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Anatomy Exam 4 > L41-42: Perineum I-II > Flashcards

L41-42: Perineum I-II Flashcards

1
Q

Boundaries of the perineum

A
  • Inferior to the pelvic diaphragm, bounded by the ischial tuberosities, coccyx and pubic symphysis
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2
Q

Two triangles of the perineum, contents

A
  • Anal triangle: IT to IT to coccyx, contains anal canal and ischioanal fossae
  • Urogenital triangle: IT to IT to pubic symphysis, contains in….
    a. ) Males: penis, scrotum, testis and epididymis
    b. ) Females: vulva (external genitalia), which are mons pubis, labia majora and minora, vestibule, vaginal orifice, clitoris
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3
Q

Two halves of the anal canal. Describe in terms of embryologic origin, epithelial lining, innervation, blood supply, lymphatics

A
  1. ) Upper
    - from hindgut endoderm, simple columnar epithelium, autonomic nerves, superior rectal (from IMA) and middle rectal (off internal iliac), superior rectal vein (to IMV to portal system), lymphatics travel superior to IM nodes
  2. ) Lower
    - from proctodeum ectoderm, stratified squamous epithelium, somatic (inf rectal branch off pudendal nerve) innervation, inferior rectal (off internal pudendal), inferior rectal vein to internal pudendal to iliac to IVC, lymphatics travel inferiorly eventually to superficial inguinal nodes
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4
Q

Two sphincters of anal canal. Which is voluntary? Involuntary?

A
  1. ) Internal = smooth muscle continuation and thickening of inner circular muscle, involuntary
  2. ) External = skeletal muscle, voluntary
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5
Q

Innervation of external anal sphincter

A
  • Inferior rectal nerve (branch of pudendal nerve)
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6
Q

Boundaries of the ischiorectal(anal) fossa

A
  • skin, levator ani, obturator internus, sacrotuberous/spinous ligaments, deep transverse perineal muscle
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7
Q

Function of ischiorectal fossa

A
  • Fat-filled spaces to allow for expansion of rectum
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8
Q

Contents of ischiorectal fossa

A
  • Fat and CT
  • Pudendal canal with: pudendal nerve, internal pudendal artery, internal pudendal vein, obturator internus n enters and exits early
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9
Q

What travels through the lesser sciatic foramen?

A
  • Pudendal nerve (S2-4)
  • Internal pudendal artery
  • Internal pudendal vein
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10
Q

Branches of pudendal nerve

A
  • Inferior rectal, dorsal nerve of penis/clitoris, perineal nerves
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11
Q

Branches of internal pudendal artery

A
  • Inferior rectal, branches to penis/clitoris
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12
Q

Describe clinical facts (vascular, innervation) of internal/external hemorrhoids

A
  1. ) internal hemorrhoids: involves superior rectal vein, results from backup in the portal system, non-painful as autonomic innervation
  2. ) external hemorrhoids: involves inferior rectal vein, results from forceful straining, heavy lifting, coughing, painful as somatic innervation (inferior rectal nerve, branch off pudendal)
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13
Q

What forms the pudendal canal?

A
  • Fascia of obturator internus as it splits inferiorly
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14
Q

What are the superficial fascial layers of the perineum and from what do they form?

A

a. ) Fatty superficial layer is continuation of Camper’s fascia (in abdomen) into the ischiorectal fat
- In males: disappears in scrotum, replaced by Dartos muscle
- In females: seen in labia major and mons pubis

b. ) Fatty membranous layer is continuation of Scarpa’s fascia (in abdomen) and forms Colle’s fascia in perineum. Forms tubuluar sheath around penis and clitoris. Attaches to Dartos muscle in males
c. ) Deep fascia (investing): surrounds external abdominal oblique and rectus sheath in abdomen. In perineum, surrounds perineal muscles (ischiocavernosus, bulbospongiosus and superficial transverse perineal muscle). Fuses to suspensory ligament of penis/clitoris. In males, continues as deep penile fascia (Buck’s fascia), which keeps corpora together

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15
Q

Potential space between Colle’s fascia and perineal membrane?

A
  • superficial perineal pouch
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16
Q

Space between superior fascia of UG diaphragm and perineal (aka inferior fascia of UG diaphragm) membrane

A
  • deep perineal pouch
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17
Q

Contents of male superficial perineal pouch

A
  • Root of penis
  • Ischiocavernous muscle
  • Bulbospongiosus muscle
  • Superficial transverse perineal muscle
  • Spongy urethra
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18
Q

Contents of male deep perineal pouch

A
  • Membranous urethra
  • External urethral sphincter
  • Bulbourethral (Cowper’s) glands
  • Deep transverse perineal muscle
  • Dorsal nerve of penis
  • Internal pudendal arterial branches
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19
Q

Contents of the scrotum

A
  • Testes, epididymis, spermatic cord, Colle’s fascia, Dartos muscle
20
Q

Dartos muscle innervation

A
  • Genital branch of genitofemoral nerve
21
Q

What is the function of Buck’s fascia?

