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S&F IV: Exam Two- European Gigalo > Pelvic Vasculature and Perineum > Flashcards

Pelvic Vasculature and Perineum Flashcards

1
Q

Anterior Division of the Internal Iliac Artery

A
  1. Obturator Artery (can arise from inferior epigastric; important to remember when repairing hernia
  2. Umbilical Artery (gives off some superior vesical arteries; obliterated distal part =medial umbilical ligament)
  3. Inferior vesical artery
  4. Middle rectal artery
  5. (F) Vaginal and uterine artery (must ligate during hysterectomy)
  6. Inferior gluteal artery
  7. Internal pudendal artery
    * Focus on where vessels are going as there is much variation
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2
Q

Uterine Artery

A

Passes OVER the ureter; must remember to ligate during ovariectomy

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3
Q

Internal Pudendal Artery

A

Travels out the greater sciatic foramen and back thru the lesser to supply perineal structures

*If it traveled thru the pelvic diaphragm, it could cause a potential site for herniation of pelvic organs

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4
Q

Posterior branches of Internal Illiac

A
  1. Iliolumbar artery
  2. Lateral sacral artery
  3. Superior gluteal artery
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5
Q

Inferior rectal nerve

A

Branch of the internal pudendal nerve that innervates the external anal sphincter and provides somatosensory to the bottom 1/2 of the anal canal

*Other branches of internal pudendal also include the dorsal nerve of the penis/clitoris and the scrotal/labial nerves

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6
Q

Beginning of anal canal

A

Coccyx

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7
Q

Internal Anal Sphincter

A

Parasympathetic stimulation for the splanchnic nerves causes relaxation of the sphincter

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8
Q

External anal sphincter

A

Somatic innervation from the pudendal nerve and contains three subgroups: 1. Deep part

                2. Superficial part
                3. Subcutaneous part
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9
Q

Anorectal ring

A

Composed of deep part of external anal sphincter, puborectalis, and internal anal sphincter

*Palpable during exam

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10
Q

Anal columns

A

Fold of mucosal membrane; contain the portal caval anastomoses

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11
Q

Anal valves

A

Epithelial folds indicating the site of the pectinate line

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12
Q

External hemorrhoids

A

Varicoses of the inferior rectal veins; very painful since lower half of anal column is somatosensory

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13
Q

Perianal abscess

A

Infection in the ischiorectal fossa that typically stems from torn anal valves or a fistula; can travel from side to side and anteriorly to affect urogenital structures

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14
Q

Urogenital Diaphragm

A

Lies inferior to the pelvic diaphragm and prevents herniation of prostate, uterus, and bladder thru the pelvic diaphragm

-Connected to inferior ramus and ischium

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15
Q

Deep perineal pouch

A

Consists of striated muscles (deep transverse perineal muscle and sphincter urethrae) and bulbourethral glands (M)

-Also contains the pudendal NAV

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16
Q

Deep transverse perineal muscle

A

Stabilizes the perineal body and reinforces the pelvic diaphragm

*Middle-layer muscle

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17
Q

Sphincter urethrae

A

Voluntary muscle that relaxes during microtuition; also fnxns during ejaculation

*Middle-layer muscle

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18
Q

Membranous urethrae

A

Found in the UGD; thinnest part of the urethra most susceptible to tearing, especially during catheterization

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19
Q

Bulbourethral glands

A

Found in the UGD; secretes lubricant during sexual arousal into the penile (spongy) area of the urethra

20
Q

Superficial Perineal Pouch

A

Found inferior to the inferior fascial layer of the UGD and superior to the superior perineal fascia

Contains the superficial transverse perineal muscle, the erectile tissues (Crura and bulb), the internal pudendal NAV, and the bulbospongiosus and ischiocavernosus

21
Q

Superficial perineal fascia

A

Colle’s Fascia-a continuation of Scarpa’s fascia; attaches posteriorly to the perineal body and laterally to the ischiopubic rami

