<p>Pelvis Guide</p><p>Pelvic inlet pg 429 Posteriorly: sacral Ala + Sacral promontory, rim of pelvic bone Anteriorly: superior pubic symphysis</p><p>Pelvic outlet pg 432 Posteriorly: coccyx Anteriorly: Inferior pubic symphysis Laterally: ischial tuberosity/Ischiopubic rami and sacrotuberous ligaments</p><p>Sciatic formans pg 432 What exits out of each hole?</p><p>Pelvic floor pg 434 Levator Ani Iliococcygeus - most of muscle originates @ obturator internus fascia Pubococcygeus Puborectalis - Pubic bone - wraps around anal sphincter muscle. Coccygeus</p><p>Differences in pelvis between men and women pg 428</p><p>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</p><p>DRAW Deep perineal pouch M/F pg 438 CC: Abscess can form in the anterior recesses of the ischioanal fossa</p><p>DRAW Rectum and Anal Canal pg 440</p><p>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.)</p><p>Gonadal veins: Right into IVC Left into Left Renal vein. </p><p>Ureters can be compressed - 3 locations Renal Pelvis Crossing iliac artery bifurcation Entering the bladder</p><p>DRAW Ligaments attached to the bladder M/W pg ???</p><p>DRAW Urethra M/W pg 445 fig 5.44</p><p>Contribute to ejaculatory Fluid Ductus Deferens Seminal Vesicle fluid Prostatic fluid Bulbourethral glands</p><p>Green Box urethral injury pg 490 proximal spongy urethral rupture, urine can get down into scrotum</p><p>Lymph pg 477, 496</p><p>Conjoint tendon pg 287 this was on the practical </p><p>DRAW testes/reproductive system in men p 449-450 Fig 5.46</p><p>DRAW reproductive system in women pg 453 Fig 5.49</p><p>Cervix - internal os -external os -Fornices of the cervix</p><p>Axis of the vagina Anteflexion and anteversion</p><p>Pouch of Douglas pg 462 -uterine rectal pouch F -uterine vesical pouch F -Rectal vesical pouch M</p><p>DRAW internal iliac artery branches pg 472</p><p>Deep Dorsal Vein Drains erections CC: Blockage</p><p>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</p><p>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</p><p>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</p><p>Erection/Ejaculation Point/Shoot parasympathetics/sympathetics</p><p>Possible Oral questions:</p><p>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</p><p>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.</p><p>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)</p><p>Describe coronary artery branches for Rt dominated person:</p><p>Rt coronary A. -> SA nodal A -> AV nodal A -> Rt. marginal A -> Posterior interventricular A</p><p>Left coronary A -> Anterior interventricular A. -> Left circumflex -> Left Marginal A. </p><p>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 </p><p>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</p><p>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.</p><p>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</p><p>Branches of Aortic arch 1. brachiocephalic trunk 2. Left common carotid 3. Left subclavian A. </p><p>Branches of thoracic Aorta 1. Pericardial Branches 2. Bronchial AA 3. Esophageal AA 4. Subcostal A</p><p>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</p><p>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</p><p>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</p><p>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</p><p>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</p><p>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</p><p>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</p><p>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</p><p>Fascia attaching: -Colle’s fascia -Perineal membrane -Deep investing fascia</p><p>List structures passing through pelvic inlet/outlet </p><p>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. </p>