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Endo Test 2 > Perineum and Spaces > Flashcards

Perineum and Spaces Flashcards

1
Q

what is os coxae formed from?

A

fusion of 3 paired bones and sacrum:
ilium
pubis
ischium

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2
Q

ilium

A

broad ala “wing”

  • body forms upper 2/5ths of acetabulum
  • posteriorly ilium articulates with sacrum
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3
Q

Ischium

A
  • body forms posterior-inferior 2/5ths of acetabulum
  • short superior ramus and inferior ramus forms the obturator foramen
  • rami articulate with the pubis
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4
Q

Pubis

A
  • consists of a short body

- superior and inferior rami (superior rami forms the anterior 1/5th of acetabulum)

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5
Q

Pubis symphysis

A
  • fibrocartilaginous disc that links the two pubis bones

- classically it is the only site of mvmt in the pelvis, especially during pregnancy

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6
Q

sacroiliac joints

A

synovial joint between sacrum and ilium

  • reinforced by anterior, posterior and interosseous sacroiliac ligaments
  • additional reinforcement comes from sacrotuberous ligament: which runs from sacrum to the pubic tuberosity
  • Mvmt: primarily a gliding motion, but can be rotary: interosseous sacroiliac and sacrotuberous ligaments resist rotary motion
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7
Q

sacrotuberous ligament

A

sacrum to ischial tuberosity

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8
Q

sacrospinous ligament

A

from sacrum/coccyx to ischial spine

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9
Q

lumbosacral joint

A 
LV5/SV1
fibrocartilaginous joint (like intervertebral joints)
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10
Q

iliolumbar ligament

A

bipartite ligament

spans from transverse process LV5 to iliac crest

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11
Q

position of pelvis in normal erect position

A
  • normally tips at 50-60 degrees from the horizontal
  • base of sacrum is 4 inches higher than the symphysis
  • ASIS and the symphysis pubis lie in the same vertical plane
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11
Q

gynecoid

A

most common female pelvis

- slightly oval-shaped pelvic inlet, the most circular

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11
Q

platypelloid

A

least common in both sexes
- exaggerated transverse inlet diameter
“flat” - provides greatest size of pelvic inlet

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11
Q

true conjugate

A

from sacrovertebral angle to superior margin of the symphysis

also called “anterior-posterior diameter”

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11
Q

diagonal conjugate

A

similar to true conjugate, however measures from the sacrovertebral angle to the inferior margin of the symphysis
- relates more to the pelvic outlet

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11
Q

transverse diameter

A

greatest width of the pelvic brim

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11
Q

coccygeus m.

A 
O: ischial spine
I:coccyx and lower sacrum
n: S4,5 ventral rami
A: supports pelvic viscera
*** most posterior muscle of pelvic diaphragm.
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11
Q

terminal line

A

“pelvic brim”- divides pelvis into 2 portions:

  1. major (false) pelvis: above line
  2. minor (true) pelvis: below line
  • the plane of the line is the superior aperture: pelvic inlet
  • the inferior aperture/irregular lower border is the pelvic outlet
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11
Q

sexual dimorphism of pelvis

A

female pelvis:

  • shallower major and minor pelvis
  • anterior iliac crests tend to evert
  • greater diameter of minor pelvis
  • everted sciatic tubers
  • broader sacrum with less curve
  • superior aperture more oval
  • subpubic angle is greater
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11
Q

android

A
  • most common male pelvis (2nd most common in females)

- heart shaped pelvic inlet

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11
Q

anthropoid

A
  • 2nd most common male pelvis (third most common in females)

- exagerated (tall) anterior/posterior inlet

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11
Q

two best shapes for birthing?

A

gynecoid and platypelloid

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11
Q

oblique diameter

A

from sacroiliac articulation of one side to iliopectineal (iliopubic) eminence of other side

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12
Q

diameters of superior aperture?

A

true conjugate
diagonal conjugate
transverse and oblique diameter

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12
Q

broad ligament

A

ligament found only in females, reaches across pelvis and is folded over uterus

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12
Q

diameters of the inferior aperture?

A
  1. transverse: between the inner surfaces of the ischial tuberosity
  2. anterior sagittal - from transverse diameter to the symphysis
  3. posterior sagittal: from transverse diameter to the sacrococcygeal junction
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13
Q

obturator internus muscle

A 
- covers obturator foramen
O: inner surface of obturator membrane
I: greater trochanter of femur 
N: n. to obturator internus
A: external rotation of thigh
  • note: leaves the pelvis as a tendon that passes around the margin of the lesser sciatic notch
  • covered by a heavy fascia called the obturator fascia from which levator ani muscle arises
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14
Q

boundaries of anal triangle?

