Anatomy Anal Triangle Flashcards
1
Q
What does the pelvis refer to?
A
the region above the pelvic diaphragm
2
Q
What does the perineum refer to?
A
the region below the pelvic diaphragm
3
Q
What is the pelvis made up of?
A
the ischial spine obturator foramen pubic symphysis ischial tuberosity coccyx greater sciatic notches lesser sciatic nothces
4
Q
What are the three ligaments that are extremely important for the structural integrity of the pelvis?
A
SI joint ligament
Sacrospinous ligament
sacrotuberous ligament
5
Q
What 2 ligaments stabilize the SI joint?
A
The sacrospinous ligament and the sacrotuberous ligament
6
Q
What is a combination of numerous named ligaments?
A
the SI joint
7
Q
What do the sacrospinous and sacrotuberous ligaments make?
A
they turn the greater and lesser notches into foramina
8
Q
The obturator foramen is filled in with (blank)
A
obturator membrane
9
Q
What two muscles arise from the obturator membrane and act on the hip joint?
A
the obturator externus and the obturator internus
10
Q
two triangles fill in the area of the perineum, what are these 2 triangles?
A
the anal triangle
the urogenital triangle
11
Q
The (blank) is defined as the area inferior to the pelvic diaphragm between the coccyx and the pubis and including all the structures in the two triangles.
A
perineum
12
Q
The midsaggital point separating the 2 triangles is also known as the perineum by obstetricians but is really the (Blank)
A
perineal body
13
Q
What is the pelvic floor made up of?
A
the levator ani and coccygeus (bowel shaped collection of muscles)
14
Q
The obturator internus leaves the pelvis to attach to the (blank)
A
femur
15
Q
In the female, the anal triangle is identical but the (blank) has an additional opening for the vagina.
A
UG
16
Q
How do we get nerves and blood vessels out of the pelvis?
A
leaves the pelvis via the greater sciatic foramen and then pass into the perineum by running over superfical to the sacrospinous ligament but deep to the sacrotuberous ligament.
17
Q
Why do the nerves and blood vessels out of the pelvis travel the way that they do?
A
to allow them to have access to the perineum without compromising the integrity of the pelvic floor
18
Q
What does the anal triangle contain?
A
contains the anal canal, the ischioanal fossa, and the pudendal nerves and vessels as they pass through on their way to the UG triangle.
19
Q
What does the pudendal nerves and vessels give off along their way to the UG triangle?
A
inferior rectal vessels and nerves
20
Q
What are the boundaries of the ischio anal fossa?
A
external anal sphincter andlevator ani medial, obturator muscle and ischium lateral, levator ani superior, sacrotuberous lig. and gluteus maximus posterioly.
21
Q
What is the medial boundary of the ischio anal fossa?
A
external anal sphincter and levator ani medial
22
Q
What is the lateral boundary of the ischio anal fossa?
A
Obturator muscle and ischium lateral
23
Q
What is the superior boundary of the ischio anal fossa?
A
pelvic diaphragm/ levator ani
24
Q
What is the posterior border of the ischio anal fossa?
A
sacrotuberous lig. and gluteus maximus
25
What is the inferior border of the ischio anal fossa?
skin
26
What is the anterior border of the ischio anal fossa?
anterior border extends all the way forward to the pubis as the anterior recess.
27
How do you expose deep gluteal muscles and piriformis?
reflect gluteus maximus muscle
28
What enter superiorly and inferiorly to the piriformis muscle?
gluteal nerves and vessels
29
Why do pudendal nerves and vessels leave the pelvis?
to gain the perineum
30
Where does the pudendal nerve exit?
greater sciatic foramen
31
The pudendal nerve exits the greater sciatic foramen passing (blank) to the sacrospinous lig and gains the perineum passing deep to the sacroptuberous lig.
superificial
32
In the ischioanal fossa, the pudendal nerve gives off the (blank) and then enters the pudendal canal to travel anteriorly towards the UG triangle.
inferior rectals
33
What does the pudendal nerve innervate?
the external sphincter and the UG trangle muscles and is the sensory nerve of the perineum
34
the internal pudendal artery and vein follow the pudendal nerve into the pudendal canal giving off (blank)
branches such as the inferior rectal vessels :)
35
Where will you find the obturator internus?
