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M2 Reproduction > perineum anatomy > Flashcards

perineum anatomy Flashcards

1
Q

perineum location

A

most inferior part of the pelvis between the thighs, separated from the pelvic cavity by the pelvic diaphragm and containing the anal and urogenital triangles

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2
Q

lithotomy position

A

lower limbs flexed at the hips and knees, abducted and supported in stirrups

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3
Q

ischiorectal fossa shape and contents

A

wedge shaped (horseshoe) space filled with fat, communicates posteriorly through the deep postnatal space but no anterior communication

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4
Q

ischiorectal fossa functions

A

passageway for neurovascular structures (pudendal nerve and internal pudendal vessels)

facilitates defecation by accommodating the movement and expansion of anal canal

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5
Q

ischiorectal fossa boundaries

A

base: skin
edges: junction of medial and lateral walls
medial walls: sloping levator Ani muscle and anal canal
lateral wall: obturator internus muscle, pudendal canal, ischial tuberosity
anteriorly: perineal body, urogenital diaphragm, anterior recess
posteriorly: recess, gluteus maximus, sacrotuberous ligament

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6
Q

what is the urogenital diaphragm?

A

double layered tough fibrous tissue that fills the urogenital triangles and gives attachment to the external genitalia

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7
Q

contents of the deep perineal pouch

A

• part of the membranous urethra
• external urethral sphincter muscle
• bulbourethral glands
• deep transverse perineal muscles

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8
Q

control and innervation of the external urethral sphincter

A

controls the flow of urine through the urethra, voluntarily controlled by the somatic nervous system and innervated by the pudendal nerve

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9
Q

location and function of the deep transverse perineal muscles

A

origin: internal surface of the ischial rami
insertion: the perineal body
function: provide structural support to adjacent pelvic and perineal structures (innervated by pudendal nerve)

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10
Q

testis descent movement

A

posterior abdominal wall –> abdomen –> through inguinal canal (thru deep inguinal ring to inguinal canal to superficial inguinal ring) –> scrotum (scrotal sac)

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11
Q

process of formation of tunica vaginalis

A

part of the peritoneum –> evaginates to form processus vaginalis –> closed off outpouching a few weeks before birth –> becomes the tunica vaginalis with fluid in-between the visceral and parietal layers

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12
Q

functions of fluid in tunica vaginalis layers

A
  1. lubrication of testes to reduce friction and prevent damage
  2. protection and cushion to absorb minor shock and trauma
  3. regulates temperature, keeping testes at optimal temp for spermatogenesis
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13
Q

hydrocele formation and types

A

formed by an abnormal collection of serous fluid between the two layers of tunica vaginalis

  1. communicating hydrocele : failure of processus vaginalis to obliterate, creating a potential space that gets bigger throughout the day due to gravity
  2. non-communicating hydrocele: due to injuries, infection, tumours, heart failure or liver disease, will not change in size
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14
Q

what is the hydrocele transillumination test?

A

shine a flashlight on the swollen scrotum, if the testicle transilluminated then it is a fluid filled mass and not a solid mass

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15
Q

coverings of the testes (superficial to deep)

A
  1. skin
  2. camper fascia
  3. scarpa fascia
  4. external oblique muscles
  5. internal oblique muscles
  6. transversalis fascia
  7. processus vaginalis (obliterates to become tunica vaginalis)
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16
Q

bulbourethral gland / Cowper’s gland functions

A

accessory sex gland in males that produces pre-ejaculatory fluids to neutralize acidic urine residue

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17
Q

penis function

A

male external genital orhan used for micturition and sexual intercourse

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18
Q

parts of the penis (and their functions)

A

root: proximal part located in the superficial perineal pouch, contains the paired cylindrical corpora cavernosum (crus attached to perineal membrane and ischialpubic ramus) and single corpora spongiosum (bulb anchored to perineal membrane)

body: free part of the penis between the root and glans

glans: most distal end of the penis shaped by the bulbous expansion of the corpus spongiosum, membranous urethra passes through the corpus spongiosum here

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19
Q

type of skin covering the penis shaft

A

thin, loose, elastic and able to stretch during erection, lacks hair follicles and sebaceous glands and contains a prepuce (foreskin) covering the glans

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20
Q

phimosis pathology

A

inability to retract the prepuce covering the glans penis, treated by circumcision or resolving by puberty

complications include foreskin inflammation, UTI (poor hygiene), penile cancer risk

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21
Q

deep perineal pouch contents in females

A

part of female urethra, part of vagina, sphincter urethrae and deep transverse perineal muscles

22
Q

parts of female external genitalia (anterior to posterior)

A

mons pubis
labia majora (hair bearing)
labia minora (non-hair bearing)
clitoris (homologous to make penis)
vestibule (area enclosed by labia minora)
fourchette (posterior meeting of labia minora)

23
Q

female erectile tissues

A

paired cylindrical shaped corpora cavernosa (crus attached to perineal membrane and ischiopubic ramus), corpus spongiosum split into 2 to form 2 bulbs of the vestibule, uniting ventral to the urethral orifice to form spongiosum erectile tissue (glans of clitoris)

24
Q

urethra length in males vs females

A

males: 20cm

females: 3-4cm

25
Q

vagina relations

A

anterior to: rectum, anal canal, perineal body
posterior to: urinary bladder, urethra
upper end: expanded, receives the cervix