A

anterior: posterior edge or urogenital diaphragm
posterior: boundaries of perineum (coccyx and caudal sacrum)
lateral: ischiopubic rami and obturator internus m. below
superior: roof of triangle is formed by interior aspect of pelvic diaphragm
inferior: skin and superficial fascia of perineum

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15
Q

pelvic diaphragm

A

supports pelvic viscera
- perineum below pelvic floor
- incomplete to allow passage of urethra and vagina
contains Levator ani m. and coccygeus m.

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16
Q

urogenital diaphragm

A

supports midline structures such as urethra, vagina and prostrate

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17
Q

three parts of levator ani muscle?

A
  1. iliococcygeus
  2. pubococcygeus
  3. puborectalis

all innervated by perineal branches of S3,4
action is to support pelvic viscera

18
Q

pubococcygeus m.

A

O: pubis
I: coccyx
N: Perineal branches S3,4
a: supports pelvic viscera

middle muscle

19
Q

iliococcygeus m.

A

O: arcus tendineus
I: coccyx
N: perineal branches of S3,4
A: supports pelvic viscera

*** most posterior muscle, just above coccygeus muscle

20
Q

puborectalis m.

A 
O: pubis
I: puborectalis muscle from opposite side on posterior side of rectum
N: perineal branches of S3,4
*** maintains anal rectal junction
* most anterior muscle
21
Q

coccygeus m.

A 
O: ischial spine
I:coccyx and lower sacrum
n: S4,5 ventral rami
A: supports pelvic viscera
*** most posterior muscle of pelvic diaphragm.
22
Q

pelvic peritoneum

A
  • does not contact floor and walls of pelvis
  • draped over superior aspects of pelvic structures and forms distinctive folds and pouches
  • rectouterine/vesicouterine pouch in females
  • rectovesical pouch in males
23
Q

retrovesicle pouch

A
  • pouch formed in males between rectum and the bladder
24
Q

moving external to internal in the perineum…

A 
skin
	superficial fascia
		Camper’s fascia
		Colle’s (Scarpa’s) fascia
	sup. perineal space (& contents)
	perineal membrane
	deep perineal space (& contents)
	sup. fascia of UG diaphragm
	ischioanal fossa
	pelvic diaphragm (levator ani m.)
	extraperitoneal CT
	peritoneum
	peritoneal space in pelvis
25
Q

broad ligament

A

ligament found only in females, reaches across pelvis and is folded over uterus

26
Q

what does anal triangle contain?

A

external anal sphincter

internal pudendal vessels:

  • inferior rectal aa.
  • perineal aa.
  • deep and dorsal aa. of the penis/clitoris

nerves:
- pudendal n (S2-4): inferior rectal nn, perineal nn, dorsal n. to penis
- perineal branch of S4

27
Q

divisions of perineum?

A

line connecting the ischail tuberosities:

  1. anal triangle
  2. urogenital triangle
28
Q

boundaries of anal triangle?

A

anterior: posterior edge or urogenital diaphragm
posterior: boundaries of perineum (coccyx and caudal sacrum)
lateral: ischiopubic rami and obturator internus m. below
superior: roof of triangle is formed by interior aspect of pelvic diaphragm
inferior: skin and superficial fascia of perineum

29
Q

urogenital diaphragm

A

stretches anteriorly between the two ischiopubic rami creating the UG and anal regions of the perineum

  • made of sphincter urethrae (urethrovaginalis in females), compressor urethrae and deep transverse perineal m.
30
Q

sphincter urethrae m.

A

called urethrovaginalis m. in females

surrounds membranoud urethrae

31
Q

compressor urethrae m.

A

extends laterally from sphincter

32
Q

deep transverse m.

A

posterior to sphincter urethrae m.

33
Q

transverse perineal ligament

A

where fascia on superior and inferior surfaces of muscles of urogenital diaphragm fuse
- anteriorly does not extend to pubis, the deep dorsal v. or penis and the clitoris of the female enter through this gap.

