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RE > Anatomy of the Pelvic Floor and Perinea > Flashcards

Anatomy of the Pelvic Floor and Perinea Flashcards

1
Q

Pelvic Musculature and Connective Tissue:

A

insert diagram

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2
Q

Pelvic Diaphragm:
- forms
- is
- shape

A
  • boundary between true pelvis and
    perineum
  • musculature of floor of pelvis
  • bowl-shaped
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3
Q

Pelvic Diaphragm:
- muscles

A
  • coccygeus
  • levator ani: puborectalis,
    pubococcygeus, iliococcygeus
  • obturator internis (lateral wall)
  • piriformis (posterolateral wall)
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4
Q

Pelvic Diaphragm:
- levator ani function

A
  • dynamic support of
    abdominopelvic viscera
  • urinary and faecal continence
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5
Q

Pelvic Diaphragm: Puborectalis Attachments and Function:

A
  • unilateral
  • arises from the internal aspect of
    the pubic bone of innominate
  • slings around the back of rectum

maintains faecal continence, when relaxed straightens anal canal to allow defecation

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6
Q

Pelvic Diaphragm: Pubococcygeus:

A
  • arises from the pubic bone of
    innominate
  • attaches to the coccyx
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7
Q

Pelvic Diaphragm: Iliococcygeus:

A
  • arises from the tendonous arch of
    obturator internis muscle
  • fascia thickens inferiorly which
    iliococcygeus attaches to
  • passes inferiorly to attach to the
    coccyx
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8
Q

Obturator foramen filled by

A

obturator membrane

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9
Q

Obturator internis attaches to

A

the pelvic aspect of the obturator membrane

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10
Q

Pelvic Diaphragm:

A

insert diagram

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11
Q

Pelvic Diaphragm:

A

insert diagram

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12
Q

Pelvic Dipahragm:

A

insert table

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13
Q

Pelvic Diaphragm:

A

insert table

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14
Q

Pelvic Floor:

A

The pelvic floor consists of the pelvic diaphragm, associated fascia, deep perineal pouch and the perineal membrane

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15
Q

What sits on the internal aspect of the piriformis muscle?

A

Nerves arising from the sacral plexus

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16
Q

Pelvic Floor:

A

insert diagram

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17
Q

Pelvic Fascia: Components:

A
  • Deep pelvic fascia: parietal and
    visceral
  • Endopelvic fascia:
  • Superficial perineal fascia
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18
Q

Pelvic Fascia:

A

insert slide

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19
Q

Deep Pelvic Fascia:

A
  • surrounds muscles and pelvic
    viscera deep to the superficial
    fascia
  • include deep and superficial
    perineal pouches
  • parietal layer: covers muscles,
    continuous with transversalis fascia
    and iliopsoas fascia
  • visceral: forms adventitia of each
    visceral structure in the pelvis

insert diagram

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20
Q

Endopelvic Fascia:

A
  • between layers of deep fascia
  • not true ligaments because not
    attaching bone to bone
  • fixing visceral structures to
    bone/soft tissue structures

Female:
- uterosacral: uterus to sacrum
(posterior aspect of
endopelvic fascia)
- cardinal/transverse cervical: largest
- pubocervical

Male:
- rectovesical septum:

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21
Q

The perineum includes all structures inferior to the

A

pelvic diaphragm

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22
Q

Endopelvic Fascia:

A

insert diagram

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23
Q

Superficial Perineal Fascia:

A
  • Camper’s and Scarpa’s Fascia

insert diagram

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24
Q

Endopelvic Fascia:

A

insert diagram

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25
Q
A

insert diagram

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26
Q

Perinea:

A

insert diagram

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27
Q

Perinea:
- Region
- surface anatomy boundaries

A
  • superficial to inferior fascia of
    pelvic diaphragm (deep pelvic
    fascia)
  • anterior: mons pubis/root of penis
  • lateral: medial surface of thigh
  • posterior: gluteal fold + inter-
    gluteal cleft
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28
Q

Perinea:

A

insert diagram

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29
Q

Perinea: Osteological Boundaries:

