Pelvis and perineum Flashcards
(106 cards)
1
Q
Bony landmarks creating the boundary of the perineum
A
- pubic symphysis
- ischial tuberosity
- coccyx
2
Q
triangles of the perineum?
what bony prominences separate them?
name of the fascia between the sides of the pubic arch, below the pubic symphysis
A
- urogenital and anal triangle
- ischial tuberosities
- perineal membrane
3
Q
Muscle of perineum action:
Superficial and deep transverse perineal muscles
A
support & fix perineal body (pelvic floor) to:
i. support abdominopelvic viscera
ii. resist increased intra-abdominal pressure
4
Q
external anal sphincter function
A
constricts anal canal during peristalsis, resisting defecation.
supports and fixes perineal body/pelvic floor
5
Q
external urethral sphincter function
A
compresses urethra to maintain urinary continence
6
Q
bulbospongiosus in male and female function
A
- compresses bulb of penis to expel last drops of urine/semen
- assists in clitoral erection & bulb of vestibule. compresses greater vestibular gland
7
Q
ischiocavernosus
A
maintains erection of penis or clitoris by compressing outflor veins and pushing blood from root of penis or clitoris into body
8
Q
perineal and anococcygeal body functions
- damage/rupture leads to..
A
muscle attachment areas in the perineum
- prolapse of pelvic viscera
9
Q
pelvic diaphragm
- fascia
- structures piercing
A
superficial and deep fascia make it up
urethra and rectum pierces diaphragm
10
Q
what are the parts of the male urethra?
A
spongy
prostatic
membranous/intermediate
11
Q
male uretha:
widest part?
narrowest?
A
widest= prostatic. urinary & reproductive tracts merge here. ejaculatory ducts open here
narrowest= membranous/intermediate. contraction of muscle surrounding controls urinary continence
12
Q
Penis muscles
A
2 (left and right) corpus carvenosa
1/single corpus spongiosum
13
Q
what is the terminal aspect of the penis called
A
glans penis, covered by the prepuce (foreskin)
- provides transit for the urethra via the external urethral meatus
14
Q
what is the corpus cavernosa covered by
A
tunica albuginea
extra= buck’s fascia is around everything
15
Q
action:
corpus spongiosum
corpus cavernosum
A
corpus spongiosum= urethra is transmitted
corpus cavernosum= contains majority of erectile tissue in the penis
16
Q
sensory innervation of penis?
A
dorsal nerve of penis, a branch of pudendal
17
Q
location of internal/vesical urethral sphincter?
innervation?
voluntary or involuntary?
A
inferior surface of bladder
involuntary
- sympathetic T11-L2
- parasympathetic S2-S4 pudendal
18
Q
location of external urethral sphincter?
i. in males
ii. in females
innervation?
voluntary or involuntary?
A
i. neck of urinary bladder/anterior prostatic urethra. forms annular sphincter
ii. skeletal muscle encircling membranous urethra, extends to ischial rami and urethra/vagina
voluntary
deep branch of pudendal S2-S4
19
Q
contents of the vulva
blood supply
innervation
A
- labia majora
- labia minora
- mons pubis
- clitoris
- vestibule & bulbs of vestibule (enlosed by LM)
- vestibular glands (Bartholin’s)
internal pudendal artery
pudendal nerve
20
Q
clitoris
A
- erectile corpora cavernosa tissue. genital tubercle origin embryologically
- 2 crura, meet in midline to form body. projects downwards to the prepuce and glans lying in the anterior labial commissure
21
Q
anal triangle
A
area between ischial tuberosities, sacrotuberous ligaments and coccyx.
contains anus
internal and external anal sphincters
- external sphincter has deep, superficial and subcutaneous parts
22
Q
ischio-anal (ischio-rectal) fossa
A
allow the anal canal to expand during defaecation
23
Q
What passes through the lesser sciatic foramen to enter the ischio-anal (Rectal) fossa?
A
- nerve to obturator internus
- pudendal nerve
- internal pudendal artery
24
Q
structures constituting the birth canal
A
uterus, cervix, vagina
25
layers of uterus
Perimetrium
Myometrium
Endometrium
26
as pregnancy advances, the uterus physiologically has an upper and lower segment:
what area of the uterine body does the lower segment develop from?
the area between the cervix and uterus
isthmus and lower half inch of corpus.