34
Q

superior fascia of UG diaphragm

A

from transversalis fascia

35
Q

inferior fascia of UG diaphragm

A

known as perineal membrane

36
Q

superficial perineal space

A

deep to skin, inferior to perineal membrane Colle’s fascia

Components of sexual apparatus:

  • erectile bodies
  • musculature
  • vessels
  • nerves
37
Q

deep perineal space

A

space between inferior and superior fascia

- contains muscles of UG diaphragm, vessels and nerves

38
Q

moving external to internal in the perineum…

A 
skin
	superficial fascia
		Camper’s fascia
		Colle’s (Scarpa’s) fascia
	sup. perineal space (& contents)
	perineal membrane
	deep perineal space (& contents)
	sup. fascia of UG diaphragm
	ischioanal fossa
	pelvic diaphragm (levator ani m.)
	extraperitoneal CT
	peritoneum
	peritoneal space in pelvis
39
Q

Ischioanal fossa

A
  • fossa is filled with adipose tissues
  • Boundaries:
    superior: levator ani and pelvic diaphragm
    inferior: skin of perineum
    Posterior: right and left ischioanal fossa
    anterior: components of external anal sphincter and UG diaphragm fuse to prevent communication
    –. anterior recesses: extend anteriorly between the levator ani and UG diaphragm
40
Q

what does anal triangle contain?

A

external anal sphincter

internal pudendal vessels:

  • inferior rectal aa.
  • perineal aa.
  • deep and dorsal aa. of the penis/clitoris

nerves:
- pudendal n (S2-4): inferior rectal nn, perineal nn, dorsal n. to penis
- perineal branch of S4

41
Q

external anal sphincter

A
  • voluntary muscle surrounding the anal canal

- divided into superificial, subcutaneous and deep

42
Q

internal pudendal vessels

A

branch of the internal iliac
leaves the pelvis through the greater sciatic foramen
- crosses the ischial spine and passes through the lesser sciatic foramen jin the pudendal canal

43
Q

pudendal canal

A

fascial canal created by the splitting of the obturator fascia

44
Q

inferior rectal aa

A

first branch of pudendal vessel after entering the pudendal canal
supplies the sphincter, anal canal and skin of anus

45
Q

perineal aa.

A

arise near the posterior edge of the UG diaphragm

- branches from transverse perineal aa. and posterior scrotal (labial aa.)

46
Q

deep and dorsal aa. of the penis (clitoris)

A

terminal branches of the internal pudendal aa.

run superior to the UG diaphragm

47
Q

pudendal n.

A 
S2-4
follows same course as the internal pudendal aa. 
branches are: 
inferior rectal nn. 
perineal nn. 
dorsal n. of the penis
62
Q

perineal branch of S4

A

cutaneous distribution to the skin of the posterior anal triangle

  • may contribute to innervate external sphincter
  • innervates lateral most aspect of anal and UG regions down onto medial thigh
63
Q

boundaries of male UG triangle

A

anterior: pubis
lateral: ischiopubic rami
posterior: dorsal edge of UG diaphragm
superior: pubo-coccygeal portion of levator ani muscles

63
Q

UG diaphragm

A
  • voluntary muscular sheet between ischiopubic rami: from the pubis to ischial tuberosities:
  • sphincter urethrae m. forms anterior portion and deep transverse perineal m. forms posterior portion
  • does not extend anteriorly to pubis, but rather anterior gap is filled with transverse perineal ligament where the deep dorsal vein to penis travels through
  • bulbourethral glands and muscles of diaphragm are sandwiched between faschial sheath layers to form the deep perineal space.
63
Q

superficial perineal fascia

A
  • Colle’s fascia
  • most superficial fascia layer of UG diaphragm
  • forms superficial penile fascia = Darto’s fascia (superficial fascia of scrotum )
63
Q

Darto’s fascia

A

superficial fascia of scrotum

formed from Colle’s fascia

63
Q

deep perineal fascia

A
  • intimately surrounds the cavernous bodies
  • forms deep penile fascia (Buck’s fascia)
    creates potential space b/w superficial and deep penile fascia
68
Q

Buck’s fascia

A

deep fascia of penis

69
Q

transverse perineal a.

A

supplies are of central tendon

- comes from perineal a.

70
Q

posterior scrotal (labial) a.

A

runs into the scrotum (labia) in the superficial perineal space
- comes from perineal a.

71
Q

artery of the bulb

A

branch from internal pudendal a.

- supplies bulbourethra gland and bulb of corpus spongiosum

72
Q

urethral a.

A

branch of internal pudendal a.

- enters spongy body to supply urethra dn the glans

73
Q

deep arter of penis

A

terminal branch of internal pudendal a. that supplies cavernous body

74
Q

dorsal artery of the penis

A

terminal branch of internal pudendal a. that supplies dorsal surface of penis

75
Q

deep dorsal vein of penis/clitoris

A

single large midline v. deep to deep fascia

76
Q

perineal branches of the pudendal nerve?

A
  1. posterior scrotal (labial) n.
  2. deep branches
  3. dorsal n. of the penis or clitoris

Endo Test 2 (10 decks)

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