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GIGU Exam 2 > Pelvic & Perineal Myology > Flashcards

Pelvic & Perineal Myology Flashcards

1
Q

Components of the Lateral Pelvic Wall

A
  • Obturator Internus Muscle
  • Obturator Fascia
  • Pudendal Canal
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2
Q

Lateral Pelvic Wall: Obturator Internus Muscle

A
  • Found don the lateral pelvic walls
  • At the posterior aspect of the os coxa, the muscle tendon forms (muscles runs towards the sacrum and coccyx)
  • This tendon passes thru the lesser sciatic foramen and attaches to the greater trochanter of the femur
  • Obturator canal is associated with the muscle’s superior origin, allowing neurovasculature to pass thru
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3
Q

Obturator Internus Muscle: Origin and Insertion

A
  • Origin: pelvic surface of the ilium and ischium, and obturator membrane
  • Insertion: Greater Trochanter of the Femur
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4
Q

Obturator Internus Muscle: Innervation

A

Nerve to Obturator Internus

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5
Q

Obturator Internus Muscle: Action

A

Rotates the thigh laterally, helps hold the femur head in the acetabulum

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6
Q

Obturator Fascia

A
  • Covers the medial aspect of the obturator internus muscle and divides the obturator internus muscle into a superior pelvic portion and an inferior perineal portion
  • Has a thickened central tendon that provides the attachment point for the muscles that create the pelvic diaphragm or pelvic floor – called the tendinous arch of the levator ani; creates the pudendal canal inferiorly
  • This fascia is continuous with the transversalis fascia from the abdomen
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7
Q

Obturator Fascia: Pudendal Canal (Alcock’s Canal)

A
  • Space that runs inside the obturator fascia in its inferior (perineal) aspect within the ischioanal fossa
  • Provides the passageway for the internal pudendal vessels and pudendal nerve
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8
Q

Posterior Pelvic Wall

A

Part of the pelvis is formed by the sacrum, coccyx, SI Joint, associated ligaments, and the piriformis

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9
Q

Piriformis Muscle: Origin and Insertion

A
  • Origin: Pelvic surface of S2-S4 vertebrae, the superior margin of the greater sciatic notch, and sacrotuberous ligament
  • Insertion: Greater Trochanter of the Femur
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10
Q

The Piriformis moves passes through the ___ ____ ____ and sits below the __ ___

A
  • Greater Sciatic Foramen
  • Sacral Plexus
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11
Q

Piriformis: Innervation

A

N to the Piriformis

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12
Q

Piriformis: Action

A

Laterally rotates and abducts the thigh, helps with holding the femur head in the acetabulum

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13
Q

Pelvic Floor (Pelvic Diaphram)

A

The bottom of the lesser pelvis is filled by a bowl or funnel-shaped pelvic diaphragm created by muscles and fasica

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14
Q

Muscles of the Pelvic Diaphragm

A
  • Levator Ani (Puborectalis M, Pubococcygeus M, Iliococcygeus M)
  • Coccygeus M
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15
Q

Levator Ani

A
  • Group of three thin, sheet-like muscles that create the internal pelvic floor
  • It is contracted to ensure support to the pelvic viscera but relaxes during urination and defecation
  • Muscles run from the Obturator Fascia (tendinous arch of levator ani) and the pubis to the ischial spine, separating the obturator internus muscle into a pelvic and perineal portion
  • Contains a gap anteriorly (Urogenital Hiatus) and a gap posteriorly (Rectal Hiatus)
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16
Q

Levator Ani: Urogenital Hiatus

A
  • Anterior, near the pubic bones
  • Allows the urethra and vagina room to pass through the pelvic diaphragm
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17
Q

Levator Ani: Rectal Hiatus

A
  • Posterior
  • Opening for the rectum
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18
Q

Levator Ani: Iliococcygeus Muscle

A
  • The posterolateral part of the Levator Ani complex, closest to the Coccygeus muscle
  • Runs from the posterior tendinous arch of the levator ani to the ischial spine
  • Development of this muscle is variable and can appear more tendon-like than muscle in the body
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19
Q

Iliococcygeus Muscle: Origin and Insertion

A
  • Origin: Posterior part of the tendinous arch of the Obturator Fascia and Ischial Spine
  • Insertion: Coccyx and Anococcygeal Ligament (Anococcygeal Body)
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20
Q

