Lecture 11

Question 1

SACROTUBEROUS LIGAMENT

closes off what?

Answer 1

Ligament running from sacrum to ischial tuberosity

Its presence closes off lesser sciatic notch to become lesser sciatic foramen.

Question 2

SACROSPINOUS LIGAMENT

Its presence closes off greater sciatic notch to become

Answer 2

Ligament running from sacrum to ischial spine is

greater sciatic foramen.

Question 3

where does the sciatic nerve exit?

Answer 3

the pelvis through the greater sciatic foramen.

Question 4

Ischiorectal fossa

Answer 4

fossa lies between urogenital diaphragm and pelvic diaphragm.

Question 5

Deep perineal space

Answer 5

lies internal to deepest layer (transversalis fascia)

Question 6

Superficial perineal space

Answer 6

between urogenital diaphragm and superficial fascia plus skin.

Question 7

Perineal Subdivision(3)

Answer 7

Superficial = “Urogenital diaphragm”
Intermediate = Pelvic Diaphragm
Deep  = Transversalis Fascia

Question 8

Superficial = “Urogenital diaphragm”perineal subdivision

Answer 8

Transversus Perinei Profundus
External anal sphincter
Urethral sphincter

Question 9

Intermediate = Pelvic Diaphragm:perineal subdivision

Answer 9

Coccygeus

Levator ani

Question 10

Deep/perineal subdivision

Answer 10

Transversalis Fascia

Question 11

Lateral Hypaxial MM – Perineal; External Layer – Transverse Perineal M.

origin? insertion? innervation?

Answer 11

Origin: Inferior pubic ramus, ischial ramus
Insertion: Perineal body; wall of vagina or prostate
Innervation: Pudendal n. (S2-4)

Question 12

Lateral Hypaxial MM – Perineal; External Layer

External Urethral Sphincter

External Anal Sphincter

Answer 12

Origins and Insertions: Encircle urethra and anus

Innervation: Pudendal n. (S2-4)

Question 13

Lateral Hypaxial MM – Perineal;
Middle Layer – Pelvic Diaphragm, Levator Ani

Puborectalis OI

Answer 13

Origin: Superior pubic ramus
Insertion: Anococcygeal ligament
Innervation for all: Branches from sacral plexus – S4

Question 14

Lateral Hypaxial MM – Perineal;
Middle Layer – Pelvic Diaphragm, Levator Ani
Pubococcygeus OI

Answer 14

Origin: lateral to puborectalis
Insertion: Anococcygeal ligament

Innervation for all: Branches from sacral plexus – S4

Question 15

Lateral Hypaxial MM – Perineal;
Middle Layer – Pelvic Diaphragm, Levator Ani
Iliococcygeus OI

Answer 15

Origin: Internal obturator fascia of levator ani
Insertion: Anococcygeal ligament + coccyx

Innervation for all: Branches from sacral plexus – S4

Question 16

Lateral Hypaxial MM – Perineal; Middle Layer – Pelvic Diaphragm, Coccygeus

Answer 16

Origin: coccyx
Insertion: Ischial spine
Innervation: Branches from sacral plexus – S4,5

Question 17

Perineal Musculature what kind of musulature is it?

Answer 17

Remember, always three layers:

External Layer: Urogenital diaphragm (external sphincters) and deep transvese perineal muscle
Middle Layer: Pelvic diaphragm
Levator ani
Coccygeus
Iliococcygeus (more superficial and posterior)
Pubococcygeus (more anterior)
Deep Layer: Transversalis fascia

Nerves run between middle and innermost layers.

Question 18

what is the musulature innervation of the perineal musulature layers

Answer 18

MUSCULAR INNERVATION:

Superficial layer: Pudendal nerve (S2,3,4) to urogenital diaphragm.

Middle layer: Nerve to pelvic diaphragm (S4,5)

Deep layer: reduced to fascia, no innervation necessary.

Question 19

the pudendal n. pathway?

Answer 19

Exits the greater comes back into the lesser

Question 20

PELVIS AND PERINEUM

Contents of the Perineum

Answer 20

Bladder
Hindgut – Sigmoid colon, Rectum
Internal Genitalia (female)
Male: Prostate gland, Seminal vesicles

Question 21

Unpaired Branch of Abdominal Aorta:

Answer 21

Inferior Mesenteric Artery; Left Colic, Sigmoid, and Rectal AA

Question 22

Unpaired Tributary of Hepatic Portal Vein

Answer 22

Inferior Mesenteric Vein; Left Colic, Sigmoid, and Rectal VV tributaries

Question 23

Sympathetic Nerve:

Sympathetic Nerve Segmental Levels:

Sympathetic Ganglion:

Parasympathetic Nerve:

Answer 23

Lumbar Splanchnics, and Lesser and Least Splanchnic Nerves

Sympathetic Nerve Segmental Levels: T10-12, L1-2

Inferior Mesenteric Ganglion and Inferior Mesenteric Plexus

Pelvic Outflow, S2-4 via pelvic splanchnic nerves.

Question 24

NEUROVASCULAR SUMMARY
Bladder (and inferior ureter)

arterial supply

venous drainage

symp. innervation/levels
symp. pregang/postgang synapse

parasymp inn

Answer 24

Superior and inferior vesicle arteries (branches of internal iliac artery).

Superior and inferior vesicle veins (tributaries of internal iliac vein).

T12 via least splanchnic nerve.

in inferior mesenteric ganglion and plexus.

Sacral outflow (S2-4) via pelvic nerves.

Question 25

UTERUS

Location :

Development:

Innervation:

Arterial Supply:

Venous Drainage:

Answer 25

between bladder anteriorly (ventrally) and rectum posteriorly (dorsally.

mesoderm from fusion of fallopian tubes.

sympathetic – via the inferior hypogastric plexus, levels T10-12,L2; parasympathetic – sacral outflow S2-4

uterine artery, branch of internal illiac, with anastomosis from Ovarian artery, a branch of the abdominal aorta.

uterine vein, dump into XX

Question 26

OVARY

Location :

Development:

Innervation:

Arterial Supply:

Venous Drainage:

Answer 26

near kidneys, anchored by fallopian tubes to uterus.

intermediate mesoderm. Ovaries migrate somewhat caudally, retain position near kidneys.

sympathetic – similar to hindgut, level T12, follows least splanchnic nerve; parasympathetic – sacral outflow

ovarian artery, branch of abdominal aorta.

ovarian vein, dump into inferior vena cava.