Term
| What types of pelvises are most common in males? In females? |
|
Definition
Females: gynecoid pelvis
Males: android pelvis |
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Term
| Define the true conjugate |
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Definition
| From the middle of the sacral promontory to the posterior margin of the pubic symphysis |
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Term
| The true conjugate is the _______ _________ distance that the baby's head must pass in a vaginal delivery |
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Definition
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Term
| Why is the diagonal conjugate used? |
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Definition
| The true conjugate can't be measured during a pelvic exam bc the bladder is in the way. |
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Term
| The diagonal conjugate is what? |
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Definition
| An estimate of the true conjugate |
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Term
| What is the narrowest part of the pelvic canal? |
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Definition
| The interspinous distance (not a fixed distance) |
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Term
| Anteroposterior compression of the pelvis frequently fractures what? |
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Definition
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|
Term
| Lateral compression of the pelvis most frequently fractures what? |
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Definition
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Term
|
Definition
| The vertebral arch separates from the vertebral body |
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Term
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Definition
| When the vertebral arch breaks bilaterally from the vertebral body and the body slides anteriorly on the sacrum |
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Term
| When spondylolisthesis occurs with L5, what are the results? |
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Definition
| The L5 body slips into the pelvic inlet and reduces the AP diameter. Can compress the spinal nerves. |
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Term
| Increased levels of relaxin during pregnancy cause what? |
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Definition
| Relaxin causes the pelvic ligaments to relax and causes increased movement at the pelvic joints. |
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Term
| Relaxation of what occurs for parturition |
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Definition
| Relaxation of the sacroiliac joints and the pubic symphysis (10-15%). Coccyx is allowed to move posteriorly |
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Term
| What is the one diameter that doesn't change during parturition? |
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Definition
| The true conjugate distance |
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Term
| What is most often torn during pregnancy? |
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Definition
| Pubococcygeus part of levator ani |
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Term
| Why may urinary stress incontinence occur post-childbirth? |
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Definition
| The levator ani and pelvic fascia weaken and may alter the position of the neck of the bladder and urethra. |
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Term
| During childbirth the fetus may compress the ________ ________ nerves, producing what? |
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Definition
sacral plexus nerves
pain in the lower limbs |
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Term
| What may injury to the obturator nerve produce? |
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Definition
| painful spasms of the adductor muscles of the thigh and sensory deficits in the medial thigh regions |
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Term
| What structure is in danger during a hysterectomy and why? |
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Definition
| The ureter because it passes directly inferior to the uterine artery which is ligated |
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Term
| What are the collateral pathways for the internal iliac artery? (4) |
|
Definition
lumbar and iliolumbar
median sacral and lateral sacral
superior rectal and middle rectal
inferior gluteal and deep artery of the thigh |
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Term
| Blood supply from the abdomen to the ureters approaches from a _______ direction while arteries to the pelvic portion approach from _______ |
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Definition
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Term
| Ureteric calculi cause a colicky pain. Why? |
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Definition
| Hyperperistalsis superior to the obstruction |
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Term
| What are the 3 most common sites of ureter obstruction? |
|
Definition
1) junction of the ureter and the renal pelvis
2) where the external iliac crosses
3) during passage through the wall of the bladder |
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Term
|
Definition
| Herniation of the bladder into the uterus |
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Term
| The superior surface of the bladder lies where? And may extend where when full? |
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Definition
Against the pubic symphysis
Above the symphysis |
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Term
| How may urine get into the peritoneal cavity? |
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Definition
| Fractures of the pelvis or injury to the anterior abdominal wall may rupture the superior part of the bladder and peritoneum |
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Term
| The female urethra is more _______ than the male, allowing for the easier passage of catheters. |
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Definition
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Term
| Why are females more prone to infections of the urethra and bladder? |
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Definition
| The female urethra is shorter and opens to the exterior through the vestibule of the vagina. |
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Term
| Explain what a deferentectomy is? |
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Definition
| ductus deferens is ligated so that ejaculation fluids contain no sperm |
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Term
| If abscesses in the seminal glands rupture, where does the pus go? |
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Definition
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Term
| What occurs after middle-age in almost every male prostate? |
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Definition
| Benign hypertrophy of the prostate |
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Term
| What can lead to nocturia, dysuria, ,and urinal urgency in men? How? |
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Definition
| Enlargement of the prostate will obstruct the prostatic urethra and occlude it. |
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Term
| Benign hypertrophy of the prostate increases the risk of what? |
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Definition
| Infections of the bladder and kidney damage. |
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Term
| The vagina may distend in the ____ direction but is limited in the ____ direction by the ______ |
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Definition
AP direction
Lateral direction
ischial spines and sacrospinous ligaments |
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Term
| What can be palpated by manual pelvic examination in females? |
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Definition
| cervix, ischial spines, and sacral promontory |
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|
Term
Describe what vaginal fistulas are
Define - vesicovaginal
Define - urethrovaginal
Define - rectovaginal |
|
Definition
Fistulas: open communications between the vaginal lumen and other structures
Vesicovaginal: Bladder to vagina
Urethrovaginal: Ureter to vagina
Rectovaginal: rectum to vagina |
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Term
| Until the 1940's the leading cause of death of North American women was.... |
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Definition
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|
Term
| The decrease in cervical cancer is due to .... |
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Definition
| Pap smears for early detection. |
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Term
| What is an early sign of pregnancy that can be detected via bimanual palpation? |
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Definition
| Hegar's sign - softening of the uterine isthmus. The cervix feels as though it were separated from the body |
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Term
| When females are born, the ratio of uterus:cervix is what? During childhood, what is it? At puberty? Post-menopausal? |
|
Definition
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|
Term
| What happens to the uterus during pregnancy? |
|
Definition
Uterus expands. Walls thin.
