Anatomy of the Pelvic Floor Flashcards
Label the true and false pelvic cavity in the image below:
1 = true pelvic cavity 2 = false pelvic cavity
Does the false or true pelvic cavity house the pelvic organs?
- true pelvis
What name is given to the inferior lining of the pelvic cavity?
1 - pelvic hiatus
2 - pelvic floor
3 - false pelvis
4 - true pelvis
2 - pelvic floor muscles, also known as the pelvic diaphragm
What name is given to the area below the pelvic floor that makes up the perineum?
1 - pelvic hiatus
2 - pelvic floor
3 - urogenital diaphragm
4 - true pelvis
3 - urogenital diaphragm
The urogenital diaphragm is the area below the pelvic floor that makes up the perineum. It contains 2 triangles that are important, what are they called?
1 - anal triangle
2 - urogenital triangle
Label the contents numbered 1-9 in the female pelvis using the labels below:
anal canal anal aperture rectum fallopian tubes uterus ovary vagina bladder urethra
Label the contents numbered 1-9 in the female pelvis using the labels below:
1 = fallopian tubes 2 = ovary 3 = uterus 4 = vagina 5 = bladder 6 = urethra 7 = rectum 8 = anal canal 9 = anal aperture
Label the contents numbered 1-9 in the male pelvis using the labels below:
anal canal anal aperture rectum seminal vesicles ductus deferens prostate ejaculatory duct bladder urethra
1 = seminal vesicles 2 = ductus deferens 3 = prostate 4 = ejaculatory duct 5 = rectum 6 = anal canal 7 = anal aperture 8 = bladder 9 = urethra
Which somatic nerves roots, which are for voluntary movement innervate the pelvic floor/diaphragm?
1 - S2-S5
2 - S1-S4
3 - L5-S2
4 - L4-S1
1 - S2-S5
What is able to penetrate the pelvic floor/diaphragm in men?
1 - rectum and scrotum
2 - rectum and ureter
3 - ureter and scrotum
4 - rectum and ejaculatory duct
2 - rectum and ureter
What is able to penetrate the pelvic floor/diaphragm in women?
1 - vagina, cervix and rectum
2 - vagina, cervix and urethra
3 - vagina, rectum and urethra
4 - cervix, rectum and urethra
3 - vagina, rectum and urethra
What is the name given to the group of muscles that make up the pelvic floor/diaphragm?
1 - elevatur ani
2 - levator ani
3 - obturator internus
4 - obturator externus
2 - levator ani
- levator = greek for lifting up
- ani = anus
The name given to the group of muscles that make up the pelvic floor/diaphragm is called the levator ani. There are 3 main muscles that make up the levator ani. Which muscle from the list below is bound in the urogenital hiatus from both sides.It is attached attaches to the posterior surfaces of the bodies of the pubic bones anteriorly, and rectalis means that this part forms a sling around the anorectal junction and is blue in the picture?
1 - Coccygeus
2 - Iliococcygeus
3 - Puborectalis
4 - Anococcygeal raphe
3 - Puborectalis
The name given to the group of muscles that make up the pelvic floor/diaphragm is called the levator ani. There are 3 main muscles that make up the levator ani. Which muscle from the list below that arises from the posterior surfaces of the bodies of pubic bones, in addition to the anterior tendinous arch. The lateral muscle fibers go posteriorly to attach to the coccyx. The medial muscle fibres also form a tendinous raphe that forms part of the anococcygeal body. it is also coloured green in the image below?
1 - Coccygeus
2 - Iliococcygeus
3 - Pubococcygeus
4 - Anococcygeal raphe
3 - Pubococcygeus
The name given to the group of muscles that make up the pelvic floor/diaphragm is called the levator ani. There are 3 main muscles that make up the levator ani. Which muscle from the list below arises from the ischial spines and tendinous arch, and inserts on the coccyx and the anococcygeal body. Its is also coloured orange in the image below?
