Above the pectinate line: Type of muscle: Innervation: Venous drainage: Lymph drainage: Below the pectinate line: Type of muscle: Innervation: Venous drainage: Lymph drainage:

Above the pectinate line: endoderm Type of muscle: Smooth Innervation: Visceral, autonomic Pelvic splanchnics Venous drainage: Portal system Lymph drainage: With internal iliac vessels Below the pectinate line: ectoderm Type of muscle: Skeletal (striated) Innervation: General sensory, somatomotor Pudendal nerve Venous drainage: Iliac/caval system Lymph drainage: Superficial inguinal nodes

200/201/220/221 - Anatomy of Abdominal Wall, Pelvis, Perineum I, II, III Flashcards by David Fei-Zhang

How do the upper rectus sheath and the lower rectus sheath differ?

Upper sheath:
- All 3 aponeuroses envelop each rectus muscle
Lower sheath
- All 3 aponeuroses pass anterior to all the muscles
- The posterior sheath terminates abruptly at the arcuate line

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The transversus abdominis contributes to the [layer of covering of the spermatic cord]

The transversus abdominis contributes to NONE of the layers covering the spermatic cord

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The splanchnopleure gives rise to the [superficial/deep] body wall

The somatopleure gives rise to the [superficial/deep] body wall

The splanchnopleure gives rise to the deep body wall

The somatopleure gives rise to the superficial body wall

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The [layer of the body wall] contributes to the internal spermatic fascia and deep inguinal ring

The Transversalis Fascia contributes to the internal spermatic fascia and deep inguinal ring

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In females, the gubernaculum persists as which two structure?

Ovarian ligamnet

Round ligament of the uterus

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What is contained in the superficial pouch?

(In general, not specific structures)

External genital organs

Penis
Clitoris (body and crura)

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The [layer of the body wall] contributes to the cremaster muscle

The internal oblique muscle contributes to the cremaster muscle

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Which muscle maintains constant muscle tone to bend the rectum and relaxes to allow defecation?

Puborectalis (aka pubo-rectal sling)

Skeletal muscle => under somatic control*
Most medial part of levator ani (=> most medial part of the pelvic diaphragm)*

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Which structure marks the transition from internal to external anal sphincter?

Pectinate line

Where splanchnopleure meets somatopleure

This is the site of the cloacal membrane (vestigial)

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What are the boundaries of the inguinal triangle?

Lateral edge of the rectus
Inferior epigastric artery
Inguinal ligament

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List the muscle sof the pelvic diaphragm (2 but kind of 3)

Levator ani [without puborectalis?]
- Pubococcygeous
- Iliococcygeus
Ischiococcygeus

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As the testes descends, each layer of the body wall except the _____ contributes to the covering of the spermatic cord

As the testes descends, each layer of the body wall except the transversus abdominus contributes to the covering of the spermatic cord

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Between which landmarks is the largest diameter of the birth canal?

Transverse dimension of the pelvic brim

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Above the pectinate line:

Type of muscle:
Innervation:
Venous drainage:
Lymph drainage:

Below the pectinate line:

Type of muscle:
Innervation:
Venous drainage:
Lymph drainage:

Above the pectinate line: endoderm

Type of muscle: Smooth
Innervation: Visceral, autonomic
- Pelvic splanchnics
Venous drainage: Portal system
Lymph drainage: With internal iliac vessels

Below the pectinate line: ectoderm

Type of muscle: Skeletal (striated)
Innervation: General sensory, somatomotor
- Pudendal nerve
Venous drainage: Iliac/caval system
Lymph drainage: Superficial inguinal nodes

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A women with chronic, severe cramping of the uterus can get relief from severing or anesthetizing which of the following?

A. Pudendal nerve

B. Nerve roots in the sacral canal

C. Superior hypogastric plexus

D. Pelvic splanchnic nerves

C. Superior hypogastric plexus (aka Lumbar Splanchnics)

Lumbar splanchnics provide sensory innervation to the uterine body and fundus and internal sphincter

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The transversalis fasciacontributes to the[layer of covering of the spermatic cord]

The transversalis fasciacontributes to theinternal spermatic fascia (and deep inguinal ring)

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[direct/indirect] hernias are lateral to the inferior epigastric artery

Indirect hernias are lateral to the inferior epigastric artery

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Which part of the pelvis marks the course of the pudendal nerve?

Ischial spine

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Which part of the urethra constitutes the membranous urethra?

The part that passes through the UG diaphragm

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A needle through the vagina can most easily sample peritoneal fluid from which location?

Rectouterine pouch

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Which of the following is NOT part of the pelvic diaphragm?

Iliococcygeus
Pubococcygeus
Coccygeus
Obturator internus
Puborectalis

d. Obturator internus

All others are part of the pelvic diaphragm

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Where in the anal canal does the epithelium change from GI to skin?

Which type of epithelium is found in each place?

