(Netter Basic Science) Frank H. Netter - Atlas of Human Anatomy-Elsevier (2018)

Structures With High* Clinical Significance
ANATOMICAL STRUCTURES
Pubic symphysis
Ischial spine
SKELETAL SYSTEM
CLINICAL IMPORTANCE
Palpable landmark used to obtain pelvic measurements (e.g., diagonal conjugate) that
are used to assess adequacy of pelvis for childbirth; during prenatal examinations,
used for estimating fetal growth (symphysis–fundal height measurement)
Palpable landmark used to estimate interspinous diameter for childbirth and to locate
pudendal nerve for pudendal nerve block
PLATE
NUMBERS
Ischial tuberosity Palpable landmark used to estimate width of pelvic outlet for childbirth 336
Superior pubic ramus Often fractured by compression of pelvis in anteroposterior plane by crush injury 338
Ischial spine
MUSCULAR SYSTEM
Pelvic diaphragm (levator ani
and coccygeus muscles)
Endopelvic fascia
Pudendal nerve blocks target pudendal nerve at its entry into lesser sciatic foramen,
approximately 1 cm inferior and medial to attachment of sacrospinous ligament on
ischial spine
Provides support to urethrovesical angle, helping to maintain urinary continence;
weakness or injury during childbirth can lead to stress incontinence in women
Weakness or tearing of endopelvic fascial ligaments (e.g., pubovesical or cardinal
ligaments) facilitates prolapse of pelvic organs
Perineal body Tearing of perineal body can lead to prolapse of pelvic organs or loss of continence 360
Rectum
Peritoneum
DIGESTIVE SYSTEM
URINARY SYSTEM
Examined by digital rectal examination to detect internal hemorrhoids, fecal impaction,
and rectal cancer; provides access to colon for colonoscopy
Common site for metastatic spread of ovarian cancer via peritoneal fluid in peritoneal
cavity
336
336
384, 393
340, 351
350, 353
373, 375
344, 345
Urinary bladder Landmark used to identify structures of pelvis during ultrasound examination 349, 350
Ureter May be injured during hysterectomy because of its close relationship to uterine artery 346, 347
REPRODUCTIVE SYSTEM
Rectouterine pouch (of
Douglas)
Region examined with ultrasound to detect presence of abdominal or pelvic fluid;
common site of ectopic pregnancy; may be accessed via posterior vaginal fornix
345, 346
Uterus
Cervix of uterus
Palpated during prenatal examinations to assess fetal growth and during pelvic
examinations; examined with ultrasound to detect abnormalities (e.g., fibroids)
Epithelium of transformation zone of cervix is prone to dysplasia and malignancy; cells
are sampled from this region during pap examination
Vagina Posterior vaginal fornix allows access to rectouterine pouch of Douglas 345
Prostate gland
Prone to benign hypertrophy with aging; prostate cancer is second most common cancer
in men
345, 355
353, 355
349, 366
Table 6.1
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Clinical Tables