1 - Coccygeus
2 - Iliococcygeus
3 - Puborectalis
4 - Anococcygeal raphe
2 - Iliococcygeus
There are 3 origins of the levator ani, what are they?
1 - body of pubis, spine of ischium, ilium
2 - body of pubis, sacrum of ischium, ilium
3 - body of pubis, spine of ischium, coccyx
4 - ischial tuberosity, spine of ischium, ilium
1 - body of pubis, spine of ischium, ilium
There are 3 key muscles that make up the levator ani? Label them in the image below using the labels below:
puborectalis
pubococcygeus
iliococcygeus
1 = pubococcygeus 2 = puborectalis 3 = iliococcygeus
When we look from superior to inferior through the pelvis we can see that there is a gap anteriorly where in the middle of the puborectalis muscles from the right and left sides. What is this gap called?
1 - urogenital diaphragm
2 - vaginal hiatus
3 - urethral hiatus
4 - urogenital triangle
1 - urogenital diaphragm
- contains muscles of the perineum and perineum fascia
The levator muscles have a number of functions including supporting the pelvic contents. What are the other 3 key functions of the pelvic floor/diaphragm?
1 - compress urethra and vagina (maintain position and support)
2 - maintain anorectal angle (maintain anorectal angle)
3 - during childbirth, levator ani muscles support foetal head
If there is an increased pressure within the abdominal cavity what can this do to the pelvic floor/diaphragm?
- compresses pelvic organs into the pelvic diaphragm
- can stretch and damage the pelvic floor muscles
The aorta bifurcates at what vertebral level into what just above the pelvic?
1 - L1 into common iliac artery
2 - L2 into external iliac artery
3 - L4 into common iliac artery
4 - L4 into internal iliac artery
3 - L4 into common iliac artery
The common iliac artery bifurcates into what 2 arteries, and what is the anatomical landmark where this occurs?
- bifurcates into internal and external iliac
- bifurcates at level of sacroiliac joint
The internal iliac artery bifurcates into 2 further arteries, what are these called and what do they supply?
1 - anterior = urethra, uterus, vagina
2 - posterior = muscles of thigh and hips
Using the labels below, label the arteries from the internal anterior iliac artery:
anterior trunk of internal iliac artery superior vesical artery obturator artery uterine artery umbilical artery vaginal artery
1 = anterior trunk of internal iliac artery 2 = uterine artery 3 = umbilical artery 4 = vaginal artery 5 = obturator artery 6 = superior vesical artery
What 2 veins from the pelvic merge to form the inferior vena cava and at what vertebral level does this occur?
1 - L1 from left and right common iliac veins
2 - L5 from external and internal iliac veins
3 - L4 into common iliac vein
4 - L5 from left and right common iliac veins
4 - L5 from left and right common iliac veins
Where do the left and right gonadal veins drain?
1 - left and right into IVC
2 - left and right into renal veins
3 - left into left renal vein and right into IVC
4 - left and right into the left renal vein
IVC = inferior vena cava
3 - left into left renal vein and right into IVC
What part of the sympathetic and parasympathetic nervous system innervate the pelvis viscera (organs)?
- sympathetic = T12-L2
- parasympathetic = S2-S4
Which key nerve innervates the pelvic floor/diaphragm and where does this originate from in the vertebrae?
1 - pudendal nerve S2-S4
2 - sciatic nerve L4-S3
3 - superior gluteal nerve L4-S1
4 - inferior gluteal nerve L5-S2
1 - pudendal nerve S2-S4
The pudendal nerve innervates the pelvic floor/diaphragm and originates from S2-S4 vertebrae. This then bifurcates into 3 other nerves after passing through pudendal canal (alcocks canal). Using the labels below label the 3 other nerves involved:
perineal nerve
inferior rectal nerve
pudendal nerve
1 = inferior rectal nerve 2 = pudendal nerve 3 = perineal nerve
During pregnancy or surgery on the perineum, the pudendal nerve will need to be anaesthetised. What anatomical landmark on the hip bones is used to identify the location of the pudendal nerve?