White line

GI = simple columnar

Skin = stratified squamous

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Infection in which of the following locations might impair function of the external anal sphincter by interrupting its nerve supply?

A. Superficial perineal pouch

B. Ischioanal fossa

C. Deep perineal pouch

D. Rectouterine pouch

E. Pelvic peritoneal cavity

B. Ischioanal fossa

Inferior rectal branches of the pudendal nerve must traverse the ischioanal fosa to reach the external anal sphincter

Rectouterine pouch and pelvic cavity have nothing to do with rectal innervation*
Perineal pouch relates to the UG diaphragm*

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How does fluid in the superficial perineal pouch drain?

Must flow in between superficial (scarpa’s) and deep investing fascia

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What kind of muscle is found in the external anal sphincter?

Striated (skeletal) muscle

Which structure related to the uterus corrensponds to the male gubernaculum?

Round ligament of the uterus

Which layer forms the deep inguinal ring? (Aka beginning of the inguinal canal)

Transversalis fascia

What is the best surgical approach for removing a kidney stone to minimize bleeding?

**Midline** You will avoid the major veins and arteries, which open into the renal pelvis anteriorly and posteriorly (not midline)

The space between which two ligaments forms the lesser sciatic foramen?

Sacrospinus (from 1 to sacrum) Sacrotuberous (from 2 to sacrum)

The ventral ramus of **[spinal nerve]** supplies the body wall at the level of the umbilicus

The ventral ramus of **T10** supplies the body wall at the level of the umbilicus

The aponeurosis of the external oblique muscle forms, contributes to, or is otherwise related to all of the following EXCEPT: 1. Superficial inguinal ring 2. Conjoint tendon 3. External spermatic fascia 4. Sheath of the rectus abdominus muscle 5. Inguinal ligament

b. Conjoint tendon * Conjoint tendon is formed by the _internal_ oblique and transversus abdominus*

List 3 bony structures that form the boundary of the perineum Which muscles form the superior and lateral boundaries?

* Bony * Pubic symphysis * Ischeal tuberosity * Coccyx * Muscles * Pelvic diaphram superiorly * Obturator internus laterally

Incontinence due to dysfunction of the internal urethral sphincter would result from damage to which of the following? 1. Pudendal nerve 2. Pelvic splanchnic nerves 3. Sacral sympathetic trunk 4. Lumbar splanchnic nerves

d. **Lumbar splanchnic nerves** * Internal urethral sphincter is under **sympathetic control;** * Sympathetics for pelvic function come from **lumbar sympathetics** * ******Pelvic**splancnnics are**parasympathetic**

Which muscle is labeled by #2?

**Pubococcygeus** * Part of levator ani* * Muscles 1-4 are all part of the pelvic diaphragm*

What is the deepest layer of the body wall in the abdomen?

Parietal peritoneum

Which of the following is NOT a branch of the internal iliac artery? A. Ovarian artery B. Inferior rectal artery C. Obturator artery D. Inferior gluteal artery E. Uterine artery

A. Ovarian artery

Which artery is labled by #3? What structures does it supply blood to?

Pudendal artery External genitalia (penis and clitoris) *Lowest one exiting the greater sciatic foramen*

The **internal oblique** contributes to the **[layer of covering of the spermatic cord]**

The **internal oblique** contributes to the **cremaster muscle**

The **[layer of the body wall]** contributes to the **external spermatic fascia and superficial inguinal ring**

The **external oblique** contributes to the **external spermatic fascia and superficial inguinal ring**

Which artery is labled by #4?

Obturator artery Follows obturator nerve through the obturator canal

Which muscles become the conjoint tendon?

Internal oblique and transversus abdominus

The **e****xternal oblique**contributes to the**[layer of covering of the spermatic cord]**

The **e****xternal oblique**contributes to the**external eprmatic fascia (and the superficial inquinal ring)**

List 3 structures that are anchored to the perineal body (aka central tendon of the perineum)

* Pelvic diaphragm * External anal sphincter * Urogenital diaphragm (superficial and deep pouch strux)

Which muscle is labeled by #4?

**Ischiococcygeus** *Part of the pelvic diaphragm but NOT part of levator ani*

Which one of the following is in the deep perineal pouch? ## Footnote A. Greater vestibular gland B. Internal anal sphincter C. Prostate gland D. External urethral sphincter E. Bulbospongiosus muscle

D. External urethral sphincter

Which structure guides the descent of the testes?

Gubernaculum

What structures are supplied by the uterine artery?

Vagina Uterus Ovary *Ovary alos gets supply from the ovarian artery*

What are the attachments of levator ani? (3)

* Obturator internus + fascia * Middle of pubis * Ischial spine *Not the pelvic brim*

What is the only part of body wall innervated by parasymathetics?

Penis / clitoris

Which part of the bladder is innervated by sympathetic nerves?

