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2 Exam 2 Pelvis 1-3 Combined
Anatomy Exam 2
66
Anatomy
Graduate
10/21/2011

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Term
What is the demarcation between the false and true pelvis?
Definition
The pelvic brim, following along the superior margin of the pubic symphysis, pectin of the pubis, arcuate line of the ilium, ala of the sacrum and sacral promontory.
Term
What are the three bones that make up the hip bone?
Definition
Ilium, ischium, and pubis.
Term
What is the structure where the two hip bones unite anteriorly?
Definition
Pubic symphysis
Term
What part of the sacrum unites with the hip bones posteriorly?
Definition
The ala of the sacrum articulate with the ilium and are held in place by strong sacroiliac ligaments. There is actually a joint which is reasonably nonmotile, the sacroiliac joint.
Term
What ligaments and bony prominences are involved in the formation of the greater and lesser sciatic foramina?
Definition
The sacrotuberous and sacrospinous ligaments that connect the ishial tubosity and ishial spine to the sacrum. The space between the sacrotuberous and sacrospinous ligaments is the lesser sciatic foramen.
Term
In the anatomic position what two bony features of the pelvis lie on the same vertical plane?
Definition
The anterior part of the pubic symphysis and the anterior superior iliac spine.
Term
Concerning differences in male and female bony pelvises:
· Which has the widest subpubic angle?
· Which has the smallest pelvic inlet and outlet?
· Which has the shallowest true pelvis?
Definition
Which has the widest subpubic angle? Female
· Which has the smallest pelvic inlet and outlet? Male
· Which has the shallowest true pelvis? Female
Term
What is the pouch of Douglas and what is its clinical significance?
Definition
The rectouterine space or peritoneal space between the uterus and anterior rectum. Clinically it is an important area adjacent to the posterior fornix of the vagina. The thin vaginal wall is all that separates the peritoneal cavity from the outer environment. It can easily be punctured thus transmitting infection to the peritoneal cavity.
Term
What is the sacral plexus?
Definition
The sacral plexus is composed of ventral primary rami of segments S1 to S5 and the lumbosacral trunk from L4-5. These nerves combine to form the major nerves that leave the pelvis to supply the lower limb.
Term
What are the major nerves derived from the sacral plexus?
Definition
Sciatic, superior and inferior gluteal, pudendal, posterior femoral cutaneous, and pelvic splanchnics. (Don’t worry about which segments supply each nerve.)
Term
What are the two sources for sympathetic nerves in the pelvis?
Definition
Sacral sympathetic trunk (or chain) and the hypogastric plexus.
Term
What is the origin of the parasympathetic innervation to the pelvis viscera?
Definition
Pelvis splanchnics from S2-S4.
Term
What are the chief arteries off the internal iliac artery?
Definition
Superior and inferior gluteal arteries, umbilical supplying superior vesicular branches, obturator, middle rectals, internal pudendals, uterine and vaginal branches
Term
What arteries in the pelvis are unique to females?
Definition
Uterine and vaginal branches off the internal iliac, and ovarian from the lumbar aorta.
Term
What is the origin for the common variation of the obturator artery?
Definition
It may arise off the inferior epigastric branch from the external iliac and pass over the pelvic brim to the obturator canal (20% occurrence).
Term
On a rectal exam, what can be palpated anteriorly in the female?
Definition
cervix of uterus
Term
What is the muscular sheet found at the pelvic outlet? What are its components?
Definition
What are its components? Pelvic diaphragm; levator ani and coccygeus muscles.
Term
What is the name of the medial part of the levator ani that keeps the “kink” in the anus?
Definition
Puborectal sling.
Term
What is the path for the ureters? Where are the three constrictions in the ureters?
Definition
They pass down the posterior abdominal wall, over the pelvic brim, along the posterior wall of the pelvis and then anterior to the enter posterior wall of the bladder. Three constrictions are 1) at the renal pelvis, 2) where they cross the external iliac artery and pass over the pelvic brim, and 3) as they pass through the bladder wall. These areas are where large calculi, ‘kidney stones’, often are stopped and then cause increased pain. Small stones may pass with little or no pain.