Iliococcygeus Muscle: Innervation

A
  • N to Levator Ani (S4)
  • Inferior Rectal N
  • Coccygeal Plexus Branches
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21
Q

Iliococcygeus Muscle: Action

A

Supports pelvic viscera and resists increase in intra-abdominal pressure

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22
Q

Levator Ani: Puborectalis Muscle

A
  • Medial muscle in the levator ani group
  • Forms a sling (puborectal sling) that encircles the anorectal junction (passes thru rectal hiatus)
  • Thick, narrow, medial most part of levator ani
  • Helps with fecal incontinence and relaxes during defecation
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23
Q

Puborectalis Muscle: Origin and Insertion

A
  • Origin: Posterior Pubic Bone (body)
  • Insertion: External Wall of the Rectum and Anal Canal
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24
Q

Puborectalis Muscle: Innervation

A
  • N to the Levator Ani (S4)
  • Inferior Rectal N
  • Coccygeal Plexus Branches
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25
Q

Puborectalis Muscle: Action

A
  • Maintains anorectal flexure
  • Supports pelvic viscera
  • Resists increases in intra-abdominal pressure
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26
Q

Levator Ani: Pubococcygeus M

A
  • Thin, wide, intermediate part (main) of the Levator Ani
  • Located between the Iliococcygeus and Puborectalis
  • Comes together to form the anococcygeal body (anococcygeal ligament) that runs between the anus and the coccyx
  • It has accessory muscle slips associated with it that are named based on where the muscle terminates
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27
Q

Accessory Muscles Slips of the Pubococcygeus M

A
  • Pubovaginalis M
  • Puboprostaticus (Levator Prostate) M
  • Puboperinealis M
  • Puboanalis M
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28
Q

Pubococcygeus Muscle: Origin and Insertion

A
  • Origin: Posterior aspect of pubis (body), anterior most part of the tendinous arch of obturator fascia
  • Insertion: Coccyx, Anococcygeal body, contralateral Pubococcygeus M
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29
Q

Pubococcygeus Muscle: Innervation

A
  • N to Levator Ani (S4)
  • Inferior Rectal N
  • Coccygeal Plexus Branches
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30
Q

Pubococcygeus Muscle: Action

A
  • Supports pelvic viscera
  • Resists increases in intra-abdominal pressure
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31
Q

Pubococcygeus Muscle: Pubovaginalis

A

Small slips of pubococcygeus muscle near the vagina (Female only)

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32
Q

Pubococcygeus Muscle: Puboprostaticus (Levator Prostate)

A

Small slips of pubococcygeus muscle near the prostate (Male only)

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33
Q

Pubococcygeus Muscle: Puboperinealis

A

Small slips of pubococcygeus muscle towards the midline between the urethra and anus

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34
Q

Pubococcygeus Muscle: Puboanalis

A

Small slips of pubococcygeus muscle near the anus

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35
Q

Perineal Triangle

A
  • These are the two divisions of the shallow compartment (perineum) between the thighs, below the inferior aspect of the pelvis
  • Contains the genitalia and orifices for the pelvic organs to exit the body
  • Divided into triangle-like areas by an imaginary line drawn at the ischial tuberosities (interischial line)
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36
Q

Urogenital Triangle

A
  • Triangular area of the perineum that lies anterior to an imaginary line drawn between the ischial tuberosities (inter-ischial line)
  • Located anterior to the anal triangle
  • Separated from the anal triangle by the perineal body and the pelvic floor muscles by the perineal membrane
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37
Q

Components of the Urogenital Triangle

A
  • Urethra
  • Root of penis and scrotum (males)
  • Vagina, labia, clitoris (females)
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38
Q

Perineal Membrane

A
  • Component of Urogenital Triangle
  • Tough fascia that runs between the pubic arches, separating the anterior perineum from the pelvic floor and closing part of the pelvic aperture
  • Urethra and vagina perforate the membrane to reach the perineum (urogenital hiatus)
  • Erectile tissues associated with the perineum attach to the membrane as well as the associated ischiopubic rami for support
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39
Q

Deep Perineal Space

A
  • Located between the inferior fascia of the pelvic diaphragm and the perineal membrane
  • Runs laterally towards the obturator’s inferior (perineal portion) fascia
  • Within the area, one finds a portion of the urethra, external urethral sphincter muscle, deep transverse perineal muscle, and ischioanal fat; in males it also contains the bulbourethral gland and dorsal neurovasculature to the penis; in females it also contains the dorsal neurovasculature for the clitoris
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40
Q

