Gray's Review Pelvis and Perineum Flashcards
(128 cards)
1
Q
what results due to a failure of fusion of the labiosacral folds so that the external urethral orifice is between the unfused halves of the scrotum?
A
perineal hypospadias
2
Q
what forms the cloacal membrane?
A
from ectoderm of the cloaca and ectoderm of the procotodeum
3
Q
what does the cloacal membrane eventually form?
A
the anus
4
Q
where do the urogenital folds typically fuse? what does it form?
A
along the ventral side of the penis to form the spongy urethra
5
Q
what is the condition in which the urethra opens on the dorsal surface of the penis resulting from the genital tubercle developing more dorsally during development?
A
epispadias
6
Q
what is the urogenital membrane bounded by?
A
urogenital folds
7
Q
what does the urogenital membrane rupture to form?
A
urogenital orifice
8
Q
what happens when there is abnormal development of the urorectal septum (most anorectal anomalies…)?
A
result in non division of the cloaca into urogenital and anorectal parts
9
Q
what is specifically associated with a persistent cloaca?
A
common outlet of the intestinal, urinary and reproductive tracts
10
Q
when does ectopic testes occur?
A
when a portion of the gubernaculum passes to an abnormal position or fails to descend or fixed to the skin of the scrotum
11
Q
what does the genital tubercle form? what is it associated with?
A
primordial phallus
epispadias
12
Q
what do the seminiferous cords form?
A
primordia of the seminiferous tubules
13
Q
what is the condition where the urinary bladder mucosa is open to the outside in the fetus?
A
extrophy of the bladder
14
Q
what developmental failure leads to extrophy of the bladder?
A
failure of the primitive streak mesoderm to migrate around the cloacal membrane
15
Q
what does extrophy of the bladder occur in combination with?
A
epispadias
16
Q
what are responsible for the development of the testes?
A
androgens
17
Q
what is Klinefelter syndrome?
A
condition in which the male has 47 XXY chromosomes
18
Q
what is a persistent allantois associated with?
A
patent urachus and an allantoic cyst
19
Q
what is the ureteric bud (metannephric diverticulum)?
A
outgrowth from the mesonephric duct
20
Q
what does the ureteric bud form?
A
ureter, renal pelvis, and calyces and collecting tubules
21
Q
what does incomplete division of the ureteric bud result in?
A
divided kidney with a bifid ureter
22
Q
what does a complete division of the ureteric bud result in?
A
double kidney with a bifid ureter or separate ureters
23
Q
how does a double uterus form?
A
failure of fusion of the inferior parts of the paramesonephric ducts
24
Q
how does a bicornuate uterus form?
A
failure of fusion of the superior parts of the paramesonephric ducts
25
what causes agenesis of the vagina?
failure of the sinovaginal bulbs to form
26
what are involved in the development of the male urogenital structures?
mesonephric ducts
27
what can give rise to a urachal cyst? how does it present?
persistence of the epithelial linign fo the urachus
| swelling found in the midline in the umbilical region
28
what is an omphalocele?
persistence of the herniation ofhte abdominal contents into the umbilical cord
29
what does the pronephros form? When does it degenerate?
parts of the primordial urinary system
| in the first 4 weeks of development
30
when the ureters cross at the pelvic brim, what structures are they crossing anterior to?
bifurcation of the common iliac artery bilaterally
31
what would failure of the urogenital folds to fuse lead to?
agenesis of the external urethral folds
32
If an ectopic pregnancy ruptures, where is the blood likely to accumulate?
rectouterine pouch of Douglas
33
what is the most direct route to the rectouterine pouch of Douglas?
posterior vaginal fornix
34
what would a break or tear in the rectovaginal septum (fascia of Denonvilliers) result in?
the small intestine (in an enterocele) or rectum (in a rectocele) to herniate into the posterior vaginal wall, even to the point of protrusion through the vaginal introitus
35
what is an internal urethral orifice obstruction usually due to?
enlargement of the median (middle) lobe of the prostate gland
has glandular tissue = benign hypertrophy
36
what happens is the membraneous portion of the urethra is injured?
urine and blood can leak upward into the retropubic space of Retzius limited inferiorly by the urogenital diaphragm and the musce within - which are the one that are injured
37
where are the cell bodies located for pain sensation in the urinary bladder?