Term
As the ureters approach the uterus, what structure crosses immediately over them?
Definition
Uterine artery.
Term
What is the smooth area in the bladder where the ureters pierce the bladder wall?
Definition
Trigone, outlined by the inlets of the ureters and inferiorly by the outlet of the bladder.
Term
What is the name of the smooth muscle found in the urinary bladder wall?
Definition
Detrusor muscle.
Term
What is the ring of smooth muscle called at the neck of the urinary bladder?
Definition
Internal sphincter.
Term
What is its innervation (#23 above)( the ring of smooth muscle called at the neck of the urinary bladder)?
Definition
It is closed tonically by the sympathetics and stimulated to open by the parasympathetics (by inhibition of sympathetics).
Term
On rectal exam what can be palpated anteriorly in the male.
Definition
Prostate and seminal vesicles.
Term
Where is the membranous urethra located in both sexes?
Definition
Within the urogenital diaphragm.
Term
What is the pathway for sperm after passing through the superficial inguinal ring?
Definition
In the vas deferens the sperm pass through the inguinal canal, then through the deep inguinal ring, over the pelvic brim, along the lateral aspect of the bladder, join the duct of the seminal vesicle to form the ejaculatory duct, passes through the prostate gland, and enter the prostatic urethra on the posterior aspect along the colliculus seminalis.
Term
Into what does the ejaculatory duct empty?
Definition
Prostatic urethra, along the side of the colliculus seminalis.
Term
What nerve group functions during ejaculation?
Definition
Parasympathetics, cause contraction of urethral muscles. Sympathetics, cause movement of sperm down the vas and secretion of glands (emission).
Term
How does the prostate empty into the urethra compared to the ejaculatory ducts.
Definition
Numerous small ducts open into the prostatic urethra.
Term
What is the name for the longest part of the urethra in males?
Definition
Spongy urethra (since it enclosed by the corpus spongiosum.
Term
The female urethra opens into what space?
Definition
Vestibule.
Term
What arteries supply the rectum?
Definition
Superior rectal from inferior mesenteric, middle rectal form internal iliac, and inferior rectal from internal pudendal artery.
Term
What are the boundaries of the perineum?
Definition
It is a diamond formed by the pubic symphysis, pubic rami, ishial rami, ishial tubosities, sacrotuberous ligaments, and coccyx.
Term
What are its two subdivisions, and in general what is found in each?
Definition
Anal triangle; anal canal, external anal sphincter, and ishiorectal fossa. Urogenital triangle; UG diaphragm, scrotum/labia, penis/clitoris, vestibule.
Term
What are the boundaries of the ischiorectal fossae? With what is it normally filled?
Definition
With what is it normally filled? Perineal body anteriorly, laterally obturator internus muscle, levator ani. They are filled with fat.
Term
What is the UG diaphragm and how does it differ from the pelvic diaphragm?
Definition
It stretches between the inferior pubic rami. It lies superficial to the pelvic diaphragm and contains the external sphincter of the urethra.
Term
What pierces the UG diaphragm in the female? The male?
Definition
Female – urethra and vagina. Male - urethra
Term
What is found in the deep perineal space?
Definition
The urogenital diaphragm
Term
What is the superficial perineal space? And what is found there?
Definition
It is the area superficial to the UG diaphragm. It contains the structures associated with the penis and scrotum, or structures of the vestibule, clitoris, and labia, plus all the associated nerves and vessels.
Term
What is the difference between the external and internal urethral sphincter?
Definition
The external sphincter is under voluntary control while the internal sphincter is controlled by autonomic nerves.
Term
What is the chief nerve supply to the perineum?
Definition
Pudendal nerve and its branches.
Term
What is the origin of the inferior rectal nerves & vessels?
