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_Anat./GIE #3 > Perineum > Flashcards

Perineum Flashcards

1
Q

Define the term perineum.

A

Perineum: a shallow compartment inferior to the pelvic diaphragm and bounded by the pelvic outlet.

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2
Q

What are the boundaries of the perineum?

A

With the thighs abducted, the perineum is diamond-shaped, extending:
anteriorly from the mons pubis
laterally along the inner thighs
posteriorly to the intergluteal cleft

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3
Q

What are the perineal triangles?

A 
urogenital (UG) triangle (anterior)
anal triangle (posterior)
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4
Q

What divides the UG triangle and anal triangle?

A

a transverse line passing through the ischial tuberosities

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5
Q

Name the perineal layers.

A
  1. perineal skin
  2. subcutaneous fat
  3. superficial perineal (Colles) fascia
  4. deep perineal fascia (of Gallaudet)
  5. perineal membrane
  6. perineal body
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6
Q

What pierces the perineal membrane?

A

Males: urethra
Females: urethra and vagina

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7
Q

To what do the external genitalia of both genders anchor?

A

perineal membrane

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8
Q

What is the fibrous knot at the boundary between the UG and anal triangles?

A

perineal body, or central tendon of the diaphragm

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9
Q

Why is the perineal body critical for perineal integrity?

A

it provides attachment for perineal muscles, blends with the perineal membrane, and binds to parts of the pelvic fascia in both genders

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10
Q

What forms the pudendal canal?

A

The pudendal canal is actually a slit in the obturator internus fascia.

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11
Q

What passes through the pudendal canal?

A

internal pudendal vessels

pudendal nerve

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12
Q

What is the pectinate line?

A

marks the junction between hindgut and proctodeum

dividing line for blood and nerve supply

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13
Q

Describe the blood supply superior to the pectinate line of the anal canal.

A

superior rectal vessels

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14
Q

Describe the autonomic nerve supply superior to the pectinate line of the anal canal.

A

autonomics via the rectal plexus

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15
Q

Describe the blood supply inferior to the pectinate line of the anal canal.

A

inferior rectal vessels

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16
Q

Describe the innervation and somatic sensation inferior to the pectinate line of the anal canal.

A

inferior rectal nerve innervates the external anal sphincter to constrict during relaxation and relax during defecation; also provides somatic sensation to the anus

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17
Q

Visceral afferents of the anal canal travel with the _____ fibers.

A

Visceral afferents of the anal canal travel with the parasympathetic fibers.

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18
Q

What is contained within the superficial perineal space/pouch in males?

A 
superficial perineal muscles
urethra
arteries
nerves
root of the penis
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19
Q

What is contained within the superficial perineal space/pouch in females?

A 
superficial perineal muscles
urethra
arteries
nerves
clitoris
vestibular bulbs
vagina
vestibular glands
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20
Q

What is contained within the deep perineal space/pouch in males?

A 
the fat-filled anterior recesses of the ischioanal fossae
deep perineal muscles
urethra
arteries
nerves
bulbourethral glands
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21
Q

What is contained within the deep perineal space/pouch in females?

A 
the fat-filled anterior recesses of the ischioanal fossae
deep perineal muscles
urethra
arteries
nerves
vagina
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22
Q

What supports the penile weight?

A

fundiform ligament of the penis from linea alba

suspensory ligament of the penis from the pubic symphysis

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23
Q

What comprises the root of the penis?

A

penile bulb and 2 crura

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24
Q

What is the penile bulb?

A

the enlarged proximal end of the corpus spongiosum that transmits the urethra

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25
Q

What comprises a cruz?

A

a corpus cavernosum anchored to an ischiopubic ramus

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26
Q

Distally, the glans penis is made only of ______ ______.

A

corpus spongiosum

27
Q

To what vessel does the superficial dorsal vein of the penis drain?

A

pudendal vein -> great saphenous vein -> femoral vein

28
Q

Into what does the deep dorsal vein of the penis drain?

A

prostatic plexus of veins

29
Q

What do the paired dorsal penile arteries branch off of?

A

internal pudendal arteries

30
Q

What do the paired dorsal penile nerves branch off of? What do they do?

A

pudendal nerve; provide somatic sensation to the penis

31
Q

Describe the parts of the urethra. (male)

A

The INTERMEDIATE (MEMBRANOUS) URETHRA traverses the deep perineal space and terminates at the perineal membrane.

The SPONGY (PENILE) URETHRA starts at the perineal membrane, bends sharply in the bulb, and terminates at the external urethral orifice.

Within the glans penis it expands as the NAVICULAR FOSSA.

32
Q

Describe the location and function of the bulbourethral glands.

A

Location: in deep perineal space posterior to the intermediate urethra

Function: produce lubricant during sexual arousal

33
Q

What covers the superficial perineal muscles?

A

Deep perineal fascia (of Gallaudet)

34
Q

How is blood kept in the penis during erection?

