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SF4 Exam 2 > Pelvic Vasculature and Perineum > Flashcards

Pelvic Vasculature and Perineum Flashcards

1
Q

Internal Iliac Artery (branch off what, enters true pelvis to supply what, divides into what)

A

branch of common iliac artery
enters true pelvis to supple pelvic viscera, pelvic walls, perineum, and gluteal region
divides into anterior and posterior divisons

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2
Q

Posterior Division of Internal Iliac Artery (branches to what and name them)

A

branches to pelvic wall, lumbar region, and buttock
Iliolumbar Artery
Lateral Sacral Artery
Superior Gluteal Artery

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3
Q

Iliolumbar Artery ( supplies what)

A

sends branches to iliac fossa and lower lumbar region

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4
Q

Lateral Sacral Artery (course, supplies what)

A

descends anterior to sacrum

sends branches into the anterior sacral foramina to supply radicular branches to anterior spinal artery

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5
Q

Superior Gluteal Artery (course, supplies what)

A

Passes posteriorly b/w lumbosacral trunk (anterior rami or L4,L5) and anterior ramus of S1
exits pelvis via greater sciatic foramen (superior to piriformis muscle) to supply gluteal muscles

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6
Q

Anterior Division of Internal Iliac Artery (branches to what and name them)

A 
supplies pelvic viscera, gluteal region, and thigh
Obturator Artery
Umbilical Artery
Inferior Vesical Artery
Middle Rectal Artery
Vaginal Artery
Uterine Artery
Inferior Gluteal Artery
Internal Pudendal Artery
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7
Q

Obturator Artery (course)

A

passes w/ obturator nerve on lateral wall of pelvis, then through obturator foramen to supply medial thigh

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8
Q

In 25% of people obturator artery comes from where and when is this an issue

A

inferior epigastric artery

can be an issue when repairing inguinal hernia

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9
Q

Umbilical Artery (what does it give off and supply)

A

patent proximal part gives off 2-3 superior vesicle arteries- supply upper part of bladder

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10
Q

Obliterated part of umbilical artery (what does it become)

A

forms medial umbilical ligament (fold)

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11
Q

superior vesicle arteries

A

branches of umbilical artery and supply upper part of bladder

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12
Q

Inferior Vesicle Artery (what does it supply, what is special about it)

A 
supplies base (posterior wall) of urinary bladder, prostate, and seminal vesicles 
only found in males
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13
Q

Middle Rectal Artery (course, in males can come from what artery)

A 
passes medially to lower rectum, prostate, and seminal vesicle
may arise from inferior vesicle artery in males
often absent (especially females)
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14
Q

Vaginal Artery (course)

A

passes to sides of vagina

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15
Q

Uterine Artery (course, issue with course)

A

crosses superior to ureter to enter broad ligament of uterus

problem in hysterectomy because wanna cut artery not ureter

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16
Q

Inferior Gluteal Artery (course)

A

passes posteriorly b/w anterior rami of S1 and S2 or S2 and S3
leaves pelvis by passing b/w performs muscle and coccyges muscles (artery inferior to piriformis)
passes through greater sciatic foramen to supply gluteal region

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17
Q

Internal Pudendal Artery (course)

A

first passes b/w piriformis and coccygeus muscles and leaves pelvis via greater sciatic foramen to enter gluteal region
courses inferiorly, posterior to ischial spine and sacrospinous ligament and then passes through lesser sciatic foramen to enter the perineum

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18
Q

Internal Pudendal Artery (supply)

A

main blood supply to structures of perineum

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19
Q

Why does the internal pudendal artery leave true pelvis via greater sciatic foramen and reenter via the lesser sciatic foramen

A

pelvis diaphragm supports viscera and if artery penetrated it there would be a site of potential weakness and result in herniation of pelvic viscera into perineum

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20
Q

perineum (what is it)

A

diamond-shaped region of true pelvis inferior to pelvic diaphragm

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21
Q

Perineum (anterior to posterior boundaries)

A

pubic symphysis to tip of coccyx

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22
Q

Perineum (lateral boundaries)

A

pubic arches
ischial rami
ischial tuberosities
sacrotuberous ligament

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23
Q

the perineum is subdivided by an imaginary line passing though ischial tuberosities creating what?

