Perineum Flashcards
1
Q
What is the perineum? (2)
A
- External surface area & shallow compartment
- Contains: external genitalia, lower segments of genitourinary & gastrointestinal systems & perineal body
2
Q
How is the perineum bounded?
A
- Bounded
- Pelvic outlet
3
Q
What is the perineum separated from?
A
- Separated from pelvic cavity (roof)
- Pelvic diaphragm
4
Q
What is the perineum between? (3)
A
- Narrow region btw proximal parts of thigh
- Diamond shaped (x2 triangles)
- Anal triangle (post) & urogenital triangle (ant)
5
Q
Perineum: Surface Landmarks
* Borders
* Anterior:
A
Pubic symphysis,
ischiopubic rami
6
Q
Perineum: Surface Landmarks
* Borders
* Lateral:
A
Ischial tuberosity,
sacrotuberous ligament
7
Q
Perineum: Surface Landmarks
* Borders
* Posterior:
A
Coccyx
8
Q
Perineum: Surface Landmarks
* Perineal body
* Convergence of fibres:
A
- Bulbospongiosus, external
anal sphincter, superficial
& deep transverse perineal, external urethral sphincter, levator ani
8
Q
What is the superficial perineal pouch? (3)
A
- Potential space
- Subcutaneous tissue & perineal membrane
- Laterally: ischiopubic rami
9
Q
Superficial perineal pouch
Male contents: (4)
A
- Root of penis & ischiocav. &
bulbosp. muscles - Proximal part of spongy
urethra - Superficial transverse
perineal muscles - Deep perineal branches of
internal pudendal vessels &
pudendal nerves
9
Q
Superficial perineal pouch
Female contents: (5)
A
- Clitoris & ischiocv. muscles
- Bulbs of vestibule &
bulbosp. muscles - Superficial transverse
perineal muscles - Greater vestibular glands
- Deep perineal branches of
internal pudendal vessels &
pudendal nerves
10
Q
Deep perineal space
* Bounded:
* Inferiorly =
A
- Perineal membrane
11
Q
Deep perineal space
* Bounded:
* Superiorly =
A
- Inferior fascia of pelvic diaphragm
12
Q
Deep perineal space
* Bounded:
* Laterally =
A
- Inferior portion of obturator fascia
13
Q
Deep perineal space
* Contents
* Both sexes: (3)
A
- Part of urethra
- Inferior part of external urethral sphincter
- Anterior extensions of ischioanal fat pads
14
Q
Deep perineal pouch
Male contents: (4)
A
- Membranous urethra
- Deep transverse
perineal muscles - Bulbourethral glands
- Dorsal neurovascular
structures of penis
15
Q
Deep perineal pouch
Female contents: (3)
A
- Proximal part of urethra
- Mass of smooth muscle
in place of deep transverse perineal muscles - Dorsal neurovascular
structures of clitoris
16
Q
What is the Scrotum?
A
- Pouch-like structure – continuation of lower part of abdominal wall
17
Q
Scrotum
* Contains: (3)
A
- Testes, epididymus & spermatic cord
18
Q
Scrotum
* Skin: (2)
A
- Thin, wrinkled (dartos fascia and muscle)
- Pigmented, few hairs; Many sweat glands
19
Q
Scrotum
* Fascial layers (_____ muscle)
A
cremaster
19
Q
- Raphe of scrotum
- Lateral labioscrotal folds:
- Septum:
A
- Lateral labioscrotal folds: fuse
- Septum: two compartments
20
Q
Neurovascular supply: Scrotum
* Arterial = (3)
A
- External pudendal artery
- Anterior scrotal arteries - Internal pudendal artery
- Posterior scrotal arteries - Cremasteric arteries (IEA)
21
Q
Neurovascular supply: Scrotum
* Venous drainage
=
A
- Follow arteries
22
Neurovascular supply: Scrotum
* Innervation
- Ant:
*
- Post:
*
- Ant: ilio-inguinal & genitofemoral
* Anterior scrotal nerves
- Post: perineal branch of pudendal nerve
* Posterior scrotal nerves
23
Testes
* Suspended
= ______ cord
spermatic
24
Testes
* F: produce ________ & testosterone
* Secondary sexual characteristics
spermatozoa
25
Testes
* Tunica Vaginalis
- Outer....
- Inner ....
