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Reproduction (Semester 4) > 2.2 Pelvic floor and perineum > Flashcards

2.2 Pelvic floor and perineum Flashcards

1
Q

What fills the lower part of the pelvic canal and closes the abdominal cavity

Give its main functions

A

The Pelvic floor: a muscular and fibrous tissue diaphragm comprised of muscle and fascia

Functions to supports and lifts the pelvic organs

  • has a role in childbirth, continence
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2
Q

What 3 bony structures mark the pelvic inlet?

A

1) broad ‘wings’ of the iliac bones
2) the sacrum
3) the pubic symphysis

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3
Q

What 3 bony structures mark the pelvic outlet?

A

1) paired inferior pubic rami
2) the ischial bones and ischial spines
3) the coccyx

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4
Q

In the erect position what angle is the pelvic inlet to the horizonal?

A

In the erect position, the pelvis is tilted so that the plane of its inlet is at an angle of 60o to the horizontal

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5
Q

Which image shows the male vs female bony pelvis?

Compare the two and give 3 features of each

A

Female (left):

  • Circular pelvic inlet
  • Pubic arch angle wider (80-85°)
  • Less distinct sacral promontory (furthur back)
  • Broader alae (wings)

Male (right):

  • Heart shaped pelvic inlet
  • Pubic arch angle smaller (50-60°)
  • Ischial spines project more medially into pelvic cavity
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6
Q

What is the “false” vs the “true” pelvis?

A

False (Greater):

  • related to upper parts of the pelvic bones, considered part of abdomen
  • extends from pelvic inlet to top of iliac crest

True (Lesser):

  • Boundaries: pubic symphysis, pelvic brim, sacral promontory
  • has a Inlet superiorly and an outlet inferiorly
  • reproductive organs reside here
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7
Q

Where is the perineum located in relation to the true pelvis?

What 2 important openings are found here?

A

Inferior to true pelvis

It is the area where the external genitalia and openings of GI system/genitourinary system are found

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8
Q

What structure defines the upper boarder of the perineum?

A

The pelvic floor

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9
Q

What sperates the true pelvis above from the perineum below?

A

Pelvic floor muscles (the pelvic diaphragm)

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10
Q

How to structures pass between the pelvic cavity and the abdomen?

A

through the pelvic inlet

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11
Q

What 2 ligaments define the posterior half of the pelvic OUTLET?

What bones define the anterior half of the pelvic INLET and what significance does this have?

A

Sacrotuberous ligament and Sacrospinous ligament define the outlet

The bones of the inlet are the Ishiopubic rami

Important in both males and females as the external genitialia (clitorus/penis) are anchored to the bony margins of the anterior half of the pelvic outlet

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12
Q

List 3 structures that pierce the pelvic floor

A

urethra, vagina (in females), and rectum

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13
Q

Lable the diagram

A
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14
Q

The pelvic floor provides a diaphragm across the outlet of the true pelvis

what are the 2 main layers of the pelvic floor?

How can these be furthur divided?

A

1) The pelvic diaphragm:

  • Levator Ani (pubococcygeus, iliococcygeus and puborectalis)
  • Coccygeus

2) Perineum: diamond shaped space with 2 triangular regions:

  • Anterior (Urogenital) Triangle
  • Posterior (Anal) Triangle
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15
Q

How is the Anterior (Urogenital) Triangle (of the perineum) divided into 2 layers?

How can these be futhur divided?

A

1) Urogenital Diaphragm (which has 2 layers):

  • Deep perineal pouch
  • Perineal membrane

2) Superficial perineal pouch
* This is the layer where the roots of the external genitalia reside

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16
Q

What 3 structures can be found within the deep perineal pouch that are found in both sexes?

A

1) Openings for the urethra
2) External urethral sphincter
3) Deep transverse perineal muscle

17
Q

What is the perineal membrane and where is it located

where does it attach from/too and what does this seperate?

A

The perineal membrane is a thick triangular fascial sheet located inferior to the pelvic floor and deep perineal pouch

attaches laterally to the inferior pubic rami and has a gap anteriorly (does not reach pubic symphysis). It also has a free posterior boarder

Forms boundary between the deep perineal pouch and the superficial perineal pouch

18
Q

What is found within the superficial perineal pouch in both sexes

A

Muscles:

  • superficial transverse perineal muscle
  • bulbospongiosus
  • Ischiocavernosus
    • perineal body (not a muscle)

One nerve and one artery:

  • branches of the internal pudendal artery
  • the perineal nerve
19
Q

Give 2 additonal structures found in the superficial perineal pouch specific to males vs females

A

males: bulb of the penis and crus of the penis
females: bartholins glands (greater v glands) and crus of the clitoris

20
Q

Which image shows the male vs female deep perineal pouch?

Compare features of each (DOBE DONEx2)

A

MalesDOBE (image B)

  • Deep Transverse Perineal Muscle
  • Opening for urethra
  • Bulbourethral glands
  • External urethral sphincter

FemaleDONEx2 (image A)

  • Deep Transverse Perineal Muscle
  • Opening for urethra
  • No Glands
  • External urethral sphincter
  • x2 additional muscles: sphincter urethrovaginalis and compressor urethra
21
Q

Where is the superficial perineal pouch located in relation to the perineal membrane?

A

Inferior to it

22
Q

What is meant by “roots of the external genitalia”?

How does this differ in males and females?