A
  • Anterior: pubic symphysis
  • Anterolateral: ischiopubic rami
  • Posterolateral: ischial tuberosities
    and sacrotuberous ligament
  • Posterior: coccyx
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30
Q

Osteological Boundaries of the Perinea:

A

insert diagrams

31
Q

Perinea: Triangles:

A
  • divided into 2 triangles by perineal
    body transverse line
  • Urogenital Triangle:
    • anterior to transverse line
    • subdivided by perineal
      membrane (attachment of
      erectile tissue) into pouches

Anal Triangle:
- posterior to transverse line

32
Q

Perinea: Identify traingles:

A

insert diagram

33
Q

Perinea: Urogenital Triangle: Contents:

A
  • deep perineal pouch
  • perineal membrane
  • superficial perineal pouch
  • external genitalia

deep -> superficial

insert diagram

34
Q

Deep Perineal Pouch:
- location
- contents

A
  • deep to perineal membrane
  • urethra
  • external urethral sphincter
  • neurovasculature to penis/clitoris

Male:
- DTP: deep transverse perineal
muscle = skeletal
- bulbo-urethral glands

Female:
- DTP: deep transverse perineal
muscle = smooth muscle

35
Q

Perinea: Deep Perineal Pouch: Bulbo-urethral Glands: Function:

A
  • in males
  • secretions to lubricate spongy
    urethra
  • ease passage of seminal fluid
36
Q

Perinea: Deep Perineal Pouch:

A

insert diagrams

37
Q

Perinea: Superficial Perineal Pouch:
- location
- contents

A
  • superficial to perineal membrane,
    deep to superficial perineal fascia

Contents:

  • STP: superficial transverse perineal
    muscle
  • neurovasculature: deep perineal
    branches

Male:
- root of penis (bulb and crura)
- penile musculature
- spongy urethra

crura = where two ischiocavernous muscles meet
bulb= bulbospongiosus muscle

Female:
- clitoris and musculature
- greater vestibular gland
- bulbs of vestibule and musculature

38
Q

Superficial Perineal Pouch: Females:

A

insert diagram

39
Q

Superficial Perineal Pouch: Males:

A

insert diagram

40
Q

Tables:

A

insert muscles and locations

41
Q

Perinea: External Female Genitalia:

A
  • mons pubis: cushioning
  • clitoris
  • labia majora: fatty, head covered
  • labia minora
  • bulbs of vestibule: lie beneth
    bulbospongiosus
  • greater vestibular glands
  • lesser vestibular glands
42
Q

Perinea: External Female Genitalia:

A

insert diagrams

43
Q

Table:

A

insert table

44
Q

Perinea: External Male Genitalia:

A
  • scrotum: cutaneous
    fibromuscular structure that
    contains the testis, associated
    ducts and neurovasculature
  • penis
45
Q

Perinea: Male External Genitalia:

A

insert diagrams

46
Q

Anal Triangle: Features:

A
  • anus
  • ischio-anal fossae:

*projects anteriorly
*communicating with deep perineal
pouch
*forms abscesses
*filled with superficial perineal
fascia

  • posteriorly: skin and superficial
    tissue
  • superior: deep pelvic fascia
  • anterior: deep perineal pouch and
    perineal membrane
47
Q

Anal Triangle:

A

insert diagram

48
Q

What is the perineal body?

A
  • central tendon of the perineum
  • collagen and elastic fibers, with
    smooth and skeletal muscle fibers

Site of convergence of muscles:
- bulbospongiosus
- deep and superficial transverse
perineal muscle
- external anal sphincter
- levator ani

49
Q

What is shown below?

A

perineal body

insert image

50
Q

Consequences of tearing through the perineal body:

A
  • incontinence
  • decreased sexual performance
51
Q

If a patient presents with anal incontinence and erectile dysfunction consider damage to which anatomical body?

