male and female pelvis and perineum (ketchum) Flashcards
what are the three portions of the external anal sphincter
subcutaneous
sparse circular fibers
superficial tendon of perineum to coccyx attaches to: central tendon (male) perineal body (female) corrugator cutis ani fibers penetrate superficial portion
deep
encircles anal canal
major portion of anal sphincter
what is in the ischioanal fossa
adipose tissue (ischioanal fat) continuation of Camper’s fascia internal pudendal vessels inferior rectal vessels internal pudendal nerves
what are the branches of the internal pudendal artery
inferior rectal (1st branch after entering canal)
perineal–> branches into transverse perineal and posterior scrotal or labial arteries
deep and dorsal arteries of penis
which end in the perineal space
where does the internal pudendal artery leave the pelvis and where does it reenter and then travel in
leaves through greater sciatic foramen
then it goes in the lesser sciatic foramen between sacrotuberous and sacrospinous ligaments
and travels in the pudendal canal (which is formed from obturator internus fascia)
what are the major brancehs of the pudendal nerve
inferior rectal
perineal
dorsal nerve of penis
what does the posterior femoral cutaneous contribute to perineum
it sends cutaneous innervation to the lateral aspects of the anal and UG diaphragms and down medial thigh
what are the VOLUNTARY muscles that span the UG triangle
sphincter urethrae m.
surrounds membranous urethrae
compressor urethae
extends laterally from sphincter
deep transverse perineal m.
post. to sphincter urethrae m.
superficial transverse perineal mm.
at post. edge of UG diaphragm
originate from ischiopubic rami
insert at central tendon
what are the fascial sheaths of the UG triangle and what spaces do these fascial layers create
superior fascia of UG diaphragm (from transversalis fascia)
inferior fascia of ug diaphragm (aka perineal membrane)
creates superficial perineal space
and deep perineal space (which is the space b/w the perineal membrane and the superficial fascia)
what are the fascial layers of the urogenital diaphragm
superficial perineal fascia (Colle’s)
-continuation of membranous layer of superficial fascia from anterior abdominal wall
forms superficial penile fascia and is called Darto’s fascia on the scrotum
deep perineal fascia (Buck’s fascia) surrounds the cavernous bodies
what is the corpus spongiosum
what does it contain
this is the erectile tissue along the midline that is adherent to the inferior fascia of the UG diaphragm
contains the urethra
enlarged at the proximal end to form bulb
enlarged at distal end to form the glans penis
limited erectile function
what is the corpora cavernosa
what do they contain
twin erectile bodies form the crura of the penis
anchored at ischiopubic rami and adjacent UG diaphragm
they converge at the inferior margin of pubic symphysis
contain deep artery of penis
what is the facia that surrounds the erectile tissue
tunica albuginae
along the midline this CT fuses to form the septum of the penis
it is also fenestrated to allow equal filling of the cavernosae
NOTE–> the spongiosum has a separate tunic albuginea that is much thinner which prevents urethral collapse during an erection
what is the fundiform ligament
thickening of Scarpa’s fascia of the lower abdomen
arises from the lower end of scarpa’s fascia in the area of linea alba and inserts into the superfiicial (Colle’s) of the penis
what is the suspensory ligament of the penis
a triangular band of CT that arises from the pubic symphysis
inserts into deep fascia of the penis
what are the muscles surrounding and supporting the penis and another that is part of the urogenital diaphragm 3
bulbospongiosus
surrounds bulb of penis
compresses urethra
ischiocavernosus
erector of penis
superficial transverse perineal muscle (posterior edge of the UG diaphragm)
what is the vascular and innercation of the scrotum
vascular
- anterior scrotal branches (from external pudendal which branches form external iliac)
- posterior scrotal branches (from internal pudednal)
innervation
anterior scrotal branches from ilioinguinal nerve
posterior scrotal branches from pudendal nerve
what is the mons pubis
subcutaneous fat pad overlying pubis symphysis
in the female what muscles (4) attach to the central tendon (perineal body)
superficial and deep transverse perineal muscle
bulbospongiosus
external anal sphincter
what is the homolog of the corpus spongiosum in the female
vestibular bulbs
lie along the baes of the labia majora
cover the greater vestibular glands (bartholen’s glands)
what is the homolog of the corpora cavernosae in males that is in females
corpora cavernosa (forms clitoris)
this is 1 inch of erectile tissue buried in a prepuce that is attached to the pubic symphysis by the suspensory ligament of the clitoris
what are the muscles of the female erectile tissue
bulbospongiosus - wraps around the labia minus
ischiocavernossus - from the ischiopubic rami to the pubic arch forming the crura of the clitoris
in what part of the external genitalia in the female is the round ligament of the uterus found
labia majora –> homolog of the scrotal folds in the male
what is the homolog of the urethral folds in the female
the labia minora
what is different in the female UG diaphragm versus the male
compressor urethrae muscle is more pronounced
and there is a presence of the urethrovaginalis muscle
is there dartos fascia in the female?
