Endo-Repro Anatomy 1 Flashcards
Inferior hypogastric
provides autonomic nerves to pelvic viscera, and contains sympathetic fibres, and parasympathetic fibres from pelvic splanchnic nerves (S2, 3, 4).
Internal Iliac artery: (ADD DIAGRAM)
Branches:
- Obturator artery
- Superior vesical and obliterated umbilical artery
- Uterine artery in female (lying under ureter, close to cervix) – replaced by middle rectal artery in male
- Vaginal artery (female) or inferior vesical artery (male)
- Superior and inferior gluteal arteries (pass ino the buttock)
- Internal pudendal artery (winding around the ischial spine)
Muscles of Pelvic sidewall and the pelvic floor
Obturator internus
Piriformis
Levator ani
Coccygeus
Obturator internus
Action
Innervation
Abducts & externally rotates thigh, and stabilizer of the hip during walking
Nerve to obturator internus (L5, S1, S2)
Piriformis
Action
Innervation
External rotator of the thigh L5, S1 and S2
Levator ani
Action
Innervation
Supports contents of pelvic cavity Levator ani nerve (S4)
Inferior rectal nerve from pudendal (S3,4)
Coccygeus
Action
Innervation
pulls coccyx forward after defecation, closing in the back part of the outlet of the pelvis
S4, S5`
Perineum:
Boundaries of the perineum and its divisions:
- Urogenital triangle
- Anal triangle
- Ischioanal/ischiorectal fossa
Urogenital triangle Boundaries
Pubic symphisis
Tip fc coccyx
Ischeal tuberoscity
Urogenital triangle Contents
• Posterior scrotal nerves / Posterior labial nerves • Urethra • Vagina • Bulbourethral gland / Bartholin's gland • Muscles o Transversus perinei superficialis muscle o Ischiocavernosus muscle o Bulbospongiosus muscle • Crus penis / Clitoral crura • Bulb of penis / vestibular bulb • Urogenital diaphragm • Muscular perineal body • Superficial and Deep perineal pouch • Blood vessels and lymphatic
Urogenital triangle What is the perineal membrane
It is the superior border of the superficial perineal pouch, and the inferior border of the deep perineal pouch.
Its lateral margins are attached on either side to the inferior rami of the pubis and ischium, above the crus penis.
Its base is directed toward the rectum, and connected to the central tendinous point of the perineum.The base is fused with both the pelvic fascia and Colle’s fascia
What is the perineal body
is a pyramidal fibromuscular mass in the middle line of the perineum at the junction between the urogenital triangle and the anal triangle. It is found in both males and females. In males, it is found between the bulb of penis and the anus; in females, is found between the vagina and anus, and about 1.25 cm in front of the latter
Anal triangle: Boundaries
Obturator internus laterally
Tip of coccyx, ischeal tuberoscity and levator ani medially
Anal triangle:
Contents
Anus External anal sphincter muscle Ischeo-anal fossa (fat filled) Levator ani Obturator
Anal triangle: Which nerve controls the external anal sphincter
Pudendal nerve
Ischioanal/Ischiorectal fossa:
Which two muscles does this space lie between?
Obturator internus
Levator ani
Ischioanal/Ischiorectal fossa:
Which blood vessels and nerves run through this space
Internal pudendal artery/vein
Pudendal nerve
Deep and superficial perineal pouches: Which glands are located in these pouches in the male and female?
Deep Bulbourethral gland (males).
Superficial Bartholin gland (female)
Deep and superficial perineal pouches: Transverse perineal muscles
Superficial and deep perineal muscle
Pudendal Nerve: What are its root values
Sacral nerves S2, S3, S4
Pudendal Nerve: What does it supply
It carries sensation from the external genitalia of both sexes and the skin around the anus and perineum.
Motor supply to various pelvic muscles, including the external urethral sphincter and the external anal sphincter.
Pudendal Nerve: How does it exit the pelvis/enter the perineum
The pudendal nerve passes between the piriformis muscle and ischiococcygeus muscles and leaves the pelvis through the lower part of the greater sciatic foramen.[2] It crosses over the lateral part of the sacrospinous ligament and reenters the pelvis through the lesser sciatic foramen
Pudendal Nerve: Function
It carries sensation from the external genitalia of both sexes and the skin around the anus and perineum, as well the motor supply to various pelvic muscles, including the external urethral sphincter and the external anal sphincter.
- Parietal pelvic fascia
over obturator internus and piriformis
- Endo-pelvic fascia (between levator ani and peritoneum)
a. Condenses to form ligaments which provide support for pelvic viscera
Peritoneal membrane attachment for
roots of genitalia
Clitoris: Blood supply
- The deep artery of clitoris and dorsal artery of clitoris is a branch of the internal pudendal artery.
Clitoris: Venous drainage
The superficial dorsal veins of clitoris is a tributary of the external pudendal vein.
The deep dorsal vein of clitoris is a vein which drains to the vesical plexus.
Clitoris:Innervation
The dorsal nerve of the clitoris is a nerve in females that branches off the pudendal nerve to innervate the clitoris.
Penis root
Fixed, attached to the perineal membrane
Glans penis covered by
Prepuce
Crura attachment
begins at the inferior ramus of the pubic bone
Blood supply
all of the penile arteries arise from the internal pudendal artery from the internal iliac artery
Penis: Venous drainage
the veins of the penis break through the tunica albuginea and open via the circumflex veins in the unpaired deep dorsal vein, which empties into the venous plexus of Santorini. The superficial dorsal vein lies external to Buck’s fascia.
Penis:Lymph drainage
superficial inguinal and subinguinal lymph nodes. The proximal urethra drains into the pelvic lymph nodes (internal iliac and common iliac lymph nodes).
Skin of scrotum
Skin of the scrotum is pigmented and rugose and has a median raphe
Subcutaneous tissues of scrotum
Continuous with Camper’s fascia of abdominal wall
Dartos muscle function
Smooth muscle fibers interspersed within the dartos fascia (superficial fascia of scrotum), causing contraction of the scrotum, as when experiencing a cool environmental temperature.
Lymph drainage of scrotum
Lumbar Lymph nodes