A

Perineal body

52
Q

Perineal body:

A

insert diagram

53
Q
A
  • Gonadal arteries arise from the
    anterior aspect of the abdominal
    aorta at L2
  • Abdominal aorta bifurcates into
    left and right common iliac arteries
    at L4
  • Common Iliac Arteries bifurcate
    into internal and external at L5
  • External Iliac artery passes under
    the inguinal ligament to form the
    femoral artery
  • Internal Iliac Artery bifurcates into
    anterior and posterior divisions at
  • Anterior division:
    • obturator artery
    • umbilical artery -> superior
      vesicular
    • uterine artery -> vaginal artery
    • inferior vesicular -> ductus
      deferens
    • internal pudendal
    • middle rectal
    • inferior rectal
    • dorsal artery to penis/clitoris
    • perineal artery
    • transverse perineal artery
    • posterior scrotal/labial artery

the umbilical artery is a medial umbilical remnant

inferior vesicular artery only present in males

internal pudendal is terminal artery of the internal iliac artery

54
Q

Divisions of the Anterior Iliac Artery:

A

insert diagram

55
Q

What is the terminal branch of the anterior division of the internal iliac artery and what does it supply?

A
  • internal pudendal artery
  • perineum
56
Q

Anterior Division of Internal Iliac Artery

A

insert diagram

57
Q

Anterior division of the internal iliac artery

A

insert diagram

58
Q

What are the branches of the internal pudendal artery?

A
  • inferior rectal artery
  • dorsal artery of clitoris/penis
  • perineal artery which gives off
    transverse perineal and posterior
    labial/scrotal artery
59
Q

Inferior Pudendal Artery Branches

A

insert diagram

60
Q

Venous Drainage of the Perinea:

A
  • drain into plexus and named veins
  • vesical venous plexus
  • vaginal venous plexus
  • uterine venous plexus
  • prostatic venous plexus
  • rectal venous plexus
  • all drain into the internal iliac vein
  • which drains into the inferior vena
    cava at L5
61
Q

Venous Drainage of the Perineum:

A

insert diagram

62
Q

Drainage of the Gonads:

A
  • right testis drains into the IVC
  • left testis drains into the left renal
    vein
63
Q

Somatic Nerves of the Pelvis:

A
  • obturator nerve L2-4
  • does not supply anything in
    perineum
  • travels down lateral wall of the
    pelvis
  • lumbrosacral trunk L4-5
  • sacral plexus: arises on the
    internal/anterior surface of the
    piriformis muscle
  • contributions from L4
64
Q

Somatic Nerves of the Pelvis:

A

insert diagram

65
Q

Sacral Plexus:

A

insert slide

66
Q

Sacral Plexus:

A

insert diagram

67
Q

Autonomic Nerves of the Pelvis:

A
  • hypogastric (SNS and visceral
    afferents) T11/12-L2

arises from the superior hypogastric plexus -> most inferior plexus in abdo cavity

  • pelvis splanchnic (PNS) S2-4
  • inferior hypogastric plexus (ANS
    and visceral afferents)
68
Q

Autonomic Nerves of the Pelvis:

A

insert diagram

69
Q

Perineal Innervation:

A
  • genital branch of genitofemoral
    (somatic) L1-2 -> cremaster muscle
  • ilio-inguinal nerve (somatic) L1
  • Pudendal Nerve (somatic): S2-4:
    • inferior rectal
    • dorsal nerve of clitoris/penis
    • perineal nerve

Main motor and sensory supply = pudendal nerve

70
Q

Perineal Innervetion:

A

insert diagram

71
Q

What is the main motor and sensory supply to the perineum?

A

pudendal nerve

72
Q

Pudendal Nerve Pathway:

A

insert diagram

  • exit pelvis through greater sciatic
    foramen
  • loop around to ischial spine to re-
    enter into the perineum
  • through lesser sciatic foramen
  • passes through pudendal canal to
    give inferior rectal nerve
  • branches into the dorsal nerve of
    penis or clitoris when emerging
  • and perineal nerve which branches
    into posterior scrotal/labial and
    transverse muscular branches
  • surgery: anesthise pudendal nerve
73
Q

Perineal innervation:

A

insert slide

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