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(PA school) Gross Anatomy > Lecture 12 perineum pt 1 > Flashcards

Lecture 12 perineum pt 1 Flashcards

1
Q

1) What is the perineum called colloquially?
2) What does this mean?

A

1) Nether regions
2) The lowest or furthest parts of a place

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2
Q

1) Where is the pelvic compartment?
2) What is the perineal surface/ region? What shape is it with the legs abducted/ in lithotomy position?
3) What is the perineal body?

A

1) Inferior to pelvic diaphragm (levator ani and coccygeus mm.)
2) Narrow area between the thighs with legs adducted, diamond shaped
3) Fibromuscular “center of” mass of perineum

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3
Q

List and describe the 2 triangles of the perineum.
Which is deep, superficial, and covered by the perineal membrane?

A

1) Anal triangle: posterior
2) UG triangle: anterior, covered by perineal membrane, deep and superficial

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4
Q

What are the 3 layers preventing the abdomen/ pelvis from the outside?

A

1) Pelvic floor
2) Pelvic compartment
3) Perineal body

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5
Q

What are the triangles of the perineum connected by?

A

Transverse line connecting anterior ends of ischial tuberosities

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6
Q

1) Which triangle is posterior and contains the anal canal and anal sphincters?
2) Which triangle is anterior and contains vulva in females and root of scrotum + penis in males?
3) Which triangle contains the ureter and is covered by perineal membrane?

A

1) Anal triangle
2) Urogenital triangle
3) Urogenital triangle

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7
Q

1) What triangle does the perineal membrane cover?
2) What part of the pelvic outlet does it cover?
3) What perforates it in males and females?

A

1) Covers UG triangle
2) Covers anterior part of pelvic outlet
3) Urethra and vagina in females, urethra in males

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8
Q

1) What is the perineal body? What forms it?
2) Where is it?

A

1) Fibromuscular mass made by the convergence of several muscles
2) Deep to skin

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9
Q

List the 6 muscles of the perineum

A

1) *External anal sphincter m.
2) *Bulbopspongiosus m.
3) Ischiocavernosus m.
4) *Superficial transverse perineal m.
5) *Deep transverse perineal m.
6) *External urethral sphincter m.

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10
Q

What muscle of the perineum is NOT involved in the perineal body?

A

Ischiovernosus muscle

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11
Q

What 5 muscles are involved in the perineal body?

A

1) External anal sphincter m.
2) Bulbopspongiosus m.
3) Superficial transverse perineal m.
4) Deep transverse perineal m.
5) External urethral sphincter m.

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12
Q

List 2 perineal muscles that meet at the midline

A

1) Bulbopspongiosus m.
2) Ischiocavernosus m.

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13
Q

1) The perineal body receives smooth and voluntary slips of muscle from what 3 places?
2) List 2 muscles involved in the perineal body
3) What sphincter does it contain?

A

1) Ext urethral sphincter, levator ani, and muscular coats of rectum
2) Bulbospongiosis m. and Superficial and deep transverse perineal m.
3) External anal sphincter

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14
Q

List all the parts of the perineal body

A

1) Bulbospongiosis m.; Superficial and deep transverse perineal m.
2) External anal sphincter
3) Smooth and voluntary slips of muscle from ext urethral sphincter, levator ani, and muscular coats of rectum

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15
Q

1) What is around the wall of the anal canal?
2) What is the canal passage in obturator fascia? What does it cover?

A

1) Ischio-anal fossa
2) Pudendal canal; the internal aspect of obturator internus muscle

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16
Q

1) What is the ischo-anal fossa?
2) Where is it?
3) What 2 things is it filled with?

A

1) Fascia lined wedge-shaped space between the skin of the anal region and the pelvic diaphragm
2) Around the wall of the anal canal
3) Fat and loose connective tissue

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17
Q

What supports the anal canal?

A

Fat bodies of Ischio-anal fossa

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18
Q

What exit to the perineum at the pudendal canal?

A

Internal pudendal vessels and nerve

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19
Q

1) Between pelvic diaphragm and skin of the anal region is what fossa?
2) What shape is this fossa?
3) What is it mainly filled with?