1 - greater sciatic foreman
2 - ischial spine
3 - ischial tuberosity
4 - pubis symphysis
2 - ischial spine
Where does the majority of lymph from the pelvic cavity drain into?
1 - inguinal lymph nodes
2 - internal lymph nodes
3 - common iliac lymph nodes
3 - common iliac lymph nodes
The majority of lymph from the pelvic cavity drains into the common iliac lymph nodes. However, some genital structures also drain into deep lymph nodes. Which lymph nodes are these?
- deep inguinal lymph nodes
What is the perineum?
- anatomical region in the pelvis between the thighs
- most inferior part of the pelvic outlet
What separates the perineum from the pelvic cavity superiorly?
- pelvic floor/diaphragm
The perineum is divided into the anterior and posterior triangle. What other names do we use for the anterior and posterior triangles?
- anterior = urogenital triangle
- posterior = anal triangle
What forms the inferior and superior borders of the perineum?
- superior = urogenital and anal triangles
- inferior = skin
The inferior and superior borders of the perineum are formed by skin and urogenital and anal triangles, respectively. What is the name given to the 2 spaces between the inferior and superior borders?
1 - superior and superficial perineal space
2 - deep and superficial perineal space
3 - greater and less perineal space
4 - inferior and and deep perineal space
2 - deep and superficial perineal space
The superficial perineal space is what lies inferior to the deep perineal space. What part of the male and female reproductive organs is contained within the superficial perineal space?
- external genitalia
The superficial perineal space is what lies inferior to the deep perineal space. The male and female external genitalia are located in this space. What 3 main things are located in this space in females?
- clitoris
- vestibule bulbs (erectile tissue close to the inferior side of the clitoris)
- ischocavernosus (inserts on ischium)
The superficial perineal space is what lies inferior to the deep perineal space. The male and female external genitalia are located in this space. What 3 main things are located in this space in males?
1 = bulb and cura of penis 2 = ischocavernosus muscle 3 = bulbospongiosus muscle
What muscle is located in both males and females in the urogenital space that crosses the majority of the perineal space?
1 - obturator muscle
2 - piriformis muscle
3 - iliopsoas muscle
4 - transverse perineal muscles
4 - transverse perineal muscles
The deep perineal space, also referred to as the perineal membrane is a layer of dense connective tissue. Which parts of the hip bones medially does this membrane attach to?
1 - ischiopubic rami
2 - ischial spine
3 - pubic symphysis
4 - ischial tuberosity
1 - ischiopubic rami
There is a small opening in the perineal membrane directly posterior to the pubic symphysis. What is the purpose of this opening?
- allows transit for veins from penis and clitoris to pass through
Label the 4 muscles that contribute to the make up of the superficial perineal space using the labels below:
transverse perineal
ischiocavernosus
bulbocavernosus
perineal body
1 = perineal body 2 = ischiocavernosus 3 = bulbocavernosus 4 = transverse perineal
What is the perineal body, also referred to as the central tendon of the perineum?
1 - bony landmark
2 - cartilagenous structure
3 - fibro-muscular structure
4 - ligament
3 - a fibro-muscular structure
- located in the midline of the perineum between anus and urogenital triangle
The perineal body, also referred to as the central tendon of the perineum is a tough fibro-muscular structure. What is the clinical importance of the perineal body?
1 - maintain pelvic floor integrity
2 - stops incontinence
3 - supports penis erections
1 - maintain pelvic floor integrity
- especially important in females
The perineal body is critical for maintaining the integrity of the pelvic floor, especially in females. During pregnancy what can happen to the perineal body?
- can rupture during vaginal birth
- widens the gap between the anterior free borders of levator ani muscle of both sides
- increases risk of prolapse of the uterus, rectum, or even the urinary bladder
What is an episiotomy?