Goes from obturator membrane through the greater sciatic foramen to the femur
36
Where do you find the levator ani?
it is the base of the bowl so it goes from anterior to posterior and the 2 halfs of the levator ani meet at the posterior midline.
37
In the the levator ani, there is a hole in the membrane that makes what?
a urogenital hiatus (females->vagina and urethra go through here, males -> urethra)
38
THe coccygeous muscle is located where?
more posterior and superior to the levator ani
39
What all does the pudendal canal have within it?
pudendal nerve, artery and vein
40
(blank) is approx. 10 cm in length and begins at the S3 vertebra and extends to the rectoanal junction.
rectum
41
The anal canal begins at the superior limit of the (blank) where the rectal ampulla narrows and ends at the anus.
pelvic diaphragm
42
What is the superior border of the anal columns?
| What is the inferior border of the anal columns?
Superior border->junction b/w rectum and anal canal
| inferior border->anus
43
The (blank) marks the point where viscero motor and sensory above give way to somatic motor and sensory below and is also the point of junction between the embryonic hindgut and the proctodeum.
Pectinate line
44
Go from the anal column outwards and name all the layers
anal columns-> internal venous plexus->internal anal sphincter-> external anal sphincter muscle
-> levator ani Muscle
45
How may blood supplies does the rectum have?
3
| superior, middle and inferior rectals w/ anastomoses
46
The common illiacs branch into the internal and external illiacs. The internal illiac then branches into the (blank)
pudendal artery
47
Where do the middle and inferior rectal arteries come off of?
middle comes off of the internal illiac
| inferior comes off of the pudendal
48
What is the venous drainage of the rectum?
external and internal venous plexus drain into the inferior, superior, and middle rectal veins.
Middle and inferior veins will drain into systemic circulation via the internal illiac veins and the superior rectal vein will drain into the IMV into the portal vein
49
Since venous drainage of the rectum can go into the portal vein then what can result if there is portal hypertension?
varices in venous plexus
50
How does lymphatic drainage work in the anal canal and rectum?
follows the pectinate line division, above the line drains to iliac nodes and below drains to inguinal nodes
51
Above the pectinate line is innervated by (blank)
Inf. hypogastric plexus (sym, par, afferents)
52
What does the sympathetic innervation to the anal canal do?
maintains tone of internal sphincter
53
What does the parasympathetic innervation to the anal cana do?
inhibit tone and evoke peristalsis (aids in defication)
54
(blank) is excitatory to parasympathetics.
distention
55
The upper anal canal (above pectinate line), afferents travel on (Blank)
pelvic splachnics
56
The lower anal canal (below pectinate line), afferents travel on (blank)
inferior rectal nerves (somatosensory)
57
What s the puborectalis?
The fibers which form a sling for the rectum. These fibers attach next to the pubis symphysis and wrap around the rectum
58
The (blank) prevents untimely flatulence and defecation during relaxation of involuntary internal anal sphincter.
puborectalis
59
What is the external sphincter innervated by?
inferior rectals nerves off the pudendal (S2-4)
60
What innervates the levator ani?
small branches off the sacral plexus (S4) and inferio rectals nerves
61
Explain the UG triangle
extends from ischial tuberositiesto the pubis and is filled in by a fibromuscular diaphragm (UG diaphragm).
62
What does the urethra pass through?
passes through the UG triangle (vagina passes through here too)
63
(blank) contains the muscles and erectile tissues of the external genitalia
the UG triangle
64
What is the UG diaphragm made up of?
the sphincter urethrae muscle and the deep transverse perineus muscle.
65
THe UG diaphragm is made up of the sphincter urethrae muscle and the deep transverse perineus muscle and both of these muscle are encased in what?
a dense connective tissue made up of the superior and inferior fascia of the UG diaphragm
66
Which is thicker, the inferior or superior fascia?
| Which is also called the perineal membrane, inferior or superior fascia?
the inferior fascia
| inferior fascia
67
What is the major attachment site of the external genitalia?
the inferior fascia :)
68
Where are the bulbourethral glands (cowpers) located?
they are only in males and are located in the UG diaphragm.
69
Where do the ducts of the bulbourethral gand enter the urethra?
superificial to the diaphragm
70
When do the bulbourethral glands secrete their mucousy secretions?
during arousal
71
What are the 2 pouches associated with the UG trangle?
a deep and superficial pouch.
