Module 3: The pelvis and perineum Flashcards
(108 cards)
1
Q
What does the bony pelvis consist of?
A
Right and left hip bones, sacrum, coccyx
2
Q
What is hip bone composed of?
A
Ilium, ischium, pubis
3
Q
What is the pelvic cavity divided into?
A
- Greater (false) cavity
- Lesser (true) cavity
*separated by pelvic brim
4
Q
Greater cavity
A
Region above pelvic brim
5
Q
Lesser cavity
A
Below pelvic brim
Contains a pelvic inlet and pelvic outlet
6
Q
Pelvic floor
A
Wide thin muscular layer of tissue that forms the inferior border of abdominopelvic cavity
7
Q
Female pelvis
A
Wider and more shallow, with a lager inlet and outlet
8
Q
Subpubic angle of female pelvis
A
90-100 degrees
9
Q
Subpubic angle of male pelvis
A
70 degrees
10
Q
Joints of the pelvis
A
- Sacroiliac joint
- Pubic symphysis
11
Q
Symphysis pubis dysfunction
A
Instability of the pubic symphysis at the pelvic joint during pregnancy
Results in increase in symphyseal width and mobility
12
Q
Symptoms of symphysis pubis dysfunction
A
Difficulty walking, pain localized to pubic area , pain that worsens w weight bearing activities and pain in perineum region
13
Q
Features of pelvic floor
A
Levator ani
Coccygeus
Urogenital hiatus
Anal aperture
14
Q
The puborectal sling
A
Attaches to pubic bone and wraps posteriorly around rectum forming the anorectal flexure
15
Q
What forms the puborectal sling?
A
Fibres of the levator ani muscle group
16
Q
Pelvic organ prolapse
A
Protrusion of pelvic organs through vaginal wall resulting from weakened pelvic floor that causes a drop of pelvic viscera
17
Q
Who is pelvic organ prolapse more common in?
A
Females, after birth
18
Q
What are the structures that may prolapse in females?
A
Bladder, rectum, uterus, cervix, vagina
19
Q
What are the structures that may prolapse in males?
A
Rectum
20
Q
Symptoms of pelvic organ prolapse
A
Difficulty initiating urine flow, strain to defecate
21
Q
Two distinct pouches of the female pelvic peritoneum
A
- Vesicouterine pouch
- Rectouterine pouch
22
Q
Vesicouterine pouch
A
Anterior abdominal wall to upper surface of urinary bladder
Anterior surface of uterus
23
Q
Rectouterine pouch of Douglas
A
Anterior surface of rectum, btwn uterus and rectum
24
Q
Pouch of the male pelvic peritoneum
A
Rectovesical pouch
25
Rectovesical pouch
Superior surface of urinary bladder to anterior surface of rectum
26
Pathway of ureter
1. Abdominal wall: crosses over common iliac arteries
2. Pelvic cavity: enters urinary bladder posteriorly
3. Pelvic wall
- Males: ductus deferens cross ureter where ureters drain into bladder
- Females: each ureter crossed by uterine artery
27
Urinary tract infection
Bacterial infection in any part of urinary system
28
Why are females at a higher risk of UTI?