A

two triangular regions:
urogenital triangle
anal triangle

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24
Q

urogenital triangle (what is it, contents)

A

anterior triangle of perineum

contains urogenital structures- root of penis (male), vulva (external gentialia of female), urogenital diaphragm

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25
Q

Anal triangle (what is it, contents)

A

posterior triangle of perineum

contains- anal canal and adjacent external anal sphincter as well as ischiorectal fossa

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26
Q

urogenital diaphragm (where is it)

A

located inferior to urogenital gap in pelvic diaphragm

part of urogenital triangle

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27
Q

anal triangle (borders)

A

posterior: tip of coccyx
lateral: sacrotuberous ligament
anterior: imaginary transverse line through ischial tuberosities

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28
Q

ischiorectal fossa (borders)

A

base of wedge: located superficially at skin surrounding anus
lateral side of wedge: obturator internus muscle
medial side of wedge: pelvic diaphragm and anal canal

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29
Q

ischiorectal (ischioanal) fossa (what is it, what does it contain)

A

wedge-shaped
fat filled- supports anal canal
contains- pudendal nerve and internal pudendal artery and vein (coursing anteriorly and inferiorly along lateral wall)

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30
Q

anterior recess of ischiorectal fossa is where

A

b/w pelvic diaphragm and urogenital diaphragm in urogential triangle

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31
Q

what supports the anal canal, allowing for distention during dedication

A

ischiorectal fossa

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32
Q 
Pudendal Canal (Alcock's canal)
(what is it, what does it contain)
A

fascial canal within obturator internus fascia on lateral wall of ischiorectal fossa
contains pudendal neurovascular bundle
extends from lesser sciatic foramen (posteriorly) to urogenital diaphragm (anteriorly)

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33
Q

Pudendal Nerve (formed from what)

A

anterior rami of S2-4 of sacral plexus

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34
Q

Pudendal Nerve (what type of nerve is it)

A

somatic (voluntary) nerve

somatic innervation to most of perineum

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35
Q

Pudendal Nerve (course)

A

passes out of main pelvic cavity via inferior part of greater sciatic foramen to enter gluteal region
descends posterior to ischial spine
passes through lesser sciatic foramen to enter pudendal canal

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36
Q

Pudendal Nerve (branches)

A

branching occurs in anal triangle:
Inferior rectal nerve
branches to structures of urogenital triangle (dorsal nerve of penis/clitoris and posterior scrotal/labial nerves)

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37
Q

Internal Pudendal Artery (branches)

A

Inferior rectal artery

branches to structures of urogenital triangle (dorsal branches to penis and clitoris)

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38
Q

how does lower half of anal canal get blood supply

A

inferior rectal artery (branch off internal pudendal, which is branch of internal iliac)

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39
Q

Anal Canal (course)

A

terminal part of large intestines
begins at narrowing of rectal ampulla at level of pubertal sling of pelvic diaphragm
bent at angle at anorectal junction
descends posteroinferiorly to anus b/w anococcygeal body and perineal body

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40
Q

what is landmark for beginning of anal canal

A

coccyx

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41
Q

Internal Anal Sphincter (what is it, innervation)

A

thickening of smooth circular muscle of upper part of anal canal wall
involuntary- parasympathetic

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42
Q

parasympathetic stimulation of the internal anal sphincter does what

A

relaxes sphincter

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43
Q

external anal sphincter (what is it, innervation)

A

striated muscle surrounding lower part of anal canal
extends from perineal body to anococcygeal body
voluntary- inferior rectal nerve

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44
Q

Name the parts of the external anal sphincter

A

Deep part
Superficial part
Subcutaneous part

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45
Q

Deep Part of External Anal Sphincter (what does it do)

A

fuses with adjacent puborectalis muscle of pelvic diaphragm

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46
Q

Superficial Part of External Anal Sphincter (what does it do)

A

moors anal canal in median place by its attachments to perineal body and anococcygeal body

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47
Q

Subcutaneous Part of External Anal Sphincter (what does it do)

A

slender

surrounds anus

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48
Q

external anal sphincter (action)

A

closes anal canal

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49
Q

whats responsible for the bend at anorectal junction

A

puborectalis

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50
Q

Puborectalis aids closure of anorectal junction how

A

drawing posterior wall of anal canal anteriorly, keeping posterior wall of anorectal junction opposed to anterior wall except during defecation

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51
Q

Anorectal ring (what is it, what is it composed of)

