Lecture 14: Perineum* Flashcards

1
Q

Urogenital and Anal triangles

A

Made from muscles of the perineum

Anal: more posterior
Urogenital: more anterior

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2
Q

What makes up the Pelvic Outlet?

A
  • Pubic Symphysis
  • Ischiopubic Ramus
  • Ischial Tuberosity
  • ST lig.
  • Coccyx

*Roughly diamond shape

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3
Q

What is the Perineal Body?

A

Made of fibrous CT, an attachment point!

Attaching is?

  • Levator ani
  • Bulbospongiosus
  • External anal sphincter
  • Perineal Muscles
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4
Q

What two main muscles make up the pelvic floor?

A
  1. Levator ani
  2. Coccygeus
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5
Q

Levator Ani divisions and supply

A
  1. Iliococcygeus
  2. Pubococcygeus

Forms a V shaped structure

Pudendal nerve (S2-4) and nerve to levator ani (S3-4)

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6
Q

Levator Ani: Pubococcygeus

A
  1. Levator Prostatae/pubovaginalis
  2. Pubococcygeus
  3. Puborectalis; helps maintain fecal continence, forms sling around the rectum (creates angulation)
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8
Q

Label Levator Ani muscles

A
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9
Q

What is the External Anal sphincter? Function and innervation?

A

Made of skeletal muscle, it closes the anus (accompanied by puborectalis) and is also under partial voluntary control!

From perineal body to anococcygeal ligament

supplied by Pudendal Nerve (S2-4) - inferior rectal branch

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10
Q

Internal Anal sphincter

A

Smooth Muscle (involuntary control (ANS))

Deep to External Anal Sphincter (seperated by CT)

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11
Q

Label

A
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13
Q

The Anal Canal

A

Where the rectum pierces the pelvic floor it becomes the Anal canal (once passed the puborectalis)

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14
Q

Arterial and Lymphatics of the perineum

A
  • *Superior rectal artery (inf mesenteric)**
  • Pre-aortic nodes @ L3*
  • *Middle rectal artery (int iliac)**
  • Internal iliac nodes*
  • *Inferior rectal artery (int pudendal)**
  • Internal Iliac nodes*

** anal canal inferior to pectinate line (SF inguinal nodes)

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16
Q

The perineal membrane

A

Has an anterior deficiency (where the deep dorsal vein of penis/clitoris moves through)

  • Attachment site for nearly all perineal muscles eg; deep transverse perineal muscles and compressor urethra
  • Forms inferior layer of urogenital diaphragm/ Deep perineal pouch
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17
Q

Urogenital Diaphragm

A
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18
Q

What’s the male/female variation of the Deep Perineal Pouch

A
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20
Q

Internal Pudendal artery important branches. Draw.

A
22
Q

Sec- the nervous system

A
24
Q

Levator divisions: Iliococcygeus

A

Attaches to fascia of Obturator internus, prevents prolapse of pelvic viscera

29
Q

Landmarks of the urogenital and anal Sphincters

A

Laterally: ischial Tuberosity

Posteriorally: Coccyx

Midline: Perineal Body

**avoid the lateral apex (where the nerves are) → impotence or incontinence

32
Q

Rectal/anal venous drainage

A

Superior and inferior recal vein meet at portal-systemic anastomosis

These drain the internal and external venous plexuses

36
Q

Superficial Perineal Pouch

A

Structures between the perineal membrane and skin

  • Nerves + vessels
  • Erectile tissues
  • Perineal muscles
  • Bartholins gands (females)
38
Q

Pudendal Nerve

A

Mirrors the artery. (S2-4) motor and sensory

Perineal muscles, ext. urethral sphincter, skin of genitalia, erectile muscles

40
Q

Saddle anasthesia

A

Compression of cauda equina (S5 to anus)