Superficial Perineal Space

A
  • Potential space between the perineal fascia and perineal membrane
  • Lies between the ischiopubic rami
  • Includes: superficial transverse perineal muscles, ischiocavernosus muscle, bulbospongiosus muscle, perineal neurovasculature (internal pudendal vessels, pudendal N); in males it also contains the root of the penis an spongy urethra; in females it also contains the clitoris, bulb of the vestibule and greater vestibular glands
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41
Q

Components of Deep Perineal Space: Females

A
  • Portion of urethra
  • External Urethral Sphincter muscle
  • Deep Transverse Perineal muscle
  • Ischioanal Fat
  • Dorsal Neurovasculature for the Clitoris
42
Q

Components of Deep Perineal Space: Males

A
  • Portion of urethra
  • External Urethral Sphincter muscle
  • Deep Transverse Perineal muscle
  • Ischioanal Fat
  • Bulbourethral Gland
  • Dorsal Neurovasculature to the Penis
43
Q

Components of the Superficial Perineal Space: Females

A
  • Clitoris
  • Bulb of the Vestibule
  • Greater Vestibular Glands
  • Superficial Transverse Perineal muscles
  • Ischiocavernosis muscle
  • Bulbospongiosus muscle
  • Perineal Neurovasculature (Internal Pudendal vessels, Pudendal N)
44
Q

Components of the Superficial Perineal Space: Males

A
  • Root of the Penis
  • Spongy Urethra
  • Superficial Transverse Perineal muscles
  • Ischiocavernosis muscle
  • Bulbospongiosus muscle
  • Perineal Neurovasculature (Internal Pudendal vessels, Pudendal N)
45
Q

Perineal Body

A
  • Central tendon of the perineum
  • Located between the ischial tuberosities
  • Helps to separate the anal from the urogenital triangle
  • Not consistent between people, and varies in size and thickness
  • Found within the superficial perineal space along the same plane as the superficial perineal muscle
46
Q

Perineal Body: Contents

A
  • Collagen
  • Elastic Fibers
  • Smooth muscle
  • Superficial Transverse Perineal muscle
47
Q

Anal Canal

A
  • Area located in the posterior perineum behind the inter-ischial line
  • Includes: anal canal, anal sphincters, pudendal canal, ischioanal (ischiorectal) fossa
48
Q

Anal Triangle: Ischioanal Fossa (Ischiorectal Fossa)

A
  • Space that runs from the wall of the anal canal to the pelvic diaphragm; also runs anteriorly and travels above the perineal membrane
  • It is part of the deep perineal pouch
  • Filled with loose concective tissue (adipose) that enables the anal canal to expand during defecation
  • Provides passage for neurovasculature to the anal canal and perineum
49
Q

Deep Perineal Muscles

A

Muscles that lie between the inferior aspect of the pelvic diaphragm muscles fascia and the perineal membrane

50
Q

What are the Deep Perineal Muscles?

A
  • External Urethral Sphincter
  • Deep Transverse Perineal M
  • External Anal Sphincter
  • Internal Anal Spincter
51
Q

Deep Perineal Muscle: External Urethral Sphincter

A
  • Compresses the urethra to maintain urinary continence
  • When it relaxes urine can be released from the body
  • Considered part of the deep perineal pouch (deep to the perineal membrane)
  • Found in the urogenital triangle
52
Q

External Urethral Sphincter: Origin and Insertion

A
  • Origin: Urethra
  • Insertion: Urethra
53
Q

External Urethral Sphincter: Innervation

A

Dorsal N of the Penis (M) or Clitoris (F)

54
Q

External Urethral Sphincter: Action

A

Constricts urethra maintaining urinary continence

55
Q

Deep Perineal Muscle: Deep Transverse Perineal Muscle

A
  • MALES ONLY!
  • Works with the superficial transverse perineal muscle to help in stabilizing the floor of the perineum including during an erection
  • Broad
  • Lies above the perineal membrane in the urogenital triangle
56
Q

Deep Transverse Perineal Muscle: Origin and Insertion

A
  • Origin: Internal surface of the Ischiopubic Ramus and Ischial Tuberosity
  • Insertion: Perineal Body, External Anal Sphincter, Median Raphe
57
Q