A

palpable landmark during rectal exam

composed of depp part of external anal sphincter, puborectalis, and internal anal sphincter

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52
Q

anorectal ring determines what about a patient

A

continence

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53
Q

Anal Columns (what are they, what do they contain)

A

characteristic vertical folds of mucus membrane

contain superior rectal vessels

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54
Q

location of portal-caval anastomosis

A

anal columns

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55
Q

anal valves (what are they)

A

semilunar epithelial folds joining inferior ends of anal columns

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56
Q

what structures indicate the pectinate line

A

anal valves

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57
Q

what does the pectinate line mark

A

juncture between hindgut endoderm and ectoderm of proctodeum

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58
Q

location of embryonic anal membrane (former cloacal membrane)

A

anal valves

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59
Q

anal sinuses (what are they)

A

recesses superior to anal valve and between anal columns

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60
Q

upper half of anal canal gets blood from where

A

superior rectal artery and vein from inferior mesenteric artery and vein

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61
Q

upper half of anal canal drains lymph through where

A

inferior mesenteric nodes

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62
Q

upper half of anal canal is innervated by what

A

stretch receptors and other visceral afferents send sensory fibers into hypogastric plexus of autonomic system
no somatic sensory fibers so area not so sensitive

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63
Q

lower half of anal canal is innervated by what (what does it respond to)

A

somatic sensory fibers from inferior rectal nerve (branch of pudendal nerve)
respond to pain, touch, and temp
very sensitive

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64
Q

lower half of anal canal is gets blood supply by what

A

inferior rectal artery

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65
Q

lower half of anal canal drains lymph through what

A

medial nodes of superficial inguinal lymph nodes (inferior to inguinal ligament)

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66
Q

what can be torn by hard stools in a chronically constipated patient, tearing anal mucosa

A

anal valves

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67
Q

tearing of anal valves can cause what

A

anal canal to be infected and from fistula through wall of anal canal into the ischiorectal fossa- can result in perianal abscess

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68
Q

perianal abscess (what is it)

A

collection of pus in fat in ischiorectal fossa

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69
Q

Perianal Abscess (how can it spread)

A

from one side to the opposite sid
anteriorly into anterior recess of ischiorectal fossa (b/w elevator ani and urogenital diaphragm) to affect urogenital structures

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70
Q

Internal Hemorrhoids (what are they)

A

varicosities of tributaries of superior rectal veins in anal columns covered by mucous membrane of anal columns

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71
Q

External Hemorrhoids (what are they)

A

varicosities of tributaries of interior rectal veins covered by skin (very painful- somatic fibers of inferior rectal nerve)

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72
Q

Urogenital Triangle (location)

A

anterior part of perineum

below part of pelvic diaphragm which has a central urogenital gap

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73
Q

Urogenital Triangle (boundaries)

A

posterior- imaginary line b/w ischial tuberosities

lateral- inferior rami of pubis and ramus of ischium

74
Q

Urogenital Diaphragm (location)

A

inferior to pelvic diaphragm

b/w and attached to inferior rami of pubis and rami of ischium

75
Q

Urogenital Diaphragm (function)

A

prevent herniation (or prolapse) of bladder, prostate, and uterus through cleft in pelvic diaphragm

76
Q

Urogenital Diaphragm (what is it)

A

layer of muscles superior to a layer of fascia

77
Q

Urogenital Diaphragm (what passes through it)

A

urethra (both sexes)

vagina

78
Q

Deep Perineal Pouch (how is it formed)

A

superior and inferior fascial layers fuse anteriorly and posteriorly (also fuse with perineal body)

79
Q

Deep Perineal Pouch (what is it)

A

space between superior and inferior fascial layers of urogenital diaphragm
striated muscles and bulbourethral glands (males)

80
Q

Deep Perineal Pouch (muscular components)

A

Deep transverse perineal muscle

Sphincter urethrae

81
Q

Deep Perineal Pouch (non-muscular contents in males )

A

membranous urethra
bulbourethral glands
Internal pudendal artery, vein, and nerve branches

82
Q

Deep Perineal Pouch (non-muscular contents in females )

A

urethra
vagina
internal pudendal artery, vein, and nerve banches

83
Q

Deep transverse perineal muscle (action and innervation)

A

action: stabilizes perineal body, reinforces pelvic diaphragm
innervation: perineal branch of pudendal nerve