Definition
Pudendal nerve and internal pudendal artery and veins.
Term
What are the names of the nerves and arteries on the dorsum of the body of the penis? What is the function of the nerves found here?
Definition
Deep dorsal vein, dorsal arteries, and dorsal nerves. Sensory to the surface.
Term
The crura and bulb of the penis make up what basic part of the penis?
Definition
Root of the penis
Term
What is the muscle layer that lies over the bulb of the penis? What is its function?
Definition
Bulbospongiosus, compresses the bulb and assists erection.
Term
How does the path of the urethra differ between the sexes?
Definition
The male urethra consists of prostatic and spongy components that are not found in the female. The membranous component is common in both.
Term
What is the bulb of the penis continuous with in the shaft of the penis?
Definition
Corpora spongiosum
Term
What is the mechanism of erection?
Definition
Upon stimulation the smooth muscle in the trabeculae and arteries of the corpora relax because of parasympathetic stimulation (via pelvic splanchnics). The arteries straighten and enlarge allowing increased blood flow into the cavernous spaces. The bulbospongiosus and ishiocavernosus muscles compress the venous drainage at the periphery of the corpora and impede outflow of blood. As a result the corpora become enlarged and rigid and erection occurs.
Term
How do the drainage patterns for the superficial veins of the perineum differ from that of the deep dorsal vein?
Definition
The perineum is drained via the internal pudendal veins back toward the lesser sciatic foramen while the deep dorsal vein drains through a defect in the UG diaphragm directly into a plexus of veins surrounding the prostate gland.
Term
What is the name of the end of the uterine tube that drapes over the ovary?
Definition
Fimbrae, which sweep over the surface of the ovary and pick up ovulated oocytes.
Term
What is the origin of the ovarian arteries?
Definition
They pass into the pelvis over the pelvic brim. They originate as paired arteries off the aorta.
Term
What is the peritoneal sheet that attaches the uterus to the lateral pelvic wall?
Definition
Broad ligament of the uterus.
Term
What is the ligamentous structure within broad ligament that contains the ovarian vessels?
Definition
Suspensory ligament of the ovary.
Term
What ligament supports the cervix/uterus within the broad ligament?
Definition
Transverse cervical or ‘cardinal’ ligament.
Term
What is the usual orientation of the uterus in relationship to the bladder?
Definition
Anteflexed anteriorly over the bladder.
Term
At what uterine anatomic landmark does the uterine artery approach the uterus?
Definition
It approaches at the uterine cervix from both sides and then its branches go superiorly and inferiorly to supply the uterus.
Term
What are the vaginal spaces around the end of the cervix?
Definition
Anterior, lateral, and posterior fornices (fornix is singular).
Term
The crura of the clitoris make up what structure in the body?
Definition
Corpora cavernosa
Term
What is the skeletal muscle that lays over the crura of the clitoris? What is its function?
Definition
Ishiocavernosus muscle. Its function is to help maintain erection in the clitoris.
Term
What is the nerve supply to the female perineum?
Definition
Perineal branches of the pudendal nerve.
Term
What is the surgical procedure called that prevents the UG diaphragm from ripping during childbirth?
Definition
Episiotomy. It is done to enlarge the vaginal orifice and prevent a jagged tear in the perineum. This heals more quickly and can prevent damage to important structures such as the perineal body that have consequences later in life in support of pelvic viscera.
Term
In the pudendal block, what bony feature does the clinician use as a guide to anesthetize the pudendal nerve?
Definition
Ishial spine.
Term
To where do the lymphatics for the cervix drain?
Definition
They pass along the uterine vessels to the internal iliac nodes and then superior along the aorta.
Term
To where do the lymphatics for the scrotum/labia drain initially?
Definition
They drain to the superficial inguinal nodes.
Term
To where do the lymphatics of the ovary/testes drain?
Definition
The lymphatics follow the ovarian and testicular blood vessels and ascend to the lumbar lymph nodes.
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