perineum / pelvis Flashcards
1
Q
what does the pelvic girdle connect
A
axial skeleton to lower limbs
2
Q
where do the internall iliac lymph nodes drain
A
Gluteal region, deep perineum and inferior pelvic viscera
3
Q
what is the perineal body
A
an irregular fibromuscular mass - contains skeletal muscle, smooth muscle and collagenous and elastic fibre
4
Q
what separates the perineum form the pelvic cavity
A
pelvic floor
5
Q
what are the 2 muscles that make up the pelvic floor
A
levator ani
coccygeus
6
Q
what bones make up the pelvis
A
2 hip bones, sacrum, coccyx
7
Q
what control is the external anal sphincter under
A
voluntary
8
Q
what are the main contents of the anal triangle
A
Anal aperture – the opening of the anus.
External anal sphincter muscle
Ischioanal fossae (x2)
9
Q
what do The veins along the sides and base of the prostate join to form
A
the prostatic venous plexus
10
Q
what is the distribution of the uterine artery
A
Pelvic part of ureter, uterus, ligament of uterus, uterine tube and vagina
travels in cardinal ligament
11
Q
what are the 2 holes in the pelvic floor
A
urogenital hiatus - urehtra + vagina
rectal hiatus
12
Q
what innervate the erectile tissues (corpora cavernosa, corpus spongiosum, clitoris, bulbs of vestibule)
A
Parasympathetic fibres from S2, 3, 4 via the hypogastric plexus
13
Q
what part of the levator ani actually lifts the canal
A
illiococcygeus - elevate pelvic floor and the anorectal canal
14
Q
where does the interior iliac artery divide into the anterior and posterior branches
A
superior border of the greater sciatic foramen
15
Q
what are the 3 parts of the hip bone
A
ilium, pubis, ischium
16
Q
what are the main actions of the Superficial transverse perineal & deep transverse perineal muscles
A
Support and fix perineal body to support abdominal/ pelvic viscera and resist increased abdominal presure
17
Q
what muscle creates the anorectal angle
A
puborectalis - where the rectum meets the anus
18
Q
what muscles does the perineal branch of the pudendal nerve innervate
A
• Bulbospongiosus
• Ischiocavernosus
• Levator ani muscles (including the iliococcygeus, pubococcygeus and puborectalis).
external urethral sphincter
19
Q
what are branches of the posterior trunk of the internal iliac artery
A
iliolumbar artery
lateral sacral
superior gluteal
20
Q
why is the coccygeus not part of the levator ani
A
doesn’t life anus
21
Q
what is the innervation of the bulbospongiosus
A
Branch of pudendal – S2-4 (muscular branch of perineal)
22
Q
does the male or female have a larger acetabulum
A
male
23
Q
what are the lateral borders of the perineum
A
inferior pubic rami and inferior ischial rami (ischiopubic) and the sacrotuberous ligament
24
Q
what are the boundaries of the anal triangle
A
the coccyx, sacrotuberous ligaments, and a theorectical line between the ischial tuberosities
25
why is it essential to aspirate before injecting LA in a pudendal nerve block
pudendal nerve accompanied by the internal pudendal artery
26
what fascia forms the pudendal canal
obturator internus
27
what does the iliac crest extend between
the anterior superior iliac spine (ASIS) to the posterior superior iliac spine (PSIS).
28
what nodes drain the body of the uterus
External iliac
29
where do the external iliac lymph nodes drain
Pelvic viscera (especially superior parts of the anterior pelvic organs)
30
what are the main actions of the external urethral sphincter
Compress urethra to maintain urinary continence
31
what is the distribution of the internal pudendal artery
Main artery to perineum, including muscles of anal canal and perineum, skin, uro-genital triangle, erectile bodies
32
where do the sacral lymph nodes drain
Concavity of the sacrum, postero-inferior pelvic viscera
33
what 2 important ligaments attach to the ischium
sacrospinous ligaemnt
| sacrotuberous ligament
34
what muscle is the pudendal canal in
obturator internus
35
how does the pudendal nerve leave the pelvis
greater sciatic foramen
36
what is the filum terminale
a continuation of the pia mater from the conus medullaris of the spinal cord
37
what is contained in the superficial perineal pouch
the erectile tissues that form the penis and clitoris
three muscles – the ischiocavernosus, bulbospongiosus and superficial transverse perineal muscles.
vestibular glands
38
what is in the central canal of the sacrum
sacral fibres of the cauda equina
39
what ligament creates the greater sciatic foramen
sacrospinous ligament
40
what is the subpubic angle in the female
Obtuse – greater than 90
41
what is the joint between the sacrum and coccyx
sacrococcygeal symphysis - fibrocartilaginous joint
42
what is the uterine artery a branch of
Anterior division of internal iliac artery
43
what indentation os found on the posterior aspect of the ilium
greater sciatic notch
44
what does the sacrospinosu ligament run between
ischial spine to the sacrum
45
what bones make the obturator foramen
ischium + pubis
46
what is the deep perineal pouch
a potential space between the deep fascia of the pelvic floor (superiorly) and the perineal membrane (inferiorly).
