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Anatomy > Pelvis And Perineum > Flashcards

Pelvis And Perineum Flashcards

1
Q

Bony pelvis functions

A

. Supports and protects pelvic viscera
. Transmits upper body weight to lower extremities
. Provides stable base for lower limb function
. Forms birth canal

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2
Q

Bony pelvis structure

A

. R/L hipbones, sacrum, and coccyx
. Hipbone formed by ilium, ischium, and pubis that fuse in puberty
. Sacrum
. Coccyx

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3
Q

Joints of pelvis and descriptions

A

. Pubic symphysis: immobile, formed by fibrocartilage interpubic disc and R/L pubic bodies
. SI joints: R/L ilia and sacrum, reinforced by ant., post., an interosseous SI ligaments, minimal gliding and rotational movements

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4
Q

Pelvic ligament function

A

. Resist rotational forces generated when sacrum is loaded w/ weight ant. To its; axis. Of rotation

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5
Q

Pelvic ligaments

A

. Sacrotuberous: from sacrum to ischial tuberosity
. Sarcospinous: sacrum to ischial spine (deep to sacrotuberous)
. Ant., post., interosseous SI: make up SI joint
. Pubic: around pubic symphysis

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6
Q

Hip fracture vs pelvic fractures

A

. Hip: fracture of femoral head

. Pelvis: fracture of actual hipbone, have to worry about pelvic viscera damage

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7
Q

Relaxin

A

. Hormone released during pregnancy
. Relaxes pelvic ligaments and softens interpubic disc
. Inc. mobility in SI joints and pubic symphysis to facilitate childbirth

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8
Q

Superior pelvic aperture

A

. Pelvic inlet
. Pelvic brim formed by pubic crest, pecten pubis, arcuate line of ilium, sacral ala, and sacral promontory
. Boundary btw greater (false) pelvis (continuous sup. W/ abdominal cavity) and lesser (true) pelvis (contains pelvic viscera)

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9
Q

Inferior pelvic aperture

A

. Pelvic outlet/birth canal
. Delineated by ischial tuberosities, ischial spines, ischiopubic rami, and coccyx
. Diamond-shaped
. Correspond to perineum

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10
Q

. Male pelvis unique factors

A

. Robust w/ heavier rami
. Larger articular surfaces
. More pronounced muscle attachments

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11
Q

Adult female pelvis unique characteristics

A 
. Ovoid pelvic inlet 
. Longer pubic rami
. Wider spaced ischial tuberosities and ischial spines 
. Reduced sacral curvature 
. Greater subpubic angle 
. Wider greater sciatic notch
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12
Q

Interspinous distance

A

. Critical minimum dimension of birth canal
. Inlet widest transversely
. Outlet widest AP
. Allows fetal head and shoulders

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13
Q

Muscles of lateral wall of pelvis

A

. Obturator internus

. Piriformis

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14
Q

Obturator internus m. OIAN

A

. O: internal surfaces off bony boundaries of obturator foramen and obturator membrane
. I: tendon exits pelvis via lesser sciatic foramen to greater trochanter
. A:
. N: nerve to obturator internus (L5/S2)

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15
Q

Iscioanal fossa

A

. Obturator internus m. And obturator fascia form lat. wall

. Inf. To levator ani m.

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16
Q

Piriformis OIAN

A

. O: anterolateral surface of sacral body, sup. Margin of greater sciatic notch
. I: tendon exits pelvis via greater sciatic foramen to greater trochanter
. A:
. N: nerve to piriformis (S1-2)

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17
Q

Pelvis diaphragm/floor

A

. Funnel-shaped group of muscles that partially close off outlet
. Support abdominopelvic viscera esp. when intra-abdominal pressure inc.
. Consists of coccygeus and levator ani group muscles.

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18
Q

Coccygeus OIAN

A

O: ischial spine
I: pelvic surface of inf. Sacrum and coccyx
A: pulls coccyx ant. And supports pelvic viscera
N: branches of S4-5

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19
Q

Levator ani group

A

. Elevates pelvic floor to resist and/or raise intra-abdominal pressure
. Puborectalis, pubococcygeus, and iliococcygeus mm.