A

1) Ischio-anal fossa
2) Wedge shaped
3) Adipose tissue and neurovascular structures

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20
Q

1) What pathology can occur at the ischio-anal fossa?
2) Describe how it feels

A

1) Ischio-anal fossa
2) Painful; fullness and tenderness between anus and ischial tuberosity

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21
Q

What is the pudendal canal and what does it contain? (2 vessels and 2 nerves)

A

Canal in obturator fascia containing:
1) Internal pudendal artery and vein
2) Pudendal nerve
3) Nerve to obturator internus m.

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22
Q

What does the pudendal canal provide neurovascular supply/innervation for?

A

Perineum

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23
Q

1) What does the internal iliac artery branch into? Where?
2) What does that divide into?
3) What supplies most of the perineal viscera?

A

1) Internal pudendal artery thru canal
2) Divide into posterior and anterior branch
3) Anterior branch

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24
Q

After the Pudendal nerve (S2-3-4) enters canal, what 3 things does it branch into?

A

1) Inferior rectal/anal n.
2) Perineal nerve (has 2 branches)
3) Dorsal n. of the penis/clitoris

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25
Q

What are the two branches of the perineal nerve?

A

1) Muscular deep br.
2) Superficial sensory br

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26
Q

The blocking of what nerve can be used as an alternative to an epidural?

A

Pudendal nerve

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27
Q

1) As the internal pudendal vessels and pudendal nerve enter [pudendal] canal, they give rise to what artery and nerve?
2) What do these supply?
3) What happens at the distal end of the canal?

A

1) Inferior rectal a. & n.
2) External anal sphincter and perianal skin
3) Both vessels and nerves bifurcate

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28
Q

At distal end of the pudendal canal, both vessels and nerves bifurcate into what?

A

1) Perineal nerve and artery
2) Dorsal artery and nerve to penis/clitoris
3) Central vein of the penis and clitoris (drains the erectile tissue)

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29
Q

Describe the 2 perineal nerve branches; what does one give rise to and where does the other go?

A

1) Superficial perineal n.: give rise to posterior scrotal and labial cutaneous branches
2) Deep perineal n.: to muscles of the deep and superficial pouches, vestibule of vagina, mucosa of inferior most part of vagina

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30
Q

1) What is the anal canal?
2) What are its two sphincters?

A

1) Continuation of rectal ampulla & anorectal flexure/puborectalis sling
2) Internal and external anal sphincter

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31
Q

1) Is the external anal sphincter voluntary? What does it surround and what does it blend with?
2) What innervates it?

A

1) Voluntary; surrounds inferior 2/3 of anal canal, blends superiorly with puborectalis
2) S4 via inferior anal (rectal) nerves (from pudendal nerve)

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32
Q

1) What makes up the internal anal sphincter? What does it surround?
2) What stimulates its tone?
3) What inhibits (relaxes) it?

A

1) Smooth muscle; superior 2/3 of anal canal
2) Sympathetic fibers from hypogastric plexus
3) Parasympathetic fibers

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33
Q

Voluntary control can usually override the involuntary reflex caused by what?

A

Fecal distention of rectal ampulla

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34
Q

1) What do the anal columns contain?
2) Where is the anorectal junction?
3) What forms the pectinate line?

A

1) Contain terminal branches of superior rectal artery and vein (IMA)
2) At superior ends of anal columns
3) Inferior limit of anal sinuses form

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35
Q

1) What do anal valves join?
2) What do they form?
3) What do these do when compressed?

A

1) Inferior ends of anal columns
2) Anal sinuses
3) Exude mucous (anal glands in dogs)

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36
Q

1) How does the anal canal superior to the pectinate line differ from the part inferior to it?
2) Why?

A

1) In its arterial supply, innervation, venous and lymph drainage
2) Different embryonic origins

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37
Q

What does the male perineum contain? (3 categories)

A

1) External genitalia (urethra, scrotum, penis)
2) Perineal muscles
3) Anal canal

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38
Q

What does the female perineum contain? (4 categories)

A

1) Pudendum/Vulva (synonymous)
2) External genitalia (5 things)
3) Perineal muscles
4) Anal canal

39
Q

1) What does the female pudendum/ vulva serve as?
2) What does it direct?
3) What does it prevent?

A

1) Serve as sensory /erectile tissue for sexual arousal and intercourse
2) Directs flow of urine
3) Prevents entry of foreign material into UG tract and include the external genitalia

40
Q

List the 6 external genitalia of the female perineum

A

1) Mons pubis
2) Labia majora (enclosing the pudendal cleft)
3) Labia minora (enclosing the vestibule of the vagina)
4) Clitoris
5) Bulbs of the vestibule
6) Greater and lesser vestibular glands

41
Q

1) What is the mons?
2) What is the labia majora? What is it bound to?
3) What does the labia major protect?

