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RE > Pelvic Floor and Perinea > Flashcards

Pelvic Floor and Perinea Flashcards

1
Q

What is the musculature of the floor of the pelvis called?

A

Pelvic diaphragm

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2
Q

What dorms the boundary between the true pelvis and perineum?

A

Pelvic diaphragm

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3
Q

Which two muscular structures make up the pelvic diaphragm?

A

Coccygeus
Levator ani

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4
Q
A
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5
Q

Which three muscles make up the levator ani?

A

Puborectalis
Pubococcygeus
Iliococcygeus

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6
Q
A
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7
Q

What is the function of levator ani?

A
  • Support of abdomen-pelvic viscera
  • Urinary and faecal incontinence
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8
Q

Which muscles form the pelvic
- lateral wall
- posterolateral wall

A

Lateral wall = obturator internus

Posterolateral = piriformis

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9
Q

Where does the piriformis muscle arise from?

A

Sacrum

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10
Q

What is found on the anterior surface of the piriformis muscle?

A

Sacral plexus

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11
Q

What does the obturator internus attach to?

A

Pelvic surfaces of ilium & ischium
Obturator membrane

Greater trochanter of femur

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12
Q

What is the nerve supply to obturator internus?

A

L5, S1 & S2

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13
Q

What is the action of the obturator internus?

A

Rotates hip joint laterally
Holds head of femur in acetabulum

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14
Q

What does the piriformis muscle attach to?

A

Proximally =
S2-S4, greater sciatic notch and sacrotuberous ligament

Distally - greater trochanter of femur

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15
Q

What is the nerve supply to the piriformis?

A

Anterior rami S1-2

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16
Q

What is the function of the piriformis?

A

Rotates hip laterally & abducts
Holds head of femur in acetabulum

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17
Q

What are the attachments of the coccygeus muscle?

A

Proximal = Ischial spine
Distal = Inferior end of sacrum and coccyx

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18
Q

What is the nerve supply to the piriformis muscle?

A

S4-5

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19
Q

What is the function of the coccygeus?

A

Pelvic diaphragm (small part)

Flexion of coccyx

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20
Q

What are the attachments of levator ani?

A

Proximal = body of pubis, obturator fascia, ischial spine

Distal = perineal body, coccyx, an-coccygeal ligament, walls of prostate/vagina, rectum & anal canal

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21
Q

What is the nerve supply to the levator ani?

A

Levator ani nerve (S3-4 branches) + Inferior anal nerve and coccygeal plexus

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22
Q

What is the function of the levator ani?

A

Pelvic diaphragm (majority of it) + resists increases in abdominal pressure

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23
Q
A
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24
Q

What are the three types of pelvic fascia?

A

Deep pelvic fascia
Endopelvic fascia
Superficial perineal fascia

(Is also superficial fascia which lines the abdominal wall - Camper’s and Scarpa’s)

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25
Q

Where is deep pelvic fascia found?

A

Covering muscles + organs

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26
Q

Where is endopelvic fascia found?

A

Between layers of deep pelvic fascia

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27
Q

Where is superficial perineal fascia found?

A

Only in urogenital triangle - continuous with superficial fascia of abdomen. Comprises subcut fatty & membranous tissue

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28
Q

What are the two types of deep pelvic fascia?

A

Parietal
Visceral

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29
Q

Where is parietal pelvic fascia found?

A

Over musculature - continuous with transversalis and iliopsoas fascia

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30
Q

What are the three types of endopelvic fascia found in women?

A

Uterosacral
Cardinal (transverse)
Pubocervical

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30
Q

Where is visceral pelvic fascia found?

A

Makes up adventitia of the viscera in the pelvis

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31
Q

What does endopelvic fascia form?

A

Ligaments between the parietal and visceral layers of the deep pelvic fascia (not true ligaments)

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32
Q

What is the function of the endopelvic fascia?

A

To anchor structures/organs in the pelvic cavity

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33
Q

What type of endopelvic fascia is found in men?

A

Retrovesical septum

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34
Q
A
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35
Q

What shape is the perineum?

A

Diamond

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36
Q

Where is the perineum found?

A

Superior to interior fascia of pelvic diaphragm

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37
Q

What is the perinea superficial to?

A

The inferior deep pelvic fascia of the pelvic diaphragm

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38
Q

What are the boundaries of the perinea?

A

Anterior = mons pubis (F) or root of penis (M)

Lateral - medial surface of thigh

Posterior - gluteal fold & inter-gluteal cleft

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39
Q
A
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40
Q

What are the osteological boundaries of the perinea?

A

Anterior - pubic symphysis

Anterolateral - ischiopubic rami

Posterolateral - ischial tuberosities and sacrotuberous ligament

Posterior - coccyx

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41
Q

What are the two triangles of the perinea?

A

The urogenital and anal triangles

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42
Q

What are the two triangles of the perineal separated by?

A

Transverse line - which travels through the perineal body

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43
Q

What is the difference between the urogenital triangle and the anal triangle?

A

Urogenital has a perineal membrane - anal does not.