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20
Q

Levator ani group muscles innervation

A

. Nerve to levator ani (S3-4)
. Inf. Rectal nn. (S2-4)
. Coccygeal plexus (S4-Co1)

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21
Q

Puborectalis m. OI

A

O: body of pubis
. I: fibers go posteromedially to insert post. To anal canal on fiber from opposite side
. Some fibers merge w/ upper portion of external anal sphincter (and around vagina in women)
. Forms puborectal sling around anorectal junction to help maintain fecal continence

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22
Q

Pubococcygeus m. OI

A

. O: pubis and ant. Portion of tendinous arch of levator ani
. I: fibers go posteromedially to insert post. To anal canal on anococcygeal ligament and coccyx

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23
Q

Iliococcygeus m. OI

A

O: tendinous arch of levator ani
I: anococcygeal ligament and coccyx

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24
Q

Tendinous arch of levator ani

A

. Thickened portion of obturator internus fascia
. Extends in arch from pubis to ischial spine
. Gives origin parts of levator ani m.

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25
Q

Urogenital hiatus

A

. Midline space btw R/: puborectalis mm.

. Transmits urethra, vagina, and anal canal

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26
Q

Obturator canal

A

. Passage btw sup. Pubic ramus and sup. Margin of obturator membrane spanning obturator foramen
. Transmits obturator n./a./v.

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27
Q

Greater sciatic foramen and contents

A

. Formed by greater sciatic notch and sup. Border of sacrospinous and sacrotuberous ligaments
. Connects pelvic cavity w/ gluteal region
. Piriformis m. Exits pelvis here
. Sup. Gluteal n./a./v. (L4-S1) pass sup. To piriformis
. Inf. Gluteal n./a./v. (L5-S2), pudendal (S2-4) and internal pudendal a./v. Pass inf. To piriformis m.

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28
Q

Lesser sciatic foramen

A

. Formed by lesser sciatic notch and inf. Border of sacrospinous ligament and sup., border of sacrotuberous ligament
. Connects gluteal region w/ perineum
. Tendon of obturator internus m. Exits pelvis here
. Pudendal n. And internal pudendal a./v. Exit pelvis via greater sciatic foramen, pass lat. around ischial spine and sacrotuberous ligament, pass medially through lesser sciatic foramen to enter perineum

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29
Q

Perineum

A

. Diamond-shaped region located inf. To pelvic diaphragm and btw prox. Thighs
. Includes external genitalia, openings of urinary, GI, and reproductive tracts, assoc. muscles, and neurovasculature

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30
Q

Boundaries of perineum

A 
. Ant.: pubic symphysis 
. Anterolateral: ischiopubic rami 
. Lat.: ischial tuberosities 
. Posteroateral: sacrotuberous ligaments
. Post.: inf. Sacrum and coccyx
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31
Q

Transverse line connecting ischial tuberosities divides perineum into _____

A

. Ant. Urogenital (UG) triangle

. Post. Anal triangle

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32
Q

What does anal triangle contain?

A

. Anal canal
. Anal orifice
. R/L ischioanal fossae

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33
Q

External anal sphincter

A

. Skeletal muscle fibers circle inf. End of anal canal
. Superficial fibers attach to perineal body and coccyx
. Deep upper fibers blend w/ puborectalis m.
. Closes anal orifice to prevent defecation

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34
Q

External anal sphincter innervation

A

. Inf. Rectal nn. (Branches of pudendal nn.)