* Serous fluid between 2 layers
* Outer parietal layer
* Inner visceral layer
26
* Tunica Albuginea
- Firm, white fibrous covering around _____
- Forms septa → runs into testis → ______ _____ _______
testis
divides into lobules
27
What is the Epididymis?
* Elongated structure
posterior to testis
28
Epididymis
* Head:
* Superior part of testis
29
Epididymis
* Tail:
* Tapering and continues
as ductus deferens
30
Neurovascular supply: T & E
* Arterial: (5)
* Testicular artery
* Cremasteric artery
* Artery to ductus deferens
* Anterior scrotal artery
= External pudendal (Fem a.)
Posterior scrotal artery
= Internal pudendal artery
31
Neurovascular supply: T & E
* Venous drainage:
* Pampiniform plexus
32
Neurovascular supply: T & E
* Innervation
- Autonomic:
* Autonomic: testicular plexus (testicular artery)
* Sympathetic & parasympathetic (vagal)
33
What is the spermatic cord? (4)
* Suspends testis within scrotum
* Contains structures coursing to and from the testis (12)
* Begins at the deep inguinal ring
* Ends at the posterior border of testis
34
Spermatic Cord
* 3 fascial layers:
* Outer spermatic
* Cremasteric (and muscle)
* Inner spermatic
34
Spermatic Cord
* 3 arteries:
* Testicular artery
* Cremasteric artery
* Ductus deferens artery
35
Spermatic Cord
* 3 nerves:
* Genital branch of genitofemoral
* Ilioinguinal
* Sympathetic nerve fibers
36
Spermatic Cord
* 3 other structures:
* Ductus deferens
* Pampiniform venous plexus
* Lymphatics
37
What is the penis?
- Erectile tissue
* Corpus cavernosa and corpus spongiosum
38
What is the root of the penis? (2)
* Found in superficial perineal pouch
* Suspensory ligament
39
Penis
What is the Bulb of penis?
* Central portion – attach inf. layer of urogenital diaphragm
40
Penis
- Bulb of penis
* Contains:
penile/spongy urethra
41
Penis
- Bulb of penis
* Covered by:
bulbospongiosus
42
Penis
- Bulb of penis
* Continued as corpus _______ of penis
spongiosum
43
Penis
* Crura
- Attach laterally –
ischial rami
44
Penis
* Crura
* Covered by:
ischiocavernosus muscles
44
Penis
* Crura
* Continued as corpus _______ of penis
cavernosa
45
Penis
* Body
* Covered by skin and ______ tissue (deep fascia of penis)
connective
46
Penis
* Body
- Paired corpora cavernosa:
- Corpus spongiosum:
- Neck of glans:
* Paired corpora cavernosa – continuous of the crura
* Corpus spongiosum – ends distally in glans
* Neck of glans – separates glans from body
47
Penis
* Glans
- Glans covered by extra skin
* Prepuce with ______ (inf)
frenulum
47
Penis
- Glans =
* Navicular fossa –
dilation of urethra in glans
48
Neurovascular Supply
What is the arterial supply of the penis? (4)
1. Dorsal artery of penis
2. Deep artery to penis
3. Artery of bulb of penis
4. Additional branches from ext. pudendal aa.
49
* Arterial
- Dorsal artery of penis:
* Skin and erectile tissue of penis
50
* Arterial
- Artery of bulb of penis:
* Bulb of corpus spongiosum, urethra, bulbo-urethral gland
51
* Venous drainage
- Deep dorsal vein of penis:
- Superficial dorsal vein of penis:
– prostatic venous plexus
– external pudendal vein
52
Neurovascular Supply
Penis: (5)
* Dorsal nerve of penis
* Perineal nerve
* Ilio-inguinal nerve
* Sympathetic fibres
* Parasympathetic fibres
53
Neurovascular Supply
* Perineal nerve
Structures:
* Bulb & urethra
53
Neurovascular Supply
* Dorsal nerve of penis
Structures:
* Skin & glans (sensory afferent)
54
Neurovascular Supply
* Ilio-inguinal nerve
Structures:
* Skin near root
55
Neurovascular Supply
* Sympathetic fibres
Structures:
* Inferior hypogastric plexus
56
Neurovascular Supply
* Parasympathetic fibres
Structures:
* Pelvic splanchnic
57
