Module 3: The Pelvis and Perineum Flashcards
Parts of the bony pelvis
-greater (false) cavity
-lesser (true) cavity
Greater (false) pelvic cavity
-region above the pelvic brim
-forms lower part of abdominal cavity
-larger and sits superior to lesser cavity
Lesser (true) pelvic cavity
-below pelvic brim
-largely closed by the pelvic floor
Main difference between the male and female pelvis
-subpubic angle
Subpubic angle in females
-much larger
-90-100 degrees
Subpubic angle in males
-smaller
-70 degrees
Joints of the pelvis
-sacroiliac joint
-pubic symphysis
Sacroiliac joint
-between sacrum and ilium
Pubic symphysis
-joins right and left pubic bones
Symphysis pubis dysfunction
-during pregnancy
-the pelvic girdle becomes more relaxed and elastic as delivery nears due
-if this happens prematurely it can make the pelvic joint at the pubic symphysis unstable
Symphysis pubis dysfunction symptoms
-difficulty walking
-pain in pubic area
-pain that worsens with weight bearing
-pain in perineum
Structures of the pelvic floor
-levator ani
-coccygeus
-urogenital hiatus
-anal apertures
Levator ani
-main pelvic floor muscle
-broad muscle group situated on either side of the pelvis
Coccygeus
-this muscle makes up posterior portion of pelvic floor
Urogenital hiatus
-u-shaped opening for urethra and vagina
Anal apertures
-passage for anal canal
Puborectal sling
-some fibres of levator ani muscle form sling around rectum
-attaches to pubic bone and wraps around rectus
What does the puborectal sling help form
-anorectal flexure
Puborectal sling function
-allows contraction of muscle fibres to keep rectum closed until defacation
Pelvic organ prolapse
-if pelvic floor weakens, pelvic viscera can push against it
-results in a protrusion at or near the vaginal opening
Pelvic organ prolapse symptoms
-difficulty initiating urine flow and may strain to defecate
Female pouches of the pelvic peritoneum
-vesicouterine pouch
-rectouterine pouch
Vesicouterine pouch
-pelvic peritoneum descends form back of anterior abdominal wall onto the upper surface of the urinary bladder and then onto anterior surface of uterus
Rectouterine pouch
-continues over the fundus of the uterus and down its posterior wall to the upper part of posterior vagina
Male pelvis peritoneum
-parietal peritoneum descends from back of anterior abdominal wall to superior surface of urinary bladder
-then passes anterior to surface of rectum
Path of ureter from abdomen to pelvis
-abdominal wall
-pelvic cavity
-pelvic wall
Abdominal wall path of ureters
-as ureters descend into the pelvic cavity, they cross over the common iliac arteries
Pelvic cavity path of ureter
-continues along lateral pelvic wall to enter urinary bladder posteriorly
Pelvic wall path of ureter
-where ureters drain into the bladder
What structure crosses ureter in males
-vas deferens
What structure crosses ureter in females
-uterine artery
Urinary tract infection
-bacterial infection in any part of urinary system
Are males or females at higher risk for a UTI
-females
Why are women more at risk for UTI
-shorter urethra
Most common locations of UTI
-urethra and bladder
UTI symptoms
-burning sensation when urinating
-localized pain in bladder
Sigmoid colon
-continuation of descending colon
-forms an S-shaped loop
Rectum
-follows curvature of sacrum
-then turns into anorectal flexure at end of anal canal
Where does rectum sit in females
-posterior to uterus
Where does the rectum sit in males
-rectum sits posterior to bladder
Venous drainage of sigmoid colon and rectum
-inferior mesenteric vein
Pregnancy hemorrhoids
-veins in lower rectum become enlarged and swollen
Pregnancy hemorrhoids symptoms
-painful itchy swellings near anus
-difficulty passing stool
-blood in stool
Rectal suppositories
-solid form of medication inserted into rectum
Pathway of vas deferens
-travels through inguinal canal within spermatic cord
Epididymitis
-bacterial infection of epididymis
-may start in bladder or kidney before spreading through ejaculatory duct to vas deferens to reach epididymis
Epididymitis symptoms
-pain localized to infected testicle
-fever
-swelling
Prostate tumour
-complications arise in later stages when tumour metastasizes to nearby bladder or distant structures through bloodstream
Prostate tumour symptoms
-can continue to grown and press on prostatic urethra where it can disrupt flow of urine or semen
-difficulty urinating
-blood in urine/semen
Male reproductive vasculature
-testicular artery
-artery to vas deferens
-pampiniform plexus
-cremasteric artery
Testicular artery
-branch off abdominal aorta
Artery to vas deferens
-branch off internal iliac artery
Pampiniform plexus
-network of veins that drains venous blood from testis into testicular vein
Cremasteric artery
-supplies fascial coverings and muscle of spermatic cord
Testicular torsion
-occurs when testicles rotate, twisting spermatic cord