DRG of S2-S4
remember - pain fibers travel through pelvic splanchnic nerve plexus (parasympathetic)
38
which muscle is responsible for rectal incontinence?
pubococcygeous muscle - the medial portion = puborectalis
39
what makes up the levator ani?
pubococcygeous
| iliococcygeous
40
damage to what structure can contribute to urinary incontinence?
urogenital diaphragm
41
what nerve is constricted in "Calvin Klein" syndrome?
lateral femoral cutaneous n. - runs behind the inguinal ligament
42
what ligaments provide direct support to the uterus?
the cardinal ligament = Mackenrodt's ligament = transverse cervical ligament - composed of fibromuscular tissues that accompany the uterine vessels
43
where do ovarian lymph nodes first drain?
into the paraaortic nodes at the level fo the renal vessels
44
where is the node of Cloquet located?
in the femoral ring adjacent to external iliac vein and beneath the inguinal ligament
45
where does the node of Cloquet drain into?
common iliac nodes
46
what travels with the internal iliac nodes? Where do they receive lymph from?
uterine artery and vein
| recieve lymph from much of the uterus - not from ovaries
47
which sphincter is important for maintaining fecal incontinence?
external anal sphincter
48
what is the tendinous arch of fascia pelvis?
dense band of CT that joins the fascia of the levator any to the pubocervical fascia that covers the anterior wall of the vagina - incontinence!
49
what is the levator ani tendinous arch?
thicken portion of the obturator internus fascia - plays no role in incontinence!
50
what can happen if the rectovaginal septum is torn?
rectocele or enterocele prolapse
51
where does lymph from cutaneous portion of anal canal drain - below pectinate line?
inguinal nodes
52
where does lymph from most of the rectum and from the mucosal zone of anal canal - above the pectinate line - drain?
internal iliac nodes
lymph from some parts of rectum drain into sacral nodes as well.
53
why does hematocolpos commonly occur?
imperforate hymen
54
what artery must be kept in mind during a hysterectomy with division of the round ligament?
cremasteric a. provides small branch to round ligament of uterus = called Samson's a.
55
what are cystoceles or utrethroceles associated with defects in?
pubocervical fascia
56
what is uterine prolapse especially due to?
weakening of the cardinal ligament
57
where do ovarian vessels and nerves run?
infundibulopelvic ligament (suspensatory ligament of the ovary)
58
what are cluneal nerves?
cutaneous nerves to parts of buttocks
59
what does the broad ligament contain?
only the uterovaginal vessels and nerve plexus - not for ovary
60
where does the superficial perineal space or cleft lie?
between the ecternal perineal fascia of Fallaudet and the membraneous layer of Colle's fascia
61
where is the perineal membrane located and what does it form?
inferior fascia of the urogential diaphragm that forms the inferior boundary of the deep perineal compartment
62
what does the superior fascia of the urogential diaphragm bind?
inferior border of the anterior recess fo teh ischioanal fossa
63
where is there no space between?
urogenital diaphragm and apex of prostate gland
64
what is the innervation to the urinary bladder?
motor and sensory inneration from parasympathetic nerve fibers transmitted by the pelvic splanchnic nerves S2-S4
65
what nerve innervates the external urethral sphincter?
the perineal branch of pudendal n.
66
what is the main blood supply to the erectile tissue?
deep artery from itnernal pudendal a.
67
what is cancer found in inguinal nodes indicative of?
cancer of the uterus at the level of the round ligaments by which cancer passes to the inguinal region
68
where do the lymphatic vessels of the ovaries and the uterine tubes ascend to?
right and left lumbar (cavil/aortic) lymph nodes = first to receive cancerous cells from ovaries
69
what structure is used as a guide for a pudendal nerve block?
ischial spine
70
what nerve is responsible for pain associated with external hemorrhoids?
pudendal n.
71
how is the uterus stabilizes and anchored to the bladder?
pubovesical and vesicocervical fasciae on anterior surface
72
what structure can be torn during childbirth that allows the bladder to herniate into the anterior vaginal wall with prolapse possible through vaginal introits?
pubovesical and vesicocervical fasciae
73
what does the median umbilical ligament contain?
urachus
74
what is a embryologic remnant of the allantoid?
median umbilical ligament
75
what is vagininismus?
painful, psychosomatic gyno disorder
distension of the cavernous tissues and the bulbospongiosus and transverse perineal muscles - the sitmulation which triggers the involuntary spasms of the perivaginal and levator ani muscles = painful intercourse or dysparenunia
76
what does a hematoma of the peritoneum spreading to his abdominal wall beneath the superficial fascia an example of
?
extravasation of the blood and urine from the superficial perineal pouch
77
what causes extravasation of the blood and urine from the superficial perineal pouch?
rupture of the spongy urethra
78
Where will the fluid accumulate with extravasation of the blood and urine from the superficial perineal pouch
between Buck's fascia and dartos muscle layer
79
what are the two main ligaments that stabilize the uterus?
uretosacral ligaments and the transverse cervical (cardinal) ligaments
80
what do uretosacral ligaments and the transverse cervical (cardinal) ligaments do?
inhibit the uterus from prolapsing into the vagina
81
what is the round ligament and where is it found?
related to the descent of the ovaries in embryologic development and continues into the inguinal canal
82
What does the broad ligament cover?
