Cobine: Pelvic Floor Flashcards by Megan Foggia

What things form the pelvic floor?

the bowl-shaped pelvic diaphragm
the perineal membrane
the muscles of the deep perineal pouch

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The pelvic floor separates the pelvic cavity from the (blank)

perineum

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What is the origin and insertion of the coccygeus?

ischial spine and sacrospinous ligament to coccyx and inferior sacrum

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What is the function of the coccygeus?

supports pelvic viscera

pulls coccyx forward after defecation

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Three paired muscles of the levator ani

puborectalis
pubococcygeus
iliococcygeus

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The puborectalis is a U-shaped sling. Where does the puborectalis arise from?

the pubis (right and left pubic bodies)

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The pubococcygeus arises from the posterior aspect of the pubic body and (blank) and attaches at (blank).
Can be divided into several sections, e.g. pubovaginalis, puboprostaticus, puboanalis.

anterior tendinous arch; coccyx

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The iliococcygeus arises from the (blank) and the ischial spine. It forms a ligament between the anal aperature and (blank). It is often thin and poorly developed.

posterior tendinous arch; coccyx

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Importance of the levator ani

support
continence
vaginal sphincter
defacation/urination

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Innervation to levator ani: direct branches from the ventral ramus of (blank) and inferior rectal branches of the (blank) nerve

S4; pudendal

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Muscles that insert at the perineal body

bulbospongiosus
external anal sphincter
gluteus maximus
pubococcygeus
superior transverse perineal

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At what level does the common iliac split into the internal and external iliacs?

L5/S1

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The internal iliac splits into what?

anterior and posterior division

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The (blank) supplies the pelvic viscera, walls, floor, perineal structures, gluteal region, and thigh.

internal iliac

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List the branches of the anterior division of the internal iliac artery

inferior gluteal
internal pudendal
inferior vesical
middle rectal
obturator
umbilical
uterine
vaginal

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Branches of the posterior division of the internal iliac artery

iliolumbar
lateral sacral
superior gluteal

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First branch of the anterior trunk - gives rise to the superior vesical artery - carries blood from the fetus to the placenta, and after birth closes off to become a solid fibrous cord - the cord creates the medial umbilical fold and the fibrous remnant, the medial umbilical ligament

umbilical artery

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This artery supplies the superior bladder and distal ureter - it usually gives rise to the artery of the ductus deferens

superior vesical artery

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This is usually the second branch off the internal iliac artery - runs along the obturator fascia on the lateral wall of the pelvis - leaves the pelvis through the obturator canal - supplies the adductor region of the thigh

Obturator artery

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What is a common variation of the obturator artery?

Arises from the inferior epigastric artery and descends the normal path of the main branch

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Lower branch of the anterior division of the internal iliac. This artery is equivalent to the vaginal artery - supplies branches to the bladder, distal ureter, and seminal vesicles

inferior vesical artery

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This artery is synonymous with the inferior vesical artery - supplies branches to the vagina and adjacent regions of bladder and rectum - anastomoses with the vaginal branch of the uterine artery and superior vesical artery

vaginal artery

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This branch of the anterior division of the internal iliac artery supplies the inferior rectum where it anastomoses with the superior and inferior rectal arteries - also supplies the seminal glands and prostate or vagina

middle rectal artery

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The middle rectal artery may arise independently from the (blank) or in common with the inferior vesical artery or internal pudendal artery

internal iliac artery

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This branch of the anterior internal iliac artery may arise from the umbilical artery - it is homologous to the artery to the ductus deferens - found within the cardinal ligament

uterine artery

The uterine artery passes over the (blank)

ureter

The uterine artery divides into a branch which supplies the (blank) and a branch which supplies the (blank) of the uterus

vagina and cervix; body and fundus

What artery does the uterine artery anastomose with to supply the ovary and uterine tube?

ovarian artery

This artery is enlarged during pregnancy

uterine artery

This branch of the anterior internal iliac artery is the main artery of the perineum. It leaves the pelvis through the greater sciatic foramen, enters the ischioanal fossa via the lesser sciatic foramen

internal pudendal artery

What does the internal pudendal artery branch into as it exits the pudendal canal?

deep and dorsal branches of the clitoris or penis

This branch of the anterior internal iliac artery passes posteriorly between the sacral nerves - leaves the pelvis through the greater sciatic foramen - supplies the muscles and skin of the butt and posterior thigh

inferior gluteal artery

This is the largest branch of the internal iliac artery (posterior division) - terminal continuation of posterior division - courses posteriorly and between nerves of the lumbosacral trunk and S1 - leaves the pelvis through the greater sciatic foramen - supplies the muscles and skin of the gluteal region as well as supplying branches to adjacent muscles and bones of the pelvic wall

superior gluteal artery

This is a branch of the posterior division of the internal iliac artery - ascends laterally back out of the pelvic inlet - divides into two branches

iliolumbar artery

What two branches does the iliolumbar artery form?