84
Q

Sphincter Urethrae (action and innervation)

A

action: voluntary sphincter of urethra (relaxed during urination)
functions to eject last bit of urine
functions in ejaculation
innervation: perineal branch of pudendal nerve

85
Q

membranous urethra (what is it)

A

thinnest, shortest, narrowest, and least dilatable part of urethra

86
Q

what is subject to tear in the deep perineal pouch during insertion of a catheter in a male

A

membranous urethra

87
Q

Inferior fascial layer (perineal membrane)

what is it, attachments

A

thick fascial layer
attached laterally to ischiopubic rami
posteriorly to perineal body

88
Q

Superficial Perineal Pouch (what is it)

A

space in urogenital triangle between inferior fascial later of urogenital diaphragm and the superficial perineal fascia

89
Q

Superficial Perinal Fascia (Colle’s Fascia)

what is it

A

continuation of Scarpa’s fascia from lower anterior abdominal wall

90
Q

Superficial Perinal Fascia (Colle’s Fascia)

attachments

A

attaches posteriorly to perineal body and posterior border of urogenital diaphragm
laterally to ischiopubic rami

91
Q

extravasated urine from a ruptured penile urethra can enter where?

A

superficial perineal pouch and scrotum

anterior abdominal wall

92
Q

extravasated urine from a ruptured penile urethra cannot enter where?

A 
ischiorectal fossa (due to attachment of superficial perianal fascia to urogenital diaphragm posteriorly)
thigh (due to attachment of superficial perineal fascia to the ischiopubic rami laterally)
93
Q

bulbourethral glands (where are they, what are they)

A

present posterior to membranous urethra (deep perineal pouch)
ducts pass through inferior fascia layer of urogenital diaphragm and open into penile (or spongy) uretha in bulb of penis

94
Q

bulbourethral glands secretions are what?

A

a lubricant during sexual arousal

95
Q

penile urethra (where is it)

A

aka spongy urethra and is in the bulb of penis

96
Q

Superficial Perineal Pouch (contents)

A 
root of penis and clitoris (fixed portion)
superficial transverse perineal muscle 
bulbospongiosus muscle
ischiocavernosus muscle
greater vestibular glands (female only)
97
Q

superficial transverse perineal muscle (what does it do)

A

fix position of perineal body

support floor of pelvis

98
Q

bulbospongiosus muscle (what does it do)

A

covers bulb of penis or bulb of vestibule (female)

99
Q

ischiocavernosus muscle (what does it do)

A

covers crura of penis or clitoris

100
Q

Penis (what is it composed of, what are its division)

A

composed of three masses of erectile tissue

divided into root (fixed within urogenital triangle) and body (free anterior portion)

101
Q

Root of penis (where is it, what are its divisions)

A

located inferior and fixed to urogenital diaphragm
two parts:
crura of penis
bulb of penis

102
Q

Crura of penis (what are they)

A

paired laterally placed erectile tissues

103
Q

Crura of penis (where do they attach)

A

attach to inferior ramus of pubis and ramus of ischium

firmly attached to the underside of inferior fascial layer of urogenital diaphragm

104
Q

Bulb of penis (what is it)

A

single centrally located erectile tissue

105
Q

Bulb of penis (attachment)

A

firmly attached to underside of inferior facial layer (perineal membrane) of urogenital diaphragm

106
Q

Bulb of penis (contents)

A

proximal portion of penile (or spongy) part of urethra

107
Q

what muscles are associated with root of penis

A

bulbospongiosus muscle

ischiocavernous muscle

108
Q

bulbospongiosus muscle in males (origin)

A

median raphe, perineal body

109
Q

bulbospongiosus muscle in males (insertion)

A

fibers cover bulb of penis

anterior fibers extend over proximal part of corpora covernosa

110
Q

bulbospongiosus muscle in males (actions)

A

aids in emptying urethra during micturition and ejaculation

contributes to erection by compressing blood engorged bulb of penis

111
Q

ischiocavernosus muscle in males (origin)

A

ischial tuberosity

112
Q

ischiocavernosus muscle in camles (insertion)

A

covers medial side of undersurface of crus of penis

113
Q

ischiocavernosus muscle in males (action)

A

aids in erection by compressing crus of penis

114
Q

Body of penis (what is it)

