Uterus + Perineum Flashcards
What organs are directly anterior and posterior to the uterus?
Ant: urinary bladder
Post: Rectum
What are the 3 parts of the uterus?
- Fundus (top)
- Body (2/3 of it)
- Cervix (1/3 of it)
What is the name for the opening in the cervix?
Os
How long are the uterine tubes?
To which part of the uterus do they attach?
What are their fcn?
~4” long
- Attach to fundus (epithelium is continuous)
- Carry ovum to uterine cavity
What are the 4 parts of the uterine/fallopian tube, starting at the uterus?
- Isthmus
- Ampulla
- Infundibulum
- Fimbria
Where is the approximate location of the ovary?
- Lateral pelvic wall
What is the ovary’s own mesentery that attaches superior of it?
Mesovarium
What attaches the ovary to the uterus and runs in the mesovarium?
What runs through it?
Ovarian ligament
- Nothing runs through it
What suspends the ovary to the lateral wall of the pelvis?
What runs through it?
Suspensory ligament–a condensation of fascia surrounding bv’s to the ovary and is technically part of broad ligament
- Ovarian a. runs thru it
What connects the uterus to the labia majora by running thru the inguinal canal?
Round ligament (not a true ligament)
What is the broad ligament?
A fold of peritoneum that extends from the sides of the uterus to the lateral walls of the pelvis
- Surrounds the uterine tubes
Explain the spatial arrangement of the ureter and uterine artery?
Why is this important?
“Water goes under the bridge”
Ureter travels under the uterine artery
- Many lawsuits follow ligation of the uterine a. during hysterectomy (don’t put staple in ureter following hysterectomy)
Where does the ovarian a. branch from and what does it travel in?
- Aorta
- Suspensory ligament
In the vagina, what is the fornix?
Recesses in the superior vagina that surround the cervix (which protrudes into the vagina)
What’s the mesentary of the uterine tube?
Mesosalphinx (salphin: “tube”)
The uterine position is ______________, while the vaginal position is ______________.
- Anteflexion
- Anteversion
(uterus is flexed, vagina is verted)
What are the 2 areas that makeup the perineum?
Anterior: urogenital diaphragm
Posterior: anal triangle
What sits in the center of the perineum?
Perineal body, AKA central tendon
- Serves as anchor point for most small mm. of the perineum
What is the term for foreskin?
Prepuce
What is the name for the space b/w the labia majora?
Vestibule
What is the female equivalent of the penile glans and prepuce?
Clitoral glans and clitoral prepuce
What is the area of the pubic region called?
Mons pubis
What are the layers of the UG diaphragm, from inf to sup?
- Inferior fascia of the UG diaphragm, AKA perineal membrane
- UG diaphragm proper, AKA the deep pouch
- Superior fascia of the UG diaphragm
Generally, what would you find below the inferior fascia of the UG diaphragm?
What is this zone called?
- Erectile tissue (both sexes)
- Superficial pouch
In the penis, where does the urethra run?
Through the corpus spongiosum
What type of tissue is the clitoris made up of?
Corpus cavernosum only
What area comes just before the eternal urethra orifice of the penis?
Navicular fossa of the urethra
What does erectile tissue consist of?
Crura (legs), bulb of penis or vestibule, cavernous bodies
What muscle covers to crus of the penis?
Ischiocavernosus m.
What is w/in the bulb of the penis?
Bulbourethral glands (AKA Cowper’s glands)
What muscle covers the bulb of the penis?
Bulbospongiosus m.
Bulbospongiosus m: OIIA?
O: Perineal body
I: Goes around bulb or vesticule
I: Deep branch of perineal n. from pudendal n.
A: Male: compresses bulb of penis, forces blood into body of penis during erection, removes urine from urethra and semen during ejaculation
Female : constricts vaginal orifice, assists in expressing secretions of greater vestibular gland, forces blood into body of clitoris
Ischiocavernosus m: OIIA?
O: Ischium
I: Crus of penis or clitoris
I: Deep branch of perineal n. from pudendal n.
A: Forces blood into penis and clitoris during erection
Superficial transverse perineal m: OIIA?
O: Ischial rami
I: Perineal body
I: Perineal branches of pudendal n.
A: Stabilizes central tendon
Cremaster m: OIIA?
O: Internal oblique and inguinal ligament
I: Pubis
I: Genital branch of genitofemoral n.
A: Retracts testicle
External anal sphincter: OIIA?