Deep Transverse Perineal Muscle: Innervation

A

Deep Perineal N

58
Q

Deep Transverse Perineal Muscle: Action

A
  • Supports and stabilizes the perineal body and pelvic floor
  • Resists increased intra-abdominal pressure
59
Q

Deep Perineal Muscle: External Anal Sphincter

A
  • Located in the anal triangle
  • Made of skeletal muscle that relaxes via conscious control to allow for defecation
  • Can be divided into subcutaneous, superficial, and deep parts
60
Q

External Anal Sphincter: Origin and Insertion

A
  • Origin: Skin and fascia surrounding the anus and anococcygeal body
  • Insertion: Perineal Body
61
Q

External Anal Sphincter: Innervation

A

Inferior Rectal N

62
Q

External Anal Sphincter: Action

A
  • Constricts the anal canal during peristalsis to resist defecation
  • Helps support and fix the perineal body
63
Q

Deep Perineal Muscle: Internal Anal Sphincter

A
  • Involuntary sphincter surrounding superior 2/3 of anal canal
  • Thickening of circular muscular layer; made of smooth muscle
  • Innervated by parasympathetic fibers from Pelvic Splanchnic Nerves
  • Maintains tonic contraction until the rectum becomes full
64
Q

Superficial Perineal Muscles

A
  • Located in the superficial perineal pouch
  • Space that lies between the perineal fascia and the perineal membrane
  • Most superficial layer of muscle
65
Q

What are the Superficial Perineal Muscles?

A
  • Superficial Transverse Perineal Muscle
  • Bulbospongiosus Muscle
  • Ischiocavernosus Muscle
66
Q

Superficial Transverse Perineal Muscle

A
  • Attaches to the perineal body and runs transversely across the perineal membrane to support the structure
  • Helps to stabilize the perineum during erections
  • Located in the superficial perineal pouch and helps to visually separate the triangles
67
Q

Superficial Transverse Perineal Muscle: Origin and Insertion

A
  • Origin: internal surface of the ischiopubic ramus and ischial tuberosity
  • Insertion: perineal body
68
Q

Superficial Transverse Perineal Muscle: Innervation

A

Deep Perineal N

69
Q

Superficial Transverse Perineal Muscle: Action

A
  • Supports the perineal body and pelvic floor
  • Resists increases in intra-abdominal pressure
70
Q

Bulbospongiosus Muscle

A
  • Associated with the corpora spongiosum (erectile tissue active during the erectile process)
  • The location and shape vary in the sexes but are located in the urogenital triangle in both
  • Part of the superficial perineal pouch
71
Q

Bulbospongiosus Muscle: Origin and Insertion

A
  • Origin: Perineal Body (F), Median Raphe of the Bulb of the Penis (M)
  • Insertion: muscle surrounds the bulb of the penis and inserts onto the perineal membrane and erectile tissues associated with the bulb of the penis (M), muscle surrounds the bulb of the vestibule and inserts onto the pubic arch and clitoris (F)
72
Q

Bulbospongiosus Muscle: Innervation

A

Deep Perineal N

73
Q

Bulbospongiosus Muscle: Action

A
  • Helps support the perineal body
  • Assists in the erection response and excretion
  • Helps in urine excretion
74
Q

Ischiocavernosus Muscle

A
  • Associated with the Corpus Cavernosum (erectile tissue) in the male and female
  • Functions in compressing venous blood to cause an erection in the body of the penis or clitoris
  • Located in the urogenital triangle and part of the superficial perineal pouch
75
Q

Ischiocavernosus Muscle: Origin and Insertion

A
  • Origin: Ischiopubic ramus and ischial tuberosity
  • Insertion: surrounds the erectile tissue of the penis or clitoris and inserts onto the perineal membrane
76
Q

Ischiocavernosus Muscle: Innervation

A

Deep Perineal Nerve

77
Q

Ischiocavernosus Muscle: Action

A

Compresses the veins associated with the penis and clitoris to cause an erection by forcing blood into the crura (erectile tissue)

78
Q

Pelvic Fascia (Membranous Fascia)

A
  • Connective tissue lies between the muscles of the pelvis and peritoneum
  • Fascia is described as having a parietal and visceral layer
79
Q

Pelvic Fascia: Parietal Pelvic Fascia

A
  • Layer of tissue lines the muscles that create the pelvic floor and the walls of the pelvis (obturator internus, piriformis, coccygeus, levator ani)
80
Q

What fascia creates the tendinous arch of the levator ani and forms the wall of the pudendal canal?

