Pelvis

Question 0

Has 2 coxal (hip) bones

3 parts: Ischium, ileum & pubis that join at the acetabulum of the hip joint

Answer 0

Bony pelvis

Question 1

Fusion of S1-5

Answer 1

Sacrum

Question 2

Transmit the dorsal primary rami of the sacral spinal nerves

Answer 2

Dorsal sacral foramina

Question 3

Transmit the ventral primary rami of sacral spinal nerves

Answer 3

Ventral sacral foramina

Question 4

Formed when laminae of S5 vertebra do not fuse

Answer 4

Sacral hiatus

Question 5

Formed by pedicles

Landmarks in locating sacral hiatus for administration of caudal anesthesia

Answer 5

Sacral cornua

Question 6

Fusion of vertebrae Co1-4

Answer 6

Coccyx (tailbone)

Question 7

From sacrum to ischial tuberosity

Answer 7

Sacrotuberous ligament

Question 8

From sacrum to ischial spine

Answer 8

Sacrospinous ligament

Question 9

Divided by the PIRIFORMIS muscle into suprapiriformis recess & infrapiriformis recess

Structures transmitted:

• superior gluteal vein, artery & nerve
• Piriformis muscle
• inferior gluteal vein, artery & nerve
• sciatic nerve
• internal pudendal vein & artery
• pudendal nerve

Answer 9

Greater sciatic foramina

Question 10

Structures transmitted:

• internal pudendal vein & artery
• pudendal nerve

The structures exit the pelvic cavity through greater sciatic foramen –> reenter the pelvic cavity through the lesser sciatic foramen –> proceed to the perineum

Answer 10

Lesser sciatic foramina

Question 11

Defined by:

• Sacral promontory (S1)
• Linea terminalis - includes the pubic crest, iliopectineal line & arcuate line

Divides the pelvic cavity into 2 parts:

• major (false) pelvis - above the pelvic inlet between the iliac crests, part of abdominal cavity
• minor (true) pelvis - below the pelvic inlet & extends to the pelvic outlet

Measurements:

• true conjugate diameter - from sacral promontory to superior margin of pubic symphysis
• diagonal conjugate diameter - from sacral promontory to inferior margin of pubic symphysis

Answer 11

Pelvic inlet

Question 12

Defined by coccyx, ischial tuberosities, inferior pubic ramus & pubic symphysis

Closed by the pelvic diaphragm & urogenital diaphragm

Measurements:

• Transverse diameter - distance between the ischial tuberosities
• Interspinous diameter - between ischial spines, contracted if

Answer 12

Pelvic outlet

Question 13

Support of the pelvic organs

Answer 13

• Pelvic diaphragm (floor)
• Urogenital diaphragm muscle
• transverse cervical ligament (Cardinal ligament of MACKENRODT)
• uterosacral ligament
• pubocervical ligament

Question 14

Coccygeus muscle & levator ani muscles (iliococcygeus, pubococcygeus & puborectalis)

Answer 14

Pelvic diaphragm

Question 15

Forms as a U-shaped sling around the anorectal junction, causing a 90* perineal flexure; important for fecal continence

Answer 15

Puborectalis

Question 16

Deep transverse perineal muscle

Sphincter urethra muscle

Answer 16

Urogenital diaphragm muscle

Question 17

Thickening of the endopelvic fascia

Laterally from cervix to the sidewall of the pelvis

Answer 17

Transverse cervical ligament (Cardinal ligament of MACKENRODT)

Question 18

From cervix to the sacrum

Answer 18

Uterosacral ligament

Question 19

From cervix to pubic symphysis

Answer 19

Pubocervical ligament

Question 20

Weakening of support of pelvic organs

• cystocele
• Rectocele
• uterine prolapse
• risk factors: multiparity, birth trauma, ⬆️ intraabdominal pressure from obesity, heavy lifting, chronic cough, menopausal loss of muscle tone
• SSX: heavy sensation in the lower abdomen, aggravated by heavy lifting, prolonged standing; urinary frequency/stress incontinence (leakage with coughing or sneezing)

Answer 20

Pelvic relaxation

Question 21

1% lidocaine solution injected transvaginally or just lateral to the labia majora around the tip of ischial spine & through the sacrospinous ligament

Pain of Childbirth is transmitted by pudendal nerve via spinal nerves S2-5

Answer 21

Pudendal nerve block

Question 22

Course of pudendal nerve

Answer 22

Exits the pelvic cavity through greater sciatic foramen

Travel around the posterior surface of ischial spine

Renters pelvic cavity through lesser sciatic foramen

Travels within the fascia of obturator internus muscle (pudendal nerve of Alcock) & divides into:

• perineal nerve
• posterior labial nerve
• inferior rectal nerve
• dorsal nerve of the clitoris

Question 23

To obtain complete anesthesia of perineal region, the ff nerves must also be anesthesized:

Answer 23

Ilioinguinal nerve

Genitofemoral nerve

Perineal branch of posterior femoral cutaneous nerve

Question 24

Basin and is more correctly applied to the skeleton of the region Region of the trunk below the abdomen and meets the lower extremity

Answer 24

PELVIS

Question 25

Surface landmarks

Answer 25

Iliac crest Anterior superior iliac spine Pubic tubercle - bony projection at the superior lateral border of the body of pubic bone Symphysis pubis Posterior superior iliac crest

Question 26

``` MUST KNOW: 1. Brim Ant - symphysis pubis Lat - iliopectineal line Post - sacral promontory ``` 2. Above False pelvis Greater pelvis Pelvis major 3. Below True pelvis Lesser oelvis Pelvis minor 4. Pelvic inlet Ant - symphysis pubis Lat - iliopectineal line Post - sacral promontory 5. Pelvic outlet Ant - pubic arch Lat - ischial tuberosities Post - tip of coccyx

Answer 26

Must know!!