A

Paired ischiocavernosus muscles compress the penile crura, forcing blood into the penile shaft and retarding venous drainage.

35
Q

What are the 3 parts of the external anal sphincter?

A

subcutaneous
superficial
deep

36
Q

What are the two parts of the external urethral sphincter (male) and what do they do?

A
  1. compressor urethrae: compresses the urethra

2. sphincter urethrae: circles and closes the urethra

37
Q

Define mons pubis (female).

A

A mound of fat overlying the pubic symphysis that responds to female hormones

38
Q

What does the labia majora contain the remants of?

A

round ligament of the uterus

39
Q

What forms the prepuce of the clitoris?

A

The labia minora meet superior to the clitoris as the prepuce of the clitoris

40
Q

What are the three parts of the clitoris? Which parts are formed of corpora cavernosa?

A

root
body
glans clitoridis
ALL PARTS are composed solely of corpora cavernosa

41
Q

Where does the deep dorsal vein of the clitoris drain?

A

uterovaginal plexus of veins

42
Q

What artery gives rise to the dorsal clitoral arteries?

A

internal pudendal artery

43
Q

What are the paired dorsal clitoral nerves branches of?

A

pudendal nerve

44
Q

What is the name for the remnants of the hymen?

A

hymenal caruncles

45
Q

Where are the vestibular bulbs and what are they made of?

A

paired vestibular bulbs are masses of corpus spongiosum lateral to the introitus in the superficial perineal space

46
Q

What are the 3 parts of the external urethral sphincter (female)?

A
  1. sphincter urethrae - circles the urethra and closes it
  2. compressor urethrae - compresses urethra
  3. urethrovaginal sphincter - surrounds and compresses urethra and vagina
47
Q

What arteries supply the anal canal and external sphincter? What do they branch off of?

A

paired inferior rectal arteries off of perineal arteries

48
Q

What arteries supply the perineal skin and contents of the superficial perineal space?

A

perineal arteries

49
Q

What arteries supply the scrotum/labia majora and what are they branches of?

A

Scrotal artery/labial artery: superficial branches of perineal artery

50
Q

What is the terminal continuation of the internal pudendal artery?

A

paired dorsal arteries of clitoris or penis

51
Q

Perineal veins follow the same course and have the same names as the perineal arteries with ONE EXCEPTION:

A

the unpaired deep dorsal vein of the penis or clitoris - bypasses the internal pudendal vein and ends in the prostatic plexus/uterovaginal plexus

52
Q

What nerves supply somatic motor and sensory fibers to somatic structures of the perineum?

A

pudendal nerves

53
Q

What is the origin, path, and target of parasympathetics to the perineum (MALE)?

A
  • -parasympathetic fibers starting at S2,3,4
  • -leave prostatic plexus as nervi erigentes (cavernous nerves)
  • -follow deep dorsal vein
  • -innervate helicine arteries of the penile erectile tissues
54
Q

What is the origin, path, and target of sympathetics to the perineum (MALE)?

A
  • -sympathetics come from two sources: L1,2; prostatic plexus
  • -L1,2 follow testicular vessels to innervate ductus deferens
  • -prostatic plexus -> prostate, bulbourethral and seminal glands
55
Q

What is the main nervous system of erection, sympathetic or parasympathetic? What happens?

A

parasympathetics in nervi erigentes (cavernous nerves) relax helicine arteries in the corpora cavernosa filling the venous spaces with blood

56
Q

What is the main nervous system of emission, sympathetic or parasympathetic? What happens?

A
  • -Lumbar sympathetics cause contraction of smooth muscle in the ductus deferens
  • -Sympathetics from the prostatic plexus cause prostate, seminal and bulbourethral glands to secrete
57
Q

During ejaculation, all 3 fibers (sympathetic, parasympathetic, somatic) work together. How?

A
  1. Sympathetics from the prostatic plexus cause the internal urethral sphincter to contract, preventing retrograde flow of semen.
  2. Parasympathetics via nervi erigente (cavernous nerves) cause the urethral wall to contract.
  3. Somatic fibers from the pudendal nerve activate the bulbospongiosus muscles to empty the urethra.
58
Q

What type of fibers activate the vestibular bulb?

A

parasympathetic

59
Q

What nerve goes to the anus?

A

inferior rectal nerve

60
Q

The inferior rectal nerve is a branch off of what?

A

pudendal nerve

61
Q

What spaces are on either side of the perineal membrane?

A

superficial and deep perineal spaces

62
Q

What artery supplies the crus of the clitoris?

A

deep artery of the clitoris

63
Q

The floor (inferior boundary) of the superficial perineal pouch is formed by the ________

A

the membranous layer (Colles) of the superficial perineal fascia

64
Q

Name 4 muscles that attach to the perineal body.

A

bulbospongiosus muscle
superficial transverse perineal muscle
deep transverse perineal muscle
external anal sphincter muscle

_Anat./GIE #3 (8 decks)

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