A

Obturator Fascia

81
Q

Visceral Pelvic Fascia (Adventitia)

A
  • Fascia that lines the pelvic organs that are sitting in the center of the pelvis
  • Fascia stops when the organ passes thru the pelvic diaphragm
82
Q

Visceral Pelvic Fascia: Tendinous Arch of Pelvic Fascia

A
  • Band of bilateral visceral fascia that runs from the pubis to the sacrum, surrounding the pelvic viscera
  • Further divided based on sex and connections
83
Q

Puboprostatic Ligament

A
  • Anterior part of the tendinous arch of pelvic fascia
  • Found in the male and connects the prostate gland to the pubis
84
Q

Pubovesical Ligament

A
  • Anterior part of the tendinous arch of the pelvic fascia
  • Found in the female and connects the pubis and the fundus of the bladder
85
Q

Sacrogenital Ligament

A
  • Posterior part of the tendinous arch of pelvic fascia
  • Runs from the sacrum around the rectum
86
Q

In the male, the Sacrogenital Ligament attaches to the ____ (___ ___)

A

Prostate (Rectoprostatic Ligament)

87
Q

In the female, the Sacrogenital Ligament attaches to the ___ (___ ____)

A

Vagina (Uterosacral Ligament)

88
Q

Endopelvic Fascia

A
  • Located next to the parietal and visceral fascia
  • Can be divided into loose and condensed
89
Q

Loose Endopelvic Fascia

A
  • Made up of loose connective tissue, variable areolar and adipose connective tissue
  • Fills in spaces between pelvic viscera to allow the organ to expand
90
Q

5 Loose Endopelvic Fascia

A
  • Retropubic Space
  • Paravesical Space
  • Rectouterine Space
  • Pelvirectal Space
  • Retrorectal Space
91
Q

Retropubic Space (Prevesical Space)

A
  • Loose endopelvic fascia lies between the pubic bones and bladder
  • Continues around the bladder as the paravesical space
92
Q

Paravesical Space

A
  • Loose endopelvic fascia lies between the obturator fascia and the sides of the pelvic viscera
  • Separated from the other spaces by the Hypogastric Sheath
93
Q

Rectouterine Space

A
  • Female only!
  • Loose endopelvic fascia lies between the cervix of the uterus and the rectum
94
Q

Pelvirectal Space

A
  • Male only!
  • Loose endopelvic fascia lies between the bladder and the rectum
95
Q

Retrorectal Space (Presacral Space)

A
  • Loose endopelvic fascia that lies between the rectum and sacrum
  • Continuous with the pelvirectal space or rectouterine spaces
96
Q

Condensed Endopelvic Fascia

A
  • Fascia that is made up of more fibrous connective tissue, containing collagen, elastic fibers and some smooth muscle
  • These condensations are often termed ligaments
97
Q

Condensed Endopelvic Fascia: Hypogastric Sheath

A
  • Band of condenses endopelvic fascia that runs from the lateral pelvic walls towards the pelvic viscera
  • Provides a path for the neurovasculature to run (similar to the peritoneum in the abdominal cavity)
  • Supports the ureters and in the male it also supports the ductus deferens
  • As it runs medially the sheath divides into three parts or laminas
98
Q

Lateral Ligament of the Bladder

A
  • Part of the hypogastric sheath that runs from the lateral wall towards the urinary bladder anteromedially
  • Provides passage for the neurovasculature to reach the bladder (superior vesical arteries and veins)
99
Q

Lateral Rectal Ligament

A
  • Part of the hypogastric sheath runs between the posterior surface of the bladder and prostate anteriorly and the rectum posteriorly
  • Provides passage for the neurovasculature to reach the rectum (middle rectal artery and vein)
100
Q

Rectovesical Septum

A
  • Males only!
  • The middle lamina of the hypogastric sheath runs between the posterior surface of the bladder and prostate anteriorly and the rectum posteriorly
101
Q

Transverse Cervical Ligament

A
  • Female only!
  • The middle lamina of the hypogastric sheath runs between the bladder anteriorly, the cervix and vagina in the middle, and the rectum posteriorly
  • Helps to support the uterus and interconnects with the Broad Ligament (peritoneum)

GIGU Exam 2 (9 decks)

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