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Pelvis Block
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52
Anatomy
Kindergarten
12/01/2012

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Term
Cystocele and rectocele?
Definition
-When the bladder herniates into the vagina during childbirth caused by a tear in the pubocervical facia
-Rectocele is the same thing but with the rectum and caused by a tear in the rectovaginal septum (may also be an enterocele with sm. intestine)
Term
Control of anal sphincters?
Definition
-Internal; para relaxes, sympathetic contracts (sm. muscle)
-External; inferior rectal br.s of pudendal (voluntary)
Term
BPH vs. adenocarcinoma?
Definition
-Happen at periurethral zone vs. peripheral part
Term
Bicornuate uterus?
Definition
-Uterus has two horns
-Caused by lack of complete fusion of the paramesonephric ducts (Mullerian ducts) at superior end
-If they don't fuse at all you get two uteri
Term
Where can we find the uterine vessels?
Definition
-It's usually the third branch of the internal iliac and courses through the cardinal (transverse cervical (ligament)
Term
What muscles make up the urogenital diaphragm?
Definition
Deep transverse perineal, the sphincter urethrae, and the compressor urethrae muscles.
Term
What muscles make up the pelvic diaphragm?
Definition
-The levatator ani (puborectalis, pubococcygeus, & iliococcygeus)
-And the (ischio)coccygeus
Term
What is the innervation to the detrusor?
Definition
-Pelvic splanchnic (para)
Term
Epispadias cause?
Definition
-When urethra opens on the dorsal surface of the penis
-Caused when the genital tubercle develops too dorsally
-Also can be from failure of fusion of the spongy urethra
Term
What causes perineal hypospadias?
Definition
-Failure of fusion of labioscrotal folds
-urethral orifice is between unfused halves of scrotum
Term
What's the ligament that guides the testis in descent? What is it called when it doesn't descend?
Definition
-Gubernaculum
-Cryptorchidism
Term
Hydrocele?
Definition
-Accumulation between the two layers of the tunica vaginalis in the scrotum (scrotal edema)
-Often from patency of the processus vaginalis so that peritoneal fluid can flow in
Term
Hydronephros?
Definition
-Swelling of renal pelvis and calyces due to obstruction
Term
Penile hypospadias?
Definition
-From the urethral folds not closing
-pee comes out the ventral penis
Term
Varicocele?
Definition
-When the pampiniform plexus gets enlarged due to blockage
-Makes scrotum look like bag of worms
Term
Colpocentesis/culdocentesis?
Definition
-Needle through posterior fornix into rectouterine pouch
Term
Pain from too full of a bladder?
Definition
-Pelvic splanchnics
-For test purposes, all innervation of the bladder is from pelvic splanchnics
Term
Muscle other than the sphincters for fecal continence?
Definition
-Pubococcygeus/puborectalis
Term
What nerve crosses under inguinal ligament closest to the ASIS?
Definition
-Lat. femoral cutaneous
-Often constricted from too tight of jeans in "Calvin Klein syndrome"
Term
Normal uterine position?
Definition
-Antiflexed and antiverted
Term
Main support ligaments of the uterus?
Definition
-Cardinal and uterosacral (/rectouterine/sacrouterine) ligaments
-Note; not broad or any others!
Term
Lymph from testis and ovaries?
Definition
-Preaortic/lumbar
Term
If we want to drain the bladder with a needle, what space do we go through?
Definition
-The retropubic space
Term
Hematocolpos?
Definition
-Filling of the vagina with blood because of an imperforate hymen.
Term
Infundibulopelvic ligament?
Definition
-aka suspensory lig of the ovary
-has nerves and blood vessels
Term
What surrounds the superficial perineal space?
Definition
-Colles' and Gallaudet's facia (the superficial and deep perineal facia)
Term
What facia is Dartos continuous with?
Definition
-Colle's and Scarpa's
Term
Control of external urethral sphincter?
Definition
-Pudendal
Term
What blood vessel and nerves give men erections? What nerves for ejaculation?