Trigone * Stimulation -\> holds pee in * Parasympathetics innervate detrusor -\> pushes pee out*

What is the primary structure cut in a midline episiotomy to enlarge the birth canal? ## Footnote A. Anococcygeal ligament B. Perineal body C. Urogenital diaphragm D. Cardinal ligaments E. Pelvic diaphragm

B. Perineal body Immediately posterior to the vagia, aterior ot the rectum * Mediolateral cut would sever UG and pelic diaphragms* * Anococcygeal ligament is posterior to the anus* * Cardinal ligaments anchor the uterus on each side*

**[direct/indirect]** hernias are medial to the inferior epigastric artery

**Direct** hernias are medial to the inferior epigastric artery

Which muscle is labeled by #1?

**Puborectalis** * Part of levator ani* * Muscles 1-4 are all part of the pelvic diaphragm*

What is the function of the pelvic diaphragm?

Supports abdominal viscera Helps raise intra-abdominal pressure * Made up of the levator ani + ischiococygeus* * Levator ani = puborectalis + pubococcygeus + iliococcygeus*

The **[structure]** is the abrupt termination of the posterior rectus sheath

The **arcuate line** is the abrupt termination of the posterior rectus sheath Below this line, the rectus abdominus lies directly on transversalis fascia

Which abdominal muscles can rotate the trunk ipsilaterally?

Internal oblique

Which 3 bones make up the innominate bone?

Ishium Ilium Pubis

Which structures are at risk during prostate surgery during each of the following approaches? * Suprapubic * Posterior

* Suprapubic * Pelvic plexus of veins -\> risk of bleeding * *Pelvic plexus of veins drains clitoris and penis* * Posterior * Pelvic plexus of nerves (parasympathetics * Can result in impotence - cannot maintain an erection

What is the difference in function between the ischiocavernosus vs. bulbospongiosus? (in the penis)

* **Ischiocavernosus** * Facilitates **erection** * Contracts to constrict venous return, thus maintaining the erection * **Bulbospongiosus** * Expells the last drops of urine during **micturition** * Contracts during **ejaculation**

Which arteries and veins supply the penis and clitoris?

Artery = **pudendal artery** Veins = **Pelvic plexus of veins** Pelvic plexus of veins comes from below the pubic symphysis \*Does not follow the pudendal canal the way the artery does\*

Which parts of the pelvis deliniate the narrowest diameter of the birth canal?

From one ishial spine to the other

Which artery is labled by #1?

Superior gluteal artery (Highest one exiting the greater sciatic foramen)

Which muscle is labeled by #3?

**Iliococcygeus** ## Footnote * Part of levator ani* * Muscles 1-4 are all part of the pelvic diaphragm*

Which artery is mainly responsible for erection?

Deep artery of the penis (in the middle of the corpus cavernosum on each side)

What ist he mesentary for the ovary?

Mesovarium

What is the function of the suspensory ligament of the ovary?

Connects the ovarian ligament to the abdominal wall **Carries blood vessels!**

Which muscle surrounds the vestibular bulb and greater vestibular gland in the female anatomy? What is its function?

Bulbospongiosus * Expels last drops of urine during micturition * Contracts during ejaculation *Same functions in male anatomy*

List the contents of the UG diaphragm (What is inside the superficial vs. deep pouch?)

* Deep pouch (aka superior) * External urethral sphincter * Deep transverse perinei * Bulbourethral gland * Superficial pouch (aka inferior, aka perineal membrane) * External genital organs

The bulbospongiosus muscle surrounds what in the female? ## Footnote A. Membranous urethra B. Body of the clitoris C. Labia minora D. Cervix E. Vestibule

E. Vestibule

Which 2 structures combine to form the ejaculatory duct?

Ampulla of ductus deferens + duct of seminal vesicle

Which artery is labled by #2?

Inferior gluteal artery

All of the following attach to the central tendon of the perineum (perineal body) EXCEPT? ## Footnote A. External anal sphincter B. Inferior fascia of the urogenital diaphragm C. Obturator internus muscle D. Deep transverse perineal muscle E. Levator ani

C. Obturator internus muscle

Which two muscles are inside the UG diaphragm?

External urethral sphincter Deep transverse perineal muscle * Both skeletal muscles* * In males, the bulbourethral gland is also within the UG diaphragm*

Which artery is labled by #5?

Superior vesicular artery (umbilical artery in fetus) *Supplies bladder, ureter, seminal vesicle and ductus deferens*

Which muscles make up the pelvic diaphragm?

* Levator ani * Puborectalis + pubococcygus + iliococcygeus * Ischiococcygeus (aka coccygeus)

What is the course of a direct inguinal hernia? 1. Lateral to the deep inferior epigastric artery 2. Through the deep in guinal ring 3. Inside a persistent processus vaginalis 4. Within the spermatic cord 5. Under the conjoint tendon

e. Under the conjoint tendon

**[direct/indirect]** hernias project through the inquinal canal and deep ring

**Indirect** hernias project through the inquinal canal and deep ring