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MD3002 Anatomy > Perineum > Flashcards

Perineum Flashcards

1
Q

What is the perineum?

A
  • Area where external genitalia and anus are found
  • Roughly diamond shaped area
  • Below pelvic diaphragm
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2
Q

What can the perineum be divided into?

A
  • Anteriorly: Urogenital triangle

- Posteriorly: Anal triangle

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3
Q

What are the 2 superficial fascial layers of the perineum?

A
  • Superficial fatty layer (continuous with Camper’s)
  • Deep membranous layer (Colle’s or perineal)
    Continuous with Scarpa’s fascia of the abdomen
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4
Q

What does the fatty layer fuse with in males?

A
  • Fuses with the membranous layer of superficial fascia in the penis and scrotum to become dartos fascia (and muscle)
  • Continous posteriorly with the ischio-anal fat pad in the anal region
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5
Q

What is the membranous layer continous with in males?

A
  • Dartos fascia in penis and scrotum
  • Attached posteriorly to the posterior margin of the perineal membrane and perineal body
  • Fuses with fascia lata
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6
Q

What is dartos fascia and muscle combined with to become?

A

Superfial and deep layers in penis and scrotum

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7
Q

What does the fatty layer of the subcutaneous tissue of the perineum become in females?

A
  • Makes up the substance of the labia majora

- Continous posteriorly with the ischio-anal fat pad in the anal region

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8
Q

What does the membranous layer attached to and fuse with in females?

A
  • Attached posteriorly to the posterior margin of the perineal membrane and perineal body
  • Fused with fascia lata
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9
Q

What is the perineal membrane?

A
  • Layer of fibrous tissue in the perineum
  • Spans the urogenital triangle between the ischiopubic rami
  • Attaches to the perineal body in the midline posteriorly
  • Provides major support for urogenital organs
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10
Q

How do nerves and vessels reach the penis/clitoris?

A

Anterior aperture in perineal membrane

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11
Q

What does the deep perineal membrane divide?

A

Divides urogenital triangle into 2 potential spaces:

  • Deep perineal (siperior)
  • Superficial perineal (inferior) compartment (pouch)
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12
Q

What do the cocygeus and levator ani muscle make up?

A

The pelvic diaphragm

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13
Q

What does the deep fascia of the abdominal wall become at the pelvis?

A

Pelvic fascia

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14
Q

What fascia covers the levator ani and cocygeus muscle?

A
  • Superior fascia of pelvic diaphragm

- Inferior fascia of plevic diaphragm

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15
Q

What lies inbetween the Inferior fascia of pelvic diaphragm and perineal membrane?

A

Deep perineal pouch

  • Deep transverse perineal muscle (v. small)
  • External urethral sphincter
  • Bulbourethral gland
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16
Q

What muscles lie between the pernial fascia and perineal membrane?

A

Superficial perineal pouch

  • Ischiocavernous muscle
  • Bulbospongiosus
  • Superficial transverse pernieal muscle
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17
Q

Name the layers of fascia in the perineum from superficial/inferior to deep/superior?

A
  • Perineal fascia
  • Perineal membrane
  • Inferior fascia of pelvic diaphragm
  • Superficial fascia of pelvic diaphragm
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18
Q

What is the perineal body?

A

Tendinous structure in the midline between the vagina and anus where two sides of perineal diaphragm muscles fuse

19
Q

Where is the superficial perineal pouch?

A

Potential space between the perineal fascia and the perineal membrane, bounded laterally by the ischiopubic rami

20
Q

What does the superficial perineal pouch contain in males?

A
  • Root (bulb and crura) of the penis and associated muscles (ischiocavernosus and bulbospongiosus)
  • Proximal (bulbous) part of the spongy urethra
  • Superficial transverse perineal muscles
  • Deep perineal branches of the internal pudendal vessels and pudendal nerves
21
Q

What is the function of the ischiocavernosus in men?

A
  • Covers the crus of penis

- Maintains erection of penis

22
Q

What is the function of the bulbospongiosus in men?

A
  • Encloses bulb of penis
  • Compresses bulb of penis to expel last drops of urine/semen
  • Assists erection
23
Q

What does the superficial perineal pouch contain in females?

