Perineum

Question 1

Levator ani forms

Answer 1

Floor of pelvis and roof of perineum

Question 2

Blood supply and innervation of perienum

Answer 2

Internal pudendal artery

Pudendal nerve

Question 3

How do internal pudendal artery and pudendal nerve leave pelvis and enter perineum

Answer 3

Greater sicatic foramen

Lesser sicatic foramen

Question 4

Roof/floor of lesses sciatic foramen

Answer 4

Roof - sacrotuberous lig

Floor - Sacrospinous lig

Question 5

Pudendal canal

Answer 5

Internal pudendal artery and pudendal nerve become covered with deep fascia and lie on obturator internus

Question 6

Branches of internal pudendal artery nad pudendal nerve

Answer 6

Inferior rectal artery and nerve

Question 7

Perineum boundaries

Answer 7

Pubic symphysis
L/R ischiopubic ramus
L/R ischial tuberosities
Coccyx

Question 8

Two triangles of perineum

Answer 8

Urogenital triangle (anterior )
Anal triangle (posterior)

Question 9

Orientations of triangle

Answer 9

Urogen - horizontal with floor

Anal - vertical

Question 10

Urogenital triangle divided into

Answer 10

Deep and superficial pouch of perineum

Question 11

Deep pouch location, composition, innervation

Answer 11

Below levator ani and expands entire urogen triangle
Muscle and conn tissue membrane
Voluntrary control by perineal branches of pudendal nerve

Question 12

What must happen before micturition can occur?

Answer 12

Muscles of deep pouch must relax

Question 13

Perineal membrane

Answer 13

Inferior membrane of deep pouch

Question 14

External genitalia location

Answer 14

Below deep pouch

In the superficial pouch

Question 15

Contents of deep pouch

Answer 15

Deep transverse perineal muscle 
External urethral sphincter muscle
Compressor urethra (female)
Membranous urethra 
Bulbourethral glands (males)
Branches of pudendal nerve - dorsal nerve and arteries of the penis and clitoris

Question 16

Superficial pouch muscle and location to perineal membrane

Answer 16

Inferior
Crura of penis/clitoris 
Bulb of penis/vestibular bulbs 
Ischicavernosus m
Bulbospongiosus m 
Greater vestibular gland m (females)
Superficial transverse perineal muscle

Question 17

Perineal body…attachment points for

Answer 17

Mass of tissue in btween ischial tuberosities
Levaotr ani
Deep perineal membrane
Bulbospongiosus membrane
External anal sphincter

Question 18

Tears of perineal body lead to

Answer 18

Compromise structure of pelvis/perineum…prolapse of organs and urinary incontinence

Question 19

Scarpas fascia

Answer 19

Abdominal region

Question 20

Dartos fascia

Answer 20

Region of scrotum and penis (no superficial fatty fascia here)

Question 21

Colles fascia

Answer 21

Region of urogenital triangle (superficial fatty has disappeared)

Question 22

Exceptions to fascial cleft between superficial and deep fascia

Answer 22

Scarpas fascia will fuse to fascia lata

Lateral and posterior edge of Colles will fuse to perineal membrane

Question 23

What does Colles connection to perineal result in?

Answer 23

No communication between deep pouch and anal trinalge

Question 24

Anal canal divides anal triangle into

Answer 24

Ischioanal fossae

Question 25

Boundaries of anal trinalge

Answer 25

Superior and medial - sloping of levator ani (pelvic diaphragm) Lateral - Obturator internus (important) Posterior - skin

Question 26

Pudendal (Alcock's) canal formed by ____ and contains ____

Answer 26

Obturator fascia | Internal pudendal artery, vein, and pudendal nerve

Question 27

What emerges from pudendal canal

Answer 27

Inferior rectal arteries and nerves

Question 28

When does rectum end?

Answer 28

When puborectalis encircles it

Question 29

Internal anal sphincter composed of

Answer 29

Thickened continuation of inner circular layer of smooth muscle from retum

Question 30

External sphincter composed of

Answer 30

Skeletal muscle

Question 31

Anocyccygeal rphe

Answer 31

Attaches external sphincter to coccyx

Question 32

Anal columns and sinuses

Answer 32

Folds and recesses between columns of anal canal | Mucous membrane

Question 33

Anal valves

Answer 33

Join anal columns at inferior ends

Question 34

Anal crypts and why significant?

Answer 34

Spaces behind anal valve | Focal point for infection...can lead to ischioanal fossa fistula

Question 35

Pectinate line formed from

Answer 35

Lower margins of anal valves

Question 36

Arterial supply above and below pec line

Answer 36

above - inferior mesenteric by superior rectal arteries | Below - internal pudendal by inferior rectal arteries

Question 37

Venous drainage change at pec line

Answer 37

Above - hepatic portal vein by superior rectal vein | Below - caval system by inferior rectal veins

Question 38

Lymphatic drainage change at pec line

Answer 38

Above - internal iliac lymph nodes (deep) | Below - inguinal lymph nodes (superficial)

Question 39

Innervation change at pec line

Answer 39

Above - autonomic fibers (poor localization) | Below - Pudendal nerve (precise localization)