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35
Q

Ischioanal fossae

A

. Wedge shaped, fat-filled lat. to anus
. Inf. Boundary: perianal skin
. Lat.: obturator fascia covering obturator internus mm.
. Sup.: Inf. Surface of levator ani m. Covered by deep fascia
. Med.: walls of anal canal
. Post.: sacrotuberous ligament
. Ant.: ant. Recesses of ischioanal fossae extending to UG triangle

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36
Q

Anterior recesses of ischioanal fossae

A

. Extend to UG triangle
. Sup. To muscles of deep perineal pouch
. Pyramid shaped
. Apex is closed, points ant. Toward pubis
. Base is open and continuous post. W/ ischioanal fossae
. L/R fossae communicate deep to anococcygeal ligament in deep post-anal space
. Permits movement of pelvic diaphragm and expansion of anal canal

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37
Q

Pudendal canal

A

. In lat. wall of ischioanal fossa w/in obturator internus m. Fascia
. Transmits pudendal n. And internal pudendal a./v. And branches that supply perianal structures

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38
Q

Superficial perineal fascia components

A

. SubQ of perineum
. Fatty layer
. Membraneous layer

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39
Q

Fatty layer of superficial perineal fascia

A

. Continuous w Camper’s fascia
. Forms labia majora and mons pubis in females
. Minimal/absent in scrotum/penis in males

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40
Q

Membraneous layer of superficial perineal fascia

A

. Colles fascia
. Continuous w/ dartos fascia
. Attaches lat. to ischiopubic rami and fuses post. Perineal body and post. Border of perineal membrane
. Fuses w/ deep fascia of thigh (fascia lata) at inguinal ligament

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41
Q

Deep perineal fascia

A

. Investing fascia of muscles of superficial perineal pouch
. Attaches lat. to ischiopubic rami
. Ant. Continuous w/ deep fascia of external oblique and rectus sheath

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42
Q

Perineal membrane

A

. Tough investing fascia of the muscles of deep perineal pouch
. Attaches lat. to ischiopubic rami and partially spans UG triangle
. Divides the UG region from inf. Surface of pelvic diaphragm (sup.) to the Colles fascia into 2 stacked fascial pouches

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43
Q

Superficial perineal pouch

A

. Enclosed compartment
. Potential space located btw Colles fascia (inf) and perineal membrane (sup)
. Laterally bounded by ischiopubic rami
. Post. Bounded by fusion of Colles fascia and post. Margin of perineal membrane
. Contains erectile tissues, superficial perineal muscles, nn. Vessels, portion of urethra (males and females), vagina and greater vestibular glands in females

44
Q

Deep perineal pouch

A

. Loosely defined
. Btw perineal membrane (inf), inf. Fascia of pelvic diaphragm (sup) and obturator internus fascia (lat)
. Contains deep perineal mm., dorsal neurovasculature of penis/clit, portions of urethra, bulbourethral glands in males, and ant. Recesses of ischioanal fossae

45
Q

Perineal body

A

. Musculofibrous mass in median plane btw anal canal and vestibule of vagina or bulb of penis
. Fuses to post. Border of perineal membrane and sup. W/ rectovesical/rectovaginal septum
. Site of convergence of several perineal mm.
. Maintains integrity of pelvic floor and fecal incontinence

46
Q

Muscles that converge in perineal body

A

. Bulbospongiosus m.
. Superficial and deep transverse perineal mm.
. External anal sphincter m.
. Fibers from external urethral sphincter m.
. Levator ani
. Smooth muscle fibers from rectum

47
Q

What happens if there is disruption of perineal body?

A

. Pelvic floor laxity
. Weakening of urethral and anal sphincters
. Herniation or prolapse of pelvic viscera (bladder, uterus, vagina, and/or rectum)

48
Q

Penis components and descriptions

A

. Shaft: corpus spongiosum (ventral midline tube w/ urethra) and paired corpora cavernosa lined w/ endothelium forming sinuses btw tubes
. Glans of penis: terminal expansion of corpora spongiosum (distal urethra and external urethral orifice)
. Corona of glans: projection of glans beyond corpus spongiosum
. Prepuce (foreskin): hood of kin and fascia. Sheathing glans, attached ventrally by frenulum of perpuce

49
Q

Coverings of penis from superficial to deep

A

. Skin
. Superficial dartos fascia
. Deep (Buck) fascia
. Tunica albuginea covering each of the erectile bodies

