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Perineum Flashcards

1
Q

In strict anatomical terms, where is the perineum and what does it contain?

A

It is the narrow region between the proximal parts of the thighs inferior to the pelvic diaphragm

It is functionally defined as the outlet of the pelvis and contains:
Anal canal, anal aperture, and associated sphincter muscles
Distal urethra, external openings of the urinary tract, and associated sphincter muscles
Lower vaginal canal and external orifice (in females)
External genitalia and fascial layers/muscles that support them

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2
Q

What are the three bones of the ox coxa and at what age do they fuse?

A
  1. Ilium superiorly
  2. Ischium posteroinferiorly
  3. Pubis anteroinferiorly

Fuse at 18 years of age

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3
Q

Which ox coxae bones fuse first and what is their connection called?

A

Pubis and Ischium creating the ischiopubic ramus

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4
Q

What connects the ox coxae posteriorly and anteriorly?

A

Posteriorly - sacrum by the sacroiliac joints and reinforced by:
(Superficial to deep)
1. Anterior sacroiliac ligaments
2. Interosseous sacroiliac ligaments (strongest)
3. Posterior sacroiliac ligaments

Anteriorly - symphysis pubis and reinforced by:

  1. Superior pubic ligament
  2. Inferior pubic ligament
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5
Q

What is an important landmark at the S1 vertebra?

A

Sacral promontory

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6
Q

What are the parts of the linea terminals?

A
  1. Arcuate line of the ilium
  2. Pecten pubis (AKA pectineal line) of the pubis
  3. Pubic crest of the pubis
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7
Q

What and where do the sacrospinous ligament and sacrotuberous ligament connect?

A

Sacrospinous ligament (more anterior) - connects sacrum to the ischial spine

Sacrotuberous ligament (more posterior) - connects sacrum to the ischial tuberosity

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8
Q

How do you form the urogenital triangle and the anal triangle?

A

Urogenital triangle - draw a line between the ischial tuberosity and then two lines towards the symphysis pubis

Anal triangle - draw a line between the ischial tuberosity and then two lines towards the coccys

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9
Q

What nerve fibers controls the external anal sphincter?

A

GSE nerve fibers from the inferior rectal nerve (S2-S4) which branched off from the pudendal nerve

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10
Q

What nerve fibers controls the internal anal sphincter and what do they do?

A

GVE (parasympathetic and sympathetic)

Parasympathetic - opens sphincter
Sympathetic - closes sphincter

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11
Q

What courses through the pudendal canal?

A

Pudendal nerve

Internal pudendal artery/vein

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12
Q

What forms the pudendal nerve?

A

It is a branch from sacral plexus formed by S2, S3, S4 anterior rami

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13
Q

What are the branches of the pudendal nerve?

A
  1. Inferior rectal nerve (first branch)
  2. Perineal nerve
  3. Dorsal nerve of penis or clitoris
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14
Q

What and where do the nerve fibers of the inferior rectal nerve provide?

A

GSE to external anal sphincter and GSA to the anal canal below the pectinate line

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15
Q

The inferior fascia of the UG diaphragm is also known as what?

A

Perineal membrane

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16
Q

What is the space between the superior fascia of the UG diaphragm and the perineal membrane (AKA inferior fascia) and what does it contain?

A

Deep perineal space (or pouch) and contains the UGD muscles

17
Q

Where are the glands for males and females located and what are they called?

A

Males - Deep perineal space, Cowper’s gland (AKA bulbourethral)

Females - Superficial perineal space, Bartholin’s gland

18
Q

What marks the separation between the abdomen and the true pelvis and what forms it?

A

The pelvic inlet which is posteriorly composed of the two parts of the sacrum (sacral promontory and sacral ala) and anteriorly composed of the three parts of the linea terminals (arcuate line of the ileum, pecten pubis or pectineal line of the pubis, pubic crest of the pubis)

19
Q

Identify A-G

A 
A. Anterior superior iliac spines
B. Greater sciatic notch
C. Ischial spine
D. Lesser sciatic notch
E. Pubic tubercle
F. Ischial tuberosity
G. Ischiopubic rami
20
Q
  1. Identify 1-4

2. Which is the strongest of 1-3?

A
  1. Anterior sacro-iliac ligaments
  2. Interosseous sacro-iliac ligaments (strongest)
  3. Posterior sacro-iliac ligament
  4. Sacral promontory
21
Q

Identify A and B

A

A. Sacrospinous ligament

B. Sacrotuberous ligament

22
Q

Identify 1-6

A
  1. Symphysis pubis
  2. Ischiopubic ramus
  3. Sacrotuberous ligaments
  4. Coccyx
  5. Pelvic outlet
  6. Pelvic inlet
23
Q

Anatomically, is the symphysis pubis inferior or superior to the coccyx?

24
Q

From an inferior point of view of the pelvic diaphragm, the lateral sides are superficial and the center of the diaphragm is deep.

True or False

A

False. It is bowl/funnel shaped so the center is more superficial while the lateral sides are deep

25
What are the boundaries of the ischioanal fossae?
Laterally: obturator internus muscle (perineal portion, seen best in left image) Superomedial: pelvic diaphragm Inferior: skin and fascia
26
What forms the boundaries of the pelvic outlet?
1. Symphysis pubis anteriorly 2. Ischiopubic rami anterolaterally 3. Sacrotuberous ligaments posteriolaterally 4. Coccyx posteriorly
27
What forms the pudendal canal?
Fascia of the obturator internus
28
What and where do the nerve fibers of the perineal nerve provide?
GSE to 5 muscles perineal region, GSA to scrotum or vestibule, and GVE fibers (will learn more later)
29
What and where do the nerve fibers of the dorsal nerve of penis or clitoris provide?
GSA innervation to the penis or clitoris (will learn more later)
30
What are the borders of the anterior recesses of the ischio-anal fossae?
Apex: closed and pointed anteriorly towards pubis Base: open and continuous posteriorly with the ischio-anal fossa Inferior: superior fascia of the UG diaphragm Superomedial: pelvic diaphragm muscles Lateral: obturator internus muscle
31
What are the five layers of the UG triangle?
A. Pelvic diaphragm B. Superficial layer of fascia of the UG diaphragm C. UG diaphragm D. Perineal membrane E. Structures within superficial perineal space
32
What two muscles within the deep perineal space make up the UG diaphragm
1. External sphincter urethra | 2. Deep transverse perineus muscle
33
Identify A-E
``` A. Corona of glans B. Glans penis C. External urethral orifice D. Prepuce E. Frenulum of glans ```
34
Identify A-H
``` A. Prepuce of clitoris B. Glands clitoris C. Urethral opening D. Labia Majora E. Labia Minora F. Vaginal opening G. Vestibule H. Frenulum of clitoris ```
35
What is the difference between varicocele and hydrocele?
Variocele - results from pampiniform plexus of veins around the spermatic cord becoming varicose. Looks and feels like “a bag of worms.” Will not transmit light when illuminated Hydrocele - excessive accumulation of serous fluid within the tunica vaginalis. Will be illuminated with transillumination
36
What is a palpable landmark which can be used to approximate the path of the pudendal nerve for anesthetizing it?
Ischial spine

Anatomy (5 decks)

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