A
  • Crus of the clitoris and ischiocavernosus muscle
  • Bulb of vestibule and bulbospongiosus muscle
  • Greater vestibular glands
  • Superficial transverse perinela muscles
  • Deep perineeal branches of the internal pudendal vessels and pudendal nerves
24
Q

What is the function of the ischiocavernosus in females?

A
  • Covers the crus of clitoris

- Maintains erection of clitoris

25
Q

Whaat is the function of the bulbospongiosus in females?

A
  • Encloses bulb and greater vestibular gland
  • Sphincter of vagina
  • Assists in erection of clitoris
  • Compresses greater vestibular gland
26
Q

Where is the deep perineal pouch located?

A

Potential space between the perineal membrane, the inferior fascia of the pelvic diaphragm, and the inferior portion of the obturator fascia

27
Q

What the deep perineal pouch include in males?

A
  • Membranous urethra
  • External urethral sphincter
  • Bulbo-urethral glands
  • Deep transverse perineal muscles
  • Dorsal neurovascular structures of the penis
  • Anterior recess of the ischio-anal fossa
28
Q

What is included in the deep perineal pouch in females?

A
  • Proximal part of the urethra
  • Inferior part of the external urethral sphincter muscle
  • Compressor urethra
  • Urethrovaginal sphincter
  • Deep transverse perineal muscles
  • Dorsal neurovascular structures of the clitoris
  • Anterior recess of the ischio-anal fossa
29
Q

What is the ischioanal fossa?

A
  • Large fascia-lined, wedge-shaped spaces between:
  • Skin of the anal region
  • Levator ani (pelvic diaphragm)
  • Obturator internus and ischium
  • Anal canal
30
Q

How can the ischional fossa communicate with each other?

A

Posterior to the anal canal

31
Q

What does the ischioanal fossa contain?

A
  • FAtty tissue that allows for changes in the position and size off the anal canal and anus during defecation
  • The inferior rectal vessels and nerves that suppy the external anal sphincter
  • The perforating branches of S2 and S3
  • Perineal branch of the S4 nerve
  • Pudendal neve and internal pudendal vessels (lateral wall)
32
Q

What is patholigically significant about the ischioanal fossa?

A

Site of infection and abscess that may require surgical intervention (can pass through fibres of anal sphinter into fossa which then conects to deep perineal pouch)

33
Q

What is the pudendal canal also known as?

A

Alcock’s canal

34
Q

What is the pudendal canal?

A

A horizontal passageway within the obturator fascia, along the lateral wall of the ischio-anal fossa

35
Q

What does the pudendal canal contain?

A
  • Pudendal nerve
  • Internal pudendal artery
  • Internal pudendal vein
  • Branches will pierce wall of canal and travel in perineum towards either anal canal or perineal branches
36
Q

What do the internal pudendal vessels supply?

A
  • Perineum
  • \Urethra
  • Posterior 2/3 of scrotum or labia
  • Cavernous tissue of the penis or clitoris
  • Skin of shaft and glans of the penis or clitoris
37
Q

What do the external pudendal vessels supply?

A

Anterior 1/3 of scrotum or labia

38
Q

What is the external pudendal a branch of?

A

Femoral vessels

39
Q

What does the lymph from superficial perineal structures (e.g penis, scrotum and labia) drain to?

A

Superficial inguinal lymph nodes

40
Q

What does the lymph from the deep perineal structures (eg corpora cavernosa, corpus spongiosum, bulb of penis and vestibule proximal vagina and urethra) drain to?

A

Internal iliac nodes

41
Q

What is the nerve supply to the perineum derived from?

A

S2-4 pudendal nerves and pelvic plexuses (aka inferior hypogastric)

42
Q

Where can urine travel if membranous urethra is ruptured?

A
  • Will escape into deep perineal pouch

- May pass through urogenital hiatus and distribute extraperitoneally around bladder

43
Q

What happens to urine if the proximal spongy (bulbar) urethra is ruptured

A
  • Escapes through the rupture into the superficial perineal pouch
  • Descends into the scrotum
  • RIses onto the anterior abdominal wall deep to the superficial fascia
  • “Blue swimming trunks” - bruising trapped under Scarpa’s anf Colles (perineal) fascia only in the front

MD3002 Anatomy (14 decks)

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