50
Q

Components of vulva

A 
. Mons pubis 
. Labia majora 
. Labia minora
. Clit 
. Vestibule
51
Q

Mons pubis

A

. SubQ fat pad superficial to pubic symphysis

52
Q

Labia majora

A

. Paired fatty skin folds lat. to labia minora

53
Q

Labia minora

A

. Paired folds of skin and fat-free fascia med. to majora
. Unite ant. To form dorsal perpuce and ventral frenulum of Clit
. Unite post. To vestibule at frenulum of labia majora

54
Q

Clit

A

. Has body and glans
. Fused corpora cavernosa
. Dorsal and ventral surfaces of clit same as penis
. Thinner fascial layers than penis

55
Q

Vestibule in vulva

A

. Area btw labia minora

. Contains external urethral orifice, vaginal orifice, and openings of ducts of greater vestibular (Bartholin) glands

56
Q

Root of penis

A

Formed by erectile bodies (corpora cavernosa, corpus spongiosum) proximally

57
Q

Crura of penis

A

. Prox. Portions of corpora cavernosa that attach to ischiopubic rami
. R/L crura fuse at pubic symphysis

58
Q

Bulb of penis

A

. Broad proximal portion of corpus spongiosum
. Attaches to inf. Surface of perineal membrane
. Urethra pierces sup. Surface of bulb and turns ant. To becomes spongy urethra

59
Q

Membraneous urethra

A

Part of male urethra within deep perineal space

60
Q

Spongy urethra

A

. Traverses superficial perineal pouch w/in penis bulb

. Continues distally through penis body w/in corpus spongiosum

61
Q

What forms root of clit?

A

. Proximal

. 2 crura

62
Q

Crura of clit

A

. Proximal portions fo corpora cavernosa
. Attach to ischiopubic rami
. R/L crura unite to form body and glans of clit at pubic symphysis

63
Q

Bulbs of vestibule in vulva

A

. 2, pear-shaped erectile bodies
. Lat. to vestibule and vaginal opening
. Attach to inf. Surface of perineal membrane
. Constrict vaginal. Orifice when engorged

64
Q

Superficial perineal mm.

A

. Innervated by branches of deep perineal n.
. Bulbospongiosus mm.
. Ischiocavernosus m.
. Superficial transverse perineal m.

65
Q

Bulbospongiosus mm. OIA In males

A

. Paired muscles that envelope bulb of penis
O: perineal body and midline raphe of ventral surface of bulb
I: perineal membrane and fascia of corpora spongiosum and cavernosa
A: aid in expulsion of semen/urine, help maintain erection by restricting vv.

66
Q

Bulbospongiosus mm. OIA In females

A

. Paired mm. That envelope ipsilateral bulb of vestibule and greater vestibular gland
O: perineal body
I: pubic arch, fascia fo body of clit
A: assist in clit erection, compress greater vestibular glands and constrict vaginal opening

67
Q

Ischocavernosus m. OIA

A

. Paired muscles enveloping crura
O: ischiopubic ramus
I: crura and perineal membrane
A: maintains erection by compressing crura and restricting vv.

68
Q

Superficial transverse perineal m. OIA

A

. Paired mm. That course parallel and superficial to post. Border of perineal membrane
O: ischiopubic rami and ischial tuberosities
I: perineal body
A: stabilize pelvic floor and perineal body

69
Q

Greater vestibular glands

A

. Mucus-excreting glands lat. to vaginal vestibule
. At post. Ends of vestibular bulbs
. Provides lubrication to vaginal orifice

70
Q

Episiotomy

A

. Enlarges vaginal orifice

. Incision through perineal skin and mm. Through post. Vaginal wall

71
Q

Perineal lacerations

A

. Occur during childbirth

. Can damage perineal body and external anal sphincter

72
Q

Bartholin cyst

A

. Ducts of greater vestibular glands may become obstructed
. Cause fluid swelling
. Small cysts resolve on their own
. Larger cysts are drained

73
Q

Extravasation of urine

A

. Injury ruptures spongy urethra and tear Buck fascia
. Passage of urine into superficial perineal pouch
. Blood/urine may accumulate around penis or lower abdominal wall deep to scarpa’s fascia
. Usually looks butterfly shaped around penis
. Won’t pass into thighs because Colles fascia fuses to fascia lata
. Fluid can’t pass into anal triangle because Colles fascia fuses w/ post. Edge of perineal membrane

74
Q

Deep perineal mm.

