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Sita GenitoUrinary System > Lecture 15: Perineum > Flashcards

Lecture 15: Perineum Flashcards

1
Q

Urogenital and Anal Triangles

A

V shape. 2x triangles at an angle with eachother
Pelvic triangle:
1. Urogenital triangle: Anterior and horizontal
2. Anal triangle: Posterior and Inferior
- Perineal body inb/w at centre

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2
Q

Components of the Pelvic outlet

A 
Pubic Symphysis
Ischiopubic Ramus
Ischial Tuberosity
ST ligament
Coccyx
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3
Q

Perineal body

A 
Fibrous CT (tough and palpable landmark)
The attachment and anchor point for 4x muscles:
1. Levator ani
2. Bulbospongiosus
3. External Anal sphincter
4. Perineal muscles
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4
Q

Pelvic Floor

A

Levator Ani + Coccyges = continuous muscle sheet
Pelvic Floor is a diaphragm –> separates abdominal and pelvic cavity –> opposite archs (funnel shape bowl)
Function: stop pelvic viscera from prolapsing (keep pelvic contents inside pelvis)

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5
Q

Divisions of Levator Ani

A
  1. Pubococcygeus: slings around midline where urogenital structures come out. Deficiet b/w. (3x components)
  2. Illiococygeus
  3. Ischiococygeus: remnant muscle not used for same function
    - Perineal body is anchor point for levator ani muscles
    - supplied by Pudendal nerve (S2-4) and Nerve to Levator Ani (S4)
    Note: Levator Ani S4 nerve located ontop of pelvic cavity –> damage results in prolapse of levator ani and pelvic contents
    - All used to stop prolapse
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6
Q

Pubococcygeus Divisions within Levator Ani

A
  1. Levator prostatae/pubovaginalis
  2. Pubococcygyeus
  3. Puborectalis: 1. Sling around rectum 2. Creates angulation -> both helping maintain faecal continence
    - relaxes when you deficate
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7
Q

Illiococcygeus of the Levator Ani

A

1/2 Attaches to the fascia of obturator internus
Prevents prolapse of the pelvic viscera
Pudendal nerve and nerve to levator ani

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8
Q

External Anal sphincter

A

External anal sphincter runs from PB (perineal body) –> ACL (anococcygeal ligament)
Skeletal muscle –> conscious control
Different fibre direction (wraps around itself) –> helps to close off anus (pubic control aided by puborectalis)
Pudendal nerve (S2-4) (part of peritneum) + INFERIOR rectal branch

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9
Q

Internal Anal sphincter

A

Smooth muscle –> Autonomic control

Deep to External Anal sphincter (separated by CT)

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10
Q

Ischioanal Fossa Diagram

A

**

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11
Q

Ischioanal Fossa

A

Fossa= fat
Medially: sphincters
Laterally: obturator internus + ischial tuberosity
- Inferiolaterally: Pudendal nerve + Internal Pudendal a&v
Superior: Levator Ani muscle/Pelvic diaphragm
Floor: skin and fascia

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12
Q

Clinical relevance of Ischioanal Fossa

A

Pudendal nerve bloocks

Access to anal canal

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13
Q

Ischioanal Ulcers

A

Hitting pudendal vessels may lead to impotence or incontenence

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14
Q

Palpable landmarks of Ischioanal fossa

A

Laterally: Ischial tuberosity
Posteriorly: Coccyx
Midline (b/w anus and vagina/scrotum): Perineal Body
- Avoid Lateral apex: Pudendal vessels enter perineum here. Supply Sexual, sensation, continence function at risk

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15
Q

Anal canal

A

Rectum pierces pelvic floor
Anal columns: contain a terminal radicle of Superior Rectal vessels (some glands)
Below Pectinate line: Mesothelium/mucous membrane –> skin
Puborectalis forming sling around rectum (**spot in diagram)

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16
Q

Rectal/Anal Arterial Supply

A
  1. Superior Rectal Artery (Inferior Mesenteric) - run length of anal column
  2. Middle Rectal Artery (Int. Illiac) - variable size
  3. Inferior Rectal Artery (Int. Pudendal)
17
Q

