Anatomy tut wk 30 Pelvis 1

1. Contrast true pelvis with false pelvis. Indicate features along pelvic
brim
true pelvis the cavity situated b/w pelvic inlet and pelvic floor. Encloses all
pelvic regions. Features along pelvic brim starting posteriorly: sacral
prominence, anterior margin of ala, sacroiliac joint, arcuate line, pectineal
line, pubic crest, pubic symphysis.
false pelvis space within the pelvis that is situated above the pelvic brim. So
surrounded by iliac crest and fossa. Regarded as part of the posterior abdominal
wall.



2. Explain the alignment of the bony pelvis (noting planes of inlet & outlet)
and the significance of the narrow pelvic plane (of least dimensions)

In erect posture, gravity passes in front of primary curvatures, and behind
2ndary curvatures of vertebral column. Sacrum has a primary curvature, while
the lumbar is 2ndarily curved. Due to the pronounced lumbar lordosis, the pelvis
tilts forward, with the inlet sloping down and
forwards. ASIS is on same level as top of pubis.

- Pelvic inlet demarcates the true from the false
pelvis. It runs from pubic symphysis to pubic
crest, to pectineal line of pubis, to arcuate line, to
sacroiliac joint, anterior margin of ala, to sacral
promontory.
- Pelvic outlet is b/w pubic symphysis and tip of
coccyx posteriorly, with ischial tuberosities
laterally. Made up of two planes of triangle shape
at right angles. anterior triangle (urogenital) is
more horizontal, while posterior (anal) triangle is
more vertical.
- Plane of least dimensions is through ischial spines and S4, and base of
pubic symphysis

3. Indicate how the bony pelvis of a male can be distinguished from that of
a female (noting different pelvic types that can occur in females and their
obstetric significance)

Females typically have the gynecoid shape,
with a small false pelvis relative to the true
pelvis. The greater sciatic notch has an L
shape.

Males are usually android, with a small true
pelvis relative to the false pelvis. Greater
sciatic notch has a J shape.

Females can have an android pelvis, with a
narrower plane of least dimensions (funnel
pelvis).


4. Explain how a foetal head navigates the pelvis during childbirth
Infants head rotates 90 degrees from inlet where it is transverse, to outlet, where
skull lies directly behind pubic symphysis. Also flexes fully, so that the part of the
skull presented is circular in shape (diameter 9.5cm) as opposed to the 13.5cm
of mid extension.

5. Explain the how stability of the sacrum is maintained while
weightbearing (due to the reverse keystone effect). Indicate effect on
joints of pelvis during pregnancy and explain pain from sacroiliac joints
following childbirth (noting site of referral)
The sacrum is wedge shaped, with a narrower width posteriorly. Without
ligamentous support, the sacrum
would want to slide down and
forwards, along with the vertebral
column. The interosseus sacroiliac
ligaments pull the posterior iliac
bones together. The greater the
weight on the sacrum, the more the
iliac bones are pulled together. This
is known as the reverse keystone
effect.

During pregnancy, relaxin is
released, increasing the mobility of
pelvic joints. Pain in these joints is
common (and transient) after
childbirth due to excess stretching. Sacroiliac joints supplied by L5-S3 (upper
buttock and lower back pain, can be in hips and knees even).

6. Explain role of pelvic floor (particularly puborectalis) for faecal
continence

The pelvic floor is made up is made up of levator ani, which suspends like a
hammock from the sidewall of the pelvis. It is made up of three parts:
pubococcygeus, iliococcygeus and isciococcygeus.
Pubococcygeus is the anterior part, its most important part being the U shaped
puborectalis that attaches anteriorly to the pelvic surface, looping around the
anorectal junction, fusing with the external anal sphincter. Responsible for faecal
continence, by creating an acute angle at the puborectal junction. The rectum is
only straight during defecation.

7. Indicate the lowest part of peritoneal cavity in a male and in a female.
Explain its significance (noting the relationship of the recto-uterine pouch
to the posterior fornix of the
vagina)

The lowest part of the peritoneal
cavity in the female is the
rectouterine pouch, while in the
male it is the rectovesical pouch.
Fluid will gravitate to here. The
rectouterine pouch passes beyond
the uterus onto the posterior fornix
of the vagina. It is more vulnerable
to perforation and infection (home
abortions), also a potential site of
surgical drainage.












8. Indicate the pelvic apertures. List
structures traversing the pelvic inlet (to
pelvic walls & to pelvic cavity)

Between abdomen and pelvis pelvic inlet
Between back and pelvis ventral sacral
foramina
Between lower limbs and pelvis obturator
canal, greater and lesser sciatic foramen

The pelvic inlet is the major avenue of
communication between the abdomen and
the pelvis. Structures traversing aperture:
- obturator nerve, lumbosacral trunk, sympathetic trunk, hypogastric nerves,
superior rectal, ovarian, median sacral, internal iliac and ascending lumbar
vessels, ureters, pelvic colon, and vas deferens.

9. List the unpaired viscera (urinary, digestive & genital) and paired
viscera


10. Explain the significance of the small true pelvis of a neonate (and child)
regarding position of viscera.
The small true pelvis means that pelvic viscera project upwards (esp bladder).
into lower abdominal cavity. As you grow, pelvis increases in size, allowing
bladder and uterus to ascend.