A

. Innervated by deep perineal mm.
. Deep transverse perineal mm.
. External urethral sphincter m.

75
Q

Deep transverse perineal mm. OIA

A

. Paired mm. That course parallel and deep to post. Border of perineal membrane
O: ischiopubic rami and ischial tuberosity
I: perineal body and external anal sphincter
A: stabilize pelvic floor and perineal body

76
Q

External urethral sphincter m. In males

A

. Voluntary sphincter composed of striated m.
. Inf. Fibers encircle membraneous urethra and attach to ischiopubic rami (also called compressor urethrae m.)
. sup. Fibers extend sup. To neck of bladder spanning ant. Prostate gland and prostatic urethra

77
Q

External urethral sphincter m. In females

A

. Compound urogenital sphincter w/ Several components
. Upper fibers encircle proximal urethra forming external urethral sphincter proper
. Lower fibers encircle urethra and vagina (sphincter urethrovaginalis) and anchor the urethra to ischiopubic rami (compressor urethrae m.)

78
Q

Bulbourethral (Cowper’s) glands

A

. Produce pre-cum
. Lat. to membranous urethra w/in deep perineal pouch
. Ducts penetrate perineal membrane and bulb to empty into spongy urethra

79
Q

Anterior recesses of ischioanal fossae

A

. Bilateral projections of ischioanal fat into UG triangle sup. To perineal membrane and post. UG diaphragm

80
Q

Pathway of pudendal n. And internal pudendal n. To reach perineum

A

. Exit pelvis via greater sciatic foramen and course lat. to ischial spine and sacrospinous ligament
. Turn med. through lesser sciatic foramen to enter pudendal canal w/in lat. wall of ischioanal fossa
. Courses ant. W/in canal giving off branches that pierce fascial walls of canal to reach targets

81
Q

Pudendal nerve

A

. S2-4

. Provide motor and sensory innervation to perineal structures

82
Q

Inferior rectal (anal) n.

A

. Crosses ischioanal fossa to arch anal canal
. Motor innervation to external anal sphincter and levator ani m.
. Sensory from perianal skin and anal canal inf. To pectinate line

83
Q

Inferior rectal n. Damage causes ____

A

Damage results in loss of sensation in anal orifice and fecal incontinence

84
Q

Perineal n.

A

. Supplies structures w/in superficial and deep perineal pouches
. Superficial perineal n. Gives rise to post. Scrotal/labial nn. Innervation skin of central perineum
. Deep perineal n. Innervates all skeletal muscles of UG triangle, provide sensory to vaginal vestibule, lower vagina, and urethra

85
Q

Dorsal n. Of penis/clit

A

. Sensory from distal penis/clit
. Courses ant. W/in deep perineal pouch sup. To perineal membrane
. Accompanied by internal pudendal a. Then by terminal branch (dorsal a. Of penis/clit)
. Pierces perineal membrane and courses ant. On dorsal surface of body of penis/clit

86
Q

Anterior scrotal/Labial nn.

A

. Branches of ilioinguinal nn. And genital branch of genitofemoral nn.
. Convey sensory from ant. Scrotum/vulva

87
Q

Perineal branch of post. Femoral cutaneous n.

A

. Supplies skin of posterolateral perineum

88
Q

Internal pudendal artery

A

. Main blood supply of perineum
. From internal iliac a. (Ant. Division) and courses w. Pudendal m.
. Passes sup. To perineal membrane, causes ant. W/in deep perineal pouch
. Terminates by dividing into deep and dorsal aa. Of penis/clit
. W/in deep pouch it accompanies dorsal n. Of penis/clit

89
Q

Branches of internal pudendal artery

A 
. Inf. Rectal a.
. Perineal a. 
. Artery to bulb of penis/vestibule (pierces perineal membrane to enter bulb)
. Deep a. Of penis/clit 
. Dorsal a. Of penis/clit
90
Q

Inf. Rectal artery

A

. Supplies external anal sphincter
. Mucosa of anal canal inf. To pectinate line
. Skin of anal triangle

91
Q

Perineal artery

A

. Gives off muscular branches then terminate as post. Scrotal/labial aa.