A

continuation of crura and bulb of penis

115
Q

part of penis not located in superficial pouch

A

body of penis

116
Q

Body of penis (consists of what)

A

corpora cavernosa

corpus spongiosum

117
Q

corpora cavernosa (what/where is it)

A

dorsally (superiorly) located cylinders of erectile tissue

continuation of crura

118
Q

corpus spongiosum (what/where is it)

A

ventrally (inferiorly) located cylinder

continuation of bulb of penis

119
Q

corpus spongiosum expands distally as

A

glans penis

120
Q

corpus spongiosum (contents)

A

distal part of penile (spongy) urethra

navicular fossa

121
Q

navicular fossa (what is it)

A

dilated part of penile urethra in the glans penis

terminates at external urethral orifice

122
Q

Facial layers of penis (name them)

A 
prepuce
suspensory ligament of penis
fundiform ligament of penis
superficial penile fascia
deep penile fascia
tunica albugina
123
Q

prepuce (what is it)

A

folded double layer of superficial penile fascia and skin that surrounds glans penis

124
Q

what is removed during circumcision

125
Q

suspensory ligament of penis (what is it)

A

arises from pubic symphysis and inserts into facia surrounding penis

126
Q

fundiform ligament of penis (where does it attach)

A

descends from linea alba to attach to penile fascia

127
Q

superficial penile fascia (what is it continuous with)

A

continuous with Scarpa’s (membranous) fascia of anterior abdominal membrane and dartos facia and superficial perineal fascia of superficial perineal pouch

128
Q

Deep penile fascia (Buck’s fascia)

where is it, what does it do

A

located deep to superficial dorsal vein of penis

encloses deep dorsal arteries and veins of penis and corpora of penis

129
Q

tunica albuginea of penis (what does it do)

A

directly invests corpora cavernous with very thick layer of dense fascia to hold two corpora together

130
Q

tunica albuginea of penis (what does it form

A

fuses in midline of penis to form a septum

131
Q

Artery of bulb supplies what

A

erectile tissue of bulb of penis and corpus spongiosum

132
Q

blood supply of penis are branches from what

A

internal pudendal artery

133
Q

what branches of internal pudendal artery supply the penis

A

artery of bulb
deep artery of the penis
dorsal artery of the penis

134
Q

what veins drain the penis

A

deep dorsal vein of penis

superficial dorsal vein of penis

135
Q

deep arteries (artery of crus) of the penis supplies what

A

erectile tissues of crura and corpora cavernosa

136
Q

dorsal artery of the penis supplies what

A

skin of penis, fascial sheath surrounding erectile tissues

137
Q

what anastomosis occurs in penis and where

A

dorsal artery of penis and artery of bulb at glans penis

138
Q

dorsal vein of penis (location, drains from where to where)

A

midline of penis
drains blood from corpora of penis
drains into prostatic venous plexus and/or vesicle venous plexus

139
Q

superficial dorsal vein of penis (drains what to where)

A

drains blood from skin and fascia into superficial external pudendal vein

140
Q

sensory innervation of penis

A

dorsal nerve of penis (branch of pudendal)- passes through deep perineal pouch

141
Q

skin of penis drains to what lymph nodes

A

superficial inguinal nodes

142
Q

deep structures of penis drain to what lymph nodes

A

internal iliac nodes

143
Q

erection (what type of nerve fibers and what do they cause to happen)

A

parasympathetic

cause relaxation of smooth muscle in deep arteries of penis and artery to bulb

144
Q

erection (what is happening)

A

parasympathetics relax muscle of arteries
blood flows to erectile tissues, engorging them
veins surrounding erectile tissues become compressed and blood ceases to drain

145
Q

erection (what nerve is involved and how)

A

pudendal nerve
innervates bulbospongiosus and ischiocavernosus muscles- compress venous plexus at periphery of bulb and crura to stop venous drainage

146
Q

what do sympathetics do to an erection

A

cessation of erection- constriction of smooth muscles of arteries

147
Q

ejaculation (what kind of nerve fibers, what do they do)

A

sympathetics
cause contraction of smooth muscle of urethra to expel semen
close sphincter vesicae at neck of bladder to prevent reflux of semen into bladder

148
Q

ejaculation (what nerve is involved and how)

A

pudendal nerve

cause contraction of bulbospongiosus muscle to compress penile urethra

149
Q

clitoris (what are the parts)

