Pelvis and Perineum Flashcards
A plane spanning the _____ ______ to the superior margin of the _______ _______ marks the division between the greater pelvis (false pelvis) and lesser pelvis (true pelvis).
sacral promontory to the superior margin of the pubic symphysis
What are the three parts of the coxal bone?
Ilium, pubis, ischium
Can the three parts of the coxal bone of a young person look like a fracture on x-ray? What type of tissue connects these three parts in a young person?
Yeah. Hyaline cartilage connects the three parts
Which ligament separates the greater sciatic foramen from the lesser sciatic foramen?
The sacrospinous ligament
The pelvic outlet is closed by the…?
by the pelvic diaphragm and urogenital diaphragm
Babies must follow a path along the pelvic ______ during birth.
axis
Name seven differences between the male and female pelvis.
Females have:
- Thinner bones
- Shorter inlet
- Larger outlet
- Wider pubic arch and angle
- Flared iliac wing
- Ischial tuberosities are wider
- Obstetrical conjugate diameter is larger
Do the muscles of the pelvic floor hold the weight/pressure of abdominal organs?
Yeah
Relaxation of the _______ muscle, which forms a sling around the anorectal junction, aids in defacation.
puborectalis muscle
Why is it better to perform a mediolateral episiotomy rather than a midline episiotomy?
A midline episiotomy can cut the perineal body, the anchor point for bulbospongiosus, external anal sphincter, and transverse perineal muscles - that heals slowly.
What is the difference between flexion and version (angles of the female repro system)?
Flexion is the angle between the axis of the body of the uterus and the cervix.
Version is the angle between the axis of the cervix and the vagina.
Does the peritoneum drape over the pelvic organs?
Yeah
What is the broad ligament of the uterus? Name its three parts.
The peritoneum that drapes over the uterus, ovaries, and fallopian tubes.
Mesosalpinx is the part that covers the uterine tubes.
Mesovarium is the part over the ovaries.
Mesometrium is the part over the uterus.
Weakened supportive ligaments of the uterus can cause uterine _______.
prolapse
What are the lowest two cavities of the female body when in recumbent position?
- Hepatorenal pouch
2. Rectouterine pouch of Douglas
The male urethra runs through the ______ ______ of the penis; the majority of the erectile tissue is called the ______ _______.
urethra runs through the corpus spongiosum, the other two lateral shafts are called the corpora cavernosa
What is the male equivalent of the rectouterine pouch of Douglas called?
Rectovesical fossa
What main artery supplies pelvic organs with blood?
The anterior division of the internal iliac
Name the six branches of the anterior internal iliac artery that supply organs in the female pelvis.
- Internal pudendal
- Middle rectal
- Vaginal, with branch to bladder
- Uterine
- Umbilical
- Superior vesical
Where is the ureter in relationship to the uterine artery? Why is this important?
The ureter runs underneath the uterine artery. In a hysterectomy, surgeons need to cut the artery but not the ureter.
Where do the ovarian arteries originate from?
The lateral aspect of the aorta a few cm below the renal arteries.
Name the five branches of the anterior internal iliac artery that supply organs in the male pelvis.
- Internal pudendal
- Inferior vesical
- Umbilical
- Superior vesical
- Middle rectal
Pelvic innervation
Sacral plexus
- pudendal nerve (S2, 3, 4)
- nerve to pelvic diaphragm (S3, 4)
Pelvic plexus
- pelvic splanchnic (S2, 3, 4): parasympathetic
- hypogastric plexuses, mixed
That’s all Kwan said so whatever
Describe where a needle is inserted and the anesthetic effects for each of the following:
Spinal block via lumbar puncture
Caudal epidural block
Pudendal nerve block
Spinal block via lumbar puncture: insert needle at L3/L4. Anesthetizes from the waist down, including subperitoneal and intraperitoneal organs.
Caudal epidural block: performed at the sacral hiatus. Anesthetizes subperitoneal organs plus areas and cutaneous sensation supplied by the pudendal nerve.
Pudendal nerve block: anesthetizes pudendal nerve (slide doesn’t say where the needle should go)
Which two triangles make up the perineum and what is found at the center of the perineum?