Rectal/Anal Lymphatic Drainage

A

Lymphatics follow Arterial system

  1. Superior: Pre-aortic nodes L3
  2. Middle: Internal Illiac
  3. Inferior: Internal Illiac
  4. Anal canal Inferior to Pectinate line: Superficial Inguinal nodes - is skin –> lymphatics follows venous
18
Q

Rectal/Anal Venous Drainage

A
  1. Superior Rectal vein
  2. Inferior Rectal vein
    - quite superficial structures
    Join at Internal and External Venous plexuses
19
Q

Complications of Rectal/Anal Venous Drainage

A
  1. Porto-systemic anastomosis (High pressure –> distended vessels —> valves not working –> backflow –> varices)
  2. Haemorrhoids: Superificial structures –> at risk of haemorrhage re infections and inflammation
20
Q

Perineal membrane

A

= Urogenital diaphragm = Deep Perineal Pouch
Function: another boundary stopping most of the deficiet –> stops urogenital structure herniating through
Muscle attachment site
Midline deficiet

21
Q

Anterior deficit in Perineal membrane

A

Deep dorsal vein of penis/clitoris bypasses pudendal system –> entering straight into the vesicular plexus (pelvis’ venous plexus)

22
Q

Layers of the Urogenital Diaphragm/Perineal Membrane

A
  1. Superior Fascial Layer: deep, blends w. perineal body + membrane (thin membranous layer)
  2. Muscles: Sphincter urethrae + Deep transverse perineal muscles
  3. **Inferior Fascial Layer: superficial, perineal membrane
23
Q

Fascia and communication around Urogenital Diaphragm/Perineal membrane/Deep Perineal Pouch

A

Scarpa’s membranous fascia of the abdomen
= continuous with Dartos fascia of penis/scrotum = continuous with Colle’s fascia of perineum
ALL attach to the Perineal body

24
Q

Trauma around Perineal membrane/ Deep perineal pouch/ Urogenital Diaphragm

A

Trauma –> Bowl of penis bleeds –> blood pours into Superficial pouch –> fascia continuous so blood can fill up into Lower abdomen (and dorsal artery, vein and nerve)

25
Q

Deep Perineal Pouch/Membranous Urethra muscles

A

Visceral structures and Perineal membrane creates the deep perineal pouch
Muscles surrounding urethral and vaginal openings
1. External Urethral Opening
2. Sphincter Urethrovaginalis
3. Compressor Urethra = required more in men due to the bend in their urethra
4. Deep Transverse Peroneal muscle

26
Q

Urethra of men and woman

A

Mens urethra= bends

Woman’s urethra = straight = requires less help of the compressor urethra

27
Q

Features of Male Perineum

A 
Membranous urethra 
Bulbourethral glands (in deep perineal pouch. secretes mucous)
Neurovascular stuff (dorsal nerve of penis)
28
Q

Features of Female Perineum

A

Vagina
Compressor urethrae muscle
Dorsal nerve of the Clitoris
Bartholin’s glands in Superficial pouch

29
Q

Superficial perineal pouch

A 
Structures b/w Peroneal membrane and Skin
Contains:
1. Nerve and vessels
2. Erectile tissue
3. Perineal muscles
4. Bartholin's glands (females)
5. Everything more superifical is fat
30
Q

Internal Pudendal Artery

A

Main male branches: Inferior Rectal, Perineal, Deep artery of penis (+ scrotal, artery of bulb of penis + deep artery of penis)
Main female branches: Inferior Rectal, Perineal, Deep artery of clitoris (+ labial, artery of bulb of vestibule + deep artery of clitoris)
Diagrams *
Schematic*

31
Q

Pudendal Nerve

A 
S2-4
Supplies:
1. Perineal muscles
2. External Urethral Sphincter
3. Skin of Genitalia and Perineum
4. Erectile muscles (ischial cavernosus and bulbospongiosum)
32
Q

Pudenal Nerve clinically

A

risk of damage if insert needle in lateral apex of ischioanal fossa

Sita GenitoUrinary System (28 decks)

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