iliac branch - passes laterally into the iliac fossa | lumbar branch - supplies the posterior abdominal wall, the psoas major and quadratus lumborum

Usually two of these arteries off of the posterior internal iliac artery - give off spinal branches which supply the sacral meninges enclosing the roots of the sacral nerves - supply the erector spinae muscles and skin covering the sacrum

lateral sacral arteries

Collateral pathways to the internal iliac artery

``` lumbar and iliolumbar median sacral and lateral sacral superior rectal and middle rectal inferior gluteal and deep artery of the thigh right internal and left internal iliac ```

Pelvic veins follow the course of all internal iliac artery branches except these three

umbilical artery iliolumbar artery some of the internal pudendal artery

Venous drainage from the pelvis is into the internal iliac veins which join the (blank)

common iliac veins

In the rectal plexus, where do superior rectal veins drain? Where do the middle and inferior rectal veins drain? Why is this significant?

hepatic portal system; caval system; important porta-caval shunt in incidences where the hepatic portal system is blocked

Inferior part of the rectal plexus around anal canal has two parts. What are they?

internal rectal plexus and external venous plexus

The (blank) vein that drains the erectile tissue of the penis and clitoris passes directly into the pelvic cavitiy. What plexuses does it join with?

deep dorsal; prostatic or vesical plexuses

On the left, the ovarian veins join the (blank); on the right, the ovarian veins join the (blank)

left renal vein; IVC

``` What lymph nodes do the following structures drain to? perineum (skin, penis, scrotum, vulva) uterus lower limb gluteal region anal canal (below pectinate line) vagina ```

superficial inguinal nodes

What lymph nodes do the following structures drain to? | perineum (clitoris and glans penis, distal spongy urethra)

deep inguinal nodes

What lymph nodes do the following structures drain to? | anterosuperior pelvic viscera

