Ch. 16 Anatomy of the Female Pelvis

The innominate bones of the pelvis consist of the: A. ischium, ilium, and pubic bones B. ilium, sacrum, and coccyx bones C. sacrum, coccyx, and pubic bones D. sacrum, ischium, and ilium bones

A. ischium, ilium, and pubic bones

The uterine artery branches off of the: A. abdominal aorta B. Uterine plexus C. internal iliac artery D. external iliac artery

C. internal iliac artery

The piriformis muscles or iliopsoas may be confused for the:

ovaries or adnexal masses because of their location within the pelvis

Free fluid, when excessive, may also be noted within:

the adnexa, lower quadrants of the abdomen, and may delineate the borders of pelvic organs

The boundaries of the female pelvis are considered:

to be from the iliac crest to a group of muscles known as the pelvic diaphragm, located at the base of the pelvis

Branches of the uterine artery include the:

-arcuate arteries, which may be visualized with Doppler interrogation along the lateral aspect of the myometrium

A patient presents to the sonography department with a history of uterine prolapsed. Which of the following best describes this disorder? A. a condition that results from the weakening of the pelvic diaphragm muscles and allows for the displacement of the uterus, often through the vagina B. a congenital anomaly that results in the duplication of the uterus C. a condition that results in the abnormal invasion of the myometrium through the bladder wall leading to hematuria D. an abnormality that describes the inversion of the myometrium and endometrium

A. a condition that results from the weakening of the pelvic diaphragm muscles and allows for the displacement of the uterus, often through the vagina

The right ovarian artery branches off of the: A. aorta B. right renal artery C. uterine artery D. internal iliac artery

A. aorta

The pelvic ligament that extends from the lateral aspect of the uterus to the side walls of the pelvis is the: A. broad ligament B. ovarian ligament C. piriformis ligament D. round ligament

A. broad ligament

The paired muscles that are located lateral to the uterus and anterior to the iliac crest are the: A. lliopsoas muscles B. rectus abdominis muscles C. obturator interni muscles D. piriformis muscles

A. lliopsoas muscles

Pelvic bones, when visualized on sonography, will produce: A. posterior shadowing B. posterior enhancement C. mirror image artifact D. minimal enhancement

A. posterior shadowing

Which vessels supply blood to the deeper layers of the myometrium? A. radial arteries B. spiral arteries C. straight arteries D. arcuate arteries ​

A. radial arteries

The urinary bladder, uterus, and ovaries are located within the: A. true pelvis B. false pelvis

A. true pelvis

The abdominal aorta bifurcates into the: A. internal iliac arteries B. common iliac arteries C. ovarian arteries D. external iliac arteries

B. common iliac arteries

Prolapse of the pelvic organs most often involves the: A. rectus abdominis and obturator internus muscles B. levator ani and coccygeus muscles C. obturator internus and levator ani muscles D. piriformis and iliopsoas muscles

B. levator ani and coccygeus muscles

The pelvic ligament that provides support to the ovary and extends from the ovary to the lateral surface of the uterus is the: A. cardinal ligament B. ovarian ligament C. broad ligament D. suspensory ligament of the ovary

B. ovarian ligament

Pelvic muscles appear: A. echogenic B. anechoic C. hypoechoic D. complex

C. hypoechoic

The vagina is located ______to the uterus: A. anterior B. posterior C. inferior D. medial

C. inferior

The pelvic ligament that provides support to the ovary to the pelvic side wall is the: A) Cardinal ligament B) Ovarian ligament C) Broad ligament D) Suspensory ligament of the ovary

D) Suspensory ligament of the ovary

Are the majority of pelvic ligaments identified during a routine sonographic examination of the pelvis?

NO! -However, when surrounded by free fluid, the dense broad ligaments may be identified as echogenic structures extending from the lateral borders of the uterus bilaterally

What type of blood supply does the ovaries have?

a dual blood supply

Vascular structures can provide:

both important diagnostic information and landmarks during a sonographic examination of the female pelvis

The radial arteries then divide into:

both the straight arteries and spiral arteries

pelvic diaphragm (levator ani and coccygeus muscles)

inferior near the vagina in transverse

The vagina extends:

inferiorly from the external os of the cervix to the external genitalia, where it is positioned posterior to the urethra

iliopsoas muscle

lateral and anterior to iliac crest

obturator internus

lateral to the ovaries

weakness in which of the following muscles leads to prolapse of the uterus?

levator ani

what is the path of venous drainage from the left ovary?

ovarian vein- left renal vein-IVC

What is the path of venous drainage from the right ovary?

ovarian vein-IVC

which part of the female pelvis has a dual blood supply?

ovary

Which pelvic muscle group is most often mistaken for ovaries?

pirifromis

Piriformis

posterior

where is free fluid most likely to collect in the female pelvis?

pouch of douglas

A weakening in the levator ani muscles could:

result in prolapse of the pelvic organs

The posterior border of the pelvic cavity is marked by:

sacrum and coccyx

which uterine arteries can be demonstrated in the periphery of the uterus in a multigravida patient?

straight arteries

The ligaments of the pelvis provide:

support to the ovaries, uterus, and fallopian tubes

The pelvic diaphragm muscles provide:

support to the pelvic organs.