26
Q

cervical-vaginal relations

A

cervix projects into vagina to form vaginal fornix (anterior, posterior, 2 lateral fornices) around the cervix margin - posterior fornix is covered by the peritoneum

27
Q

what is the Pouch of Douglas

A

extension of the postero-inferior reflection of the peritoneal fold between the uterus and rectum

28
Q

blood supply of the vagina

A

uterine, vaginal, internal pudendal arteries

29
Q

lymph drainage of the vagina

A

upper 4/5: iliac nodes
lower 1/5: superficial inguinal nodes

30
Q

nerve supply of the vagina

A

upper 4/5: inferior hypogastric plexus (stretch sensitive only)
lower 1/5: pudendal nerve (somatic innervation for touch and temperature)

31
Q

vestibular/Bartholin’s gland anatomy

A

lies at the vaginal orifice and opens into the vaginal orifice by a single duct (homologous to the male Cowper’s gland)

32
Q

presentation and treatment of a Bartholin cyst

A

presents as a cyst with localized pain, treat via incision and drainage

33
Q

what does the per-vaginal examination during labour look for?

A

assesses the state of the cervix and the progressive descent of the fetus through the birth canal - looks for cervical effacement (where the cervix softens, things and shortens) that occurs shortly before delivery

34
Q

what to identify in a uterine bimanual examination

A

size: uterus should be orange-sized
shape: may be distorted by masses (eg large fibroids)
position: retroverted or anteverted
surface characteristics: smooth or nodular
tenderness: if present, may suggest inflammation

35
Q

parts of the urethra in males (proximal to distal)

A
  1. preprostatic urethra (1-2cm)
  2. prostatic urethra (3-4cm, widest)
  3. membranous urethra (1-2cm)
  4. spongy/penile urethra (longest part)
36
Q

membranous urethra anatomy

A

membranous urethra is surrounded by external urethral sphincter and formed from skeletal muscle (under voluntary control by the pudendal nerve)

37
Q

spongy urethra anatomy

A

distal to membranous urethra and extends to /opens at external urethral orifice, surrounded by corpus spongiosum and wides distally at the navicular fossa (aka end of the penis)

38
Q

membranous urethra rupture vs spongy urethra rupture

A

extravasation of fluid into retroperitoneal space + bladder and prostate floating in urine vs extravasation of fluid into superficial perineal pouch, scrotum, around penis and in the anterior abdominal wall

39
Q

mechanism of erection and ejaculation

A

erotic stimulation –> parasympathetic fibers stimulated, relaxing the smooth muscles in the fibrous trabeculae + dilates the arteries –> cavernous spaces filled with blood –> blood filled space compresses the veins against the tunica albuginea –> blocks the backflow of blood, leading to pool of blood in the penis (erection) –> stimulation of sympathetic NS to close internal urethral sphincter during ejaculation

40
Q

what is the perineal body?

A

fibromuscular structure located at the midline of the perineum, at the junction of the anal and urogenital triangles

41
Q

attachments of the perineal body

A

bulbospongiosus muscle, deep+superficial transverse perineal muscles, external anal sphincter muscle, levator ani muscles

42
Q

when is an episiotomy performed, and why?

A

performed to enlarge the birth outlet and facilitate the delivery of the fetus while preventing multiple tears in the birth canal

43
Q

what structures are excised in a mediolateral episiotomy?

A

skin, subcutaneous tissues, superficial and deep transverse perineal muscles, bulbospongiosum, part of levator ani, posterior vaginal wall

44
Q

supply and branches of the internal pudendal artery

A

internal pudendal artery is a branch of the anterior division of the internal iliac artery, exits the pelvis inferiorly via the greater sciatic foramen and reenters via the lesser sciatic foramen (to supply the skin and structures of the perineum, anal, and urogenital regions)

branches of the pudendal artery are the inferior rectal artery, the perineal artery, and the dorsal artery of the penis/clitoris

45
Q

lymphatic drainage of the perineum

A

mostly into the superficial inguinal nodes, while glans penis and clitoris drain into the deep inguinal nodes, and the testes drain into the para-aortic lymph nodes

46
Q

pudendal nerve roots and supply

A

arises from ventral rami of S2, S3, S4, supplies motor and sensory innervation + sympathetic autonomic fibres

leaves the pelvis through the greater sciatic foramen, curves around the sacrospinous ligament, enters the perineum through the lesser sciatic foramen

47
Q

structures forming the pudendal canal

A

formed by the fascia of the obturator internus and deep pelvic fascia, pudendal nerve + internal pudendal artery + internal pudendal vein run thru the canal

48
Q

pelvic splanchnic nerves roots and supply

A

arises from preganglionic nerves from the lateral horn of the spinal matter at sacral segments S2, S3, S4

49
Q

what is the pudendal nerve block?

A

regional anaesthesia technique to provide perineal anaesthesia (bony landmark is the ischial spine)

50
Q

penile musculature in males

A
  1. ischiocavernosus muscle spiralling over the corpora cavernosum to aid in support and movement
  2. bulbospongiosus muscle spiralling over the corpora spongiosum aiding in emptying the urethra

both are skeletal muscles innervated by the pudendal nerve

51
Q

penile musculature in females

A
  1. ischiocavernosus muscle spiralling on the crura of the clitoris to compress it for clitoral engorgement
  2. bulbospongiosus muscle covering the vestibular bulb to contribute to clitoral erection

M2 Reproduction (2 decks)

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