external iliac nodes

``` What lymph nodes do the following structures drain to? most pelvic viscera (inferior aspects) anal canal (above pectinate line) deep perineal structures inferior rectum prostate ```

internal iliac nodes

What lymph nodes do the following structures drain to? | gonads

lumbar nodes

The lymph nodes in the pelvic are highly interconnected. Why is this important?

these interconnections allow cancer to spread rapidly

The (blank) drains into numerous sites allowing rapid spread of prostate cancer to occur. The venous drainage allows its spread to occur to the (blank) which has potential connections to the CNS

prostate; vertebral venous

The pelvis is mostly innervated by the (blank) and (blank) spinal nerves and the (blank) autonomic nerves

sacral; coccygeal; pelvic

These two muscles form a bed for sacral and coccygeal nerves

piriformis | coccygeus

What nerve passes through the lesser pelvis passing through the obturator membrane and innervating the medial thigh?

obturator nerve (L2-L4)

What is it called where L4 joins L5 (above the pelvic brim) and then with the sacral plexus (just below the pelvic brim)?

lumbosacral trunk

These nerves arise from the sacral plexus and leave the pelvis via the greater sciatic foramen

sciatic (L4-S3) pudendal (S2-S4) superior gluteal (L4-S1) inferior gluteal (L5-S2)

main nerve of the perineum and the chief sensory nerve to the external genitalia Leaves the pelvis through the greater sciatic foramen Enters the perineum via the lesser sciatic foramen.

pudendal

Terminal branches of the pudendal: innervates the external (blank), external (blank), sensory to external (blank) and (blank) surrounding anus and perineum

urethral sphincter; anal sphincter; genitalia; skin

Lies on the pelvic surface of the coccygeus Innervates coccygeus and part of the levator ani Anococcygeal nerves arise from this plexus

coccygeal plexus

Autonomic nerves enter the pelvic cavity via four main routes. What are they?

1. sacral sympathetic trunks 2. periarterial plexuses 3. hypogastric plexuses (superior/inferior) 4. pelvic splanchnic nerves

Continuation of the lumbar sympathetic trunks, provides sympathetic innervation to the lower limbs - send communicating rami to each anterior ramus of the sacral and coccygeal nerves - send small branches to the inferior hypogastric plexus - only 10% of symp contribution to pelvis

sacral sympathetic trunks

Main function of the sacral sympathetic trunks?

provide postsynaptic fibers to the sacral plexus for symp innervation of the lower limb

This plexus provides postsynaptic, sympathetic, vasomotor fibers to the superior rectal, ovarian, internal iliac arteries, and their derivative branches - minor routes by which sympathetic fibers enter the pelvis

periarterial plexuses

Main function of the periarterial plexuses?

vasomotion of the arteries they accompany

Most important route by which sympathetic fibers are conveyed to pelvic viscera

hypogastric plexuses

This plexus is a continuation of aortic plexus, also branches from L3,4 lumbar splanchnics - becomes right and left hypogastric nerves after entering the pelvis - descend lateral to the rectum - converge with the pelvic splanchnics to form the left and right inferior inferior hypogastric plexuses

superior hypogastric plexus

What plexus is made up of the right and left hypogastric nerves joining with the pelvic splanchnics?

inferior hypogastric plexus

The inferior hypogastric plexus forms sub-plexuses like the vesical and prostatic which travel with appropriate branches of the internal iliac artery to target organ - terminal branches penetrate the deep perineal pouch to innervate (blank)

erectile tissues

Originate from the anterior rami of S2-S4 - convey presynaptic parasympathetic fibers - join hypogastric nerves to form the inferior hypogastric plexus - help supply superior hypogastric plexus

pelvic splanchnics

Pelvic splanchnics provide parasympathetic innervation to the pelvic (blank) and (blank) colon

viscera; descending/sigmoid

Visceral afferent fibers travel with (blank) nerves - most characteristically follow the course of (blank) fibers (can also follow parasympathetic)

autonomic; sympathetic

Course of pain fibers in the pelvic depends upon whether the pain is arising from above or below the (blank)

pelvic pain line

What does the pelvic pain line refer to?

organs being above or below the peritoneum

SUPERIOR to the pain line, visceral afferent fibers conduct pain by following (blank) fibers to reach cell bodies in the inferior thoracic/upper lumbar spinal ganglia

sympathetic

INFERIOR to the pain line, visceral afferent fibers conduct pain by following (blank) fibers to reach cell bodies in the spinal sensory ganglia of S2-S4

parasympathetic

What is the exception to the pelvic pain line?

large intestine-- the pelvic pain line is located in the middle of the sigmoid colon

Is erection a parasympathetic or sympathetic response?

parasympathetic

Is emission a parasympathetic or sympathetic response?

sympathetic

What kind of response is ejaculation?

somatomotor, sympathetic

What kind of response is remission?

sympathetic

Dilation and straightening of helicine arteries, engorgement of corpus cavernosum Contraction of bulbospongiosus and ischiocavernosus muscles, traps blood

erection

Sperm and other secretions released in prostatic urethra, contraction of ductus deferens, seminal glands and prostate Contraction of internal urethral sphincter

emission

Contraction of bulbospongiosus, levator ani, EAS, gluteal muscles (somatomotor) Propulsion of semen along the penile urethra (sympathetic)

ejaculation

Vasoconstriction and recoil of helicine arteries, flaccid Relaxation of bulbospongiosus and ischiocavernosus muscles, drainage of blood into deep dorsal vein Refractory period

remission

4 steps of male sexual response

erection - emission - ejaculation - remission

4 steps of female sexual response

arousal - plateau - orgasm - resolution

Parasympathetic (Pelvic splanchnic nerves, S2-S4) Increased vestibular and vaginal secretions Erection of clitoris (similar mechanism to erection of the penis)

arousal

(lasts minutes to hours) – Sympathetic (L1-L2 nerves) Vascular engorgement (clitoris, labia, breasts, lower vagina) Erection of nipples Sex flush (reddening of chest) Dilation of upper vagina Tenting of the uterus (lengthening of vagina)

plateau

Somatomotor (S2-S4), Sympathetic Contraction of bulbospongiosus, ischiocavernous (~1 second intervals, variable) Dilation of cervix Uterine contractions (oxytocin) Dipping of the uterus (shortening of vagina)

orgasm

Sympathetic Return of pre-arousal stage Relaxation of bulbospongiosus and ischiocavernosus muscles, drainage of blood into deep dorsal vein No refractory period

resolution

What provides collateral flow from the posterior abdominal and pelvic wall to the spinal cord?

lumbar and iliolumbar arteries

What provides collateral flow from the back to the spinal cord?

median sacral and lateral sacral

What provides collateral flow to the rectum?

superior rectal and middle rectal (also between inferior rectal)

What provides collateral flow to the gluteal muscles and hip joint?

inferior gluteal and the deep artery of the thigh

What provides collateral flow to the impotence and claudication of the buttocks and thighs?

right and left internal iliac

Do males have a vesical venous plexus?

In general, the perineum will drain to the (blank) nodes, and the pelvic viscera will drain into (blank) nodes

inguinal; iliac

Is pain above or below the pelvic pain line less likely to be felt consciously?

Below

Where is the pelvic pain line located?

In the sigmoid colon

Cobine: Pelvic Floor Flashcards

(98 cards)