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Genitourinary MBCHB2 > Lecture 9: Perineum > Flashcards

Lecture 9: Perineum Flashcards

1
Q

What structures form the pelvic outlet?

A
  • Pubic symphysis
  • Ischiopubic ramus
  • Ischial tuberosity
  • Sacrotubous ligament
  • Coccyx
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2
Q

What are the three major divisions of the levator ani? and what nerves supply it?

A
  • Ischiococcygeus
  • Iliococcygeus
  • Pubococcygeus
Pudendal nerve (S2-4) 
Levator ani nerve (S3-4)
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3
Q

What can the pubococcygeus be further divided into?

A

Puborectalis (sling around rectum)
Levator prostate

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4
Q

Where is the iliococcygeus located and what does it do? and again what are them nerves?

A

Attatches to fascia of obturator internus, prevents prolapse of pelvic viscera

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

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5
Q

What is the perineal body?

A

What we classically think is the perineum

  • Composed of fibrous CT
  • Attaching: Levator ani, bulbospongiosus, external anal sphincter, perineal muscles
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6
Q

At what point does the rectum become the anal canal?

A

When rectum pierces the pelvic floor it becomes the anal canal

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7
Q

What is the anal canal and what are some distinguishing features?

A

Transitional region b/w true gut and outer skin

Features:

  • Pectinate line / anal columns
  • Ext. anal sphincter
  • Hiltons white line
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8
Q

What is the external anal sphincter and what is it attached to? what innervates it?

A
  • Skeletal muscle
  • Attached b/w perineal body to anococcygeal ligament (ACL)
  • Closes anus (rectal control aided by puborectalis)
  • Pudendal nerve (S2-4) -> inf. rectal branch
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9
Q

What are the landmarks of the anal triangle?

A
  • Ischial tuberosity (laterally)
  • Coccyx (posteriorly)
  • Perineal body

Be wary of the lateral apex….

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10
Q

What could be an issue with ischioanal ulcers?

A
  • Hitting pudendal nerves/vessels may lead to impotence of incontinence

Thus surface anatomy is important

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11
Q

What is the function of the perineal membrane in the urogenital triangle?

A

Support urogenital organs esp. at site of urogenital hiatus in levator ani muscle.

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12
Q

What structures exist in the deep perineal pouch for males?

A
  • Membranous urethra
  • Bulbourethral glands
  • Dorsal nerves and arteries of the pneis
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13
Q

What structures exist in the deep perineal pouch for females?

A
  • Vagina
  • Compressor urethrae and urethrovaginalis muscle
  • Dorsal nerves/arteries of the clitoris

NB: Greater vestibular glands are in the superficial pouch

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14
Q

What is the superficial perineal pouch?

A

Structures b/w perineal membrane and the skin

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15
Q

What structures are found in the superficial perineal pouch?

A
  • nerves and vessels
  • Erectile tissues
  • Perineal muscles
  • Greater vestibular glands (females only)
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16
Q

For males how does the fascia of the genitals communicate with other structures in a trauma sense?

A

Scarpas fascia of the abdomen is continuous with dartos fascia of the penic/scrotum which is continuous with perineal (colles) fascia.

This means that trauma here can result in blood pooling elsewhere.

17
Q

What are the main branches of the internal pudenal art. in males?

A
  • Inf. rectal
  • Perineal
  • Dorsal art. of penis
18
Q

What are the main branches of the internal pudenal art. in females?

A
  • Inf. rectal
  • Perineal
  • Dorsal art. of clitoris
19
Q

Describe the process of defaecation, muscles and nerves involved:

A
  • Relaxation of puborectalis (pudendal and n. to lev ani) to straighten anorectal angle
  • Relaxation of sphincters (internal = PNS via Pelvic splanchnic, External (pudendal, conscious))
  • PNS pelvic splanchnic causes contraction of rectal muscles
  • Increased abdo pressure via abdo wall and diaphragm contraction. Stabilised by closure of the larynx
20
Q

Describe Micturation (urination) // sacral stretch reflex:

A

ANS mostly:

  • PNS (pelvic splanchnic) -> sacral spinal reflex results in detrusor muscle contraction
  • SNS (L1-2 fibres) contracts internal urethral spincter (PNS overcomes this to cause relaxation)
  • Somatic -> Pudendal, external urethral sphincter relaxation
  • CNS can facilitate or inhibit.
21
Q

What are the nerves involved in sex?

A
  • PNS: Pelvic splanchnic from inf. hypogastric plexus. (vasodilation and thus erection)
  • SNS: From ingerior hypogastric plexus; Ejaculation (SM contraction) and contraction of internal urethral sphincter (prevents backflow into bladder)
  • Pudendal nerve; Sensory of penis or clitoris and cyclical contraction in orgasm
22
Q

What can pudendal nerve damage/entrapment result in?

A
  • Pain
  • Numbness
  • Altered sensation of ejaculation
  • Fecal incontinence
  • Urinary incontinence
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38
Q

Describe the determatomes of the perinium

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39
Q

Draw a diagram relating all the compartments of the pelvis

A

Genitourinary MBCHB2 (26 decks)

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