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Anatomy > Extra Pelvis/perineum cards > Flashcards

Extra Pelvis/perineum cards Flashcards

1
Q

Levator ani complex- O, I, In

A

O- (laterally/peripherally) attaches to pubic bone body, tendinous arch of obturator internus + ischial spine
I- (centrally) vag wall/prostate, perineal body, rectum/anus junction + anococcygeal ligament
In- levator ani (S4) + inferior anal nerve

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2
Q

obturator internus- O, I, Axn, In

A 
O- pubis/ischium + obturator membrane
(exits LSF) 
I-greater trochanter
Axn- lateral rotator of thigh
In- nerve to obturator internus (L5-S2)
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3
Q

Coccygeus- O, I, Axn, In

A

O- anterior sacrum + coccyx
I-ischial spine
Axn-supports pelvic viscera, flexes coccyx
In-ventral rami S4 + S5

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4
Q

piriformis- O, I, Axn, In

A 
O- anterior sacrum 
(exits GSF) 
I-greater trochanter 
Axn- lateral rotator of thigh 
In- ventral rami S1 +S2
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5
Q

which muscles attach to the anterior sacrum?

A

coccygeus and piriformis

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6
Q

which two muscles are lateral rotators of the thigh?

A

piriformis and obterator internus

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7
Q

what is the narrowest FIXED diameter of the pelvis?

A

AP diameter, obstetric/true conujate

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8
Q

what is the narrowest non-fixed diameter of the pelvis

A

interspinous distance (between ischial spines)

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9
Q

how is the obstetric/true diameter estimated?

A

take the diagonal conjugate (BOTTOM of pubic symphysis to the sacral promontory) and subtract 1cm

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10
Q

where is the endopelvic fascia?

A

fills potential spaces - prevesical + retrorectal, paravesicular and retrouterine.
Denser condensations of it form ligaments

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11
Q

where is the hypogastric sheath? what does it allow passage of?

A

separates pre/para vesical spaces and retrorectal spaces

-passage of structures (neurovasc, ureters, vas defrens) from lateral pelvic wall to viscera?

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12
Q

what makes up the pelvic floor/diaphragm? (medial to lateral)

A

levator ani- puborectalis, pubococcygeus, ileococcygeus

extends to membrane obterator internus laterally) coccygeus (most posterior

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13
Q

borders of the pelvic wall: anterior

what does it support?

A

pubic symphysis, bodies and rami.

-supports weight of bladder

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14
Q

borders of pelvic wall: lateral

A 
body of ilium + ischium
obterator foramen (covered by membrane of Ob internus)
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15
Q

borders of pelvic wall: posterior

A

sacrum and coccyx, sacrospinous + sacrotuberous ligaments, piriformis

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16
Q

what are the only truly intraperitoneal elements of the pelvis?

A

uterine tubes (with ovary)

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17
Q

what does the pelvic inlet (superior pelvic aperature) divide?

A

greater and lesser pelvis

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18
Q

landmarks of pelvic inlet (superior pelvic aperature)

A

all defined by pelvic brim: sacral promontory

linea terminalis: arcuate line, pectin pubis, pubic crest

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19
Q

what is the other name for the superior pelvic aperature? where are the anterior and posterior landmarks?

A

pelvic inlet: diagonal line..
anterior- upper pubi symphysis
posterior: sacral promontory

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20
Q

what is the other name for the inferior pelvic aperature? what are the anterior and posterior landmarks?

A

pelvic outlet: horizontal line
anterior- pubic arch (under pubic symphysis)
posterior- coccyx

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21
Q

what does the pelvic outlet/inferior pelvic aperature divide?

A

lesser pelvis and perineum

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22
Q

landmarks of the borders of the pelvic outlet/inferior pelvic aperature?

A

pubic arch of ischiopubic rami
ischial tuberosities
sacrotuberous ligaments
tip of coccyx

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23
Q

where are the pubic tubercles?

A

anterior surface on either side of pubic symphysis

-bumps pushing out from just along/under pubic crest

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24
Q

where does the common iliac “bifurcate”?
what does the internal iliac descend toward?
where is the ureter in relation to this?

A

L5-S1

  • internal iliac descends toward GSF
  • ureter crosses anterior to bifurcation
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25
Q

what vertebral level is the rectosigmoid jxn?

what is the anatomical change here that shows this change?

A

S3

  • convergence of tenia coli (to form continuous longitudinal muscle)
  • absence of epilpoic appendages
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26
Q

what is the rectum supported by in the lesser pelvis?

A

laterally- lateral rectal ligament

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27
Q

what are the two main groups of the 5 flexures of the rectum?

A

2 anteroposterior

3 lateral

28
Q

what are the 2 anteroposterior flexures of the rectum?

A

sacral (sacrum/coccyx contour)

anorectal (@ pelvic diaphragm) - 80 degrees formed by puborectalis muscle

29
Q

what are the 3 lateral flexures of the rectum?

A

“transverse folds/ valves of houston”
superior (left)
intermediate (right)
inferior (left)

30
Q

where is the rectal ampulla located between?

A

inferior flexure/ valve of houston and pelvic diaphragm

31
Q

what kind of tissue is the labia majora composed of?

A

subQ fat and smooth muscle

32
Q

where are the bulbs of the vestibule located?

