Pelvis

minimum diametrs of true pelvis (conjugates)

inportant in for successful childbirth to see if a C-section is needed

minimum obstric (true) conjugate value

over 11cm for vaginal delivery

diagonal conjugate

measurement used to see measurement of pelvic inlet by palpating sacral promontory

pelvic ligaments relaxation

relax to become more flexible for childborth

interspinous distance

distance between ischial spines, not fixes due to relaxation of peliv ligaments, meaning that it can change shape for baby to pass through

sacroiliac joint

between the sacrum and ilium bones of the pelvis

female pelvis

wider and larger pelvic outlet to help with childbirth, more round

pelvis shapes in men

android (heart shape) and anthropoid (long oval)

pelvis shapes in white females

android (heart shape) and gynecoid (round inlet, wide pelvic cavity, large outlet)

pelvis shapes in black females

gynecoid (round inlet, wide pelvic cavtiy, large outlet) and anthropoid (long oval)

platypelloid shape

flattened inlet, wide transverse diameter and short anteroposterior diameter, makes vaginal delivery difficult

anterior superior iliac spine (ASIS)

prominent bony landmark on iliac bone of pelvis, serves as attachment for muscles and ligaments

anteroposterior compression of pelvis

during crush accident that result in fracture of pubic rami

lateral compression of the pelvis

ilia (larged wing bone on upper part of pelvis) and acetabula (hip socket where head of femur is) get broken

acetabulum

the femoral head goes into the pelvis

anterior longitudinal ligament

strong fibrous band that rubs along anterior surface of vertebral bodies from base of skull to sacrum

relaxin

hormone that lets pelvic ligaments relax in pregnant women.

relaxin causes what changes in women?

circumference of lesser pelvis increases pubic symphysis becomes more flexible (10-15% inc in pelvic diameter except true conjugate)

pubococcygeus

main part of levator ani that is most damaged in childborth that can lead to urinary incompetence

pevlic floor

levator ani and coccygeus get damaged from childbirth

lamaze

prenatal training allows pelvic muscles on peliv floor to relax and increase intrabdominal pressure preventing injury during childbirth

levator ani

group of muscles that support pelvi floor and support pelvic organs, maintain urinary & fecal continence and assist in childbirth

piriformis

muscle located deep to gluteal region and does external rotation and abducition of hip (s1-s2)

obturator internus

external rotation of the hip (L5-S2)

levator ani group

pubococcyeus, iliococcygeus, puborectalis

coccygeus

posterior to levator ani and helps support pelvic organs (S4-S5)

anterior rami

ventral divisions of spinal nerves they contribute toe the formation of the plexys that carrt motor and sensory info to lower limb and pelvis area (S1-S2)

sacral plexus compression

during childborht fetal head can compress sacral plexus and put pain on lower limb

sacral plexus

network of nerves located in pelvis that provides motor and sensory info to lower limb, pelvis floor and perineum

obturator nerve

innervates msucles in the medial thigh and adductors

damage to obturator nerve

vulnerable during surgery and pain cause pain and sensory loss in adductor compartment of thigh

artery order to pelvis

abdominal aorta → common iliac artery → internal (anterior division) iliac artery → obturator artery, umbilical artery, uterine artery

trigone

triangular region on the base of the urinary bladder, when strwetched to a certain degree tells the brain it is time to empty the bladder

ureter potential damage

close to pelvic arteries, can be dmaaged during hysterectomy (uterien artery clamped) or ovariectomy (ovarian arteries ligated)

collateral circulation of pelvis

ligation of internak ilia artery to control hemorrhage but bloodcan still reach pelvic organs through alternative routes

external iliac lymph nodes

drain lower limb, anterior abdominal wall and external genitalia

internal iliac lymph nodes

drain pelvic organs, perineum and gluteal region

pelvic urinary organs

ureters, urinary bladder, urethra

extternal artery pathway

common ilia artery → external iliac artery → femoral artery → popliteal artery → tibial arteries → dorsalis pedis artery

ureter potential damage

is in danger of damage during surgery sinve it can result from interruption of blood flow

traction of ureter

ureter is delicate and excess pulling or tearing of it can lead to a tear or rupture

ureteruc calculi

stones in the uterus that can block flow of urine and pain

where does obstruction of ureter occur the most? (where it is constricted)

junction of ureer & renal pelvis, when ureter crosses pelvis brim, passes thriugh bladder wall

internal iliac artery

main blood supply to pelvis organs, gluteal muscles, and perineum (portion of skin between genital and anus)

ductus deferens

muscular tube that carrys sperm from epididymis to ththe ejaculatory duct

outer structures in penis

the urethra on the bottom, 2 columns of corpora cavernosa (erectile tissue) and corpus spongiosum (around urethra)

suprapubic cystotomy

distended bladder may be approached surgically to the pubic symphysis, performed when urethra is blocked or damaged

distended bladder

bladder is stretches and enlarged during to being filled with urine, can lead to extravasation of urine.

