Perineum Flashcards
What muscle’s fascia forms the Alcock’s Canal/Pudendal Canal?
fascia of Obterator Interus**
What artery can be accidentally tied off during hernia surgery because it is near the Inferior Epigastric?
Abnormal Obturator A.
What is the anchoring point/ collection of tendons of the UG diaphragm called?
Perineal Body
What forms the ejaculatory duct?
Seminal Vesicle + Vas Deferens
What neuromuscular bundle exits through the lesser sciatic foramen? What was this bundle’s original course?
Pudendal N. + Internal Pudendal A. + Nerve to Obturator Internus exits through the Greater Sciatic Foramen, loops around SacroSPINOUS ligament, and comes back out through the LESSER SCIATIC FORAMEN
- tendon to OBTERATOR INTERNUS also leaves via LESSER SCIATIC FORAMEN
What is a site of possible infection/tumors in females?
Rectouterine Pouch (behind the uterus)
POUCH OF DOUGLAS*
What muscle covers the BULB? The crura?
- Bulbospongiosus
2. Ischiocavernosus
What muscles are the components of the DEEP POUCH
- Deep Transverse Perineal Muscle
2. Sphincter Urethrae Muscle
What two branches does the PUDENDAL N. spit into?
Inferior Rectal N.
&
Perineal N.
Scarpa’s fascia becomes _______ fascia in the Perineum
COLLES
The uterus has 2 rotations
What is it called at the junction of uterus & vagina?
What is the bend between body of uterus & cervix proper?
- Anteverted
2. Anteflexion
What muscles form the pelvic diaphragm?
Levator Ani + Coccygeus (Iliococcygeus & Pubococcygeus)
How is the weakness in the anterior portion of the Pelvic diaphragm strengthened?
UG DIAPHRAGM
Where do the inferior Rectal N and Inferior Rectal A. originate from?
Pudendal N.
&
Internal Pudendal Artery
What is the order of layers of the UG diaphragm looking up through the legs?
- Inferior Fascia
- UG Muscle
- Superficial Fascia
What is the Bulb of the penis covered with? (Is this present in the female?)
What travels through this?
Bulb covered with CORPUS SPONGIOSUM
- Urethra Travels through this
- no Corpus Spongiosum in female
Where are the bulbourethral glands/ GREAT VESTIBULAR Glands located in the female? Where are the Cowper’s glands located in the male?
- Superficial Pouch
2. DEEP pouch
What is another word for the inferior fascia?
Perineal Membrane
What two muscles are found within the UG Diaphragm Proper (Deep pouch)?
- Sphincter Urethrae
2. Deep Transverse Perineus Muscle
What is the path the Pudendal Nerve travels? What nerve roots contribute to the Pudendal N.?
(S2, 3 ,4)
- Leaves the inside of pelvis via GREATER SCIATIC FORAMEN
- hooks the Sacrospinous Ligament
- Re-enters the LESSER SCIATIC FORAMEN
-to access the PERINEUM
What is an ectopic pregnancy? Why does this occur?
Implantation in the uterine tube
- Ovulation occurs EXTRA-PERITONEALLY
What are the three subsets of the BROAD Ligament?
- Mesovarium (mesentery of ovary)
- Mesosalphinx (of uterine tube)
- Mesometrium ( of endometrium)
What ligament suspends the ovary laterally to the pelvic wall? What is the blood supply to the ovary? Where does this artery come off of?
SUSPENSORY ligament
- Ovarian Artery (of the AORTA–> Gonadal)
What passes under the Uterine Artery?
URETER
– must be careful off this during Hysterectomy
The inferior vesicle artery of the male is replaced by______ in the female. The uterine Artery is a branch of what?
VAGINAL Artery
(textbooks says Uterine A. & Vaginal A can be separate or together)
- Uterine A. is a branch of Anterior Division of Internal Iliac
During a Straddle Injury, trauma can cause blood to pool into what area?
- blood from damage to the spongy urethra (mainly a male thing) can flow up the potential space between:
1. the rectus sheath and
2. Scarpa’s fascia
Where do the ovaries point? What is the course of the ROUND Ligament?
ovaries –> point posteriorly
Round Ligament = inserted on labia major
The true pelvis is found above or below the Arcuate Line?
Below
What are the boundaries of the PERINEUM? (4)
- Pubic Symphysis
- Coccyx
- TWO Ischial Tuberosities ( on sides)
Who has a shorter urethra and thus a higher risk of bladder infections?
FEMALES
What forms the body of the clitoris?
Of the penis?
- 2 Crus –> Corpus Cavernosum
2. 2 Corpus Cavernosum + 1 Corpus Spongiosum
Who has a split BULB? Male or females?
