Posteriorly: Sacral Ala + Sacral Promontory, Rim of Pelvic Bone

Pelvis Guide

Pelvic inlet pg 429 Posteriorly: sacral Ala + Sacral promontory, rim of pelvic bone Anteriorly: superior pubic symphysis

Pelvic outlet pg 432 Posteriorly: coccyx Anteriorly: Inferior pubic symphysis Laterally: ischial tuberosity/Ischiopubic rami and sacrotuberous ligaments

Sciatic formans pg 432 What exits out of each hole?

Pelvic floor pg 434 Levator Ani Iliococcygeus - most of muscle originates @ obturator internus fascia Pubococcygeus Puborectalis - Pubic bone - wraps around anal sphincter muscle. Coccygeus

Differences in pelvis between men and women pg 428

W M Pelvic inlet more circular -wider Heart Shaped inlet Less distinct promentory, wider sacral ala More distinct sacral promentory Pubic Arch angle 80-85degrees Pubic Arch ange 50-60degrees

DRAW Deep perineal pouch M/F pg 438 CC: Abscess can form in the anterior recesses of the ischioanal fossa

DRAW Rectum and Anal Canal pg 440

Perineal body Levator Ani Deep and superficial transverse perineal mm. External anal sphincter Bulbospongiosus Perineal membrane In women: urethral vaginalis m. Episiotomy -clean incision for repair -Cut through the perineal body -For child birth Rectal arteries - 3 different supplies Superior Rectal Artery - from the inferior mesenteric a. Middle Rectal Artery - from anterior trunk of internal iliac a. Inferior Rectal Artery - from the inferior pudendal a. (a branch of the internal iliac a.)

Gonadal veins: Right into IVC Left into Left Renal vein.

Ureters can be compressed - 3 locations Renal Pelvis Crossing iliac artery bifurcation Entering the bladder

DRAW Ligaments attached to the bladder M/W pg ???

DRAW Urethra M/W pg 445 fig 5.44

Contribute to ejaculatory Fluid Ductus Deferens Seminal Vesicle fluid Prostatic fluid Bulbourethral glands

Green Box urethral injury pg 490 proximal spongy urethral rupture, urine can get down into scrotum

Lymph pg 477, 496

Conjoint tendon pg 287 this was on the practical

DRAW testes/reproductive system in men p 449-450 Fig 5.46

DRAW reproductive system in women pg 453 Fig 5.49

Cervix - internal os -external os -Fornices of the cervix

Axis of the vagina Anteflexion and anteversion

Pouch of Douglas pg 462 -uterine rectal pouch F -uterine vesical pouch F -Rectal vesical pouch M

DRAW internal iliac artery branches pg 472

Deep Dorsal Vein Drains erections CC: Blockage

Ligaments of the uterus and ovary pg 460 broad ligament mesometrium mesosalpinx mesovarium Round ligament Suspensory lig of ovary (the ingundibulopelvic lig) - ovarian artery travels in Ligament of the ovary

Nerves to cover: pg 462-471 -Superior hypogastric plexus -Hypogastric n. pg 470 -pelvic splanchnic nn. - carrying s2-s4 parasympathetics -Inferior hypogastric plexus -post ganglionic sympathetics inn pelvis from T10-L2 -visceral afferents -rectal plexus -uterovaginal plexus -prostatic plexus -vesicle plexus

MOST important somatic pelvic nerve Pudendal n. S2-S4 pg 491-492 Fig 5.76 - out the greater sciatic foramen - found along ischial spine inn: skin and perineal muscles anal and urethal sphincters

Erection/Ejaculation Point/Shoot parasympathetics/sympathetics

Possible Oral questions:

What passes through horizontal plane of intervertebral disc T4/T5? -Sternal Angle -Separation of superior mediastinum and inferior mediastinum -Beginning and end of aortic arch -Where SVC penetrates the pericardium to enter heart -Trachea bifurcates into L/R bronchi -Superior limit of pulmonary trunk

What pierces the diaphragm and at what vertebral level does this occur? -Caval opening T8 = inferior vena cava, Rt. Phrenic n. and Rt pericardophrenic n. -Esophageal hiatus T10 = esophagus and Rt Vagus n. -Aortic Hiatus T12 = Descending Aorta, thoracic duct and azygos vein.

What landmarks are noted by transverse plane @ Vertebra L1? -Mid point between jugular notch and pubic symphysis -9th costal cartilage -Pyloric orifice -Duodenal C-shape -Body of the Pancreas -Hila of the kidney (inferior part of Left hilum/superior part of right hilum) -Origin of the celiac trunk (superior border of body L1) -Origin of SMA inferior border of L1 (or L2)

Describe coronary artery branches for Rt dominated person:

Rt coronary A. -> SA nodal A -> AV nodal A -> Rt. marginal A -> Posterior interventricular A

Left coronary A -> Anterior interventricular A. -> Left circumflex -> Left Marginal A.