92
Q

Deep artery of penis/ clit

A

. Enters crus of corpus cavernosum

. Continues into body of penis/clit

93
Q

Dorsal artery of penis/clit

A

. Main arterial supply to distal penis/clit
. Courses ant. On dorsal surface of corpus cavernosum btw tunica albuginea and deep penile/clitoral fascia
. Medal to dorsal n. And lat. to deep dorsal vein

94
Q

External pudendal artery

A

. Arises Rome emoral a. In femoral triangle

. Supplies body wall structures of ant. Urogenital region

95
Q

Venous drainage of perineum

A

. Internal pudendal v.
. Deep dorsal v. Of penis/clit
. Superficial dorsal v. Of penis/clit

96
Q

Internal pudendal v. And branches

A

. Drains most of perineum to internal iliac v.
. Tributaries follow course of internal pudendal a. And branches
. Inf. Rectal v.: drains internal rectal venous plexus inf. To pectinate lines and perianal skin
. Perineal v: receives post. Scrotal/labial vv. And other venae comitantes of internal pudendal a. Branches

97
Q

Deep dorsal v. Of. Penis/clit

A

. Unpaired vessel draining cavernous spaces of erectile tissues
. Courses inf. To pubic symphysis and drains to prostatic (male) or vesicular (female) venous plexus
. Drains into internal iliac v.

98
Q

Superficial dorsal v. Of penis/clit

A

. Paired vessels (R/L)
. Drain into external pudendal vv.
. Btw superficial and deep fascia of penis/clit
. Courses in plane btw superficial fascia (dartos in males) and. Deep fascia of penis/clit

99
Q

Order of neurovasculature of penis/clit from superficial to deep

A 
. Right dorsal n. 
. Right dorsal a. 
. Deep dorsal v. 
. Right dorsal a. 
. Right dorsal n.
100
Q

Lymphatic drainage of perineum in male

A

. Lymph from scrotum and skin of penis drains to superficial inguinal lymph nodes
. Glans and distal urethra drain to deep inguinal lymph nodes
. Erectile bodies and prox. Urethra drain to internal iliac nodes w/in pelvis

101
Q

Lymphatic drainage of perineum in females

A

. Lymph drains to superficial and deep inguinal lymph nodes in femoral triangle
. Urethra, gland of clit, and ant. Labia minora drain to internal iliac nodes w/in pelvis

102
Q

Innervation coordinating erection

A

. Parasympathetic dilates penis/clit aa. And relaxes smooth muscle in venous sinuses of erectile bodies
. Blood flows into sinusoids producing erection
. Pressure from inc. blood volume produces spinal reflex (via. Pudendal n.) that causes reflexive contractions of bulbospongiosus and ischiocavernosus mm. (Impede venous drainage)

103
Q

Innervation coordination of emission

A

. Sympathetic causes peristalsis of reproductive ducts and accessory sex glands
. Seminal fluid (male) or vaginal and glandular secretions (female) release

104
Q

Innervation coordination of ejaculation

A

. Sympathetic constricts internal urethral sphincter m.
. Spinal reflex (via pudendal n.) produces rhythmic contractions of somatic pelvic mm.
. Rhythmic contractions of bulbospongiosus m. Propel semen through urethra

105
Q

Innervation coordination of remission

A

. Sympathetic produces vasoconstriction
. Relaxes bulbospongiosus and ischiocavernosus mm.
. Allows blood to drain from erectile tissues

106
Q

Obturator fascia

A

. Invests pelvic and perineal surfaces of obturator internus m.

107
Q

Tendinous arch (Argus tendineus) of pelvic fascia

A

. Fascial bands running from pubis to sacrum bilaterally

. Flanks viscera where they penetrate pelvic floor

Anatomy (49 decks)

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