Pelvic vessels, bones, muscles

The internal iliac artery, also known as the ____ courses posterior and lateral to what structures?

Aka hypogastric artery. It runs posterior and lateral to the ovaries, uterus, vagina, bladder, and most pelvic floor muscles

How does the uterine artery course?

Along the lateral margin of the uterus; between the two layers of the broad ligament

The transversus abdominus forms what borders of the abdominopelvic cavity?

Anterolateral borders

What arteries can be mistaken for cysts? How can one disprove this potential finding?

Arcuate arteries; use Doppler to confirm or R/o

What do the radial/basal arteries branch into? What do they perfuse? What do they do?

Basal arteries give rise to spiral arteries that perfuse the functional layer (outer 2/3 of endometrium) and slough off during menses in response to hormones that cause ischemia.

Where does the iliacus muscle fuse to the psoas muscle? What do they form?

Below the level of the iliac crest. Together they form the pelvic side wall.

What are the ovaries dual sources of blood?

Branches of the uterine arteries and also the ovarian arteries.

How do arcuate vessels appear sonographically and where are they in relation to the cervix and uterus?

In the myometrium they are seen as anechoic tubular structures; they are lateral to the cervix and ascend lateral to the uterus within the broad ligament

Around the 5th lumbar vertebra, the psoas muscle separates from the spine and moves more lateral. What purpose does this serve?

It creates a space between the psoas muscle and the spine for the common iliac vessels.

What muscles are part of the pelvic diaphragm?

Levator Ani muscles (iliocyccgeus & pubococcygeus) and coccygeus muscles

What are the triangular muscles located in the true pelvis that are lateral to the urinary bladder?

Obturator internus muscles

How do the iliopsoas muscles appear sonographically?

On transverse images they are lateral to the bladder in the anterior portion of the pelvis. They appear as low gray echoes with a bright echogenic area within due to the femoral nerve, tendon, and fat.

How are muscles described sonographically and in general?

Paired, elongated, oval, relatively hypoechoic; surrounded by fascia; with echogenic thin lines that represent striations (visualized in the sagittal plane).

The piriformis passes thru what notch and inserts onto what part of the femur?

Passes thru the greater sciatic notch and inserts on to the greater trochanter of the femur.

What notch does the obturator internus pass thru? Where on the femur do they insert?

Passes thru the lesser sciatic notch and inserts medially on the greater trochanter of the femur

What is the the name of the area below the pelvic floor muscles?

Perineum

Which muscles are flat, triangular, and located in the true pelvis?

Piriformis

Levator Ani is ______ to the vagina

Posterior to

What bones does the pelvis consist of?

The 3 innomate bones (form the anterior and lateral margins), and the sacrum and coccyx (form the posterior wall).

What does the right ovarian vein empty into? What does the left ovarian vein empty into?

The right empties directly into the IVC while the left empties into the left renal vein

How does the obturator internus appear sonographically? What plane is used to best view them?

Thin, linear, low-level echoes abutting the lateral walls of the urinary bladder; best seen on transverse images.

What vessels give rise to the arcuate arteries? What do they encircle?

Uterine artery branches into arcuate arteries; they encircle the uterus

What pair of muscles is most posterior in the pelvic diaphragm?

coccygeus muscles

What do the arcuate arteries branch into? What do these arteries penetrate?

Arcuate branch into radial arteries that penetrate the myometrium.

The uterine artery also gives branches to what structures?

Cervix, fallopian tubes, and ovaries

Can the piriformis be seen sonographically? If so, where?

Not often, due to bowel gas, but located posterior to the uterus, anterior to the sacrum.

Where does the piriformis muscle originate? Where is it in relation to the levator ani?

Originates in most posterior aspect of the true pelvis; the anterior surface of the sacrum and the ilium; is more superior and lateral to the levator ani.

What is the internal iliac artery used as a landmark to locate?

Ovaries. It is posterior to the ovaries, usually

What are the muscles of the true pelvis?

Piriformis, obturator internus, & pelvis diaphragm

What is the long, fusiform muscle located on the side of the lumbar region of the spine?

Psoas major; they arise from the lumbar transverse processes and T12-L2

What are the 5 muscles of the false pelvis?

Rectus abdominus, transversus abdominus, psoas, iliacus, & iliopsoas (think: higher up and extending downward)

What muscle extends vertically on each side of the anterior wall of the abdomen?

Rectus abdominus; they are superficial muscles.

Ovarian arteries arise from the lateral margin of the aorta at a level slightly inferior to the _____

Renal arteries

What do radial arteries branch into? What part of the endometrium do these smaller vessels supply?

Straight aka basal arteries; supply the basal layer of the endometrium, which is the deeper part that doesn't slough off during menses.

What vessel bifurcates to form the common iliac arteries? Where?

The aorta bifurcates to form the common iliac arteries, and the those bifurcate at L4 to form the internal and external iliac arteries

The rectus abdominus extends from the pubic symphysis and pubic crest to _____

The costal cartilages of ribs 5,6, & 7 and the xyphoid.

The uterine artery branches off what artery?

The hypogastric artery (IIA)

What group of skeletal muscles stretch across the pelvic floor like a hammock, positioning the organs?

The pelvic diaphragm, consisting of the iliococcygeus and iliococcygeus.

What are the most inferior muscles of the pelvis?

The pelvic diaphragm, consisting of the levator ani muscles (iliococcygeus and pubococcygeus muscles) and the coccygeus muscles.

What muscle is most frequently mistaken for ovaries?

The piriformis

What forms the linea alba?

The rectus sheath fusing with the transverse abdominus

What are the innominate bones?

The three bones that form the hip: ilium, ischium, and pubis.

How do the external iliac arteries course in relation to muscles and ligaments?

They course through the false pelvis, along the anterior/medial aspect of the iliopsoas muscle. Once they reach the inguinal ligament, they are known as femoral arteries

How are the iliac veins similar and dissimilar to the arteries?

They follow the same route but are located more posterior and medial to the arteries.

Where do obturator muscles originate? How do they course? What do they cover?

They originate along the arcuate line of the innominate bones; course parallel to the lateral walls of the true pelvis; cover the anterior and lateral walls of the true pelvis.

Are the iliopsoas muscles in the true or false pelvis? What are they a landmark for? What part of the femur do they attach to?

They're in the false pelvis and are a landmark of the lateral border of the true pelvis. They attach to the lesser trochanter.