Constriction sites of esophagus - Junction of esophagus w/the pharynx -Where esophagus is crossed by aortic arch -Where esophagus is compressed by left main bronchus -At esophageal hiatus of the diaphragm

Fascial layers of spematic cord and abdominal fascia origin Most exterior -External spermatic fasica -> Aponeurosis of external oblique middle -Cremaster fascia -> Aponeurosis of internal oblique most interior -Internal spermatic fasica -> Transversalis fascia Tunica vaginalis - parietal and visceral

Trace blood flow starting with hemiazygos vein and ending with superior epigastric A. Hemiazygos v. crosses midline ->azygos vein -> SVC -> R. Atria -> R. Ventricle -> pulmonary trunk -> pulmonary arteries -> lungs -> Pulmonary veins -> L. Atrium -> L. Ventricle -> Ascending aorta/aortic arch -> R/L Subclavian a. -> internal thoracic a -> Superior epigastric a.

Branches of the abdominal Aorta 1. Inferior phrenic As. 2. Celiac trunk 3. Middle suprarenal As. 4.Superior Mesenteric A. 5. Renal As 6. Testicular/Ovarian As. 7. Lumbar As. 8. Inferior Mesenteric A 9. Median sacral A 10. Common iliac As

Branches of Aortic arch 1. brachiocephalic trunk 2. Left common carotid 3. Left subclavian A.

Branches of thoracic Aorta 1. Pericardial Branches 2. Bronchial AA 3. Esophageal AA 4. Subcostal A

Major Retroperitoneal structures SADPUCKER S= suprarenal glands A= Aorta/IVC D= Duodenum (2nd and 3rd segments also some of 4th) P= Pancreas (tail is intraperitoneal) U= ureters C= Colon (ascending and descending) K= Kidneys E= Esophagus R= Rectum

What Structures pass through greater sciatic foramen Inferior Gluteal VAN Sciatic N Superior Gluteal VAN Nerve to Quadratus femorus + Vessels Piriformis M. Nerve to obturator internus Name 8-9 things that dump into Portal Vein Splenic vein [Short gastric veins dump into splenic vein] Superior Mesenteric vein [R.gastro-omental and anterior/posterior pancraticoduodenal veins] R + L Gastric Veins Cystic vein Paraumbilical Vein Inferior mesenteric vein [Superior Rectal vein and L. Colic Vein] Pancreatic Vein Left gastro-omental vein

What structures are found in the superior mediastinum Thymus R/L Brachiocephalic veins Left superior intercostal veins Superior vena cava arch of aorta and its 3 branches trachea esophagus phrenic nerves vagus nerves L. Recurrent Laryngeal n. Thoracic duct Lymphatics

Name Layers of the perineum [S to D] 1. Skin 2. Superficial fatty layer 3. Colle’s fascia 4. Superficial perineal pouch 5. Perineal membrane 6. Deep perineal pouch 7. Superficial fascia 8. Fascia and muscles of pelvic floor

Where would you find portasystemic anastamoses w/ portalhypertension + what veins are involved? @ gastroesphageal junction Left gastric vein <-> Tributaries to azygos vein @Anus superior rectal vein <-> Middle and inferior rectal veins @Anterior abdominal wall para-umbilical veins <-> veins on anterior wall

What structures are found in deep perineal pouch [female] -external urethral sphincter m. -sphincter urethrovaginalis m. -compressor urethra m. -Deep transverse perineal m. -Perineal A + N -Opening for urethra -Opening for vagina

Same question in superficial perineal space [Female] -ischiocavernosus m. -bulbospongiosus m. -superficial transverse perineal m. -bulb of vestibule -crus of clitoris -body of clitoris -glans of clitoris -Bartholin’s glands

What muscles attach @ perineal body? What Fascia attaches? [Female] -Levator Ani -Deep transverse perineal m. -Superficial transverse perineal m. -Sphincter urethrovaginalis -External anal sphincter -Bulbospongiosus muscle

Fascia attaching: -Colle’s fascia -Perineal membrane -Deep investing fascia

List structures passing through pelvic inlet/outlet

Inlet: Rectum sigmoid colon (in false pelvis) ureters gonadal vessels internal iliac vessels Ductus Deferens [M] Round ligament of uterus [W] Lumbosacral trunk obturator n. Hypogastric nerve plexus sympathetic trunk lymphatics psoas major m. Outlet: Anus Urethra Vagina [Women] Deep Dorsal Vein of the penis or clitoris Cavernous nn. pudendal n. (branches only) Obturator N + A Inferior rectal VAN (double check this) Psoa major m.