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ENDO exam 2 > male and female pelvis and perineum (ketchum) > Flashcards

male and female pelvis and perineum (ketchum) Flashcards

1
Q

what are the three portions of the external anal sphincter

A

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

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2
Q

what is in the ischioanal fossa

A 
adipose tissue (ischioanal fat)
			continuation of Camper’s fascia
		internal pudendal vessels
		inferior rectal vessels
		internal pudendal nerves
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3
Q

what are the branches of the internal pudendal artery

A

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

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4
Q

where does the internal pudendal artery leave the pelvis and where does it reenter and then travel in

A

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)

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5
Q

what are the major brancehs of the pudendal nerve

A

inferior rectal

perineal

dorsal nerve of penis

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6
Q

what does the posterior femoral cutaneous contribute to perineum

A

it sends cutaneous innervation to the lateral aspects of the anal and UG diaphragms and down medial thigh

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7
Q

what are the VOLUNTARY muscles that span the UG triangle

A

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

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8
Q

what are the fascial sheaths of the UG triangle and what spaces do these fascial layers create

A

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)

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9
Q

what are the fascial layers of the urogenital diaphragm

A

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

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10
Q

what is the corpus spongiosum

what does it contain

A

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

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11
Q

what is the corpora cavernosa

what do they contain

A

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

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12
Q

what is the facia that surrounds the erectile tissue

A

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

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13
Q

what is the fundiform ligament

A

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

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14
Q

what is the suspensory ligament of the penis

A

a triangular band of CT that arises from the pubic symphysis

inserts into deep fascia of the penis

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15
Q

what are the muscles surrounding and supporting the penis and another that is part of the urogenital diaphragm 3

A

bulbospongiosus
surrounds bulb of penis
compresses urethra

ischiocavernosus
erector of penis

superficial transverse perineal muscle (posterior edge of the UG diaphragm)

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16
Q

what is the vascular and innercation of the scrotum

A

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

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17
Q

what is the mons pubis

A

subcutaneous fat pad overlying pubis symphysis

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18
Q

in the female what muscles (4) attach to the central tendon (perineal body)

A

superficial and deep transverse perineal muscle
bulbospongiosus
external anal sphincter

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19
Q

what is the homolog of the corpus spongiosum in the female

A

vestibular bulbs
lie along the baes of the labia majora
cover the greater vestibular glands (bartholen’s glands)

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20
Q

what is the homolog of the corpora cavernosae in males that is in females

A

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

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21
Q

what are the muscles of the female erectile tissue

A

bulbospongiosus - wraps around the labia minus

ischiocavernossus - from the ischiopubic rami to the pubic arch forming the crura of the clitoris

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22
Q

in what part of the external genitalia in the female is the round ligament of the uterus found

A

labia majora –> homolog of the scrotal folds in the male

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23
Q

what is the homolog of the urethral folds in the female

A

the labia minora

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24
Q

what is different in the female UG diaphragm versus the male

A

compressor urethrae muscle is more pronounced

and there is a presence of the urethrovaginalis muscle

25
Q

is there dartos fascia in the female?

A

no

26
Q

where does the superficial dorsal vein of the urogenital area (Clitoris or penis) drain to

A

external pudendal vein to femoral vein

27
Q

where does the deep dorsal vein of the penis/clitoris drain

A

prostatic plexus and pudendal plexus

28
Q

which testis is lower

A

the left

29
Q

what does the tunica vaginalis form from

A

processus vaginalis

partially covers the testes (almost entirely)

30
Q

what is the tunica albuginae

A

the innermost layer of the testes

dense CT
divides the organ into lobules
each lobule contains:
-convoluted seminiferous tubules
-straight seminiferous tubules
-rete testis
31
Q

what are the coverings of the testes starting at skin

A

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

32
Q

what are the parts of the epididymis

A

head
body
tail

33
Q

where does the ductus deferens travel as it leaves the testes

A

passes through inguinal canal to enter pelvis
passes anteriorly to the external iliac vessels
crosses the bladder medial to the ureters

34
Q

what makes the ejaculatory duct

A

fusion of the ductus deferens and the seminal glands

35
Q

how does a congenital hydrocele occur

A

processus vaginalis remains patent and peritoneal fluid can accumulate in the scrotum

36
Q

what nerves are contributing to the inguinal canal and spermatic cord

A 
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

37
Q

from what does the prostate gland arise

A

outgrowths of prostatic urethra

38
Q

what is the arterial supply to the testis and epididymis

A

testicular artery and vein (pampiniform plexus)

39
Q

what is the arterial/vascular supply to the ductus deferens

A

deferential a and v.

40
Q

what is the vascular supply of the prostate

A

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)
41
Q

from what do the seminal vesciles arise

A

ductus deferens

42
Q

what is the genearl morphology from testis to urethra

A 
testis
	epididymis
	ductus deferens
	seminal vesicles
	ejaculatory ducts
	prostatic urethra
43
Q

what are the relationships of the prostate gland (anterior, posterior, superior and inferior)

A 
relationships
		anteriorly - pubis
		posteriorly - rectum
		superiorly – base of bladder
		inferiorly - levator ani m.
44
Q

what are the anatomical lobes of the prostate

A

anterior – isthmus (anterior to prostatic urethra)

median – area between ejac. ducts and urethra

lateral – bulging posterolateral portions

posterior – posteromedian tissue joining lateral lobes

45
Q

what are the zones that clinicians use to describe the prostate

A

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)

46
Q

what are the 3 mesenteries that suspend the ovary

A

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

47
Q

what are the 4 parts of the uterine tubes

A

infundibulum fimbriated distal end

ampulla greatest portion of tube

isthmus thick walled, constricted lumen

uterine portion within muscular wall of uterus very constricted lumen

48
Q

what are the 3 parts of the uterus

A

fundus- portion of the body that projects above the uterine tubes

body - includes uterine cavity

cervix - muscular tubular caudal portion projecting into vagina
-os

49
Q

what are 4 positions that the uterus can be in

A

anteverted - tilted forward on vagina

anteflexed – fundus points forward (relative to cervix)

retroverted - tilted back toward rectum

retroflexed – fundus points backward

50
Q

by palpating in the vagina, what can be examined

A 
bladder & urethra			
uterus, uterine tubes & ovaries			
small intestine loops			
rectum			
colon in rectouterine pouch
51
Q

what is the vagina lined with

A

thin walled tube of CT and muscle

lined with stratified squamous epithelium

52
Q

what are the three parts of the broad ligament

A

mesovarium- supports ovary

mesosalpinx- adjacent to uterine tubes

mesometrium- from uterus to lateral pelvic wall

53
Q

what are the female peritoneal pouches

A

recto-uterine

vesico-uterine

54
Q

what does the broad ligament do for the pelvis

A

divides female pelvis into anterior and posterior segments

55
Q

what is the arterial supply to the ovary

A

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

56
Q

what is the arterial supply to the uterus

A

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

57
Q

what is the arterial supply of the vagina

A

vaginal branches of the uterine artery

vaginal artery –> usually a terminal branch of inferior vesicle

internal pudendal artery - lower portion

58
Q

what is the venous drainage of the vagina

A

via vaginal venous plexus

most drains superiorly

lower portion drains to pudendal vv.

ENDO exam 2 (4 decks)

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