Definition
-Pelvic splanchnics (para) and deep artery of penis.
-Lower thoracic and lumbar splanchnics (sympathetic); need to both stimulate internal sphincter and contraction of smooth muscle in vas defs, prostate, and seminal vesicles
Term
What lymph nodes drain the uterus?
Definition
-Fundis goes to lumbar
-Near round ligament goes to inguinal
-Lower part goes to external iliac
Term
Lymph drainage for vestibule of the vagina?
Definition
-Superficial inguinal (drain all body wall stuff below umbilicus)
Term
Pain in anus?
Definition
-None above pectinate, but pudendal below it (via the inferior rectal nerve)
Term
What do we have to watch for during a hysterectomy?
Definition
-The ureter as the uterine vessels cross over it (water under the bridge)
Term
Vaginismus?
Definition
-When a woman has involuntary spasms of the perineal musculature, often upon penetration
-Makes sex painful
Term
Between what two facial layers is an extravasation of urine from a perineal hematoma if it is spreading to underneath Scarpa's layer?
Definition
-Between Gallaudet's and perineal membrane
-Will work it's way out from under Gallaudet's to between Bucks and Dartos
-Then it will follow Dartos up to under Scarpa's (and probably down under Colle's as well)
Term
What does lymph drainage for prostate?
Definition
-Internal iliac and sacral
Term
Pain from cervix? Referred?
Definition
-Goes via pelvic splanchnics
-Above this goes via lower lumbar splanchnics
-Can be referred to perineum and lateral thigh
Term
What are the sacral splanchnics?
Definition
-They are NOT the pelvic splanchnics
-They carry mostly sympathetics with very little pain etc.
Term
Where do the testis drain into?
Definition
-The left one goes to left renal, the right goes directly to IVC
-Remember, the left renal functions as a pseudo left IVC receiving the left suprarenal, gonadal, and inf. phrenics (goes up to IVC)
Term
What do the seminal vesicles do?
Definition
-Produce the alkaline fructose solution
Term
Placenta previa?
Definition
-When the embryo implants all the way at the bottom of the uterus, covering the internal os
Term
What is first to get lymph from the cervix?
Definition
-The internal iliac (mostly)
Term
What is the arterial circle of death?
Definition
-When an aberrant obtuator artery arises from the inf. epigastric crossing the pectinate ligament and taking the place of the normal obtuator artery
-May be injured in surgery
-Present in 20-30% of population
Term
Pain from testis? Referral?
Definition
-Viceral afferent from T10-L2 from lumbar splanchnics
-Referred to the abdomen
-Note; the genital br. of genitorfemoral has efferent only
Term
What are the shortest and longest pelvic diameters?
Definition
-Shortest is the interspinous distance (most reliable determinant of capacity for vaginal birth)
-Longest is the transverse
Term
When does sexual differentiation begin? When can we tell? And when does it end?
Definition
-Week 7, 12, & 20
Term
How is the vagina formed?
Definition
-The paramesonephric (mullerian) fuse to form the uterus and the superior 1/3 of the vagina (and the uterine tubes where they don't fuse)
-The mullerian ducts induce the formation of the sinovaginal bulbs before they fuse, and then the sinovaginal bulbs fuse to form the solid vaginal plate which canalizes to form the distal 2/3 of the vagina
Term
What gives MIF? What does the Y chrom code for?
Definition
-Sertoli cells give mullerian inhibiting factor
-testes determining factor (TDF)
Term
Name causes of female pseudointersexuality?
Definition
-CAH (at 21 usually, but also at 11)
Term
Name causes of male pseudointersexuality?
Definition
-Can be from 5 or 17 def. (with 5 we have lack of DHT but get change to male, i.e. virilization, at puberty)
-Can also be from complete androgen insensitivity (aka testicular feminization)
Term
Late preterm? What is full term?
Definition
-weeks 34-36
-70% of premees fall in this category
-37 is full term
Term
Low vs. very low vs. extremely low birth weight?
Definition
<2500g (5.5lb)
<1500g (3.3lb)
<1000g (2.2lb)
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