A

1) Fatty eminence anterior to pubic symphysis, fat increases at puberty and covered in hair
2) Prominent folds of skin, bound the pudendal cleft (between labia majora)
3) Urethral and vaginal orifice

42
Q

1) What does the labia major contain? (3 things)
2) What is it externally covered in in adults?

A

1) Fatty tissue, smooth muscle, & terminal ends of round ligament of uterus
2) Pigmented skin, sebaceous glands, & pubic hair.

43
Q

What structure of the labia major often disappears after vaginal birth?

A

Anterior commissure from mons pubis to posterior commissure or fourchette

44
Q

1) What are the labia minor? What do they contain a core of?
2) What encloses the labia minor?
3) What does it surround?

A

1) Fat free folds, hairless, core of erectile tissue and vessels
2) Pudendal cleft/labia majora
3) The vestibule into which the urethra, vagina, & vestibular glands open

45
Q

The labia minor anteriorly form 2 lamina; what are they? What do they each unite to form?

A

1) Medial laminae unite to form frenulum of the clitoris
2) Lateral laminae unite to form the prepuce of the clitoris

46
Q

What do the labia minor form posteriorly?

A

The posterior frenulum of labia minora

47
Q

1) What type of tissue makes up the clitoris?
2) What make up its root and body? What 2 things do these transition into?

A

1) Erectile tissue
2) 2 crura; corpora cavernosa and glans

48
Q

1) What is the vestibule?
2) What is this opening for?

A

1) Space surrounded by the labia minora
2) Urethra, vagina, and ducts of greater and lesser vestibular glands

49
Q

1) What are the bulbs of the vestibule?
2) What are they deep to?
3) What are they covered by?

A

1) Paired masses of elongated erectile tissue
2) Deep to the vestibule of the vagina
3) Bulbopspongiosus m.

50
Q

List and define the two types of vestibular glands

A

1) Greater (Bartholin gland): each side of vestibule, open on each side of the vaginal orifice, secrete mucous during sexual arousal
2) Lessor glands: smaller, bilateral, between urethral and vaginal orifice, secrete mucous

51
Q

1) What artery supplies the vulva? What does it supply specifically?
2) What is the venous drainage of the vulva?
3) What does venous engorgement during sexual arousal cause?

A

1) Internal pudendal; most of skin, external genitalia, perineal m.
2) Tributaries of internal pudendal veins
3) Increase in size and consistency of clitoris and bulbs of the vestibule

52
Q

1) Where do the vulva lymphatic drain initially?
2) What innervates the vulva anteriorly, laterally, and posteriorly?
3) What is the main nerve of the perineum?

A

1) To superficial and deep inguinal nodes
2) Anteriorly: ilio-inguinal and genitofemoral nerves,
-Laterally: pudendal nerves
-Posteriorly by posterior cutaneous n. of the thigh.
3) Pudendal nerve

53
Q

1) What is the anatomic position of the penis?
2) What are its 3 parts?
3) What does it contain 3 cylinders of?

A

1) Anatomical position is erect
2) Root, body, glans
3) Erectile tissue (corpora)

54
Q

List and describe the 3 cylinders of erectile tissue (corpora) of the penis

A

1+2) Paired corpora cavernosa: Fused in median plane, except posteriorly where they separate and form crura of penis
3) Single corpora spongiosum ventrally: Contains spongy urethra

55
Q

1) What forms the crura of penis?
2) What contains spongy urethra?

A

1) Fused in median plane except posteriorly where they separate and form crura of penis
2) Single corpora spongiosum ventrally

56
Q

1) What covers each of the 3 cylinders of erectile tissue in the penis?
2) What 2 things make up this structure?

A

1) Fibrous capsule
2) Tunica albuginea and deep fascia

57
Q

What does the root of the penis contain? What 3 things does this contain?

A

Consists of Paired Crus (Crura) and unpaired Bulb:
1) Proximal parts of corpora
2) Crus attached near ischial tuberosities
3) Bulb pierced by the urethra

58
Q

1) What is the root of the penis continued as?
2) Where is this?

