ejaculatory ducts, prostatic ducts, prostatic utricle equivalent to vagina)
-membranous urethra - (external urethral sphincter)
-spongy cavernosa urethra -(passes thru length of penis within the corpus sponginosum, duct of bulbourethral gland enter here)

27
Q

List the female reproductive structures

A
  1. ovaries
  2. uterine tube
  3. uterus
  4. divisions of uterus, positions, walls
  5. structures of the uterus for support
  6. vagina
  7. female external genitalia (vestibule, clit, labia major, labia minor)
28
Q

describe the ovaries

A

lateral to infundibulum of uterine tube
contain ovarian follicles
secrete estrogen and progesterone
-ovulation - oocyte released into peritoneal cavity near ostium* and enters infundibulum by fimbriae trapping it
** ovarian ligament!! connects ovary to uterus

29
Q

describe the uterine tube

A

intramural portion “uterine part” (lies in uterine wall)
isthmus (thick muscular wall extends from uterine wall to ampulla)
ampulla (dilated, longest segment- common site for fertilization and ectopic)
Infundibulim (distal, terminates in fimbriae and contains the ostium which opens to the peritoneal cavity)

30
Q

describe the uterus

A

btween rectum and bladder
facilitate movement of sperm from cervix
nourishes embryo, contracts to push fetus/placenta out

31
Q

describe the divisions, positions, and walls of the uterus

A

Body- upper 2/3:
a. fundus (rounded portion above the uterine tubes
b. isthmus (narrow region connects to the cervix
Cervix/neck - narrow cylinder that enters and projects into the vag
a. internal os
b cervical canal
c external os (opening into the vag)

position: anteverted (50%)
retroverted (25%)
midposition (25%)

Walls:

  • perimetrium (outer serous coat)
  • myometrium (middle muscle)
  • endometrium (inner mucous coat)
32
Q

describe the support structures for the uterus

**MIGHT NEED TO ADD MORE email him

A
pelvic floor/diaphragm
urogenital diaphragm (triangle)
*Round ligament of uterus-comes anterior
*Transverse cervical ligament 
*Uterosacral Ligament-comes posterior and rounded
33
Q

describe the vagina

A

tube that connects the uterus to the vestibule
dilates and extends the width of the pelvic outlet during birth
external orifice opens into the vestibule- hymen membranous fold separates
*FORNIX encircles cervix of uterus (kind of in the vag)
-anterior (palpate bladder on digital exam)
-lateral r/l
-posterior (palpate rectum on digital exam) –site for culdocentesis- insert needle to collect fluid sample to assess pelvic conditions or collect oocytes for invitro fertilization

34
Q

describe the external genitalia

A
  1. vestibulae - region where the vag and urethera open into after passing the urogenital diaphragm
  2. clitoris- body and glans formed from two corpus cavernose
    -anterior to opening of urethre
    A. URETHRA- descends short distance from bladder to opening, passes thru pelvic floor and urogenital diaphragm
  3. labia major (scrotum equivalent)- contains CT layers, round ligament passes thru the inguinal canal and ends here
  4. labia minor-medial to labia majora and forms the lateral walls of the vestibule
35
Q

list the boundaries of the perineum (diamond shape)

A

ant: pubic symphysis
anterolateral:ischipubic rami
lateral:ischial tuberosity
posterolateral:sacrotuberus ligament
posterior: coccyx
floor= pelvic diaphragm
roof = skin/fascia
divided into two smaller triangles: urogenital triangle and anal triangle

36
Q

describe the urogenital triangle

A
"shelf" 
A. superficial perineal space
-btwn superifical perineal fascia (COLLEs FASCIA) and inferior fascia of urogenital diaphragm (PERINEAL MEMBRANE)
-muscles: 
   a. ischiocavernosus
   b. bulbospongiosus
   c. superficial transverse perineal

B. Deep perineal space

  • btwn inferior fascia of urogenital diaphragm (PERINEAL MEMBREANE)) and superior fascia of urogenital diaphragm
  • muscles: (urogenital diaphragm comprised of:
    a. deep transverse perineal muscle
    b. sphincter urethrae
    c. sphincter urethrovaginalis muscle female
    d. compressor urethrae female
37
Q

describe the anal triangle

A

muscles:
- obturator internus
- external anal sphincter
- pubococcygeus
- iliococcygeus
- puborectalis

also has rectum and anal canal
rectum: sigmoid colon to anal canal
-dilated part = ampulla for storing feces– superior to pelvic diaphragm
-venous blood flow connects to IVC (via inferior and middle rectal vein)
and portal venous system (via superior rectal vein)

Anal canal:
-separated from the rectum by the pelvic diaphragm
- it starts at pelvic diaphragm and ends at anus
-visceral (upper 2/3) involuntary smooth muscle
internal anal sphincter –>internal hemorrhoids
** venous return is thru portal system
—-pectineal line—–
-skeletal (lower 1/3) -somatic voluntary
external anal sphincter–>external hemorrhoids
venous return is thru caval system back to IVC*

pectinate line = diff venous return, nerve supply, lymph

38
Q

describe the bony pelvis

A
  1. ring of bone - R/L hip, sacrum, coccyx form it
  2. pelvic girdle as a unit supports the abdomen and provides dynamic link btwn vertebral cloumn and lower limbs
  3. ILIOPECTINEAL line (pelvic brim) divides the pelvis into
    –pelvic major/false pelvis (above)
    –pelvic minor/true pelvis (below)
  4. Hip bones:
    ilium
    ischium
    pubis
  5. sacrum
  6. coccyx