Borders of the True Pelvis
Pelvic Inlet: Pelvic inlet, brim and Superior pelvic aperture (P.I.S)
-Above=Public symphysis and crest
-Sides = Iliopectineal Line
-Posterior = Sacral promontory
Pelvic Outlet: Inferior pelvic aperture (P.I.I.S.C)
What separates the pelvis from the perineum? And forms the floor of the Pelvis?
The Pelvic Diaphragm
Where are the Pubic Tubercles and the ASIS in the anatomical position?
Located on the same vertical plane
What are the components of the Lateral Wall of the Pelvis?
Hip bone below the pelvic inlet
Obturator internus muscle
Is the Diaphragm complete or incomplete at the urogenital hiatus?
Incomplete so as to allow passage of urethra (m/f) and vagina (f)
Function of Pelvic Diaphragm
Supports all pelvic viscera
Involved in voluntary control of micturition and support of uterus
Which pelvis is >80 degrees (has a larger pelvic inlet and outlet) and is shallower and wider
The Parietal Pelvic Fascia is continuous above with the fascia lining the abdominal wall
True: Eg. Transversalis fascia
T/F The Parietal Pelvic Fascia forms a looser connective tissue membrane on the pelvic surface of muscles and blends with the periosteum of the bony pelvic boundaries?
False - A RELATIVELY DENSE Membrane
Thickening of the obturator internus fascia and important as the origin of a large portion of the levator ani muscle
Superior Fascia of the Pelvic diaphragm
The Parietal fascia covering the pelvic surface of the pelvic diaphragm
Visceral Pelvic Fascia
Looser connective tissue investing the pelvic viscera (Uterus, vagina, bladder, rectum)
Subperitoneal Pelvic Fascia
Fatty continuation of the extraperitoneal fascia from the abdomen into the pelvis
All the ligaments formed blends medially with the visceral fascia covering the visceral organs and laterally with the parietal pelvic fascia
What are the ligaments formed from the condensations of the Subperitoneal Pelvic Fascia
Lateral cervical ligaments
Blood Vessels of the Pelvis
Common Iliac Artery -> Bifurcates at the pelvic brim in front of sacroiliac joint into -> External and Internal iliac arteries.
Internal Iliac artery
Passes downwards into the pelvis and contributes most of the its blood supply.
What are the exceptions of the Internal Iliac artery supply?
The Ovarian artery (branch of abd aorta)
Superior rectal artery (terminal branch of inferior mesenteric)
T/F The rectum ends at the anorectal junction in front of the tip of the coccyx as the rectum pierces the pelvic diaphragm
Descend on surface of psoas major muscles
Cross into pelvis OVER difurcation of Common Iliac arteries
Enters the urinary bladder at the superolateral angle, course obliquely through the wall app 3/4inch before opening into the bladder
What crosses over the Ureter in Females
The Uterine Artery:
Water (Ureter) runs under the bridge (Uterine artery)
Name the three sites for Kidney Stones
Junction of ureter and Renal pelvis
Where ureter crosses pelvic brim
Passage through the urinary bladder
Posterior to the pubis, rises into the abd as it fills, lifting peritoneum off inner surface of the anterior abd wall
Where does the Neck of the Male Bladder rest?
On the Prostate gland - so its alittle higher in the pelvis
Where does the neck of the Female bladder rest?
On the urogenital diaphragm - so it has a lower position in the pelvis
What are fornices?
Extensions of the vagina.
Vaginal recesses at upper end formed around the vaginal portion of the cervix
Which is LONGER - The posterior or anterior vaginal wall?
Posterior (because of angle betw vagina and cervix)
Which is DEEPER and LONGER - The anterior, posterior or lateral fornices?
Posterior (because of angle betw vagina and cervix)
What separates the vagina from the anal canal?
A lot of muscles embedded here, site for episiotomy
What are the posterior borders/Relations of the Vagina?
Upper 1/3= Uterorectal pouch of Douglas
Middle 1/3 = Rectal Ampulla
Lower 1/3 = Perineal body
Structure of the Uterus
Fundus = Above entrance of the uterine tubes
Body = Beneath the entrance of the uterine tubes
Cervix = Narrow inferior portion
What is the lower portion of the body of the uterus adjoining the supravaginal segment of the Cerix?
Isthmus of the Uterus
Why is the normal uterus considered to be Anteversioned?
Pull exerted on the cervix by uterosacral ligaments.
Located on either side of uterus immediately below the fundus in the free edge of the broad ligament
What are the segments of the uterine tubes?
Infundibulum= funnel shaped lateral end - Fimbriae (fingerlike processes of the infundib), Ovarian fimbbria (attached to the ovary
Ampulla= widest part of tube and site of fertilizt
Isthmus = Narrowest part of tube closest to uterine wall
Intramural part - segment piercing the uterine wall
How can pathogenic organisms enter the body during sex?
Through vagina->cervix-->uterus-->uterine tubes
What is an ectopic pregnancy?
Implantation and growth of a fertilized ovum outside the uterine cavity
How is an ectopic pregnancy life threatening?
Eroding action of the trophoblast quickly destroys the wall of the tube and causes an effusion of a large amt of blood into the uterovesical pouch or the uterorectal pouch of Douglas
Is the broad ligament a Single or double layered fold?
Double layered extending from lateral margins of uterus to lateral pelvic walls
Suspensory Ligaments of the Ovary
Lateral-most part of the broad ligament which encloses the ovarian vessels, nerves and lymphatics
What structures are enclosed by the Broad ligament?
Uterine tubes (in upper free border)
Uterine and ovarian blood vessels
Runs in the posterior lamina of the broad ligament from uterine pole of ovary to uterus just below uterotubal junction
Runs in the anterior lamina of the broad ligament from pt just below uterotubal junction to labia majora via inguinal canal.
What are the chief supports of the Uterus?
Levator Ani muscles
Transverse cervical ligaments (Cardinal ligament, Mackenrodt's ligament)
T/F The uterine artery runs in the base of the broad ligament and crosses the ureter at 90 deg near the lateral fornix of the vagina?
T/F The uterine artery ascends along the lateral border of the uterus within the broad ligament and ends by anastomosing with the ovarian artery?
This is true. Before ascending it also gives off descending cervical and vaginal branches
How is prolapse of the uterus caused?
Weakening of the Levator ani muscles, perineal body or ligaments supporting the uterus during childbirth or due to poor muscle tone.
When does prolapse of the uterus usually occur?
During menopause when the pelvic fascias tend to atrophy along with the pelvic organs.
T/F The ovarian ligament connects the ovary to the uterus?
True. The Ovarian ligament aka the upper part of the gubernaculum
What are the borders of the Ovarian Fossa?
Anterior-External Iliac vessels
Posterior - Internal iliac vessels and ureter