After childbirth the uterus:cervix ratio is 3:1 and has a nodular body that extends into the pelvis |
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Term
| What happens to the uterus during menopause? |
|
Definition
Uterus decreases in size
1:1 uterine:cervix ratio |
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Term
| What abnormal position is the uterus more likely to prolapse in? Why? |
|
Definition
retroverted uterus.
When abdominal pressure is increased the retroverted uterus is positioned over the vagina and may prolapse into the vagina |
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Term
| What will a mother feel during birth with regional anesthesia? |
|
Definition
| She will be conscious of her uterine contractions but won't feel any pain of labor |
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Term
| What with a mother feel during birth with a spinal block? Where is it introduced? |
|
Definition
L3-L4
Anesthesia inferior to the waist level. All feeling below the waist is eliminated. |
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Term
| What dermatomes are anesthetized with a pudendal n. block? What is the mother able to feel during childbirth |
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Definition
S2-S4 and inferior quarter of vagina
Superior birth canal. Contractions |
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Term
Where is the caudal epidural block administered? What is blocked?
Mother feels what? |
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Definition
the sacral canal
S2-S4, cervix, superior vagina, afferent fibers of pudendal nn.
Her uterine contractions |
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Term
| Infections of the vagina, uterus, and tubes may result in ________. why? |
|
Definition
peritonitis
The female genital tract communicates with the peritoneum. |
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Term
What is inflammation of the uterine tube called? What can cause it?
What can this ultimately cause? |
|
Definition
salpingitis
infections in the peritoneal cavity
Infertility due to blockage of the uterine tubes |
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Term
| Describe a surgical method of birth control |
|
Definition
| ligation of the uterine tubes |
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Term
|
Definition
| collection of pus in the uterine tube |
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Term
| In the case of pyosalpinx, what may occur? |
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Definition
| A blastocyst cannot pass and so an ectopic pregnancy occurs. |
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Term
| Where is the most common site for an ectopic pregnancy? |
|
Definition
| The ampulla of the uterine tube. |
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Term
| If not diagnosed what may occur in an ectopic pregnancy? |
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Definition
| It may result in rupture of the uterine tube and severe hemorrhage during the first 8 weeks of gestation. |
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Term
| Why may a ruptured ectopic pregnancy be misdiagnosed as acute appendicitis? |
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Definition
| The right uterine tube lies close to the appendix |
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Term
What does the epoophoron form from?
What is a persistent epoophoron called? |
|
Definition
The embryonic kidney (mesonephros)
duct of the epoophoron (duct of Gartner) |
|
|
Term
|
Definition
| Lies between the layers of the broad ligament along each side of the uterus |
|
|
Term
| What is a vesicular appendage |
|
Definition
| The remains of the cranial end of the mesonephric duct that goes on to form the ductus epididymis |
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Term
| What can be palpated by rectal examination? |
|
Definition
| sacrum, coccyx, ischial spines and tuberosities, enlarged internal iliac lymph nodes, pathological thickening of the ureters, swellings in the ischioanal fossae, inflamed appendix |
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|
Term
| Why is the perineal body especially important in females? |
|
Definition
| It is the final support of the pelvic viscera |
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|
Term
| Why may prolapse of the pelvic viscera occur in females? |
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Definition
| During childbirth tears or stretching of the perineal body may cause prolapse of the bladder, uterus, or vagina. |
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Term
Why is an episiotomy performed?
What is the major muscle incised during a median episiotomy? |
|
Definition
To widen the vaginal canal during surgery or birth.
The perineal body. |
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|
Term
Fractures of the pelvic girdle can cause damage to what internal structure?
What then occurs? |
|
Definition
The intermediate part of the urethra
Blood and urine into the perineal pouch and then through the urogenital hiatus to extraperitoneally |
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|
Term
Where is the common site of rupture of the spongy urethra?
