Lecture 11 Flashcards
SACROTUBEROUS LIGAMENT
closes off what?
Ligament running from sacrum to ischial tuberosity
Its presence closes off lesser sciatic notch to become lesser sciatic foramen.
SACROSPINOUS LIGAMENT
Its presence closes off greater sciatic notch to become
Ligament running from sacrum to ischial spine is
greater sciatic foramen.
where does the sciatic nerve exit?
the pelvis through the greater sciatic foramen.
Ischiorectal fossa
fossa lies between urogenital diaphragm and pelvic diaphragm.
Deep perineal space
lies internal to deepest layer (transversalis fascia)
Superficial perineal space
between urogenital diaphragm and superficial fascia plus skin.
Perineal Subdivision(3)
Superficial = “Urogenital diaphragm” Intermediate = Pelvic Diaphragm Deep = Transversalis Fascia
Superficial = “Urogenital diaphragm”perineal subdivision
Transversus Perinei Profundus
External anal sphincter
Urethral sphincter
Intermediate = Pelvic Diaphragm:perineal subdivision
Coccygeus
Levator ani
Deep/perineal subdivision
Transversalis Fascia
Lateral Hypaxial MM – Perineal; External Layer – Transverse Perineal M.
origin? insertion? innervation?
Origin: Inferior pubic ramus, ischial ramus
Insertion: Perineal body; wall of vagina or prostate
Innervation: Pudendal n. (S2-4)
Lateral Hypaxial MM – Perineal; External Layer
External Urethral Sphincter
External Anal Sphincter
Origins and Insertions: Encircle urethra and anus
Innervation: Pudendal n. (S2-4)
Lateral Hypaxial MM – Perineal;
Middle Layer – Pelvic Diaphragm, Levator Ani
Puborectalis OI
Origin: Superior pubic ramus
Insertion: Anococcygeal ligament
Innervation for all: Branches from sacral plexus – S4
Lateral Hypaxial MM – Perineal;
Middle Layer – Pelvic Diaphragm, Levator Ani
Pubococcygeus OI
Origin: lateral to puborectalis
Insertion: Anococcygeal ligament
Innervation for all: Branches from sacral plexus – S4
Lateral Hypaxial MM – Perineal;
Middle Layer – Pelvic Diaphragm, Levator Ani
Iliococcygeus OI
Origin: Internal obturator fascia of levator ani
Insertion: Anococcygeal ligament + coccyx
Innervation for all: Branches from sacral plexus – S4
Lateral Hypaxial MM – Perineal; Middle Layer – Pelvic Diaphragm, Coccygeus
Origin: coccyx
Insertion: Ischial spine
Innervation: Branches from sacral plexus – S4,5
Perineal Musculature what kind of musulature is it?
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.
what is the musulature innervation of the perineal musulature layers
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.
the pudendal n. pathway?
Exits the greater comes back into the lesser
PELVIS AND PERINEUM
Contents of the Perineum
Bladder
Hindgut – Sigmoid colon, Rectum
Internal Genitalia (female)
Male: Prostate gland, Seminal vesicles
Unpaired Branch of Abdominal Aorta:
Inferior Mesenteric Artery; Left Colic, Sigmoid, and Rectal AA
Unpaired Tributary of Hepatic Portal Vein
Inferior Mesenteric Vein; Left Colic, Sigmoid, and Rectal VV tributaries
Sympathetic Nerve:
Sympathetic Nerve Segmental Levels:
Sympathetic Ganglion:
Parasympathetic Nerve:
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.
NEUROVASCULAR SUMMARY
Bladder (and inferior ureter)
arterial supply
venous drainage
symp. innervation/levels
symp. pregang/postgang synapse
parasymp inn
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.
UTERUS
Location :
Development:
Innervation:
Arterial Supply:
Venous Drainage:
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
OVARY
Location :
Development:
Innervation:
Arterial Supply:
Venous Drainage:
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.