Shorter urethra- bacteria doesn't have to travel far to infect bladder
29
Most common sites of UTI
Urethra and bladder
30
Symptoms of UTI
Burning with urination, localized pain at bladder, centre of pelvis and around pubic bone
31
Sigmoid colon
Forms S-shaped loop in upper pelvic cavity, ends at S3, continuous w rectum
32
Rectum
Follows curvature of sacrum (sacral flexure) before turning posteriorly at anorectal flexure, ends at anal canal
33
Location of rectum in females
Posterior to uterus
34
Location of rectum in males
Posterior to bladder
35
Venous drainage of sigmoid colon and rectum
Inferior mesenteric vein
36
Pregnancy hemorrhoids
Occurs in third trimester when veins in lower rectum become large and swollen
37
Symptoms of pregnancy hemorrhoids
Painful and itchy swellings in lower rectum, near anus, constipation, blood in stool if blood vessels rupture
38
Vas deferens
Superior to epididymis
Meets with seminal vesicle to form ejaculatory duct
39
Location of prostate
Inferior to bladder
Anterior to seminal vesicle
40
Pathway of vas deferens
Through inguinal canal with spermatic cord
41
Epididymitis
Bacterial infection of epididymis
Affects testis, epididymis, vas deferens, bladder
42
Epididymitis in children who havent hit puberty
Infection may start in bladder or kidney before spreading through ejaculatory duct to vas deferens to reach epididymis
43
Symptoms of epididymitis
Localized pain of infected testicle, fever, unilateral swelling of testes
44
Prostate tumor
Present in males 50+, as it grows it presses on prostatic urethra and disrupts flow of urine
45
Symptoms of prostate tumor
Difficulty urinating, blood in urine/semen
46
Male reproductive vasculature
Testicular artery
Artery to vas deferens
Pampniform plexus
Cremaster artery
47
Where does the testicular artery branch off?
Abdominal aorta
48
Where does the artery to the vas deferens branch off?
Internal iliac artery
49
What is the pampniform plexus?
Network of veins that drains venous blood from testis into testicular vein
50
What does the cremaster artery supply?
Fascial coverings and muscle of spermatic cord
51
Testicular torsion
Testis rotate, twisting the spermatic cord that supplies and drains blood from testis
**age 12-18
52
Symptoms of testicular torsion
Sudden, severe pain, swelling, change in scrotum colour (redness/darkening) on affected side of scrotum, localized pain in inguinal region of abdomen
53
Location of vagina
Inferior to uterus
Anterior to rectum
Posterior to bladder
54
Ectopic pregnancy
Egg attaches somewhere outside of uterus such as in uterine tube
55
Symptoms of ectopic pregnancy
Usual pregnancy symptoms at first
Then as embryo grows theres pelvic pain on affected side, and sharp pain if fallopian tubes burst
56
Arterial supply of female reproductive system
Ovarian arteries
Uterine arteries
Vaginal branches of uterine and internal iliac arteries
57
Ovarian arteries
Lateral branches of abdominal aorta at L1, supply ovaries and distal uterine tubes
58
Uterine arteries
Branches of internal iliac arteries, anastomose w ovarian arteries, supply proximal uterine tubes
59
Venous drainage of female reproductive system
Right and left ovarian vein
Right and left uterine veins
60
Right and left ovarian vein
Right drains into IVC while left drains into left renal vein
61
Uterine veins
From a plexus that drains to internal iliac veins
62
Ovarian cysts
Fluid filled sac that develops on an ovary, may effect ovaries, mesosalphinx (pelvic peritoneum) and ovarian arteries
63
Symptoms of ovarian cysts
Unilateral pelvic pain (dull and heavy) localized to ovary w cyst, pain during intercourse
64
Perineum
Diamond shaped area bounded by pubis symphysis anteriorly, ischial tuberosities laterally and coccyx posteriorly
65
What is the perineum divided into?
