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The Pelvic Wall

The Pelvic Wall Anatomy

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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