O: Tip of coccyx, anococcygeal ligament
I: Deeper fibers surround anal canal, attach posteriorly to coccyx and anteriorly to central point of perineum
I: Perineal and inferior rectal branches of pudendal nerve
A: Closes anal orifice
What artery generally supplies the perineum?
Internal pudendal a.
What nerve generally supplies the perineum?
Pudendal n.
In order to perform a pudendal nerve block, what should you locate?
Why would you do this?
- Ischial spine
- Childbirth or surgery, etc.
Are the crura (2x crus) part of the cavernosa or spongiosum?
Corpus cavernosum
To divide the perineum into 2 triangle, draw a line b/w the _________________.
Ischial tubersities
What runs b/w the sacrum/coccyx to the ischial tuberosity?
Which triangle is it a part of?
- Sacrotuberous ligament
- Anal triangle
Between what 2 layers is the superficial pouch located?
B/w colle’s fascia and inferior fascia of the UG diaphragm
- What are the mm. of the superficial pouch?
* What else is in there?
- Ischiocavernosus m.
- Bulbospongiosus m.
- Superficial transverse perineus m.
- External anal sphincter m.
- Vestibular glands (females only!)
- Crura and bulb
- Some of neurovascular bundle
- Perineal body
What is the deepest part of the superficial pouch called, (just after the pouch ends)?
Inferior fascia of the UG diaphragm AKA perineal membrane
What pierces the inferior fascia of the UG diaphragm?
- Urethra
- Vagina (females only)
By stripping off the inferior fascia of the UG diaphragm we expose what layer?
The deep pouch
- What are the mm. of the deep pouch?
* What else is in there?
- Deep transverse perineus m.
- Sphincter urethra m.
- Bulbourethral glands AKA Cowper’s glands (male only!)
- Vagina, urethra
What is the most superior structure of the perineum, which is exposed after we remove the deep pouch?
Superior fascia of the UG diaphragm
What main branches does the internal pudendal a. give off in the perineum?
(at least know the first 2)
- Inferior rectal a.
- Perineal a.
- Dorsal a. of the penis/clitoris
- Deep a. of the penis/clitoris
Sphincter urethrae m: OIIA?
O: External fibers from junction of inferior pubic and ischial rami and adjacent fascia; internal fibers pass medially to surround membranous urethra
I: Male: median raphe in front and behind urethra. Female: encloses urethra, attaches to sides of vagina
I: Perineal branches of pudendal nerve
A: Compresses urethra at end of micturition; in female also compresses the distal vagina
Deep transverse perineal m: OIIA?
O: Ischium
I: Male: medial tendinous raphe and perineal body. Female: sides of vagina
I: Perineal branches of pudendal nerve
A: Stabilizes perineal body, supports prostate/vagina
What is the most important branch of the pudendal n. in the perineum?
What roots does the pudendal n. come from?
- Perineal n.
- S2, S3, S4
What is unique about the bulb in females?
It is split open by the vagina
What aa. do the monkey’s eyes consist of?
Deep artery of penis (from internal pudendal a.)
*Where does the superior rectal a. originate from?
Middle?
Inferior?
- IMA
- Anterior division of internal iliac a.
- Internal pudendal a. (off same ant division)
Injury to the pelvis that damages the urethra is know as __________________.
A “straddle injury”
What are the names of the parts of the urethra in males?
(0. Preprostatic)
1. Prostatic
2. Membranous
3. Spongy
How could damage to the spongy urethra (e.g. in straddle injury) be problematic in males?
Blood or urine could flow up to the potential space b/w the rectus sheath and Scarpa’s fascia to just below the navel
An obstetrician has to perform an episiotomy on a birthing mother due to the large head of her Lithuanian baby. What midline structure would she prefer not to cut?
A) Crus B) Ishiorectal fat C) Superficial transverse perineal m. D) Perineal body E) Deep transverse perineal muscle
D) Perineal body
Will therefore perform a medio-lateral episiotomy
Left ovarian v. drains into where? What about the right?
- Left renal v.
- IVC
What n. branches as it crosses over the ischial spine?
Pudendal n.
What are the 3 branches of the pudendal n?
- Perineal n.
- Dorsal n. of clitoris/penis
- Inferior rectal n.
Dartos m: OIIA?
What was this layer before descent of testes?
O: Subcutaneous tissue of scrotum, superficial to superficial fascia (Colles)
I: Skin and midline fibrous septum of scrotum
I: Genital branch of genitofemoral n. (same as cremaster m.)
A: Corrugates (wrinkles) scrotal skin
- Was camper’s fascia in abd