Anal triangle posteriorly and urogenital triangle anteriorly
66
Perineal membrane
Separates the urogenital triangle into superficial and deep pouches
67
Pouches of the urogenital triangle
Superficial perineal pouch
Deep perineal pouch
68
Superficial perineal pouch
Contains muscle, skin, external genitalia
69
Deep perineal pouch
Contains urogenital diaphragm, external urethral sphincter and deep transverse perineal muscles
70
Perineal body
Fibromuscular mass at centre of perineum that provides attachment for muscles of perineum and strengthens pelvic floor
71
Ischiorectal fossa
Wedge-shaped space btwn ischium and anal canal, allows for expansion of anal canal during defecation
72
Pudendal canal
On lateral wall of each ischiorectal fossa, formed within obturator fascia, contains pudendal nerve and internal pudendal vessels
73
Ischiorectal abscesses
Infection of the anal canal that causes abscesses that perforate laterally through the external sphincter into the lower ischiorectal space
74
Symptoms of ischiorectal abscesses
Pain/discomfort when walking and sitting, painful defecation, painful, swollen and tender at site of abscesses
75
Muscles of the penis
1. Ischiocavernosus
2. Bulbospongiosus
76
Ischiocavernosus
Cover 2 cura of the penis at the root
77
Bulbospongiosus
Cover bulb of penis
78
Foreskin of penis
Thin, loose skin at back of glans
79
Frenulum of penis
Fold of skin attaching to foreskin on ventral surface of glans
80
Advantages of having cicumsised penis
Reduces risk of bacterial growth that can cause infection or inflammation of foreskin
81
Disadvantages of having circumsised penis
Surgical complications such as bleeding, infection; decreased sensitivity at glans due to a loss of nerve endings
82
Balantis
Inflammation of foreskin or head of penis due to infection or chronic skin conditions in uncircumsised men
83
Symptoms of balantis
Pain, red, swollen penis, sometimes painful urination
84
How is the clitoris attached to the perineal membrane
2 cura and 2 vestibular bulbs
85
Parts of the clitoris
1. Body
2. Glans
86
Body of clitoris
Formed by union of right and left crus
87
Glans of clitoris
Distal, formed by union of vestibular bulbs
88
Female external genitalia
Mons pubis
Prepuce
Frenulum
89
Mons pubis
Rounded mass of fatty tissue formed by union of labia majora
90
Prepuce
Anterior and superior to clitoris, formed by union of labia minora
91
Frenulum
Anterior and inferior to clitoris, fusion of labia minora forms one frenulum
92
Vulvitus
Inflammation of vulva (labia majora and minora)
93
Symptoms of vulvitis
Redness and swelling in vulva, itching and burning, some cases vulva turns white, cracks or develops fluid filled blisters that break open, ooze and crust over
94
The greater vestibular glands
Posterior to vestibular bulbs on each side of vaginal orfice
Produce mucus during sexual arousal, carried by ducts that open at vaginal orfice
95
What are the greater vestibular glands homologous to in males?
Bulbourethral glands
96
Muscles of the clitoris
Two ischiocavernosus muscles cover the cura
Two bulbospongiosus muscles cover the vestibular bulbs and greater vestibular glands
97
Vasculature of the pelvis and perineum
Umbilical artery
Inferior vesicle artery
Internal pudendal artery
98
Umbilical artery
Transport deoxygenated blood from fetus to placenta, after birth proximal branches become superior vesical artery that supplies upper part of bladder
99
Inferior vesicle artery
Supplies bladder, ureter, seminal vesicles, prostate and ductus deferens
100
How does the internal pudendal artery enter the perineum?
Exits through greater sciatic foramen and enters lesser sciatic foramen to perineum through pudendal canal
101
What does the internal pudendal artery supply?
Skin and muscles of anal triangle, urogenital triangle and associated erectile bodies
102
Priapism
Common side effect of drug use, leads to prolonged (>6hrs) painful erection of penis or clitoris unassociated with sexual arousal
103
Female priapsim
Impaired outflow of blood, swollen clit due to inadequate drainage
104
Male priapism
Uncontrolled inflow of blood from branches of internal pudendal artery leading to red and swollen glans and shaft of penis
105
Pudendal nerve
S2-S4
Main branch of sacral plexus to perineum
106
Where does the pudendal nerve travel?
Leaves through greater sciatic foramen, crossing the ischial spine and enters perineum through lesser sciatic foramen
107
Where does the perineal nerve travel?
Branch of pudendal nerve that runs from deep perineal pouch to the superficial pouch
108
What does the perineal nerve supply?
Sensory and motor innervation to urogenital region