72
Explain the location of the deep pouch
it extends superficially from the perineal membrane to the investing fascia of the pelvic diaphragm
73
What is the homolog of bulbourethral gland in females?
greater vestibular gland (bartholin's gland)
74
Where do we find the vestibular gland (bartholins)?
| Where does it drain?
within the superficial pouch
| to vagina
75
What does the vestibular gland (bartholins) secrete?
mucus during arousal
76
What are the three bodies of erectile tissue attached to the perineal membrane of a male?
two crura laterally
| one midline bulb housing the urethra
77
The three erectile tissues attached to the perineal membrane of a male is covered by a dense tissue called (blank) and are covered by the deep (blank) which binds them together to form the penis
```
tunica albuginea
perinal fascia (Buck's)
```
78
Where are the glans of the penis?
in the mushroom cap filled with erectile tissue
79
Explain the anatomy of the penis
Bulb of penis->corpus spongiosum-> glans of penis.
Corpus spongiosum is within the corpus cavernosum.
THe bulb of the penis is within the crus of penis
80
What does the crura if the penis become?
| What does the bulb become?
corpora cavernosa
| corpus spongiosum
81
(blank) lines the scrotum and ultimately blends with the membranous layer of the abdominal wall.
Dartos fascia
82
Bucks fascia (on the penis that encircles the spongy urethra and the tunica albuginea) is continous with the (blank) fascia
deep perineal fascia (the investing fascia of muscles)
83
What is the distribution from laterally to medially of the nerves, arteries, and veins of the dorsal penis?
dorsal nerve, artery, dorsal vein (one that is the median)
| N, A, V, A, N
84
The foreskin in an uncircumsised male covers the glans except during (blank)
erection
85
In female external genitalia, the bulb is (blank)
split into 2
86
What are the 2 bulbs of the female external genitalia separated by?
vestibule of the vagina
87
Does the vestibule of the vagina contribute to the formation of the clitoris?
no
88
Where do the glans of the female external genitalia come from?
the extensions of the crura on either side.
89
The female erectile tissues are contained in (blank)
dense connective tissue called tunica albuginea
90
The four bodies of erectile tissues are covered with (blank)
skeletal muscle
91
What are the 2 muscles of the superficial perineal pouch?
bulbosponiosus muscle
| ischiocavernosus muscle
92
In the external male genitalia, the bulbospingiosus muscle is divided in the midline. T or F?
False
93
Ischiocavernosus muscle, bulbospongiosus muscle, and superficial transverse perineal muscle are covered by (blank)
the deep perineal fascia (gallaudet's/Bucks).
94
Bucks fascia is continuous with the (Blank) of the anterior abdominal wall muscles.
investing fascia
95
After the pudendal nerve gives off the inferior rectals, what next does it give off?
deep perineal branches to the muscle, superificial perineal branches to the skin and the
dorsal nerve of the penis (entirely sensory)
96
What does the internal pudendal artery give off?
perineal branches
artery to the bulb
deep artery
dorsal artery of penis in male or dorsal artery of clitoris in female
97
What is the venous drainage to the pudendal vein?
perineal branches
venous branch from the bulb
and the deep vein flow into the pudendal
The deep dorsal vein of the penis goes into the prostatic plexus
98
The pudendal nerve in the female follows the exact pattern as that in the male except that the female has a (blank) nerve
dorsal nerve of clitoris
99
What is the fatty fascia?
| What is the membranous fascia?
campers
| scarpas
100
Do males have campers fascia in their external genitalia?
| Do males have scarpas fascia in their external genitalia?
no they have dartos fascia instead and smooth muscle
| No they have superficial perineal (Colles) fascia
101
Where do we find Buck's fascia?
the investing layer on the penis
102
Where do we find gallaudets fascia?
is continuous with buck's fascia and goes over the muscles of genitalia and UG diaphragm
103
Where do superifical fascia layers extend?
| Deep?
superficial extend into anal triangle
| Deep stop at posterior borer of UG diaphragm
104
Where do both the superificial and deep fascia stop?
the fascia lata
105
Where is the vestiule of the vagina?
it is the space between the labia minora and contains the openings of the urethra, vagina, and greater and lesser vestibular glands
106
What is another name for paraurethral glands?
skene glands
107
Where do skene glands (paraurethral) glands empty and what do they secrete?
into urethral orifice and secrete a water fluid (like prostate)
