Download SESSION 1 - Pelvis (Skeleton, Floor, Peritoneum), Rectum, Anal

SESSION 1 - Pelvis (Skeleton, Floor, Peritoneum),
Rectum, Anal Canal & Ischioanal Fossa
1. In the upright position, which two bony points on the pelvis lie on the same
vertical plane? Which two points lie on the same horizontal plane?
2. Has the male or female pelvis the wider sub-pubic angle?
3. Where on the hip bone do the three constituent bones all meet?
4. What is the root nerve supply of the majority of the pelvic floor muscles and
how does coccygeus differ in this respect?
5. There is a "white line" on the pelvic wall from which the anterior pelvic floor
muscles arise. Upon which other muscle does this white line lie?
6. Into which three structures do the pelvic floor muscles insert?
7. Which of the pelvic floor muscles is a continuous sling?
8. What are the bony boundaries of the pelvic inlet?
9. Despite the fact that there is virtually no movement in the sacro-iliac joint, it is
still a synovial joint. True or false?
10. Consider the shape and facets of the sacro-iliac joint. If all the ligaments
around it failed, would the sacrum tend to fall into or out of the pelvis?
11. What is the definition of the perineum?
12. What are the boundaries of the ischio-anal (ischiorectal) fossa?
13. Which neurovascular bundle runs medially, directly through the fat within the
ischio-anal fossa?
14. The upper third of the rectum has peritoneum on its .……… and ….……
surfaces, whilst the middle third has peritoneum only on its ……….surface.
The lower third is ………the peritoneum.
15. Is the anterior well of the bladder covered with peritoneum? How would this
knowledge affect your technique for suprapubic catheterisation?
16. Where does the rectum begin and end?
17. The rectum, true or false?
(a) has two convex flexures to the right
(b) has two convex flexures to the left
(c) Is straight
18. What are the valves of Houston?
19. What muscle maintains the lower rectum at a right angle to the anal canal?
20. How does the mucosa differ between the upper and lower halves of the anal
canal? What marks the watershed between these two halves?
21. Name three features of the upper anal canal.
22. Do haemorrhoids occur in the lower or upper anal canal?
23. Which layer of rectal wall muscle forms the internal anal sphincter? How far
down the anal canal does this sphincter reach or does it stop at the level of the
puborectalis?
24. What are the names of the three parts of the voluntary external anal sphincter?
Which nerve supplies them?
25. Is the sensory innervation of the lower pelvic organs (derived from the cloaca)
mostly via sympathetic or parasympathetic?
26. What is the nerve supply to the peri-anal skin and posterior scrotum?
27. The arterial supply to the rectum and anal canal comes from three sources.
What are these three arteries and where do they come from? Do they all
supply all layers of the bowel?
28. There is a portosystemic anastomosis in the lower rectum and upper anal
canal. What are the systemic and portal components of this anastomosis?
29. Bleeding from haemorrhoids (piles) is usually bright red. Is this statement true
and if so, what conclusion can be drawn from it?
30. At rectal examination, apart from assessing the anal and the lower rectal
mucosae, what other organs can be felt in the two sexes?
31. Are faeces stored all day in the rectum ready for convenient evacuation?