uterine tubes, uterus, and vessels
83
what is the arcus tendineus fascia pelvis?
joins the fascia of the levator ani to the pubocervical fascia on the vagina
84
which lymph nodes would be involved in a pelvic lymphadectomy which often would be desired in surgical resection for prostate cancer?
internal iliac lymph nodes
| sacral nodes
85
what lymph nodes can communicate with lymphatics within the vertebral canal and metastasize cranially?
sacral lymphatics
86
which nodes would mostly likely be infiltrated by metastasis of testicular cancer and why?
paraaortic and lumbar nodes
because testicular lymphatics run in close association with the testicular vessels and drain the testicles and epididymis
87
what does the deep inguinal nodes recieve and drain?
more superficial vessels and drain the glans penis
88
what would rupture of the preprostatic urethra, prostatic urethra, or urinary bladder leads to fluid accumulation where?
within the pelvis because they are not located in the perineum
89
what carried the afferents of the cremastric reflex?
ilioinguinal n.
90
what carries the motor/efferent output of the cremasteric reflex?
genitofemoral n.
91
where do S2-S4 dermatomes provide sensation?
perineum and posterior thigh
92
what structure of the male produces fructose?
seminal vesicles = alkaline content = fructose + choline
93
what does the prostate gland secrete?
prostaglandins
citric acid
acid phosphatase
94
what do the testes produce?
spermatozoa
| sex hormones
95
what do the bulbourethral glands (Cowper's glands) produce?
mucous secretions that enter the penile bulb
96
where is site of implantation of placenta pre via?
internal cervical os
97
where is the normal site of implantation?
uterine fundus
98
what will implantation within the mesentaries of the abdomen result in?
abdominal pregnancy
99
What nerves contain pain fibers for internal hemorrohoids?
there is no pain because this area is innervated by visceral afferent fibers
100
What are the first lymph nodes to receive lymph from the cervix?
internal iliac nodes
101
what nerve would have to be anesthetized in order to drain an abcess in the anterior recess ofhte ischioanal fossa?
perineal nerve
102
what does the superficial perineal branch of the perineal nerve supple?
labia majora
103
what does the inferior rectal nerve innervate?
skin around anus
| external anal sphincter
104
if an abscess in the posterior recess of the ichioanal fossa (horseshoe anal abscess) which nerve would have to be anesthetized to drain it?
inferior rectal n.
105
after a repair of inguinal hernia, two days post op = hypovolemic shock. the vessel crossing the pectineal (Cooper's) ligament as it descends into the pelvis was injured by a staple = confirming "arterial circle of death" - what vessel is this?
abberrant obturator artery
106
where does the aberrant obturator a. arise from?
inferior epigastic a.
107
what nerve is typically injured in vasectomy procedure leading to postvasectomy pain syndrome?
visceral afferent T10-L2 - thats why it hurts the belly when guys are kicked in the nuts
108
which artery is the most likely source of blood from a hematoma following a tubal ligation?
ovarian a.
109
which pelvic distances will not move even if the women is given "relaxin"?
true conjugate diameter
110
which pelvic distance changes dramatically with childbirth due to relaxation of the joints?
interspinous distance
111
what nerve innervations the major adductors of the thigh and the skin of the medial aspect of the distal thigh?
obturator n.
112
what pelvic distance is most easily measured?
interspinous distance
113
where does lymph from testes drain?
lumbar nodes
114
where is a common site of rupture of the urethra?
bulb of the penis
115
what is "butterfly" ecchymosis associated with?
superficial pouch extravasation
rupture of buck's fascia
more common
116
what is ruptured in a penile fracture?
tunica albuginia
117
what happens with penile ecchymosis?
Buck's fascia is intact - penis swells with urine
118
what innervates the anterior scrotum?
ilioinguinal and genital branch of genitofemoral n.
119
what innervates the posterior scrotum?
scrotal branches of perineal n. from pudendal n.
| posterior cutaneous nerve of the thigh
120
what structures can be palpated in men?
prostate
seminal visicle
bulbourethral gland
rectovesical pouch
121
what structures can be palpated in a female?
posterior wall of vagina
cervix
rectourterine pouch of douglas
122
what is an "anal wink"
cutaneous reflex mediated by pudendal n. S2-4
123
if the puboprostatic l. is torn, what can happen?
can tear urethra - posterior urethral tear - urine will leak into perivesicle space
124
what should i assume if I see a high riding prostate?
significant damage in pelvis
125
what nerve should I be mindful of during vasectomy?
ilioinguinal n.
126
what ligament is continuous with perineum?
broad ligament
127
what level is epidural administers and what spinal levels are affected?
S2
| S1, S2, S3, S4, C1
128
where are spinal blocks inserted?
subarachnoid space
