Wu Notes Pelvis Week Flashcards
What two nerves are vulnerable in a indirect inguinal hernia?
Ilioinguinal nerve is inside the inguinal canal
Genital branch of the genitofemoral in the spermatic cord
What nerve innervates the perineum?
Ilioinguinal nerve
Inguinal region
Area around the inguinal ligament from ASIS to pubic tubercle
If the processes vaginalis doesn’t close, what can happen?
Indirect inguinal hernia (more common in men) Hydrocele in men
Inguinal canal contents
- Round ligament in women/ Spermatic cord in men
- Ilionguinal nerve: groin/anterior perineum pain
- Genital branch of genitofemoral nerve: scrotal pain + loss of cremaster reflex
Lack of cremaster reflex (ipsilateral testicle contracts if you scratch the inner thigh) is a sign of a testicle issue or hernia.
What nerve is associated with the cremasteric reflex?
Genitofemoral nerve (L1/L2)
Ligaments maintaining anteversion of uterus
- Round ligament
- Cardinal/Transverse Cervical ligament - carries uterine vessels; most supportive
Ovary ligaments
Suspensory ligament
Ovarian ligament
Analogous structure of gubernaculum in females
Ovarian ligament + round ligament.
They first anchor the ovary to the uterus and then comes out again to anchor them ot the labia (female scrotum)
Site of sperm production
Seminiferous tubules (pockets in the testes)
In a hysterectomy, don’t forget…
To take out the uterus, you have to take out the blood supply –> be careful not to cut the ureter.
The relationship of the uterine vessels to the ureter has a greater clinical significance (“water under the bridge”)
Ureter is under the uterine vessels.
Both iliohypogastric and ilioinguinal pierce
internal oblique
Lymphatic drainage of gonads (testes and ovaries)
Para-aortic nodes/lumbar nodes
Contents of spermatic cord
-
Fascia:
- Ext spermatic fascia (from ext oblique)
- Cremaster fascia (from int oblique)
- Int spermatic fascia (from transversalis fascia)
- Tunica vaginalis (from parietal peritoneum)
-
Artery:
- Testicular artery
- Cremaster artery
- Deferential artery
-
Veins:
- Pampiniform plexus
- Testicular, cremaster, and deferential vein
- Genital branch of genitofemoral nerve
- Vas deferens
Tunica albuginea vs Tunica vaginalis
Tunica albuginea covers the testis. Thicker capsule you would see if you cut the testicle open.
Tunica vaginalis is the wrapping around the testis. (parietal and visceral layer). Covers the individual corpus spongiosum and the two corpus cavernosa. It is an extension of parietal peritoneum
Contents of inguinal canal
Analogous structures in male and female genitalia
Water under the bridge
The uterine vessels lie on top of the ureter. In hysterectomies, it’s easy to damage the ureter if you’re not careful.
Why are men so much more likely to get an indirect inguinal hernia?
Their inguinal canal is bigger to accomodate the spermatic cord, which is much larger than teh round ligament.
SEVENUP: Sperm passage
Seminiferous tubules
Epididymus
Vas deferens
Ejaculatory duct
Urethra
Penis
True pelvis vs false pelvis vs perineum
True pelvis: area under the peritoneum and above pelvic floor
False pelvis: abdominopelvic area; all abdominal things in the convines of the pelvis,. Ex) Sigmoid colon
Perineum is under the pelvic floor
Borders of perineum
Male urethra- posterior and anterior
Posterior urethra
- Membranous
- Prostatic
Anterior urethra
- Spongy urethra (bulbous + penile)
- Fossa navicularis
Pelvic fractures are associated with what type of urethra injury
Posterior injury –> bleed into pelvis
Straddle injuries are associated with what type of urethra injury - where is extravasation?
Straddle injuries are an anterior urethra injury where Buck’s fascia and the bulbospongiosus is ruptured.
Blood goes into superficial perineal space because dartos fascia is continuous with scarpas fascia
May damage bulbo-urethral glands, which is in the deep perineal space
Internal urethral sphincter
- Involuntary; visceral efferent
- Tonic contraction to hold in the urine
- Made of smooth muscle
External urethral sphincter
- Voluntary via pudendal nerve
- Skeletal muscle
- Located in the urogenital diaphragm
Internal iliac artery- branches
Borders of superficial and deep perineal pouch
Which fascia are continuous in the penis
Scarpa’s, Dartos, and Colles
(technically colles and dartos split at the scrotum though)
Which fascia overlies the deep dorsal vein of the penis? the dorsal arteries?
deep (buck’s) fascia
In peeing,
Parasympathetic =
Sympathetic =
Pudendal =
Parasympathetic = pee
sympathetic = don’t pee
pudendal = whatever, i’ll do what I want
Peeing process
- Visceral afferent on the bladder tells the brain that the bladder is stretched
- Parasympathetic gets activated
- Contract detrusor muscle
- Relax (?) Internal urethral sphincter
- Pudendal allows you to decide
Patient gets a straddle injury and is extravasting urine and blood from a torn bulbar urethra into the superficial perineal cleft. What fascia provide the boundaries for this space?
- Camper’s and Scarpa’s fascia
- Perineal membrane and external perineal fascia of Gallaudet
- Colles fascia nd external perineal fascia of Gallaudet
- Perineal membrane and superior fascia
- The urogenital diaphragm and apex of UG diaphragm
Colles fascia and external perineal fascia of Gallaudet.
Gallaudet = superficial perineal fascia = inferior fascia of UG diaphragm
A man has a hematoma in perineum spreading to his abdominal wall beneath the superficial fascia. Where should be initial extravasation be located?
Rupture of spongy urethra -> furine first invades between Buck’s and dartos layer