How can this happen? |
|
Definition
The bulb of the penis
Straddle injury |
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|
Term
| Why can urine in the superficial perineal space not flow into the thighs? |
|
Definition
| The superficial perineal fascia blends with the fascia lata in the thigh muscles. |
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|
Term
| Why can urine in the superficial perineal space not flow posteriorly into the anal triangle |
|
Definition
| The superficial and deep layers of perineal fascia are continuous with each other around the perineal muscles and with the perineal membrane. |
|
|
Term
What are the last reserves of fatty tissue to disappear with starvation?
In this case, what is common? |
|
Definition
fat bodies of the ischoanal fossae and buccal fat pads.
Rectal prolapse |
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|
Term
| What does the pectinate line indicate? |
|
Definition
| Marks the transition between visceral to parietal |
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Term
| Name 4 ways in which infections can reach the ishioanal fossae |
|
Definition
- after cryptitis (inflammation of anal sinuses)
- Extension from pelvirectal absess
- after a tear in the anal mucous membrane
- from penetrating wound in the anal region |
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|
Term
| What are the diagnostic signs of an ischioanal abscess? |
|
Definition
| Fullness and tenderness between the anus and the ischial tuberosity. |
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|
Term
The ischioanal fossae communicate via the ________ _________ __________.
This may cause what kind of abscess? |
|
Definition
deep postnatal space
horseshoe-shaped around the posterior aspect of the anal canal |
|
|
Term
Where is an anal fissure typically located?
What nerves supply this region? |
|
Definition
posterior midline
inferior rectal nn. |
|
|
Term
| What's the danger with a perianal abscess? |
|
Definition
| May spread infection to the ischioanal fossa and spread into the pelvis (pelvirectal) |
|
|
Term
| What are internal hemorrhoids? |
|
Definition
| prolapses of rectal mucosa containing dilated veins from the internal rectus venous plexus |
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|
Term
What is thought to produce internal hemorrhoids?
Where do they occur most frequently? |
|
Definition
Breakdown of the muscularis muscosae
left lateral, right anterolateral, right posterolateral positions |
|
|
Term
| What are external hemorrhoids? |
|
Definition
| Thromboses in the veins of the external rectal venous plexus |
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|
Term
| What are predisposing factors for hemorrhoids? (4) |
|
Definition
- pregnancy
- chronic constipation
- prolonged toilet sitting and straining
- disorders impeding venous return |
|
|
Term
| Superior rectal vein drains into the _________ while the middle and inferior rectal veins drain into the _________ |
|
Definition
inferior mesenteric (portal)
IVC (systemic) |
|
|
Term
| The anal canal superior to the pectinate line is _______ and so is innervated by what? The anal canal inferior to this line is ________ and so is innervated by what? |
|
Definition
visceral
visceral afferent pain fibers
parietal
somatic sensory fibers (painful) |
|
|
Term
| Pudendal nerve damage will result in what? |
|
Definition
|
|
Term
Where is the urethra unprotected by erectile tissue of the bulb of the penis?
what does this mean? |
|
Definition
intermediate part
It's vulnerable to puncture during catheritization |
|
|
Term
| The external urethral orifice is the ____ and least ____ part of the urethra |
|
Definition
narrowest
lest distensible part |
|
|
Term
|
Definition
| inflammation of the testes |
|
|
Term
| What is glanular hypospadias |
|
Definition
| The external urethral orifice is on the ventral aspect of the glans. |
|
|
Term
| What is penile hypospadias |
|
Definition
| The external urethral orifice is on the body of the penis |
|
|
Term
| Why does glanular and penile hypospadias occur |
|
Definition
| Failure of the urogenital folds to fuse on the ventral surface of the developing penis and form the spongy urethra |
|
|
Term
|
Definition
| When the prepuce of the penis is too tight to be retracted over the glans |
|
|
Term
|
Definition
| Retraction of the prepuce over the glans constricts the neck of the glans so much that there is interference with drainage of blood and tissue fluid. Glans may enlarge |
|
|
Term
| What does female circumcision remove? |
|
Definition
| prepuce of the clitoris, clitoris, and labia minora |
|
|
Term
| Where is the site of most vulvar adenocarcinomas? |
|
Definition
| the greater vestibular gland |
|
|
Term
|
Definition
| inflammation of the greater vestibular glands |
|
|
Term
Where is a pudendal nerve block performed?
What pain is relieved? |
|
Definition
where the pudendal nerve crosses the lateral aspect of the sacrospinous ligament. Commonly performed through the vagina.
Perineal pain |
|
|
Term
| An ilioinguinal nerve block abolishes what pain? |
|
Definition
| Anterior part of the perineum |
|
|
Term
| What do kegel exercises develop? |
|
Definition
| Superficial transverse perineal muscle, bulbospongiousus and external anal sphincter |
|
|
Term
|
Definition
| Distension of bulbospongiosus and transverse perineal muscles trigger involuntary spasms of perivaginal and levator ani muscles under psychological distress. |
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