47
where is the common iliac vein formed
upper margin of the pubic symphis
48
what are the roles of the pelvic floor muscles
Support of abdominopelvic viscera
Resistance to increases in intra-pelvic/abdominal pressure
Urinary and fecal continence
49
what are the main functions of the pelvis
Transfer of weight from the upper axial skeleton to the lower appendicular components of the skeleton, especially during movement.
Provides attachment for a number of muscles and ligaments used in locomotion.
Contains and protects the abdominopelvic and pelvic viscera.
50
what is the distribution of the obturator artery
Pelvic muscles, nutrient artery to ilium and head of femur
| thigh adductor region
51
what is the best way to strengthen the pelvic floor muscles
Kegel exercises
52
has the male or female got a more shallow greater pelvis
female
53
what is the common illaic vein formed from
internal and external illaic vein
54
what nodes drain the scrotum
Skin – superficial inguinal
| Cavernous body/ spongy urethra – internal iliac
55
what is the vaginal artery a branch of
uterine artery
56
what is the innervation of the superficial transverse perineal and deep transverse perineal
Muscular (deep) branch of perineal nerve – branch of pudendal nerve & dorsal never of penis/ clitoris
57
what muscles attach to the perineal body
* Levator ani (part of the pelvic floor).
* Bulbospongiosus muscle.
* Superficial and deep transverse perineal muscles.
* External anal sphincter muscle.
58
where is the perineal body
the junction of the urogenital and anal triangles – the central point of the perineum
59
what muscle forms the lateral wall of the pelvic cavity
obturator internus
60
where to the R and L common illiac veins combine to form the IVC
L5
61
what is the anterior border of the pelvic inlet
pubic symphis
62
what is the roof of the perineum
pelvic floor
63
what is the terminal continuation of the inferior mesenteric artery
The superior rectal artery
64
what are the gonadal arteries a a branch of
abdominal aorta
65
where is the internal lilac vein formed
near the greater sciatic foramen
66
what nerve is motor to the cremasteric muscle
genitofemoral (L1/2)
67
where does the pudendal nerve supply
whole perineum
68
what is the role of perineal membrane
to provide attachment for the muscles of the external genitalia
69
what is the main arterial supply to the pelvic cavity
internal iliac artery
70
what shape is the puborectalis
U shaped sling
71
what are the main actions of the bulbospongiosus
Supports/ fixes perineal body and pelvic floor
72
what nerve plexus lies on the posterior wall of the pelvic cavity
sacral plexus
73
what are the middle/ inferior rectal arteries a branch of
Anterior division of internal iliac artery
74
where is the internal lilac artery to the external illaic vein
medial
75
what is the internal pudendal artery a branch of
Anterior division of internal iliac artery
76
what is the major innervation of the perineum
pudendal nerve S2-4
77
what innervates the coccyges
the anterior rami of S4 and S5
78
what ligament forms the lesser sciatic foramen
sacrotuberous
79
what is the innervation of the external anal sphincter
Branch of pudendal nerve- inferior anal nerve S4
80
what muscles attach to the anterior surface of the sacrum
piriformis
coccygeus
illiacus
81
what type of joints are the sacroiliac joints
syndesmosis
82
name some branches of the pudendal nerve
inferior rectal nerve,
perineal nerve,
dorsal nerve of the penis or clitoris
83
what are the main actions of the ischiocavernous
Maintain erection of penis and clitoris by constricting outflow veins
84
what nodes drain the lower vagina
Sacral and common iliac
85
what other 2 veins drain into the common illaic vein
Iliolumbar vein – drains the L4 and L5 vertebrae, and the iliopsoas muscle.
Middle sacral veins – drain part of the sacrum
86
what does the sacrotuberous ligament run between
sacrum to the ischial tuberosity
87
what are the 3 major vessels that drain the pelvis
the external iliac vein, internal iliac vein and common iliac vein
88
what are the main actions of the external anal sphincter
Constricts anal canal during peristalsis, resisting defecation
89
what type of joint is the pubic symphis
synovial ball and socket
90
what is the lateral border of the pelvic outlet
The ischial tuberosities
91
why are haemorrhoids associated with cirrhosis of the liver
increased portosystemic pressure, leading to varices in the rectum.
92
what nodes drain the ovary
Lumbar and para-aortic
93
where does the body weight fall when sitting
ischial tuberosities
94
what shape is the pelvic inlet in a male and female
male - heart
| female - oval
95
what is the course of the pudendal nerve in and out the pelvis
out greater sciatic , crosses sacrospinous ligament , enters through lesser sciatic
96
what is the term for the male and the female pelvis
female - gynaecoid
| male - android
97
does the male or female have a larger pelvic outlet
female
98
where do the common iliac lymph nodes drain
Drainage from the 3 main groups – external, internal and sacral lymph nodes
99
what is the obturator artery a branch of
Anterior division of internal iliac artery
100
what is a cystocele and rectocele
Cystocele – bladder herniation (anterior prolapse)
| Rectocele – rectal herniation (posterior prolapse)
101
what is the external illaic vein a continuation of
femoral vein
102
what muscles are most prone to damage during childbirth
Pubococcygeus and puborectalis - situated medially
103
what nodes drain the fundus and upper uterus
Pre- aortic group of lymph nodes
104
what are the 3 muscles of the levator ani
pubococcygeus, puborectalis and iliococcygeus
105
where is the pelvic outlet
end of the lesser pelvis, and the beginning of the pelvic wall
106
what is the anterior border of the pelvic outlet
The pubic arch (the inferior border of the ischiopubic rami).
