Pelvis And Perineum Flashcards by Scott Mitchell

What does the pudendal canal contain?

Internal pudendal vessels

Pudendal nerve

Nerve to obturator internus

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What does the superficial fatty layer of subcutaneous fascia contribute to in both triangles?

Urogential: only in females
- labia Majora and mons pubis

Anal triangle: both sexes
- continuous with anal fat pad

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What does the superficial membranous collies layer of subcutaneous fascia contribute to in both triangles?

ONLY urogential triangle in both sexes:
- females: continuation of scarpa’s fascia

males: continuation of scarpa’s fascia and also dartos muscle and fascia
attaches to fascia lata laterally to end and not go into anal triangle

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What does the deep membranous investing layer of perineal fascia contribute to.

Invests all perineal muscles

continuous with suspensory ligament of penis/clit
also continuous in the bucks fascia or the penis

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Superficial perineal pouch broad definition

Between collies fascia and perineal membrane

Potential space for pooling

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Deep perineal pouch broad definition

Space between perineal membrane and inferior pelvic diaphragm fascia

Potential space for pooling

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What two superficial perineal muscles maintain erection of the penis/clit?

Bulbospongiosus and ischiocavernosus

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Superficial transverse perineal muscle

Stabilizes the perineal body

- perineal body is the site of all perineal muscle attachements

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Contents of the superfical perineal pouch for women

Clit

Ischiocavernosus and bulbospongiousus muscles

Superficial transverse perineal muscle

Compressor urethrae muscle

Greater vestibular glands (bartholin glands)

Deep branches of internal pudendal vessels and perineal branches of pudendal nerves

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Superficial perineal pouch contents in males

Penis

Ischiocavernosus and bulbospongiosus muscles

Bulb of penis and spongy urethra

Penile Crura and superfical transverse perineal muscle

Deep branches of internal pudendal vessels and perineal branches of pudendal nerves

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Deep perineal pouch contents in females

Proximal urethra

External urethral sphincter

Anterior ischio-anal fat pads

Clit neurovasculature

Smooth muscle mass

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Deep perineal pouch contents in males

Membraneous urethra

External urethral sphincter

Anterior ischio-anal fat pad

Penile neurovasculature

Deep transverse perineal muscle

Bulbo-urethral glands (Cowper glands)

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Scrotal raphe

Splits right and left testicle

- directly continuous with penile raphe

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Layers of scrotum from superficial to deep

Scrotal skin

Dartos muscle and fascia

Cremaster muscle

Tunica vaginalis

Tunica albuginea

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Site of sperm storage

Tail of epididymus

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Epididymis and testis appendix embryological origin/ remnant

Epididymis = wolffian/mesonephric duct

Testis = Mullerian/ paramesonephric duct

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Pampiniform venous plexus

Drains rete testis and epididymis to the right and left testicular veins

Found on the spermatic cord
- controls thermoregulatory plexus of testis w/ spermatic cord

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Lymphatic drainage of testies and scrotum

Testes drain to lumbar lymph nodes

Scrotum drains to superficial inguinal lymph nodes

Difference between vein drainage between left and right sides

The same except for the left renal vein is larger and does have a direct tributary/branches (left gonadal and left suprarenal vein).

Pudendal nerve branches

Inferior rectal nerve (branches in the lesser static foramen

Perineal nerve (branches medial to ischial tuberosity region)

Dorsal nerve of the penis/clit (inferior to pubic symphysis)

External vs internal anal sphincter

External = skeletal muscle with voluntary innervation (S4)
-Inferior 1/3 of anal canal

Internal = smooth with autonomic innervation
-superior 2/3 anal canal

Pectinate line

Line that demarcates the superior and inferior anal canal

Differences between superior and inferior anal canal

Superior:

endoderm derived
supplied by IMA branch
portal venous system
autonomic

Inferior:

ectoderm derived
supplied by internal iliac
caval venous System
somatic via pudendal

Kidney blood supply

Renal -> segment -> inter-lobar artery -> arcuate artery

What portion of the urinalysis bladder is encased in perineum?

Superior portion

Functions of pelvic cavity

Bears weight of upper body Transfers weight to lower limbs Provides attachment for musculature Contains and protects pelvic viscera Provides support for abdominopelvic viscera Provides attachment for erectile bodies

Muscles or pelvic diaphragm

Puborectalis: U-shaped sling that is posterior to anorectal canal from contralateral pubic bones - bends anal canal anteriorly to prevent defecation (also blocks vaginal opening in females) Pubcoccygeus: medial fibers merge w/ contralateral anococcygeal ligaments Iiococcygeus Coccygeus: inferior sacrum to ischial spine - flexes coccyx and supports pelvic viscera

Levator ani muscles include what?

Puborectalis Pubococcygeus Iiococcygeus

Broad ligament

Peritoneal fold between the uterus and lateral body wall of females

Membranous Visceral vs parietal pelvic fascia

Parietal: lines the deep pelvic aspect of muscles forming the walls and floor (parts are named for the muscle they cover) Visceral: directly ensheaths pelvic organs - also known as adventitia layer

Hypogastric sheath

Thick band of condensed pelvic fascia that separates retropelvic from retrorectal spaces Has three laminae

Lamina of hypogastric sheath

Anterior: lateral ligament of the bladder: - contains superior vesicle arteries and veins Posterior: lateral rectal ligament - contains middle rectal artery and vein and rectal nerve plexus ``` Intermediate lamina: cardinal ligament (females): between uterine cervix and vagina ``` Rectovesical septum (males): between posterior bladder and prostate

3 sites of constriction in ureters

Ureter and renal pelvis Ureter and pelvic inlet Ureter and urinary bladder

What is the broad ligament analogous to in the male

Ureteric fold

Potential spaces in endopelvic fascia

Retropubic and retrorectal

Branches of the internal pudendal artery

Dorsal penile artery -supplies fibrous tissue, skin and spongy urethra of the penis Deep penile artery - supplies heliocentric arteries within corpus cavernosium

What causes an erection?

Parasympathetic fibers stimulate helicine arteries to relax allowing blood to fill - prevents venous drainage by bucks fascia being pushed up against them compressing the deep penile vein

Broad ligament and its peritoneum layers

Suspends the uterus and ovaries Mesovarium (perineum over the ovaries) Mesometrium (perineum over the uterus) Mesosalpix (perineum over the uterine tubes)

Uterine isthmus (internal os)

Separates uterus from the cervix Also separate line for perineum

Active and passive support of the uterus

Active = pelvic diaphragm and cardinal ligaments Passive = urinary bladder

Parts of uterine tube (from distal to proximal uterus)

Infundiblum w/ fimbriae Ampulla Isthmus Uterine part Ovary is attached at the isthmus and ampulla but the eggs enter the infundibulum first

Suspensory ligaments of the ovaries

Suspend the ovaries intraperitioneal and house the ovarian vessels, lymphatic and nerves Ovarian ligaments are remnants of the female gubernaculum

Innervation of the vagina

Inferior 1/4th - somatic innervation (perineal nerve) - sensitivity to pain, temp and touch Superior 3/4 - visceral innervation - inferior hypogastric plexus -> uterovaginal plexus nerves

Autonomic innervation of micturition

Parasympathetic: - relaxes internal urethral sphincter and anal sphincters - contracts destructor muscle Sympathetic: - vasoconstriction of renal vessels - contraction of internal urethral sphincter