Pelvic floor& Peritoneum

Question 1

Role of pelvic diaphragm

Answer 1

Continence and defaceation

Question 2

Name the layers of the levator ani muscles from anterior to posterior

Answer 2

Levator prostate/sphincter vagina
Puborectalis
Pubococcygeus
Iliococcygeus
Ischiococcygeus

Question 3

What forms a sling around the junction between rectum and anal canal?

Answer 3

Puborectalis

Question 4

What forms a sling around prostate/vagina?

Answer 4

Levator prostate/sphincter vagina

Question 5

What is closely related to the ischiococcygeus muscle?

Answer 5

Sacrospinous ligament

Question 6

What is the ischiococcygeus also known as?

Answer 6

Coccygeus muscle

Tail wagging muscle (can flex coccyx)

Question 7

What is found around the levator ani muscle?

Answer 7

Ligaments
Puboprostatic/pubovesical
Pubocervical& sacrocervical

Question 8

What is the perineum?

Answer 8

Region inferior to the pelvic diaphragm
Overlies outlet of bony pelvis
Diamond shaped

Question 9

Describe the perineum

Answer 9

Diamond shaped 
Anteriorly pubic symphysis
Posteriorly coccyx
Laterally ischial tuberosities
Split into anal triangle and urogenital triangle

Question 10

What is the perineal membrane?

Answer 10

Strong CT sheet which stretches across the urogenital triangle between ischiopubic rami

Question 11

What is the external sphincter of the bladder also known as?

Answer 11

Sphincter urethrae
Found deep to perineal membrane
Maintains urinary continence

Question 12

What is the perineum overlying the anal triangle called?

Answer 12

Ischioanal fossae (one on each side of anal canal)

Question 13

What is found in the deep perineal pouch?

Answer 13

Vagina and urethra/ membranous urethra

Sphincter urethrae muscle and deep transverse perineal muscles

Question 14

What passes through the small gap in perineal membrane just behind the pubic symphysis?

Answer 14

Veins from penis/clitoris

Join prostatic/vesical plexus

Question 15

Where does the perineal body lie in females?

Answer 15

In the midline between lower end of vagina and anal canal

Question 16

What is the perineal body?

Answer 16

Small wedge shaped mass of fibrous tissue

Attached to perineal membrane, levator ani and perineal muscles

Question 17

What lies in the superficial perineal pouch in males?

Answer 17

2 corpora cavernosa diverge from each other as the 2 crura of the penis
Between 2 crura is enlarged proximal end of corpus spongiosum= bulb of penis

Question 18

What forms the root of the penis?

Answer 18

The crura and the bulb of the penis

Attaches the penis firmly to the body via ischiopubic rami and perineal membrane

Question 19

Where is the urethra found in the penis?

Answer 19

In the corpus spongiosum

Question 20

What muscle covers each crus of the penis?

Answer 20

Ischiocavernosus muscle

Question 21

What muscle is found on the under surface of the bulb of the penis? function?

Answer 21

Bulbospongiousus muscle
Helps maintain erection, functions in ejaculation with the ischiocavernosus muscles
Expels last drops of urine in micturition

Question 22

What muscle helps maintain the position of the perineal body in males?

Answer 22

Superficial transverse perineal muscles

Question 23

Where is the urethral orifice in a female?

Answer 23

Small opening just anterior to vagina

Question 24

What is found on each side of the lower end of the vagina?

Answer 24

A mass of erectile tissue- the bulb of the vestibule

Join together anteriorly

Question 25

What forms the body of the clitoris?

Answer 25

2 erectile corpora cavernosa- continuous with 2 crura attached to ischiopubic rami

Question 26

Name the superficial perineal muscles in a female

Answer 26

Superficial transverse perineal muscles (separated by perineal body) Ischiocavernosus muscle (around crus of clitoris) Bulbospongiosum (encircles lower end of vagina superficial to bulb of vestibule)

Question 27

What is the bulbospongiosus muscle also called?

Answer 27

Sphincter vaginae (part of levator ani)

Question 28

What is found deep to the bulb of vestibule?

Answer 28

Greater vestibular gland- secretes mucus via a duct into vestibule

Question 29

Describe the borders of the ischioanal fossae

Answer 29

Laterally- fascia covering Obturator internus Medially- fascia in inferior surface of levator ani posteriorly- sacrotuberous ligament anteriorly- urogenital triangle

Question 30

What is found within the ischioanal fossa?

Answer 30

Fat and CT fibres Pudendal nerve passes along lateral wall in pudendal canal Internal pudendal artery

Question 31

What does the pudendal nerve divide Ito near the posterior border of the urogenital triangle?

Answer 31

Branch to penis/clitoris Perineal nerve to muscles of deep and sup perineal spaces+ sensory to skin of perineum and posterior surface of scrotum/labia majors

Question 32

What does the internal pudendal artery split up into at posterior border of urogenital triangle?

Answer 32

Deep and dorsal arteries of penis/clitoris

Question 33

Describe venous drainage of penis

Answer 33

Deep dorsal vein-> prostatic venous plexus | Superficial vein-> superficial veins of upper thigh

Question 34

How do you find the ischioanal fossa?

Answer 34

Reflect back the gluteus Maximus | Found on each side of the anal canal

Question 35

What are the consequences of pudendal nerve damage?

Answer 35

Genital numbness | Fecal& urinary incontinence

Question 36

In labour, what pain would still be felt after a pudendal nerve block and why?

Answer 36

Only anaesthetises post perineum Pain in anterior perineum (ilioinguinal and genitofemoral nerves) Pain of uterine contraction and cervical dilation (T10-L2 sympathetics)