107
what are the superior/ inferior vesical arteries a branch of
Anterior division of internal iliac artery
108
what is there erector spinae important in
achieving extension and lateral bending of the head and vertebral column.
109
what nerve is commonly blocked beforevaginal childbirth/ episiotomy
pudendal nerve block
110
what type of joint is the hip joint
synovial ball and socket
111
where on the sacrum does the sacrospinous ligament attach
median sacral crest - fusion of S1-3
112
what does the head of femur articulate with in the hip joint
acetabulum
113
where does the levator ani insert into the obturator internus
tendinous arch
114
what is the motor function of the pudnedal nerve
innervates various pelvic muscles, the external urethral sphincter and the external anal sphincter
115
what is the lateral border of the pelvic inlet
arcuate line on the inner surface of the ilium
116
what nodes drain the scrotum
Superficial inguinal
117
what is the sensory function of the pudnedal nerve
innervates the external genitalia of both sexes and the skin around the anus, anal canal and perineum
118
what is the posterior border of the perineum
tip of the coccyx
119
what is the distribution of the superior/ inferior vesical arteries
Urinary bladder, pelvic part of ureter
| In males – vas deferens, seminal gland and prostate
120
what are the boundaries of the urogenital triangle
pubic symphysis, ischiopubic rami, and a theorectical line between the two ischial tuberosities
121
what is the main function of the puborectalis
maintain faecal continence – during defecation this muscle relaxes.
122
what are the nerve roots of the pudendal nerve
S2-4
123
what is the terminal branch of the anterior trunk of the internal iliac artery
inferior gluteal artery
124
what is the superior rectal artery a branch of
Inferior mesenteric artery
125
what are the ischioanal fossa
spaced lateral to the anus
contain fat and connective tissue
allow for expansion of the anal canal during defecation
126
is the greater pelvis superior or inferior to the true pelvis
superior
127
what can avoid a prolapse of the pelvic viscera by tearing ht perineal body in childbirth
episiotomy - surgical cut in the perineum
128
what is the junction between the greater and lesser pelvis
pelvic inlet
129
what nodes drain the cervix and upper vagina
Internal iliac and sacral lymph nodes
130
what nodes drain the seminal vesicle
External and internal iliac
131
what separates the 3 hips bones before puberty
the triradiate cartilage
| fuses at 15-17
132
what is the role of the greater (false) pelvis
it provides support of the lower abdominal viscera (such as a ileum and sigmoid colon).
133
what nerve is responsible for the afferent component of penile and clitoral erection
Dorsal nerve of the penis or clitoris
134
when does the femoral vein become the external iliac vein
crosses underneath the inguinal ligament
135
what nodes drain the prostate
Internal iliac and sacral
136
what is the subpubic angle in the male
Acute – less than 90
137
what things perforate the perineal membrane in a female
vagina
| urethra
138
where does the majority of the blood in the pelvis drain
internal iliac
139
what is the posterior border of the pelvic inlet
sacral promontory (the superior portion of the sacrum) and sacral wings (ala).
140
what innervates the levitator ani
pudendal nerve (roots S2, S3 and S4).
141
what is palpated for a pudendal nerve block
ischial spine
142
what is the terminal part of the vertebral column
coccyx
143
what nerve is sensory to the anterior scrotal skin
genitofemoral (L1/2)
144
what is the innervation of the external urethral sphincter
Pudendal nerve – S2, 3, 4
145
what are the 3 main articulations of the hip bone
•Sacroiliac joint – articulation with the sacrum
•Pubic symphysis – articulation between the left and right hip bones
Hip joint – articulation with the head of femur
146
why is a mediolateral episiotomy preferable to a midline episiotomy
avoids potential tear of the medial puborectalis fibres, avoiding rectal herniation
147
what is the autonomic function of the pudnedal nerve
carries sympathetic nerve fibres to the skin of the S2-S4 dermatomal region
148
what is the anterior border of the perineum
pubic symphis
149
what is the innervation of the ischiocavernous
Branch of pudendal – S2-4 (muscular branch of perineal)
150
does the foetus pass through the lesser or greater canal in childbirth
lesser
151
what is the terminal branch of the posterior trunk of the internal iliac artery
superior gluteal artery
152
how many sacral vertebrae are there
5
153
what is the posterior border of the pelvic outlet
• The tip of the coccyx
154
where does the internal lilac artery originate
bifurcation of the common iliac artery into its internal and external branches, L5-S1
155
what muscle forms the posterior wall of the pelvic cavity
piriformis