FEMALES –> form the vagina
What are the 2 superficial terminal branches of the Pudendal Nerve? What are the 3 deep branches?
- Perineal N. (becomes Posterior Labial/Scrotul N.)
- Inferior Rectal
- Artery to the Bulb
- Deep Artery to Penis/Clitoris
- Dorsal Artery to Penis/Clitoris
What muscles are found within the superficial pouch? Which sex has the Greater Vestibular Glands in this pouch?
- IschioCavernosum (covering CRUS)
- Bulbospongiosum (covering the Bulb)
- Superficial Tranvserse Perineus
+ Crura & Bulb = erectile tissue*
FEMALES!!!!
- superficial pouch = between Colles’ Fascia & Inferior Fascia of UG
What are the layers of the Perineum from the deepest part to the most superficial?
MUST IMAGINE MRI view (through legs)
(at the bottom)
- SKIN
1. Colles Fascia
2. Superficial Pouch - Crura/Bulb
- Muscle
3. Inferior Fascia
4. Deep Pouch
5. Superior* Fascia - looking through legs –> SEE INFERIOR FASCIA FIRST*
What 3 nerves does the Pudendal Nerve split into after entering the Perineum?
- Perineal
- inferior Rectal (deep)
- Dorsal N. of Penis/Clitoris
Where is the superficial pouch?
Between the inferior fascia & Colles’ Fascia
What penetrates the SUPERIOR Fascia?
Vagina & Uterus
What is the origin and support for Levator Ani Muscle?
ARCUS TENDINEUS
- thickening across Obturator Internus Muscle
What artery enters the Cavernous Bodies of the Penis/Clit?
DEEP Artery of the Penis/Clitoris
What are the origin of the 3 rectal arteries?
- Superior Rectal
- middle Rectal
- Inferior Rectal
- Superior Rectal = IMA
- Middle Rectal = ANTERIOR INTERNAL ILIAC
- Inferior Rectal = Internal Pudendal A.
TEST!!!!
What muscles attach at the central tendon?
- Ischiocavernosus
- Bulbospongiosus
- Superficial Transverse Perineal
What kind of injury leads to one splitting the urethra? Which pat of the urethra is usually injured? What is likely to occur ?
- STRADDLE INJURY
- more likely in males (longer urethra)
SPONGY URETHRA can tear
–> blood will move internally through the area between COLLES’ Fascia (Scarpa’s) &
Rectus Sheath
FROM SUPERFICIAL POUCh (continuous w/ Colles’ Fascia & Rectus SHeath)
Arteries to GI structures branch _____. arteries to non go branch____
- Anteriorly
2. Laterally
Parasympathetic innervation of the:
- Foregut/Hindgut
- Hindgut
- Vagus
- Pelvic Splanchnics
increase peristalsis, decrease sphincter
Sympathetic innervation of the:
- Foregut/Hindgut
- Hindgut
- Greater, lesser, least Splanchnics
2. Lumbar Splanchnics
If arteries off of the abdominal aorta are blocked, what are the compensatory anastomoses?
- Superior Epigastric + Inferior Epigastric
- Superior Pancreaticoduodenal + Inferior Epigastric
- Middle Colic –> Left Colic
- Superior Rectal + Middle/Inferior Rectal
What are the 3 sites of anastomoses of portal & systemic system?
- Left Gastric & Esophageal
- Superior Rectal + Inferior & Middle Rectal
- Paraumbiilcal + Superficial & Inferior Epigastric
Above pectinate line ? Below Pectinate Line
- Internal hemorrhoids
2. External Hemorrhoids
A landmark for the pudendal nerve block would be what part of the lateral wall of the pelvis?
Ischial Spine
PED &
TIP
Peroneal Everts & Dorsiflexes, if injured, FOOT DROP
Tibial Inverts & Plantarflexes, if injured, can’t stand on TIP toes
Ear, Tonsils, Bottom to top
- Describe the Brachial Pouch Derivatives
1 Ear 2 Tonsils 3 Inferior Parathyroid (Bottom) 3 Thymus (to) 4 Superior Parathyroid (Top)
Describe the Brachia Arch Derivatives
1 2 3 4 & 6
1 = Mastication (5)
2 = Facial expression (7)
3 = Stylopharyngeus (9)
4 - Swallow (cricothyroid m.)
6 = speak (all the laryngeal muscles)
Where does the round ligament insert?
Labia Majora
What is related to the gubernaculum of the testes?
Mesovarium
Where is erectile tissue found?
SUPERFICIAL POUCH –> the bulb