*Continues in the scrotum as the Dartos muscle

22
Q

Damage to perineum

A

Often causes urethral rupture @ the 90 degree angle where it enters the UGD

=>Urine enters superficial perineal pouch and anterior abdomen

  • CANNOT enter ischiorectal Fossa or thigh due to posterior attachment of perineal membrane to UGD and lateral attachment of perineal membrane to the ischiopubic rami
  • Can be caused by landing badly on top of fence
23
Q

Muscles of superficial perineal pouch

A
  1. Superficial transverse perineal muscle
  2. Bulbospongiosus-aids the emptying of the urethra; compresses blood vessels during erection
  3. Ischiocavernosus muscles- aids in erection by compressing crus of penis
24
Q

Root of penis

A

Composed of the crus and bulb of the penis; firmly attached to the inferior fascial layer of the perineal membrane

25
Q

Suspensory ligament of penis

A

Originates at pubic symphysis and attaches to the tissue of the penis

26
Q

Buck’s Fascia

A

Located deep to the superficial dorsal vein of the penis and envelops the deep dorsal veins and arteries of the penis

27
Q

Tunica albuginea

A

White CT that invests the corpus cavernosa and forms a septum b/w the two

28
Q

Dorsal artery of the penis

A

Supplies the skin of the penis and the surrounding erectile tissues

29
Q

Penis lymphatics

A

Skin => Superficial inguinal nodes

Deep structures => Internal iliac nodes

30
Q

Erection

A

Parasympathetics relax dorsal artery of the penis and artery of the bulb to engorge the penis w/ blood

*Veins are compressed by bulbospongiosus and ischiocavernosus

31
Q

Ejaculation

A

Smooth muscle contraction of ductus deferens, seminal vesicle, and prostate gland to eject secretions; pudendal nerve activates bulbospongiosus

*Point and Shoot

32
Q

Crura of clitoris

A

Paired erectile tissues that become the body of the clitoris anteriorly

33
Q

Bulbs of vestibule

A

Split into two halves by the opening of the vagina; unite anteriorly as the glans clitoris

34
Q

Greater Vestibular Glands

A

Analogous to bulbourethral glands; secrete lubricant

*Often become blocked and infected => cysts

35
Q

Mons pubis

A

Mass anterior to the pubic symphysis covered w/ fat and hair

36
Q

Frenulum

A

Point where the labia minora unites posteriorly

*Anterior point is the prepuce of the clitoris

37
Q

Sensory innervation of the clitoris

A

Somatosensory nerves provided by dorsal nerve of the clitoris (from internal pudendal)

38
Q

Episiotomy

A

Surgical incision into posterior wall of the vagina to prevent tearing of the perineal body during childbirth; surgical repair of this incision to the perineal body is much easier to repair

*Mediolateral incisions are more common because median incisions could damage the anorectal sphincter

39
Q

Pudendal Nerve Block

A

Physician locates the ischial spine usually thru a transvaginal approach and injects anesthetic thru the vaginal wall and sacrospinous ligament to relax the pudendal nerve

*Performed to anesthetize the perineum prior to an episiotomy

40
Q

Inferior rectal artery

A

Branch of the internal pudendal artery that supplies the lower 1/2 of the anal canal

41
Q

Ischiorectal Fossa

A

Triangle formed by the skin, Obturator internus, and pelvic diaphragm

-Contains mostly fat but also the pudendal NAV bundle in the Obturator internus fascia and the external anal sphincter

42
Q

Innervation of upper 1/2 of anal canal

A

Visceral sensory to the inferior hypogastric plexus

43
Q

Crura of penis

A

Attached to perineal membrane and ischiopubic ramus

-erectile tissue

44
Q

Navicular Fossa

A

Widening of the male urethra at the glans of the penis

45
Q

Deep dorsal vein and vein to the bulb drainage

A

Prostatic venous plexus

S&F IV: Exam Two- European Gigalo (14 decks)

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