A
  • Binds erectile bodies (Corpora cavernosa and corpus spongiosum)
22
Q

Layers of penis

A
  • Tunical albuginea surrounds corpora cavernosa and corpus spongiosum
  • Deep penile fascia (Buck’s) binds erectile bodies together
  • Superficial penile fascia (Colle’s) surrounds penis externally underneath….
  • Skin
23
Q

Anatomical parts of penis

A
  1. ) Root (in superficial perineal pouch): bulb (spongiosum) attaches to UG diaphragm and crura (cavernosa) attaches to pubic rami
  2. ) Body
  3. ) Spongy urethra within corpus spongiosum
  4. ) Corpus spongiosum with expanded terminal end known as glans penis
  5. ) Corpora cavernosa
24
Q

In what position is the penis in anatomical position? What is dorsal, what is ventral?

A
  • Penis is erect in anatomical position
  • Dorsal is underside closest to corpora cavernosa
  • Ventral is topside closest to corpus spongiosum
25
Q

Muscles of the penis – function

A
  1. ) Bulbospongiosus muscles: paired skeletal muscles attached at median tendinous raphe, cover bulb of penis, compress bulb when contracted to: empty spongy urethra and form erection by compressing venous return
  2. ) Ischiocavernosus muscles: paired skeletal muscles covering R and L crus, compresses each crus to achieve and maintain erection by retarding venous blood return
26
Q

What is phimosis?

A
  • condition of penis where foreskin cannot be fully retracted over glans penis
27
Q

What is the perineal body?

A
  • fibrous mass in center of perineum that attach external anal sphincter, bulbospongiosus, superficial transverse perineal muscles
28
Q

Innervation of perineal body

A
  • perineal branches/nerve of pudendal nerve
29
Q

Innervation of bulbospongiosus, ischiocavernosus and superficial transverse perineal muscles

A
  • Perineal nerve from pudendal nerve
30
Q

Muscle that fixes the perineal body

A
  • Superficial transverse perineal muscle: from ITs inserts onto perineal body
31
Q

Innervation of external sphincter urethrae

A
  • Perineal branch of pudendal nerve, voluntary
32
Q

Innervation of skin of penis and glands penis

A
  • Dorsal nerve of penis (from pudendal nerve)
33
Q

Blood supply to penis

A
  • Deep arteries of penis (from internal pudendal artery) fill corpora cavernosa to aid in erection via helicine branches (coiled shape when penis is flaccid)
34
Q

What is the urogenital diaphragm?

A
  • These are muscles of deep perineal pouch….
  • Deep transverse perineal muscle
  • External sphincter urethra
35
Q

Contents of female urogenital triangle

A
  • Clitoris

- Labia

36
Q

Two parts of labia

A
  • Labia majora: prominent folds of skin that protect the vagina, filled with fat (Camper’s fascia), smooth muscle and terminal part of round ligament
  • Labia minora: mucous membrane folds medial to majora, form prepuce and frenulum
37
Q

What is the vestibule of the external female genitalia?

A
  • Space between labia minora containing the external meati of urethra, vagina and ducts of the greater and lesser vestibular glands
38
Q

Parts of clitoris

A
  • Root (portion in superficial perineal pouch) containing 3 masses of erectile tissue with covering muscle
  • Body: detached portion of clitoris with corpora cavernosa
39
Q

What covers the head of the clitoris?

A
  • Prepuce (foreskin)
40
Q

What anatomical structure refers to the joining of the labia minora?

A
  • Frenulum
41
Q

What is the bulb of the vestibule in the vagina?

A
  • Corpus spongiosum
42
Q

Contents of female superficial perineal pouch

A
  • Root of clitoris
  • Muscles covering the bulb and crura (bulbospongiosus and ischiocavernosus)
  • Greater vestibular glands (Bartholin’s)
  • Lesser vestibular glands (Skene’s)
  • Superficial tranverse perineal muscle
  • Perineal body
  • Perineal branches of pudendal nerve
43
Q

Contents of female deep perineal pouch

A
  • Part of urethra
  • Part of vagina
  • Sphincter urethrae
  • Deep transverse perineal muscles
  • Internal pudendal vessesl
  • Dorsal nerves of clitoris (from pudendal nerves)
44
Q

Innervation of the clitoris

A
  • Dorsal nerves of clitoris (from pudendal)
45
Q

Glands of external female reproductive tract. Function

A
  1. ) Greater vestibular glands (Bartholin’s): open into vestibule and secrete lubricating mucus during sexual activity
  2. ) Lesser vestibular glands (Skene’s): correspond to prostate, open into vestibule (lateral to urethral orifice) and secrete mucus for distribution to labia and vestibule
46
Q

Name and function of nerves that control erection, emission and ejaculation

A
  1. ) Erection: PSNS (pelvic splanchnic nerves S2-4): dilate helicine arteries, contract bulbospongiosus and ischiocavernosus muscles impeding venous return
  2. ) Emission: SNS (L1-L2): movement of semen into prostatic urethra, peristalsis of ductus deferens and seminal vesicles, contraction of prostate to add prostatic fluid
  3. ) Ejaculation: somatic (pudendal nerve S2-4) and autonomic: control expulsion of secretions and spermatozoa via rhythmic contraction of bulbospongiosus and ischiocavernosus muscles – SNS closes internal urethral sphincter and PSNS contracts urethral muscle
47
Q

Clinical relevance of perineal body in obstetrics

A
  • Torn during childbirth

- Episiotomy can be performed to control tearing

Anatomy Exam 4 (8 decks)

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