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MLA Revision > 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
Where is deep pelvic fascia found?
Covering muscles + organs
26
Where is endopelvic fascia found?
Between layers of deep pelvic fascia
27
Where is superficial perineal fascia found?
Only in urogenital triangle - continuous with superficial fascia of abdomen. Comprises subcut fatty & membranous tissue
28
What are the two types of deep pelvic fascia?
Parietal Visceral
29
Where is parietal pelvic fascia found?
Over musculature - continuous with transversalis and iliopsoas fascia
30
Where is visceral pelvic fascia found?
Makes up adventitia of the viscera in the pelvis
31
What does endopelvic fascia form?
Ligaments between the parietal and visceral layers of the deep pelvic fascia (not true ligaments)
32
What is the function of the endopelvic fascia?
To anchor structures/organs in the pelvic cavity
33
What type of endopelvic fascia is found in men?
Retrovesical septum
34
35
What shape is the perineum?
Diamond
36
Where is the perineum found?
Superior to interior fascia of pelvic diaphragm
37
What is the perinea superficial to?
The inferior deep pelvic fascia of the pelvic diaphragm
38
What are the boundaries of the perinea?
Anterior = mons pubis (F) or root of penis (M) Lateral - medial surface of thigh Posterior - gluteal fold & inter-gluteal cleft
39
40
What are the osteological boundaries of the perinea?
Anterior - pubic symphysis Anterolateral - ischiopubic rami Posterolateral - ischial tuberosities and sacrotuberous ligament Posterior - coccyx
41
What are the two triangles of the perinea?
The urogenital and anal triangles
42
What are the two triangles of the perineal separated by?
Transverse line - which travels through the perineal body
43
What is the difference between the urogenital triangle and the anal triangle?
Urogenital has a perineal membrane - anal does not.
44
What is the purpose of the perineal membrane?
Attachment for erectile tissue
45
46
What are the contents of the urogenital triangle?
Deep perineal pouch Perineal membrane Superficial perineal pouch External genitalia
47
48
What is contained in the deep perineal pouch?
Urethra + external sphincter for urethra Neurovasculature to genitals Deep transverse perineal muscles (M) (DTP) Bulbo-urethral glands (M) - Cowper's Smooth muscle (F)
49
Where are the deep and superficial perineal pouches contained?
Deep = deep to perineal membrane Superficial = superficial to perineal membrane but deep to superficial perineal fascia
50
What are the contents of the superficial perineal pouch?
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
What overlays the corpus cavernosum?
The ischiocavernous muscle
52
What contains the corpus spongiosum?
The bulbospongious muscle
53
What are the bulbs of the vestibule in F homologue to?
The bulb of the penis Is erectile tissue but has no urethra passing through it.
54
What is another name for the greater vestibular glands?
Bartolins glands
55
What is the muscle that contracts the anal canal?
External anal sphincter
56
Which muscle compresses urethra to maintain urinary continence?
External urethral sphincter
57
Which muscle supports perineal body & pelvic floor - and compresses bulb of penis to expel last drops?
Bulbospongiosus
58
Which muscle supports the pelvic body, assists in erection of clitoris & is sphincter of vagina?
Bulbospongiosus
59
Which muscle maintains erection of penis or clitoris by compressing outflow veins?
Ischiocavernous
60
Which muscles support the pelvic body and pelvic floor - in turn supporting abdominopelvic viscera?
Superficial & Deep Transverse Perineal Muscles
61
What is the homologue of the clitoris?
Penis
62
What do the crura of the clitoris follow?
The ischiopubic ramus
63
What is bulb of vestibule homologue to?
Bulb of the penis
64
How can you tell difference between labia majora and labia minora? What is the function of both?
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
What is the opening of the vagina called?
Vestibule of the vagina
66
67
What is the function of mons pubis?
Cushioning
68
What is the bulb of vestibule?
Erectile tissue 3m long - side of vagina opening - superficial to perineal membrane
69
What is the function of the bulb of vestibule?
Erectile tissue
70
What is another name for the (1) greater vestibular and (2) lesser vestibular glands?
(1). Bartholin glands (2). Scene or para-urethral glands
71
What is the function of the greater and lesser vestibular glands?
Mucous secretion on sexual arousal
72
What does the scrotum contain?
The testis, associated ducts and neurovasculature
73
What does spermatic fascia cover? Where does it arise from?
Spermatic cord and testes Anterior abdominal lateral wall
74
What is the homologue of the scrotum?
Labia majora
75
What are the two features of the anal triangle?
Anus Ischio-anal fossae
76
77
What is the perineal body? What is it made of?
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
Which muscles converge at the perineal body?
Bulbospongiosis DTPs abd STPs. (deep and superficial transverse perineal muscle) External
79
Which muscles converge at the perineal body?