A

The roots of the external genitalia are Bulbospongiosus and
Ischiocavernosus muscle

In males:

  • the Bulbospongiosus is the root of the penis
  • the Ischiocavernosus muscle is the crus/body of the penis

In females:

  • the Bulbospongiosus is the bulb of vestibule of the vagina
  • the Ischiocavernosus muscle is the crus of the clitoris
23
Q

What is the perineal body and what is its function

Give one muscle that intersects here and give 3 muscles that attach here

A

It is a connective tissue structure that acts as a central fulcrum for pelvic support. It is situated in the midline, along the posterior boarder of perineal membrane

Muscles: deep transverse perineal muscles INTERSECT here

Other muscle connect here:

  • external anal sphincter
  • superficial transverse perineal muscles
  • bulbospongiosus muscles of perineum
24
Q

How may the perineal body commonly be damaged?

How may this be avoided?

A

Perineal body commonly damaged in childbirth which causes weakness in the pelvic floor and can lead prolapse of the vagina or uterus

This might be avoided by episiotomy

25
Q

Describe the anatomical boundaries of the Posterior Anal Triangle

A

Faces posteroinferiorly:

Lateral walls: Sacrotuberous ligament
Anterior wall: Horizontal line between 2 ischial tuberosities
Posterior wall: Coccyx
Ceiling: Pelvic floor (Levator Ani muscles)

In the centre of the triangle is the Anal aperture which contains the external anal sphincter

26
Q

The Ischioanal (Ischiorectal) fossa is normally filled with ______ and forms 2 _______, 1 on each side of the anal aperture

It functions to allow movement of the pelvic _______ and expansion of ________.

The ________ nerve passes along the lateral wall of this fossa.

A

fat, gutters, diaphragm, anal canal, pudendal

27
Q

How may infection spread via the ishioanal fossa and where does it tend to spread to?

A

Because there is communication between the ischioanal fossa and the perineum, infection can esily spread from here into the perineum

28
Q

What is an Ischioanal Abscess and why are they so common?

What 3 things can this potentially lead too?

A

Ischioanal Abscess is an abscess adjacent to the anus. Can form easily because the anal mucosa is particularly vulnerable to injury (eg. can be easily torn by hard faeces)

Can lead to:

1) Inflammation/infection of anal canal as it can spread into fossa
2) Fistulas can develop
3) Infection can spread into pelvic cavity

29
Q

Where is the anal canal located in relation to the pelvic diaphragm.

A

Inferior

30
Q

The _______ line denotes the anorectal junction where the upper 2/3rds is innervated by _______ afferent fibres and the lower 1/3 is innervated by _______ afferent fibes

The _______ muscle is located at this junction and when contracted pulls the anal canal _______, preventing faeces from passing down. When we need to defecate it relaxes to allow faces to move down.

Damage to this muscle (eg. _______) could result in _______

A

pectinate, visceral, somatic, puborectalis, forward, pelvic floor damage, foecal incontinence

31
Q

What are the 2 types of hemorrhoids that can occur in the anus/anal canal?

Describe each + the significance of the pectinate line in each?

A

Internal Haemorrhoids: located above the Pectinate line

These are covered by mucus membranes, and pain fibers have visceral innervation from sympathetic nerves. These are more likely to bleed because of the greater vascularisation but they are not overly painful

External Haemorrhoids: located below the Pectinate line

These are covered by skin and because they are innervated by affernt somatic pain fibres from the inferior rectal nerves, they are much MORE painful.

32
Q

What is the relationship between the Pectinate line and venous drainage?

A

Venous drainage superior to the pectinate line drains into the hepatic portal system

Venous drainage inferior to the pectinate line drains into the caval system

33
Q

What are the 3 major branches of the Pudendal Nerve?

A

1) Inferior Rectal Nerve: motor and sensory
2) Perineal Nerve: motor and sensory
3) Dorsal nerve of the Penis/Clitoris: sensory ONLY

34
Q

What is the main arterial supply to pelvic structures, the perineum and gluteal region?

Give another important artery that does not arise from this but also supplies pelvic structures

A

Internal Iliac Artery! anterior (mainly) and posterior divisions

+ Ovarian and Testicular Arteries (directly branch off abdominal aorta)

35
Q

Which ligaments transport the ovarian and testicular arteries to the ovary/testicle?

A

Ovarian: Reaches ovary via suspensory ligament

Testicular: Reaches testicle via inguinal ligament

36
Q

What 3 arteries does the anterior division of internal iliac artery give rise to in both sexes

Give 2 additional arteries only in females

A

1) Internal Pudendal
2) Obturator
3) Umbilical (gives rise to vesical a)

+ In Females gives rise to the uterine and vaginal arteries

37
Q

What are potential effects of childbirth on nerves, muscles and ligaments what can these lead to?

A

1) stretch of pudendal nerve ➞ neuropraxia and muscle weakness
2) stretch/damage to pelvic floor and perineal muscles ➞ muscle weakness
3) stretch/rupture of ligaments which support muscles ➞ Ineffective muscle action

All 3 can lead to Prolapse and/or Incontinence (urine or faecal)

38
Q

Apart from childbirth, give 4 other causes of pelvic floor damage (COMA)

A

1) Chronic cough
2) Obesity ➞ Increases load upon pelvic musculature
3) Menopause ➞ atrophy of tissues after oestrogen withdrawal
4) Age

Reproduction (Semester 4) (20 decks)

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