- Anal triangle
- Urogenital triangle
The perineal body is at the center of the perineum - its the attachment for the perineal muscles.
What is the ischioanal fossae? What runs within it?
The fat-filled space located lateral to the anal canal and inferior to the pelvic diaphragm.. Inferior anal vessels and nerves run within it - infection can spread through these.
Name everything in the female superficial perineal space from superficial to deep (6).
- Superficial perineal fascia (Colle’s fascia)
- 3 superficial perineal muscles: bulbospongiosus, ischiocavernosus, superficial transverse perineal.
- Greater vestibular (Bartholin’s) glands
- Bulb of vestibule
- Clitoris
- Perineal membrane
The _______ ________ is critical in controlling urinary continence.
urogenital diaphragm
Name everything in the female deep perineal space from superficial to deep (3).
- Perineal membrane = inferior fascia of deep perineal muscles = fascia diaphragmatic urogenitalis inferior
- Deep transverse perineal muscle, compressor urethrae and sphincter urethrae/urethrovaginal muscle
- Superior fascia of deep perineal muscles
Name everything in the male superficial perineal space from superficial to deep (4).
- Superficial perineal fascia (Colle’s fascia)
- 3 superficial perineal muscles: bulbospongiosus, ischiocavernosus, superficial transverse perineal.
- Root (bulb and crura) of the penis
- Perineal membrane
Name everything in the male deep perineal space from superficial to deep (5).
- (Perineal membrane) inferior fascia of dpm (?)
- Bulbourethral glands, sphincter urethrae and compressor urethrae muscles and fascia (urogenital diaphragm)
- Deep transverse perineal muscle
- Superior fascia of the deep perineal muscles
- Pelvic cavity
What muscles and fascia form the urogenital diaphragm?
Sphincter urethrae muscle, compressor urethrae muscle, and deep transverse perineal muscle
What is a varicocele? What causes it? What is the treatment?
Varicose veins in the pampiniform plexus of the spermatic cord. With static flow, they are unable to cool the testis –> low sperm count or infertility. Common on the left side possibly as a result of a malignant tumor of the left kidney that blocks the exit of the left testicular vein. Tx is surgery to remove the varicose veins.
Name the eight layers of the abdominal wall and each corresponding layer of the scrotum that is derived from it.
- skin - skin
- Camper’s + Scarpa’s fascia - Dartos muscle and fascia
- External oblique - external spermatic fascia
- Internal oblique - Cremaster fascia
- Transversus abdominis - NOTHING
- Fascia transversalis - internal spermatic fascia
- Extraperitoneal fatty tissue - Alveolar tissue with localized collections of fat
- Peritoneum - tunica vaginalis
Can trauma cause extravasation of urine into places deep to Scarpa’s fascia that Kwan didn’t really explain? Will urine get into the lower extremities? Why or why not?
Yeah it can go places, but it won’t get into the lower extremities because the fascia lata is tight.
The deep fascia of the penis is also called…?
Buck’s fascia
The tunica albuginea around the _______ ________ is thinner so that the urethra remains patent during an erection.
corpus spongiosum
Which artery supplies the female perineum? Which one supplies the clitoris?
The internal pudendal artery supplies the perineum. The deep artery of the clitoris supplies the clitoris.
Which artery supplies the male perineum? Which one supplies the penis?
The internal pudendal artery supplies the perineum. The dorsal and deep arteries of the penis supply the penis.
Atherosclerosis in the ________ _________ artery may correlate with atherosclerosis in the coronary arteries and plays a role in erectile dysfunction in men.
internal iliac
Which nerve supplies the perineum? How does it get to the perineum?
the pudendal nerve; it travels through the pudendal canal
Cancers of the skin of the external genitalia will drain to the _______ _______ lymph nodes, while cancers of the testis and will drain to ______ ______ nodes.
skin cancers of external genitalia drain to superficial inguinal nodes.
testicular cancers drain to external iliac nodes
What muscles make up the pelvic diaphragm?
Levator ani (puborectalis + pubococcygeus + iliococcygeus) and coccygeus aka ischiococcygeus
What separates the deep perineal pouch from the superficial perineal pouch?
The perineal membrane