Ovarian ligaments

supports: ovaries extends from ovary to lateral surface of the uterus

Suspensory ligament of the ovaries (infundibulopelvic)

supports: ovaries and tubes extends from the ovaries to the pelvic side walls

Uterosacral ligament

supports: uterus extends from uterus to sacrum

In addition to providing support, the suspensory ligament of the ovary contains:

the ovarian artery, ovarian vein, lymphatics, and ovarian nerves

The arcuate vessels further progress within the:

uterus and eventually become the radial arteries, which supply blood to the deeper layers of the myometrium

The cardinal ligaments house the:

vasculature of the uterus

The fallopian tubes and ovaries are considered:

•bilateral adnexal structures. The course of the fallopian tubes and location of the ovaries is relatively unpredictable

Several pelvic muscles may be identified sonographically within the female pelvis:

-Muscles visualized on a sonogram include the rectus abdominis muscles, the iliopsoas muscles, obturator internus, piriformis muscles, and a group of muscles known as the pelvic diaphragm, which is composed of the levator ani and coccygeus muscles.

The anterior cul-de-sac is also referred to as the: A. space of retzius B. rectouterine pouch C. pouch of douglas D. vesicouterine pouch

D. vesicouterine pouch

Cardinal ligament

Extends from lateral surface of cervix to lateral fornix. Houses uterine vasculature

What may accumulate within potential spaces or recesses within the female pelvis?

Fluid When filled with fluid, these regions can be identified sonographically

The pelvis can further be divided into:

a true pelvis (lesser pelvis) and false pelvis (major pelvis) by an imaginary line known as the linea terminalis

The common iliac veins unite at:

almost the same level as the common iliac arteries

Round ligaments

supports: uterus (fundus) extends from uterine cornua to labia majora between the folds of the broad ligaments

Broad ligaments

supports: uterus, tubes, ovaries extends form the lateral aspect of the uterus to the side walls of the pelvis

The common iliac arteries then divide into

the external and internal iliac arteries

The innominate bones consist of:

the ilium, ischium, and pubic symphysis.

The ovarian arteries originate from:

the lateral aspect of the abdominal aorta

What is considered the most dependent part of the peritoneal cavity?

the rectouterine pouch/ pouch of douglas/ posterior cul-de-sac, making it the most likely place for fluid to collect in the pelvis

All venous structures mirror:

their arterial counterparts with the exception of the left ovarian vein, which instead of returning blood to the inferior vena cava, drains directly into the left renal vein

The spiral arteries are the:

tiny, coiled vessels that supply blood to the functional layer of the endometrium

The false pelvis in comparison to the true pelvis is located more:

•superiorly than the true pelvis, the latter (true pelvis) of which contains the urinary bladder, small bowel, sigmoid colon, rectum, ovaries, fallopian tubes, and uterus.

Within the pelvis:

•the non-gravid uterus lies within the midline of the pelvis between the urinary bladder and the rectum .

The abdominal aorta supplies:

-blood to the female genitalia. -It branches into the paired common iliac arteries, typically near the umbilicus.

The paired right and left uterine arteries are branches of the:

-internal iliac arteries. They supply blood to the uterus, the fallopian tubes, and the ovaries , and courses along the lateral aspect of the uterus within the folds of the broad ligaments

The ligament that houses the vasculature of the uterus is the: A. Cardinal ligament B. Ovarian ligament C. Broad ligament D. Suspensory ligament of the ovary

A. Cardinal ligament

The sonographic pelvic examination of a female patient reveals an extensive amount of ascites. In the transverse plane, you visualize two echogenic structures extending from the side walls of uterus to the pelvic side walls bilaterally. These structures are most likely the: A. broad ligaments B. cardinal ligaments C. ovarian ligaments D. uterosacral ligaments

A. broad ligaments

The pelvic muscle group that is located between the coccyx and the pubis is the: A. levator ani muscles B. rectus abdominis muscles C. obturator internus muscles D. piriformis muscle

A. levator ani muscles

The ovary is supplied blood by the: A. ovarian artery B. ovarian artery and uterine artery C. uterine artery D. arcuate artery