A

1) Corpus cavernosa and corpus spongiosum penis
2) Distal parts of corpora

59
Q

What 2 muscles and 1 covering cover the root of the penis?

A

1) Ischiocanvernosus and Bulbopspongiosus muscles
2) Fibrous covering tunica albuginea

60
Q

1) What is the glans of the penis?
2) What is a distinct structure of the glans? Describe this structure
3) What does the neck of the glans deliniate?

A

1) Expanded corpus spongiosum
2) Corona; projects beyond end of corpora cavernosa and over hangs the neck of the glans
3) Glands from body

61
Q

What opening does the glans of the penis contain?

A

External urethral opening of spongy urethra

62
Q

1) What supplies the anterior scrotum with blood?
2) What about the posterior scrotum?

A

1) Anterior scrotal arteries via External pudendal artery
2) Posterior scrotal arteries via terminal br. Internal pudendal artery

63
Q

1) Where are the veins of the scrotum and where do they drain?
2) Where do the lymphatics of the scrotum drain?

A

1) Veins accompany arteries, drain to external pudendal veins
2) Lymphatics drain into superficial inguinal nodes

64
Q

1) What innervates the anterior scrotum?
2) What innervates the posterior scrotum?

A

1) Anterior scrotal n via ilioinguinal n and genital branch of genitofemoral n.
2) Posterior scrotal n. via branch of superficial perineal via pudendal n. and perineal br. of the posterior femoral cutaneous n.

65
Q

The pudendal n and posterior femoral cutaneous n. are both involved in innervating what?

A

Posterior scrotum

66
Q

1) What is the arterial supply of the penis?
2) What does the venous plexus drain? What does this plexus become?

A

1) Branches of internal pudendal artery
2) Blood from cavernous spaces of the corpora cavernosa; becomes dorsal vein of penis

67
Q

1) Where does lymph from the penis drain?
2) Cavernous nerves from parasympathetic fibers from prostatic nerve plexus innervate what?

A

1) To superficial inguinal nodes
2) Helicine arteries

68
Q

1) What innervates the skin of penis and glans?
2) What joins the dorsal nerve of the penis?
3) What nerves innervate the helicine arteries of the deep artery of the penis? From what plexus?

A

1) S2-3-4 somatic sensory spinal nerves via dorsal n. of the penis - skin of penis and glans
2) Sympathetic
3) Cavernous nerves from parasympathetic fibers from prostatic nerve plexus

69
Q

List 3 homologous structures between the male and female genitalia

A

1) Bulb of penis (m) and bulb of vestibule (f)
2) Crus (both)
3) Urethra (both)

70
Q

What make up the perineal body? (4 groups of things)

A

1) Superficial and deep transverse perineal m
2) Ext anal sphincter
3) Bulbospongiosis
4) Slips of muscle

71
Q

1) What structure can episiotomies affect?
2) Stretching or tearing of what during childbirth remove support of the pelvic floor?

A

1) Perineal body
2) Attachments of muscles from perineal body

72
Q

What can stretching/ tearing of attachments of muscles from perineal body during childbirth removing support of the pelvic floor lead to? (2 things)

A

1) Stress incontinence
2) Prolapse bladder, vagina, or uterus

73
Q

1) Are pudendal nerve blocks done often today? Why?
2) What does it block?

A

1) Not done much any more due to epidural anesthesia for childbirth
2) Most of the perineum except anterior part

74
Q

1) Where would you block the pudendal nerve for the lateral perineum?
2) What type of nerve block works for the anterior perineum?

A

1) Near ischial spine
2) Ilioinguinal nerve block

75
Q

1) What is the landmark for local infiltration of anesthetic for the perineal region?
2) What part wouldn’t be blocked from this type of nerve block? Why?

A

1) Ischial spine
2) Anterior perineum; innervated by ilioinguinal nerve

76
Q

1) What is the final support of the pelvic viscera?
2) Stretching or tearing the attachment of the perineal muscles to perineal body can occur when? What does this do?

A

1) Perineal body
2) During vaginal birth, removes support provided to pelvic floor which results in prolapse of pelvic viscera (bladder)

77
Q

What two types of prolapses can result from stretching or tearing of the attachment of the perineal muscles to perineal body?

A

1) Bladder through the urethra
2) Uterus and or vagina through vaginal orifice

78
Q

1) What is an episiotomy?
2) What does current evidence suggest about episiotomies?