A

crura of clitoris

bulbs of vestibule

150
Q

crura of clitoris (what are they, where do they attach)

A

pair of laterally located erectile tissues

attached to inferior ramus of pubis and ischium

151
Q

crura of clitoris (what do they become)

A

body of clitoris anteriorly

152
Q

bulbs of vestibule (what are they)

A

homologous to bulb of penis but split into two halves by orifice of vagina and urethra

153
Q

bulbs of vestibule (what do they become)

A

glans clitoris (homologous to glans penis)

154
Q

urethra does or does not enter body of clitoris or bulbs of vestibule

155
Q

bulbospongiosus muscle in females (where does it attach, describe location)

A

attached to perineal body

cover bulb of vestibule and extend around vagina to body of clitoris

156
Q

bulbospongiosus muscle in females (action)

A

diminishes vaginal opening

157
Q

ischiocavernosus muscle in females (attached to where, describe location)

A

attached to ischial tuberosity

cover surface of crus clitoris

158
Q

ischiocavernosus muscle in females (action)

A

aids in erection of clitoris by compressing blood-engorged erectile tissue of crura

159
Q

Greater vestibular glands (Bartholin’s glands)

what are they

A

two roundish glands deep to bulb of vestibule in superficial perineal pouch
have duct that opens lateral to vaginal orifice

160
Q

Greater vestibular glands (Bartholin’s glands)

what do they secrete

A

lubricating mucus

161
Q

Greater vestibular glands (Bartholin’s glands)

what are they analogous to in males

A

bulbourethral glands

162
Q

mons pubis (what is it)

A

mass anterior to pubic symphysis

formed by pad of fat and covering of hair

163
Q

labia majora (what are they, what do they correspond to in males)

A

two folds of skin, filled with fat, covered with hair

correspond to scrotum

164
Q

anterior labial commissure (what is it)

A

where two labia majora meet anteriorly at midline

165
Q

posterior labial commissure (what is it)

A

where two labia majora meet posteriorly at midline

166
Q

labia minora (what are they)

A

two folds of skin devoid of fat and hair

167
Q

labia minora (where are they)

A

between labia majora and vaginal and urethral orifices

168
Q

the labia minora unite posteriorly as what

A

fourchette or frenulum of labia minora

169
Q

labia minor split anteriorly to cover clitoris as what

A

prepuce of clitoris

referred to as clitoral hood

170
Q

vestibule of vagina (what is it)

A

area between labia minora

171
Q

urethral orifice and vaginal orifice are found in what structure

A

vestibule of vagina

172
Q 
paraurethral glands (Skene's glands) 
(what are they homologous to in males)
A

homologous to prostate gland

173
Q 
paraurethral glands (Skene's glands) 
(where do they open)
A

open on either side of urethral orifice

174
Q

sensory innervation of clitoris is done by what nerve

A

dorsal nerve of clitoris (branch of pudendal)

175
Q

overstitching of the vaginal opening during childbirth can lead to tearing of what and results in what

A

perineal body
results in weakness of pelvic diaphragm and may result in collapse of rectum and bladder against vaginal wall or prolapse of uterus through vaginal orifice

176
Q

mediolateral episiotomy (what is it, what does it prevent)

A

surgical cutting of the vagina and posterior wall of vulva (lateral to perineal body) to enlarge vaginal orifice
prevents tearing of perineal body

177
Q

median episiotomy (what is it)

A

midline incision of the of posterior wall of the of vagina, forchette and perineal body
(incision of perineal body can easily be repaired compared to jagged tear from overstretching)

178
Q

what episiotomy is more common and why

A

mediolateral episiotomy is more common

in median physician at risk to cut external anal sphincter

179
Q

Pudendal nerve block (what is it used for)

A

anesthetize perineum prior to an episiotomy

180
Q

transvaginal approach to pudendal nerve block (how is it done)

A

find ischial spine via transvaginal palpation
needle passed though vaginal wall toward the ischial spine and though sacrospinous ligament
injection of anesthetic once through sacrospinous ligament

181
Q

perineal method of pudendal nerve block (how is it done)

A

ischial tuberosity is palpated externally though buttock

needle inserted in skin medial to ischial tuberosity and placed 1 inch deep from inferior border of tuberosity

SF4 Exam 2 (13 decks)

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