-if blood supply is not restored within 6 hours, can lead to testicular necrosis
Testicular torsion symptoms
-sudden severe pain
-swelling
-change in scrotum colour
-localized pain in inguinal region
Ectopic pregnancy
-egg attaches itself somewhere outside uterus, this commonly occurs in uterine tube but may also occur in other regions
Ectopic pregnancy symptoms
-normal pregnancy symptoms
-pelvic pain on affected side
-pain can become sharp if fallopian tubes burst
Arterial supply of female internal viscera
-ovarian arteries
-uterine arteries
Ovarian arteries
-lateral branches of abdominal aorta at L1
What do ovarian arteries supply
-ovaries and distal uterine tubes
Uterine arteries
-branches of internal iliac arteries
What do uterine arteries supply
-proximal uterine tubes
Venous drainage of female internal viscera
-right ovarian vein
-left ovarian vein
-uterine veins
Right ovarian vein
-drains into inferior vena cava
Left ovarian vein
-drains into left renal vein
Uterine veins
-form a plexus that drains to internal iliac veins
Ovarian cysts
-may affect surrounding structures such as the ovaries, pelvic peritoneum, and ovarian arteries
Ovarian cysts symptoms
-unilateral pelvic pain
-pain during intercourse
What shape is the perineum
-diamond
Anterior border of perineum
-pubic symphysis
Lateral border of perineum
-ischial tuberosities
Posterior border of perineum
-coccyx
Pouches of the urogenital triangle
-superficial perineal pouch
-deep perineal pouch
Superficial perineal pouch
-lies superficial to perineal membrane and contains muscle, skin, and external genitalia
Deep perineal pouch
-contains urogenital diaphragm, layer of skeletal muscle, and deep transverse perineal muscles
Perineal body
-fibromuscular mass at center of perineum which provides attachment for muscle of perineum
Ischiorectal fossa
-wedge shaped space between ischium and anal canal
Ischiorectal fossa function
-allows for expansion of anal canal during defecation
Pudendal canal location
-on lateral wall of each ischiorectal fossa
What does pudendal canal contain
-pudendal nerve and internal pudendal vessels
Ischiorectal abscesses
-abscesses that perforate laterally through external sphincter into lower ischiorectal space
Ischiorectal abscesses symptoms
-discomfort and pain while walking and sitting
-painful defecation
-site of abscess painful, swollen, and tender
Muscles of the penis
-ischiocavernosus muscles
-bulbospongiosus muscle
Ischiocavernosus muscles
-cover the 2 cura of penis
Bulbospongiosus muscle
-covers bulb of penis
Function of muscles of penis
-compress crura and bulb during erection
Balantis
-inflammation of foreskin due to infection or chronic skin condition
What population does balantis occur in
-uncircumsized men
Balantis symptoms
-pain
-redness
-swelling
-painful urination
Parts of the clitoris
-body
-glans
Body of clitoris
-right and left crus anteriorly form body
-attached to perineal membrane
Glans of the clitoris
-distal portion, on each side of vaginal orifice
-vestibular bulbs that anteriorly form the glans clitoris
Female external genitalia parts
-mons pubis
-prepuce
-frenulum
Mons pubis
-rounded mass of fatty tissues formed by union of labia majora
Prepuce
-anterior and superior to clitoris
-formed by fusion of the labia minora
Frenulum
-anterior and inferior to clitoris
-fusion of labia minora forms one frenulum
Vulvitis
-inflammation and infection of the vulva
Vulvitis symptoms
-redness and swelling of vulva
-itching and burning sensations
-white, cracked vulva
-fluid filled blisters that break open, ooze and crust over
The greater vestibular glands
-lie posterior to the bulbs of the vestibule on each side of vaginal orifice
What happens to the greater vestibular glands during sexual arousal
-produce a mucus that is carried by ducts
Muscles of the clitoris
-ischiocavernosus muscles
-bulbospongiosus muscles
Ischiocavernosus muscles
-cover the crura of the clitoris
Bulbospongiosus muscles
-cover the bulbs of the vestibules and greater vestibular glands
Vasculature of pelvis and perineum
-umbilical artery
-inferior vesicle
-internal pudendal artery
Umbilical artery
-transport deoxygenated blood from fetus to placenta, the proximal branches of the umbilical artery becomes the superior vesicle artery that supplies the upper part of the bladder
Inferior vesicle
-supplied structures such as bladder, ureter, seminal vesicles, prostate, and ductus deferens
Internal pudendal artery
-exits through the greater sciatic foramen and enters the lesser sciatic foramen to the perineum through the pudendal canal
What does the internal pudendal artery supply
-supplies skin and muscles of the anal triangle, urogenital triangle, and associated erectile bodies
Priapism
-common side effect of drug use and is a medical emergency
-the prolonged and erection of the penis or clitoris
Priapism symptoms female
-red and swollen
Priapism symptoms male
-glans and shaft may become large and swollen
