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The Pelvic Wall
The Pelvic Wall Anatomy
| Question | Answer |
|---|---|
| What are the general locations of the false pelvis? The true pelvis? | False (greater): above pelvic brim, portion of abdomen between iliac fossa. True Pelvis: below pelvic rim |
| What are the borders of the true pelvis? | Pelvic inlet: pubic symphisis and crest, iliopectineal lines, sacral promontory (1st sacral vertebra). Pelvic outlet: pubic symphisis , ishiopubic ramus, ischial tuberosities, sacrotuberous ligaments, coccyx |
| What structure separates the pelvis from the perineum below? | The Pelvic Diaphragm |
| What bones form the anterior wall of the pelvis? | Pubic bone, pubic symphisis |
| What structures form the lateral wall of the pelvis? | Hip bone below the pelvic inlet, obturator membrane, obturator internus muscle (N. nerve to obturator internus), A. laterally rotates thigh) |
| What structures form the posterior wall of the pelvis? | Sacrum and coccyx; piriformis muscle (N. nerve to the piriformis, A. laterally rotates thigh). |
| What is the obturator membrane? | Fibrous sheet, almost completely encloses obturator foramen, but leaves a small gap (obturator canal) for the passage of obturator nerve and vessels |
| This ligament extends from the lateral part of the sacrum and coccyx to the ischeal tuberosity | Sacrotuberous ligament |
| This ligament extends from the lateral part of the sacrum and coccyx to the ischial plate | Sacrospinous ligament |
| What are the functions of the sacrotuberous and the sacrospinal ligaments? | prevent the lower end of the sacrum and coccyx from being rotated upwards at the sacroiliac joint by the weight of the body; also convert greater and lesser sciatic notches into greater and lesser sciatic foramina |
| What muscles comprise the pelvic diaphragm? | Levator ani muscle (extensive) and the coccygeus muscle posteriorly (smaller) |
| What structures pass through the diaphragm? | Urethra, vagina, and anal canal; they pass into the perineum below |
| Where is the diaphragm incomplete? Why? | Incomplete anteriorly at the urogenital hiatus to allow for the passage of the urethra (males and females) and the vagina (females) |
| What nerve supplies the pelvic diaphragm? | Pelvic surface: ventral rami of S3 and S4; Perineal surface: perineal branch of the pudental nerve |
| What are the three major pelvic fascia layers? | Parietal pelvic fascia, visceral pelvic fascia, and superitoneal fascia |
| Describe the parietal pelvic fascia | continous with fascia lining abdominal wall, forms dense membranes on pelvic surface of muscles, blends with periosteum, named after underlying muscle group |
| What is the arcus tendinous? | Thickening of the obturator internus fascia; important as the origin of a large portion of the levator ani muscle |
| Describe the visceral pelvic fascia | Looser connective tissue investing the pelvic viscera (bladder, vagina, uterus, rectum) |
| Describe the subperitoneal pelvic fascia | Continued extraperitoneal fascia from abdomen into pelvis; condensation of the fascia form ligaments (e.g. Females have pubovescial, transverse cervical [Mackenrodt's], and sacrouterine ligaments); ligaments blend with parietal and visceral fascia |
| Describe the blood supply of the major branching/branches of the common iliac artery | bifurcates at the pelvic rim in front of the sacroiliac joint into external and internal arteries |
| Describe the path of the external iliac artery | Continues the path of the common iliac artery along the pelvic brim |
| Describe the path of the internal iliac artery | Passes down into pelvis and contributes most of blood supply to the pelvis EXCEPT for ovarian artery, superior rectal artery, median sacral artery |
| Where do the following arteries come from? Ovarian artery, superior rectal artery, median sacral artery | OA (branch of the abdominal aorta), SRA (terminal branch of the inferior mesenteric artery), and MSA (branch of the abdominal aorta |
| Describe the path and the divisions of the internal iliac artery | Divides into posterior and anterior divisions, though there is a lot of variation. |
| Describe the path and the areas supplied by the iliolumbar artery | Ascends along lumbosacral trunk in front of ala of sacrum; often separates lumbosacral trunk from obturator nerve medial to the psoas major m., supplies iliacus and psoas major m. |
| What are the (3) major branches of the posterior division of the internal iliac artery? | iliolumbar artery, lateral sacral artery, superior gluteal artery |
| Describe the path of the lateral sacral arteries | Pass medially and enter the pelvic foramina supplying nerve roots |
| Describe the path and areas supplied by the superior gluteal artery | Usually separates the lubosacral trunk from the ventral ramus of S1; leaves greater sciatic foramen above the piriformis muscles |
| What are the divisions of the anterior division of the internal iliac artery? | Umbilical artery, obturator artery, inferior vesical artery, middle rectal artery, uterine artery, vaginal artery, internal pudental artery, inferior gluteal artery |
| Describe the path of the umbilical artery | gives off superior vesical arteris (supplies urinary bladder) and continues forward as the medial umbilical ligament |
| Describe the path of the obturator artery; what is an anomalous obturator artery and why is it significant? | passes w/ obt. nerve through the obt. canal; 30% of cases, arises from the inferior epigastric artery or the external iliac artery (anomalous obturator artery); anom. ob. artery runs close to femoral ring to reach femoral canal--femoral hernia danger |
| Describe the path / area supplied by the inferior vesical artery (males only) | Gives off artery to the ductus deferens |
| Describe the areas supplied by the middle rectal artery | Actually supplies reproductive organs |
| Describe the areas supplied by the uterine artery | passes medially within cardinal ligament below the root of the broad ligament; passes above the ureter near the lateral fornix of the vagina |
| Describe the path and area supplied by the vaginal artery | homolog of inferior vesical artery in the male; runs to the side of the vagina and then descends into perineum; helps supply the bladder |
| Describe the path and area supplied by the internal pudental artery | Exits the pelvis between the piriformis and coccygeus muscles running with the pudental nerve |
| Describe the path and area supplied by the inferior gluteal artery | passes between the ventral ramus of S1 or S2 and S3; exits the pelvis through the greater sciatic foramen below the piriformis muscle |
| Describe the veins of the pelvis (briefly) | Correspond closely with the arteries; tirbutaries of internal iliac vein communicated freely with each other and others outside of their territory of drainage-->vertebral venous plexus and internal iliac vein anastomose, often leading to metastases |
| What nerves comprise the sacral plexus | The sacral plexus is formed by the lumbosacral trunk and ventral rami of S1, S2, S3, and S4 |
| Where do the sacral plexus branches exit through? | GReater sciatic foramen |
| What is the lumbosacral trunk? | Composed of descending portion of the ventral ramus of L4 and all of the ventral ramus of L5; descends over sacroiliac joint and joins S1 in the pelvis just beyond the superior gluteal artery |
| Describe the path of the pudental nerve | (S2-S4) and internal pudental vessels: exit via greater sciatic foramen below the piriformis m., hooks around sacrospinous ligament; enters perineum via lesser sciatic forament and enters pudental canal along wall of ischiorectal fossa |
| What fibers are found int he pelvic splanchnic nerves? | Preganglionic parasympathetics from S2 - S4 |
| Where does the obturator nerve originate from? | L2-L4 from lumbar plexus; runs along lateral wall of the pelvis between the external iliac and internal iliac arteries within the ovarian fossa; meets obturator artery and vein at the obturator canal |
| Describe the path of the pelvic sympathetic trunk | passes over pelvic brim behind iliac vessels; trunks descend and converge medial to the pelvic foramina; trunks fuse with each other in front of coccyx to form a small enlargement = Ganglion Impar |
Created by:
karkis77
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