- epi = greek for pubic region
- otomoy = greek for operation
- perineal body between anus and vagina is cut to increase opening size
In female and males what important pelvic organs are covered by the peritoneum?
- females = bladder, uterus and rectum
- males = bladder and rectum
The peritoneum comes down and covers the bladder, uterus and rectus forming 1 pouch in males and 2 pouches in females. What are these pouches called?
- females = rectouterine/douglas pouch (between rectum and uterus)
= vesicouterine pouch (between bladder and uterus) - males = retrovesicle pouch (between rectum and bladder
The peritoneum comes down and covers the bladder, uterus and rectus forming 1 pouch in males and 2 pouches in females.
- females = rectouterine/douglas pouch (between rectum and uterus)
= vesicouterine pouch (between bladder and uterus) - males = retrovesicle pouch (between rectum and bladder
In males there is only one, so this is the lowest pouch, but which pouch is lower in females?
- rectouterine/douglas pouch (between rectum and uterus)
- the lowest pouch in male and females is where fluid can collect from abdomen
The folds of the peritoneum encapsulate the majority of the uterus, ovaries and fallopian tubes. What is the name of the ligament that covers the majority of the uterus?
1 - broad ligament
2 - suspensory ligament
3 - round ligament
4 - ovarian ligament
1 - broad ligament
The folds of the peritoneum encapsulate the majority of the uterus, ovaries and fallopian tubes providing support and holding the female reproductive organ in place. What are the 2 ligaments that helps maintain the ovaries position?
1 - ovarian and broad ligament
2 - suspensory and broad ligament
3 - suspensory and ovarian ligament
4 - round and broad ligament
3 - suspensory and ovarian ligament
The folds of the peritoneum encapsulate the majority of the uterus, ovaries and fallopian tubes providing support and holding the female reproductive organ in place. The ovarian and suspensory ligaments helps maintain the ovaries position. Which of these ligaments also has another crucial role?
- suspensory ligament
- contains the ovarian artery, vein and nerve plexus
The folds of the peritoneum encapsulate the majority of the uterus, ovaries and fallopian tubes providing support and holding the female reproductive organ in place. What ligament contributes to maintaining the anteverted position (pointing towards the vagina) of the uterus and where does it insert?
1 - broad ligament attaches to the uterus, through inguinal canal and to the labium majora
2 - round ligament attaches to the uterus, through inguinal canal and to the labium majora
3 - suspensory ligament attaches to the uterus, through inguinal canal and to the labium majora
4 - ovarian ligament attaches to the uterus, through inguinal canal and to the labium majora
2 - round ligament attaches to the uterus, through inguinal canal and to the labium majora
The cervical ligaments of the pelvis are important ligaments located on the inferior border of the broad ligament. Why are these ligaments important in addition to structure?
1 - house lymphatics
2 - house nerves
3 - house uterine artery and veins
4 - house uterine veins only
3 - house uterine artery and veins
The cervical ligaments of the pelvis are important ligaments that are located on the inferior border of the broad ligament and house the uterine artery and uterine veins. Where do these ligaments originate from?
- cervix and lateral fornix of the vagina
The cervical ligaments of the pelvis are important ligaments that are located on the inferior border of the broad ligament and house the uterine artery and uterine veins that arise from the cervix and lateral fornix of the vagina and are important for maintaining the uterus position. Label the 3 key ligaments using the labels below:
Pubocervical
Transverse cervical/cardinal
Uterosacral
1 = Pubocervical 2 = Transverse cervical/cardinal 3 = Uterosacral
The cervical ligaments of the pelvis are important ligaments that are located on the inferior border of the broad ligament and house the uterine artery and uterine veins that arise from the cervix and lateral fornix of the vagina and are important for maintaining the uterus position. What can happen if these ligaments are weak or damaged?
- prolapse of pelvic organs