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44
Q

What is the purpose of the perineal membrane?

A

Attachment for erectile tissue

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45
Q
A
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46
Q

What are the contents of the urogenital triangle?

A

Deep perineal pouch
Perineal membrane
Superficial perineal pouch
External genitalia

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47
Q
A
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48
Q

What is contained in the deep perineal pouch?

A

Urethra + external sphincter for urethra
Neurovasculature to genitals
Deep transverse perineal muscles (M) (DTP)
Bulbo-urethral glands (M) - Cowper’s
Smooth muscle (F)

49
Q

Where are the deep and superficial perineal pouches contained?

A

Deep = deep to perineal membrane

Superficial = superficial to perineal membrane but deep to superficial perineal fascia

50
Q

What are the contents of the superficial perineal pouch?

A

Superficial transverse perineal muscles (STPs)
Neurovasculature (deep perineal branches)

Root of penis (bulb & crura) + musculature (M)
Spongy urethra (M)

Clitoris & musculature (F)
Greater vestibular gland (F)
Bulbs of vestibule & musculature (F)

51
Q

What overlays the corpus cavernosum?

A

The ischiocavernous muscle

52
Q

What contains the corpus spongiosum?

A

The bulbospongious muscle

53
Q

What are the bulbs of the vestibule in F homologue to?

A

The bulb of the penis

Is erectile tissue but has no urethra passing through it.

54
Q

What is another name for the greater vestibular glands?

A

Bartolins glands

55
Q

What is the muscle that contracts the anal canal?

A

External anal sphincter

56
Q

Which muscle compresses urethra to maintain urinary continence?

A

External urethral sphincter

57
Q

Which muscle supports perineal body & pelvic floor - and compresses bulb of penis to expel last drops?

A

Bulbospongiosus

58
Q

Which muscle supports the pelvic body, assists in erection of clitoris & is sphincter of vagina?

A

Bulbospongiosus

59
Q

Which muscle maintains erection of penis or clitoris by compressing outflow veins?

A

Ischiocavernous

60
Q

Which muscles support the pelvic body and pelvic floor - in turn supporting abdominopelvic viscera?

A

Superficial & Deep Transverse Perineal Muscles

61
Q

What is the homologue of the clitoris?

A

Penis

62
Q

What do the crura of the clitoris follow?

A

The ischiopubic ramus

63
Q

What is bulb of vestibule homologue to?

A

Bulb of the penis

64
Q

How can you tell difference between labia majora and labia minora?

What is the function of both?

A

Labia majora -outer - fatty, subcutaneous tissue - hair covered. Contain sebaceous glands.

Labia minora - inner, thinner, not fat filled, no hair

Both protect external genitalia

65
Q

What is the opening of the vagina called?

A

Vestibule of the vagina

66
Q
A
67
Q

What is the function of mons pubis?

A

Cushioning

68
Q

What is the bulb of vestibule?

A

Erectile tissue 3m long - side of vagina opening - superficial to perineal membrane

69
Q

What is the function of the bulb of vestibule?

A

Erectile tissue

70
Q

What is another name for the (1) greater vestibular and (2) lesser vestibular glands?

A

(1). Bartholin glands

(2). Scene or para-urethral glands

71
Q

What is the function of the greater and lesser vestibular glands?

A

Mucous secretion on sexual arousal

72
Q

What does the scrotum contain?

A

The testis, associated ducts and neurovasculature

73
Q

What does spermatic fascia cover?
Where does it arise from?

A

Spermatic cord and testes
Anterior abdominal lateral wall

74
Q

What is the homologue of the scrotum?

A

Labia majora

75
Q

What are the two features of the anal triangle?

A

Anus
Ischio-anal fossae

76
Q
A
77
Q

What is the perineal body?

What is it made of?

A

The site of convergence of the muscles of the pelvis & perineum = a central tendon in the perineum.

Made of collagen and elastic fibres + smooth & skeletal muscle fibres

78
Q

Which muscles converge at the perineal body?

A

Bulbospongiosis
DTPs abd STPs. (deep and superficial transverse perineal muscle)
External

79
Q

Which muscles converge at the perineal body?

A

Bulbospongiosis
DTPs abd STPs. (deep and superficial transverse perineal muscle)
External anal sphincter
Levator ani

80
Q

What can damage to the perineal body cause?

A

Incontinence (both)
Prolapse
Sexual dysfunction

81
Q

At what level does the abdominal aorta bifurcate and what does it form?

A

L4 - bifurcates into the common iliac

82
Q

What does the common iliac bifurcate into?

A

Internal and external iliac arteries

83
Q

Which are the two main arteries of the perineum?

A

Internal iliac artery (anterior and posterior)
Gonadal artery (ovarian / testes)

84
Q

What are the main branches of the anterior internal iliac artery?

A

Umbilical a.
Obturator a.
Uterine a.
Vaginal a.
Inferior vesicle a (M)
Internal pudendal a.
Middle rectal a.
Inferior gluteal a.

85
Q

What are the branches of the internal pudendal artery?