Bulbospongiosis DTPs abd STPs. (deep and superficial transverse perineal muscle) External anal sphincter Levator ani
80
What can damage to the perineal body cause?
Incontinence (both) Prolapse Sexual dysfunction
81
At what level does the abdominal aorta bifurcate and what does it form?
L4 - bifurcates into the common iliac
82
What does the common iliac bifurcate into?
Internal and external iliac arteries
83
Which are the two main arteries of the perineum?
Internal iliac artery (anterior and posterior) Gonadal artery (ovarian / testes)
84
What are the main branches of the anterior internal iliac artery?
Umbilical a. Obturator a. Uterine a. Vaginal a. Inferior vesicle a (M) Internal pudendal a. Middle rectal a. Inferior gluteal a.
85
What are the branches of the internal pudendal artery?
Inferior rectal Dorsal a. of clitoris / penis Perineal a.
86
How do the veins of the pelvis drain?
Drain into plexi --> named veins --> internal iliac vein --> IVC @ L5
87
Which nerves provide somatic sensation to the pelvis?
Obturator nerve (L2-4) Lumbosacral trunk (L4-5) Sacral plexus
88
Which spinal level does the obturator nerve arise at?
L2-4
89
Which spinal level does the lumbosacral trunk arise at?
L4-5
90
What does the obturator nerve travel with?
The obturator artery (through the obturator foramen)
91
What arises on the surface of the piriformis muscle?
Sacral plexus
92
93
What are the main branches of the sacral plexus?
Superior gluteal Inferior gluteal Posterior cutaneous of thigh Perforating cutaneous Pudendal Sciatic
94
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
1). L4-S1 2). L5-S2 3). S2-3 4). S2-3 5). S2-4 6). L4-S3
95
Which vertebral levels does the sacral plexus arise from?
L4 - S4
96
Which are the autonomic nerves of the pelvis?
Hypogastric nerve Inferior hypogastric plexus (ANS and visceral afferents) Pelvic splanchnic nerves
97
Which nerves innervate the perineum?
Ilio-inguinal n. Genital branch of genitofemoral n. Pudendal n.
98
What are the branches of the pudendal nerve?
Inferior rectal n. Dorsal n. of clitoris / penis Perineal n.
99
100
101
What are the boundaries of the greater sciatic foramen?
Greater sciatic notch Sacrotuberous ligament Sacrospinous ligament Ischial spine
102
What are the boundaries of the lesser sciatic foramen?
Lesser sciatic notch Sacrotuberous ligament Sacrospinous ligament Ischial spine Ischial tuberosity
103
What are the boundaries of the obturator foramen?
Ischiopubic ramus Superior pubic ramus Obturator membrane
104
What are the key features for sex differentiation of male and female pelvises?
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
Which aponeurotic structure attaches to the ASIS?
Inguinal ligament
106
Which bones form the pelvic girdle?
Innominate bones Sacrum Coccyx
107
What is the function of the pelvis and pelvic girdle?
Weight bearing Protection of pelvic viscera Muscle attachment of pelvis & lower limb Attachment of erectile tissue of perineum
108
What is the name of the site of convergence of the 3 bones that form the innominate bone?
Acetabulum
109
Where does the sacrospinous ligament attach?
To the lateral surface of the sacrum, coccyx & ischial spine
110
Where does the sacrotuberous ligament attach?
To the lateral surface of the sacrum, posterior surface of ilium, coccyx and ischial tuberosity
111
What are the boundaries of the pelvic inlet?
Sacral promontory Arcuate line Pecten pubis Pubic crest Pubic symphysis
112
What are the boundaries of the pelvic outlet?
Coccyx Sacrotuberous ligaments Ischial tuberosities Ischiopubic rami Pubic symphysis
113
Where is the greater (false) pelvis found?
Superior to pelvic inlet
114
Where is the lesser (true) pelvis found?
Pelvic inlet to pelvic outlet
115
Which osteological features form the linea terminalis?
Pecten pubis, pubic crest & arcuate line
116
What type of fascia invests the pelvic diaphragm?
Parietal layer of deep pelvic fascia
117
What does the deep pelvic fascia form the roof of?
Roof of perineum
118
Which structures form the pelvic floor?
Pelvic diaphragm & fascia Deep perineal pouch Perineal membrane
119
Which structures are located within the deep perineal pouch?
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
What are the endopelvic fascia ligaments in the female called?
Cardinal (transverse), uterosacral, pubocervical
121
Which tendinous structure lies in the transverse plane between the two triangles of the perineum?
Perineal body
122
What are the three types of endopelvic fascia found in women?
Uterosacral Cardinal (transverse) Pubocervical

MLA Revision (9 decks)

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