no
where does the superficial dorsal vein of the urogenital area (Clitoris or penis) drain to
external pudendal vein to femoral vein
where does the deep dorsal vein of the penis/clitoris drain
prostatic plexus and pudendal plexus
which testis is lower
the left
what does the tunica vaginalis form from
processus vaginalis
partially covers the testes (almost entirely)
what is the tunica albuginae
the innermost layer of the testes
dense CT divides the organ into lobules each lobule contains: -convoluted seminiferous tubules -straight seminiferous tubules -rete testis
what are the coverings of the testes starting at skin
skin with dartos fascia and muscle dartos continuous with campers and scarpa’s fascia
external spermatic fascia
cremaster muscle
cremasteric fascia
internal spermatic fascia
tunica vaginalis
tunia albuginae
what are the parts of the epididymis
head
body
tail
where does the ductus deferens travel as it leaves the testes
passes through inguinal canal to enter pelvis
passes anteriorly to the external iliac vessels
crosses the bladder medial to the ureters
what makes the ejaculatory duct
fusion of the ductus deferens and the seminal glands
how does a congenital hydrocele occur
processus vaginalis remains patent and peritoneal fluid can accumulate in the scrotum
what nerves are contributing to the inguinal canal and spermatic cord
ilioinguinal nerve (enters inguinal canal) distributes to .... upper anterior scrotum and gives off anterior scrotal/labial nerve
genitofemoral nerve –> genital branch
passes through inguinal canal and supplies the cremastor muscle
from what does the prostate gland arise
outgrowths of prostatic urethra
what is the arterial supply to the testis and epididymis
testicular artery and vein (pampiniform plexus)
what is the arterial/vascular supply to the ductus deferens
deferential a and v.
what is the vascular supply of the prostate
inferior vesical artery
- -> capsular arteries (main portion of gland)
- -> urethral artery
Veinous drainage (to internal iliac) prostatic plexus (anterior and lateral portions) vescial plexus (to base of bladder)
from what do the seminal vesciles arise
ductus deferens
what is the genearl morphology from testis to urethra
testis epididymis ductus deferens seminal vesicles ejaculatory ducts prostatic urethra
what are the relationships of the prostate gland (anterior, posterior, superior and inferior)
relationships anteriorly - pubis posteriorly - rectum superiorly – base of bladder inferiorly - levator ani m.
what are the anatomical lobes of the prostate
anterior – isthmus (anterior to prostatic urethra)
median – area between ejac. ducts and urethra
lateral – bulging posterolateral portions
posterior – posteromedian tissue joining lateral lobes
what are the zones that clinicians use to describe the prostate
3 or 4 identified zones
peripheral zone (PZ)–> (most common site for carcinomas)
transition zone (TZ)–> most common site for BPH
central zone (CZ)–> surrounds ejaculatory ducts)
what are the 3 mesenteries that suspend the ovary
mesovarium
from broad ligament to ovary
suspensory ligament
attached to upper pole of ovary via uterine tube
ovarian ligament)
from lower end of ovary to lateral border of uterus
what are the 4 parts of the uterine tubes
infundibulum fimbriated distal end
ampulla greatest portion of tube
isthmus thick walled, constricted lumen
uterine portion within muscular wall of uterus very constricted lumen
what are the 3 parts of the uterus
fundus- portion of the body that projects above the uterine tubes
body - includes uterine cavity
cervix - muscular tubular caudal portion projecting into vagina
-os
what are 4 positions that the uterus can be in
anteverted - tilted forward on vagina
anteflexed – fundus points forward (relative to cervix)
retroverted - tilted back toward rectum
retroflexed – fundus points backward
by palpating in the vagina, what can be examined
bladder & urethra uterus, uterine tubes & ovaries small intestine loops rectum colon in rectouterine pouch
what is the vagina lined with
thin walled tube of CT and muscle
lined with stratified squamous epithelium
what are the three parts of the broad ligament
mesovarium- supports ovary
mesosalpinx- adjacent to uterine tubes
mesometrium- from uterus to lateral pelvic wall
what are the female peritoneal pouches
recto-uterine
vesico-uterine
what does the broad ligament do for the pelvis
divides female pelvis into anterior and posterior segments
what is the arterial supply to the ovary
from the ovarian artery (which is a branch of the aortal)
this artery travels in the suspensory ligament of the ovary
this anastomoses with uterine artery that sends a branch to the ovary
what is the arterial supply to the uterus
from uterine artery (a branch off the anterior division of the internal iliac)
courses through the broad ligament to the uterus
gives off two branches
- cervical branch
- vaginal branches – (main supply to vagina)
gives off two branches towards fundus of uterus
-tubal a and ovarian branch of uterine artery
what is the arterial supply of the vagina
vaginal branches of the uterine artery
vaginal artery –> usually a terminal branch of inferior vesicle
internal pudendal artery - lower portion
what is the venous drainage of the vagina
via vaginal venous plexus
most drains superiorly
lower portion drains to pudendal vv.