A

Inferior rectal
Dorsal a. of clitoris / penis
Perineal a.

86
Q

How do the veins of the pelvis drain?

A

Drain into plexi –> named veins –> internal iliac vein –> IVC @ L5

87
Q

Which nerves provide somatic sensation to the pelvis?

A

Obturator nerve (L2-4)
Lumbosacral trunk (L4-5)
Sacral plexus

88
Q

Which spinal level does the obturator nerve arise at?

A

L2-4

89
Q

Which spinal level does the lumbosacral trunk arise at?

A

L4-5

90
Q

What does the obturator nerve travel with?

A

The obturator artery (through the obturator foramen)

91
Q

What arises on the surface of the piriformis muscle?

A

Sacral plexus

92
Q
A
93
Q

What are the main branches of the sacral plexus?

A

Superior gluteal
Inferior gluteal
Posterior cutaneous of thigh
Perforating cutaneous
Pudendal
Sciatic

94
Q

What spinal levels do the following nerves arise from?

1). Superior gluteal
2). Inferior gluteal
3). Posterior cutaneous of thigh
4) Perforating cutaneous
5). Pudendal
6) Sciatic

A

1). L4-S1
2). L5-S2
3). S2-3
4). S2-3
5). S2-4
6). L4-S3

95
Q

Which vertebral levels does the sacral plexus arise from?

A

L4 - S4

96
Q

Which are the autonomic nerves of the pelvis?

A

Hypogastric nerve
Inferior hypogastric plexus (ANS and visceral afferents)
Pelvic splanchnic nerves

97
Q

Which nerves innervate the perineum?

A

Ilio-inguinal n.
Genital branch of genitofemoral n.
Pudendal n.

98
Q

What are the branches of the pudendal nerve?

A

Inferior rectal n.
Dorsal n. of clitoris / penis
Perineal n.

99
Q
A
100
Q
A
101
Q

What are the boundaries of the greater sciatic foramen?

A

Greater sciatic notch
Sacrotuberous ligament
Sacrospinous ligament
Ischial spine

102
Q

What are the boundaries of the lesser sciatic foramen?

A

Lesser sciatic notch
Sacrotuberous ligament
Sacrospinous ligament
Ischial spine
Ischial tuberosity

103
Q

What are the boundaries of the obturator foramen?

A

Ischiopubic ramus
Superior pubic ramus
Obturator membrane

104
Q

What are the key features for sex differentiation of male and female pelvises?

A
  1. Pubic arch - ischiopubic rami - wider in F then M
  2. Subpubic angle - 80-85° F, 50-60° M
  3. Pelvic inlet / pelvic brim - round in F, heart in M
  4. Sacral promontory projection - sticks out further in M
  5. Ischial spine projection - sticks out further in M
105
Q

Which aponeurotic structure attaches to the ASIS?

A

Inguinal ligament

106
Q

Which bones form the pelvic girdle?

A

Innominate bones
Sacrum
Coccyx

107
Q

What is the function of the pelvis and pelvic girdle?

A

Weight bearing
Protection of pelvic viscera
Muscle attachment of pelvis & lower limb
Attachment of erectile tissue of perineum

108
Q

What is the name of the site of convergence of the 3 bones that form the innominate bone?

A

Acetabulum

109
Q

Where does the sacrospinous ligament attach?

A

To the lateral surface of the sacrum, coccyx & ischial spine

110
Q

Where does the sacrotuberous ligament attach?

A

To the lateral surface of the sacrum, posterior surface of ilium, coccyx and ischial tuberosity

111
Q

What are the boundaries of the pelvic inlet?

A

Sacral promontory
Arcuate line
Pecten pubis
Pubic crest
Pubic symphysis

112
Q

What are the boundaries of the pelvic outlet?

A

Coccyx
Sacrotuberous ligaments
Ischial tuberosities
Ischiopubic rami
Pubic symphysis

113
Q

Where is the greater (false) pelvis found?

A

Superior to pelvic inlet

114
Q

Where is the lesser (true) pelvis found?

A

Pelvic inlet to pelvic outlet

115
Q

Which osteological features form the linea terminalis?

A

Pecten pubis, pubic crest & arcuate line

116
Q

What type of fascia invests the pelvic diaphragm?

A

Parietal layer of deep pelvic fascia

117
Q

What does the deep pelvic fascia form the roof of?

A

Roof of perineum

118
Q

Which structures form the pelvic floor?

A

Pelvic diaphragm & fascia
Deep perineal pouch
Perineal membrane

119
Q

Which structures are located within the deep perineal pouch?

A

Deep transverse perineal muscles (skeletal muscle – male, smooth muscle – female),
External urethral sphincter,
Urethra
Neurovasculature to penis or clitoris,
Bulbo-urethral glands (Cowper’s)

120
Q

What are the endopelvic fascia ligaments in the female called?

A

Cardinal (transverse), uterosacral, pubocervical

121
Q

Which tendinous structure lies in the transverse plane between the two triangles of the perineum?

A

Perineal body

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