B. ovarian artery and uterine artery

Fluid noted posterior to the uterus would most likely be located within the: A. space of retzius B. pouch of douglas C. anterior cul-de-sac C. adnexa

B. pouch of douglas

Both the straight and spiral arteries are branches of the: A. common iliac artery B. radial artery C. arcuate artery D. external iliac artery

B. radial artery

The uterine arteries supply blood to all of the following except: A. fallopian tubes B. rectum C. ovaries D. uterus

B. rectum

Which of the following are the paired anterior abdominal muscles that extend from the xiphoid process of the sternum to the pubic bone? A. lliposoas muscles B. rectus abdominis muscles C. obturator interni muscles D. piriformis muscles

B. rectus abdominis muscles

The arteries that directly supply blood to the functional layer of the endometrium are the: A. radial arteries B. spiral arteries C. straight arteries D. arcuate arteries

B. spiral arteries

Fluid noted anterior to the uterus would most likely be located within the: A. pouch of douglas B. vesicouterine pouch C. space of retzius D. rectouterine pouch

B. vesicouterine pouch

The right ovarian vein drains directly into the: A. right renal vein B. aorta C. inferior vena cava D. common iliac vein ​

C. inferior vena cava

The true pelvis is delineated from the false pelvis by the: A. space of retzius B. adnexa C. linea terminalis D. iliac crest

C. linea terminalis

The muscle located lateral to the ovaries is the: A. iliopsoas muscle B. rectus abdominis muscle C. obturator internus muscle D. piriformis muscle

C. obturator internus muscle

Another name for the rectouterine pouch is the: A. space of retzius B. pouch of retzius C. pouch of douglas D. anterior cul-de-sac

C. pouch of douglas

What is considered the most dependent part of the peritoneal cavity? A. space of retzius B. anterior cul-de-sac C. pouch of douglas D. rectovessicular pouch

C. pouch of douglas

The bilateral muscles that are located posterior to and extend from the sacrum to the femoral greater trochanter are the: A. Levator ani muscles B. Rectus abdominis muscles C. Obturator internus muscles D. Piriformis muscles

D. Piriformis muscles

Peritoneal spaces located posterior to the broad ligament are referred to as the: A. rectouterine spaces B. anterior cul-de-sacs C. lateral cul-de-sacs D. adnexa

D. adnexa

The peripheral arteries of the uterus are the: A. radial arteries B. spiral arteries C. straight arteries D. arcuate arteries

D. arcuate arteries

The space of retzius is located: A. between the uterus and bladder B. between the bladder and ilium C. along the lateral aspect of the uterus D. between the bladder and pubic bone

D. between the bladder and pubic bone

Pelvic bones, when visualized on sonography, will appear: A. anechoic B. hypoechoic C. dark D. hyperechoic

D. hyperechoic

The left ovarian vein drains directly into the: A. right renal vein B. inferior vena cava C. aorta D. left renal artery

D. left renal artery

The muscles that may be confused with the ovaries on a pelvic sonogram include the: A. rectus abdominis and obturator internus muscles B. levator ani and coccygeus muscles C. obturator internus and levator ani muscles D. piriformis and iliopsoas muscles

D. piriformis and iliopsoas muscles

What other term is used to describe the space of retzius? A. posterior cul-de-sac B. anterior cul-de-sac C. murphy pouch D. retropubic space

D. retropubic space

What structure within the female pelvis lies posterior to the urinary bladder and anterior to the rectum? A. broad ligament B. rectus abdominus muscle C. space of retzius D. uterus

D. uterus

Pelvic muscles will appear as:

hypoechoic structures with varying degrees of echogenic, striated muscle fibers noted in the transverse and longitudinal scanning planes.

The rectouterine pouch:

located between the rectum and uterus, may also be referred to as the posterior cul-de-sac or pouch of Douglas

If a patient presents with free fluid in the pelvic spaces, where else should the sonographer interrogate?

morison pouch

The bony pelvis consists:

•the sacrum, coccyx, and innominate bones. -These bones mark the boundaries of the pelvic cavity.

Between the anterior wall of the urinary bladder and symphysis pubis lies:

•the space of Retzius, or retropubic space, an area that contains extraperitoneal fat

Each ovary receives its nourishment from:

an ovarian artery and a uterine artery

Rectus abdominis muscle

anterior in location

The vesicouterine pouch, or anterior cul-de-sac, is located:

anterior to the uterus and posterior to the urinary bladder

what path does arterial blood take to supply the uterus?

aorta-common iliac arteries-internal iliac arteries-uterine arteries

The broad ligaments and suspensory ligament of the ovary are:

actually double folds of peritoneum

what is the term used to describe the normal location of the ovaries?

adnexa