A

deep to labia minora

33
Q

what enters alcock’s canal and where is this located?

A

aka pudendal canal

  • pudendal nerve
  • internal pudendal artery + vein
  • descend behind sacrospinous ligament and enter canal just inferior to it
  • nerve to obt. internus (L4-S1) is somewhat included in this
34
Q

what neurovasculature leaves alcock’s canal first (most posterior end) and what does it go on to supply?

A 
most posterior (first to leave) 
- inferior rectal artery and nerve --> go to supply anal canal and perianal skin
35
Q

what leaves alcock’s canal at the bottom (anterior) end? what does it go on to supply

A

first:
perineal artery–> posterior scrotal/labial
perineal nerve
–> deep branches- motor to perineal muscle (ischiocavernosus + bulbospongiosus)
–>superficial- sensory to posterior scrotal/labial skin
second:
dorsal penis/clit arteries –> superficial tissues, C. spongiosum
deep arteries –>erectile tissues -C. cavernosum
Dorsal nerve –> sensory to glans

36
Q

what does the post-anal space function? what does it contain?

A

-allows communication between ischioana fossae
-Supports anal canal, allows expansion
filled with ischioanal fat
contains inferior rectal vessels & nerve

37
Q

where is the anus located? where does it start and end? anterior/posterior boundaries?

A

Extends from pelvic diaphragm to anus

Between perineal body-anterior & anococcygeal ligament-posterior

38
Q

what is the difference in muscle type of the internal vs external anal sphincters?

A

internal- circular smooth muscle

external- skeletal

39
Q

venous drainage above and below pectinate line?

A

above- portal venous system

below- IVC

40
Q

what muscle helps empty residual semen/urine?

A

bulbospongiosus

41
Q

what forms the external raphe (and two compartments) ?

A

dartos muscle

42
Q

what is the clitoris composed of?

A

two crura- corpus cavernosum - glans has spongiusum (arguable?…)

43
Q

where is the corpus spongiosum of the female?

A

two bulbs of vestibule (none in clitoris)

44
Q

what is the “sphincter” muscle of the vagina? what is its other function?

A

bulbospongiosus muscle, compresses greater vestibular glands to secrete mucus into vagina

45
Q

external anal sphincter, what does the deep portion blend with? what is the innervation of the external anal sphincter?

A

Deep portion blends with puborectalis

Innervated by inferior rectal nerve

46
Q

where on the sacrum to sacrospinous and sacrotuberous ligaments attatch

A

both: lateral sacrum

47
Q

limits of the pelvic cavity: inferior? deepest ?

A

Inferior limit is pelvic diaphragm, deepest centrally at pelvic outlet

48
Q

which parts of the levator ani complex merge at the acoccocygeal ligament?

A

only pubococcygeus and iliococcygeus (not puborectalis)

49
Q

what vessels does the lateral ligament of the bladder contain?

A

Conveys superior vesical vessels

50
Q

what vessels does the lateral ligament of the rectum contain?

A

Conveys middle rectal vessels

51
Q

what vessels does the cardinal ligament (rectovesical septum-males) contain?

A

Conveys uterine vessels & ureters (male & female)

52
Q

what is the path of the ovarian artery? what does it supply ?

A

Originates from abdominal aorta
Descends to lateral pelvis, crosses ureter anteriorly
Enters lesser pelvis anterior to external iliac
Enters ovary on lateral aspect

Supplies lateral ovary & tube

53
Q

superior rectal artery- what does it cross?

A

Crosses left common iliacs

54
Q

where do iliolumbar veins drain to? but most pelvic veins drain where? which drain to portal venous system?

A

Iliolumbar veins drain to common iliac veins

  • Most pelvic veins follow arteries and drain to internal iliac veins–> IVC
  • superior rectal: portal venous system
55
Q

what does the obturator nerve supply?

A

Anterior/posterior divisions supply medial thigh

No pelvic distribution

56
Q

SNS or PSNS contract internal genitalia?

A

SNS

57
Q

SNS or PSNS stimulate erectile bodies?

A

PSNS

58
Q

what are the 4 branches (although supply is variable) that can supply blood to ureter in pelvis?

A

Internal iliac
Superior vesical
Uterine (female)
Inferior vesical (male)

59
Q

where do visceral afferents from ureters enter the CNS?

A

Visceral afferents enter CNS at T10-L3

60
Q

where is the intermediate urethra located? (pelvis or perineum?)

A

perineum- deep pouch

61
Q

what is another name for female paraurethral glands? where are they located?

A

skene’s: anterior wall of vagina, either side of lower urethral opening
(secretions related to pleasure)

62
Q

internal pudendal crosses exits GSF superior or inferior to piriformis?

A

inferior

63
Q

what arteries anastomose for rectal supply?

A

superior rectal (From IMA) Anastomoses with middle/inferior rectals

64
Q

what is included in sacral plexus? where do most exit?

A

L4-S4 ventral rami

most exit GSF

65
Q

what kind of fibers form the internal urethral orifice? what about internal urethral sphincter in males?

A

Radial fibers in neck form internal urethral orifice

Circular fibers form internal urethral sphincter in males

66
Q

what is the inferior rectal nerve also known as ?

A

inferior ANAL nerve

Anatomy (13 decks)

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