cystoscope

used to exmaine interior aspect of bladder

how can a cystoscope remove tumors?

highfrequency current can remove them

injury to pelvis floor

results in cystocele or herniation of bladder into caginal wall

why are bladder infections more common in women?

distensible female urethra allows for easy passage pf catheters and cysotscope into bladder

enterocele

prolapse of lower intestinal loops

bulb of urethra gland (cowpers)

lubrication during intercourse & pre-ejeculation

vasectomy

male sterilization where part of vas deferens is ligated

seminal vesciles

make majority of semen and make secretion rich in fructose

abscesses in seminal vesicles

may rupture and pus can enter peritoneal cavity

rectal palpation purpose

for the seminal vesicles and prostate

benign hypertrophy of prostate

impede urination leading to nocturia, dysuria, and urgency of urination

prostatic utricle

embryological remnant of uterus and vagina in the male

thin wall distensible vagina allows for palpation of…

pelvis strcutres, cervis, ischial spines, sacral promontorym arteries, and ovaries

vagina in close proximity to pevlci organs issue

trauma can result in weakness, necrosis, tears from fistulas between vagina and adjacent structure

cludoscope

inserted into vagina to examine ovaries and uterine tubes

culdocentesis

puncture in rectovaginal pouch in order to drain an pelvic abcess through the vaginal fornix

vaginal speculum (pap smear)

distend vagina to harvest cervical cells from external ostium for cervix exam

pap smear function

cell collection technique that results in less cervical cancer

uterus normal shape

anteverted and anteflexed

increase in intraabdominal pressure

presses uterus against bladder

retroverted uterus

can lead to prolapse and a high risk pregnancy

hysterectomy

removal of the uterus often due to cervical cancer

genral/regional anesthesia

used to reduce pain and discomfort during childbirth

types of regional anesthesia

spinal (lumbar), pudendal nerve (in vagina), caudal epidural bloack (lumbar puncture)

fimbrae

attract egg to fallopian tube for attachment

infundibulum

funnel shaped opening at end of uterine tube that catches the oocyte after ovulation

ampulla

widest and longest part of the uterine tube

how is patency of uterine tubes

radiography, hysterosalingography (uses radiography) , endoscope

ligation of uterine tubes

surgical methid ofbirth control that involves cutting, tying, and burning uterine tubes

pelvic inflammatory disease (PID)

inflammation of the female reproductive organs by gonorrhea or chlamydia

what do adhesions of the fallopian tube look like

web like strcure that increase chance of ectopic pregnanbcy

abdominal tubal ligation

suprapubic incision is used to do it

laparoscopic tubal ligation

uses laparoscope to tie off uterine tubes

ectopic pregnancy

blastocyst can implant in mucosa of uterine tube

where is a laparoscope inserted

into the peritoneal cavity thru small incision near umbillicus

laparoscope purpose

examination of pelvic visera and diagnosing diseases

endometriosis

seeding of endometrial tissue outside the uterus

rectal prolapse location

supportive fat in ischioanal fossa dissappears (in starvation)

rectal palpation

for pelvic strcurtes like prostate, cervix, sacrum, ischial spinesm ureters, iliac lymph nodes

proctoscope

used to examine inside rectum to see hemorroids or rectal tumor

resection of rectum in males

plane of rectovesical septum is followed to avoid damage to prostate & urethra

pelvic viscera prolapse cause

perineal body is damaged during childbirth, trauma, disease or infection

episiotomy

cut on 1 side laterally to prevent rupture. perofmred during chuildborth to enlarge the vaginal orifice

median episiotomy

incises perineal body (cut streat down, more dangerous)

mediolateral episiotomy

avoids perineal body (cuts down more towatrds the side)

3 parts of the male urethra

prostatic urethra, membranous, spongy (longest)

rupture of membranous urethra

extravasation of urine and blood into deep pouch and extraperitoneally around prostate and bladder

straddle injuries

rupture of spongy urethra and urine extravastation into bulb of penis, allows urine to enter superficial perineal space

external anal sphincter

voluntary, fecal incompetence is when u lose control of this sphincter

pectinate line

transition from visceral (above) to partieal (below) in the anal region.

internal hemorrhoids

prolapses of rectal mucosa containing dilated veins of internal rectal venous plexus

urethral catheterization

to remove uncontaminated urine and irrigate the bladder and dilate using a urethral sound