21: pelvis and perineum

Question 1

Where would the urethra be torn in order to have fluid accumulation in lower abdomen and around penis and scrotum?

Answer 1

The urethra would have been torn as it passed the perineum membrane.

Question 2

What fascial continuities allowed urine to accumulate in the spaces of the lower abdomen and penis and scrotum?

Answer 2

Scarpas fascia (anterior abdominal wall) Membranous layer of superficial penis fascia Dartos fascia (scrotum) Colle’s fascia (perineum)

Question 3

Why does urine not go into thigh?

Answer 3

Colle’s fascia (membranous superficial fascia of perineum) attaches to ischiopubic rami and to the perineal membrane

Question 4

Why does urine not go into the anal triangle?

Answer 4

Scarpa’s fascia attaches to fascia lata of the thigh

Question 5

What neurovascualr structures could be damaged by an abscess in the iscioanal fossa?

Answer 5

pudendal nerve and internal pudendal vessels; inferior rectal nerves and vessels

Question 6

two anatomical landmarks for local pudendal nerve block?

Answer 6

ischial spine ischial tuberosity

Question 7

how does a perineal abscess start?

Answer 7

infection within anal sinus

Question 8

What are the major features of the anal canal?

Answer 8

anal column pectinate line anal valves anal sinus

Question 9

Epithelium above pectinate line

Answer 9

simple columnar

Question 10

Epithelium below pectinate line

Answer 10

Stratified squamous

Question 11

Innervation above pectinate line

Answer 11

VA

Question 12

Innervation below pectinate line

Answer 12

SA

Question 13

Why are external hemorrhoids more painful?

Answer 13

They occur below pectinate line, meaning they have SA innervation.

Question 14

Lymphatic drainage above pectinate line

Answer 14

to iliac nodes

Question 15

Lymphatic drainage below pectinate line

Answer 15

Inguinal nodes

Question 16

List the structures that are normally palpable upon male rectal exam

Answer 16

distended bladder

prostate

sacrum

coccyx

Question 17

List the structures that are normally palpable upon female rectal exam

Answer 17

distended bladder

cervix

sacrum

coccyx

Question 18

What is the relationship between the ureter and the common iliac artery (female)?

Answer 18

The Ureter courses above the common iliac artery

Question 19

Whats the relationship of the ureter with the common iliac artery (male)

Answer 19

ureter courses over common iliac artery; also courses over the internal iliac artery

Question 20

Begnign prostatic hyperplasia

Answer 20

The begnin enlargement of the prostate

Compresses bladder causing:

1. difficulty starting stream (compresses urethra)
2. frequent urination (reduced bladder volume, incomplete emptying)

Question 21

What is 1 labeling?

Answer 21

levator ani

Question 22

What is 2 labeling?

Answer 22

Obturator internus

Question 23

Hematuria

Answer 23

blood in urine

Question 24

Symptoms of bladder cancer

Answer 24

• Blood in urine (hematuria)
• can obstruct ureteral bladder orifice
  
  • urethral obstruction
    
    • increased urination due to incomplete bladder emptying
    • difficulty in starting stream

Question 25

#1

Answer 25

Anal column

Question 26

#2

Answer 26

pectinate line

Question 27

#3

Answer 27

anal valves

Question 28

#4

Answer 28

anal sinus

Question 29

what innervates the posterior aspect of labia or scrotum?

Answer 29

pudendal nerve

Question 30

what innervates the anteiror aspect of labia or scrotum

Answer 30

ilioinguinal nerve

Question 31

Does the ureter pass in front of or behind the ovary?

Answer 31

BEHIND

Question 32

What is important about the path that the pudendal nerve and vessels take?

Answer 32

It allows them to pass around the posteiror margin of the pelvic diaphragm without penetrating (and therefore weakening) it