A

1) Surgical incision of the perineum and inferoposterior vaginal wall to enlarge the vaginal orifice to “control” the damage to the perineal muscles
2) Current evidence suggests it causes more damage (harm) than good.

79
Q

What are the 4 degrees of tears during childbirth?

A

Ist degree = vaginal mucosa only
2nd degree = down into superficial and deep transferse perineal muscles
3rd degree = involves external anal sphincter
4th degree enters the rectum

80
Q

1) What type of abscess can occur in the female perineal region?
2) How is it treated?

A

1) Greater vestibular gland (Bartholin glands) abscess
2) Catheter

81
Q

1) Parasympathetic stimulation in the female sexual response results in what?
2) B/c of this stimulation, what is closed? Why?

A

1) Venous engorgement of the erectile tissue in the clitoris and bulbs of the vestibule.
2) Arteriovenous anastomosis (a-v-a) diverts more blood flow to the cavernous sinuses

82
Q

List 4 results of parasympathetic stimulation during female sexual response

A

1) Increased vaginal secretions
2) Erection of the clitoris
3) Engorgement of erectile tissue in the bulbs of the vestibule
4) Bulbospongiosus and ischiocavernosus muscles reflexively contract to decrease venous drainage

83
Q

1) In female sexual response, return to flaccid state results in what stimulation?
2) What does it open? What does this divert?
3) What muscles relax? Why?
4) What arteries recoil?

A

1) Sympathetic stimulation
2) Opens the a-v-a, diverting blood away from the cavernous sinuses
3) Bulbo- & ischiocavernosus muscles relax to improve venous drainage into the dorsal vein
4) Helicine arteries

84
Q

What 2 things is most arterial blood bypassing when the penis is in a flaccid state? Why?

A

“Empty potential spaces” or sinuses in corpora cavernosa by means of arteriovenous anastomosis (a-v-a) that are open in the flaccid state

85
Q

What occurs during male sexual arousal? (2 things simultaneously)

A

1) Parasympathetic stimulation conveyed by cavernous nerves from prostatic plexus from S2-3-4 opens the a-v-a to direct blood into the erectile tissue sinuses
2) Tonic contraction of the smooth muscle in the coiled helicine a. is inhibited, straightens, enlarging their lumen directing more blood into the erectile sinuses

86
Q

1) What is blood doing during erection?
2) What muscles reflexively contract during erection? Why?

A

1) Blood thru a-v-a filling the sinuses of the corpora of the penis
2) Bulbo- and ischiocavernosus muscles to compress the veins of the corpora, to impede venous drainage

87
Q

1) What does sympathetic stimulation result in in male sexual response? When?
2) What is added? How?
3) Define ejaculation

A

1) Semen delivered to prostatic urethra via ejaculatory ducts; after peristalsis of the ductus deferentes and seminal glands
2) Prostatic fluid added by contraction of smooth muscle in the prostate
3) Semen is expelled from urethra

88
Q

What 3 things cause ejaculation?

A

1) Sympathetic stimulation closes the internal urethral sphincter
2) Parasympathetic stimulation contracts urethral muscles
3) Pudendal n. stimulation contracts the bulbospongiosus muscles

89
Q

1) What happens to the penis in remission of male sexual response?
2) What does sympathetic stimulation do during this stage?
3) What muscles contract during this stage? Why?

A

1) Penis gradually returns to flaccid state
2) Sympathetic stimulation opens a-v-a and contraction of the helicine artery smooth muscles to recoil – thus reduce blood flow to cavernous sinuses
3) Contraction of the bulbo- and ischiocavernosus muscles relaxation allows for blood to drain from the venous plexuses into the deep dorsal vein

90
Q

What are the 3 main causes of ED?

A

1) Neurologic: Injury to prostatic plexus or cavernous nerves such as occurs with prostatectomy for Prostate
2) CNS (depression or medication side effects) or Endocrine (pituitary or testicular) resulting in “LOW T”
3) Vascular

91
Q

1) What is a neurologic cause of ED?
2) How is this treated?

A

1) Injury to prostatic plexus or cavernous nerves such as occurs with prostatectomy for Prostate Cancer surgery
2) Prosthesis

92
Q

What two endocrine organs’ dysfunction can result in ED?

A

Pituitary or testicular

93
Q

What does the Central vein of the penis and clitoris do?

A

Drains the erectile tissue

(PA school) Gross Anatomy (28 decks)

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