27
C section= what section is opened and what type of incision is used?
lower segment
transverse incision (Pfannenstiel)
28
pouches?
uterovesical pouch
pouch of douglas (rectouterine pouch)
29
ligaments
i. broad ligament
ii. round ligament of uterus
iii. ovarian ligament/ligament of ovary
iv. suspensory ligament of ovary
v. cardinal ligament of the uterus = transverse cervical ligament
uterosacral
inguinal
sacrotuberous
sacrospinous
30
position of uterus
anteverted and anteflexed
opposite is retroverted and retroflexed leading to prolapse of uterus into the vagina if ^ intra-abdo pressure
31
through which vaginal fornix can you enter the rectouterine pouch?
posterior
(anterior and lateral ones are the others). fornixes are created because the vagina surrounds the cervix creating two domes
32
cervix vs uterus
cervix is a fixed structure. uterus is supported, but has the ability to move (& ^ in size during pregnancy)
33
uterine tubes/fallopian tubes/oviduct divisions
infundibulum
ampulla= longest and widest. fertilisation occurs here
isthmus
intramural or uterine part
34
Blood supply to gonads and genetalia is from which branches?
branches of aorta= ovarian (gonadal) and internal iliac
35
ovarian arteries:
- what vertebral level do they originate from?
- where does it path within and how does it supply the ovaries?
- which vessel does it anastamose with?
- L2
- it passes within the suspensory ligament and supplies the ovaries via the broad ligament
- uterine artery
36
ovarian veins; where do they drain?
left= left renal vein
right= IVC
37
where does the uterine artery and ureter meet?
the uterine artery crosses OVER the ureter at the level of ischial sphine, junction of cervix and lateral part of fornix of vagina.
-- water under the bridge
38
ovary lymphatics?
para-aortic lymph nodes
39
fundus and upper uterine body lymph nodes?
pre-aortic lymph nodes
40
most part of uterine body lymph?
external iliac LN's
41
uterine cervix and upper vagina lymph?
internal iliac and sacral LN's
42
lower vagina
superficial inguinal
(sacral and common iliac LN's)
43
breast basic info
- highly modified exocrine glands
- in superficial fascia of pectoral region
-- deep surface has pectoralis major, minor and serratus anterior
- 15-25 lobes with tubulo-acinar glands (parenchyma) and stroma (connective tissue)
- extends vertically from 2nd-6th rib
- extends horizontally from lateral border of the sternum to the mid-axillary line
- axillary tail: breast cancer spread
44
breast blood supply:
branches of subclavian and axillary arteries
* lateral thoracic
* lateral mammary branches
* internal thoracic
thoracoacromial
45
breast lymphatic drainage
1. Axillary
- apical
- lateral
- central
- posterior
- pectoral
2. Parasternal
3. internal mammary/thoracic
Posterior intercostal
subclavian/supraclavicular
46
first group of lymph nodes draining lateral quadrant of breast tissue?
*** axillary?
47
microscopic anatomy
puberty, pregnancy, lactation
48
uterus histology
phases:
late proliferative
secretory
49
muscular layers of the uterus histologically
serosa (adventitia)
muscularis mucosa (outer longitudinal layer and inner circular)
mucosa
50
ovary microscope follicles (histological development)
primordial, primary, secondary, graffian
different stages of oogenesis
- corpus luteum, albicans
51
what does the placenta develop from?
identify foetal vs maternal side
the trophoblast following implantation of the blastocyst into the uterine endometrium
52
functions of the placenta
1. gaseous exchange
2. metabolic transfer
3. hormone secretion
4. fetal protection
53
what stage of labour does the placenta separate from the uterine wall?
3rd stage
54
umbilical cord histology; 2 arteries and 1 vein
W?
W= wharton's jelly
55
action of umbilical vessels?
arteries: carry deoxygenated blood from the fetal circulation to placenta
veins: carry oxygenated blood from placenta to fetus. persists as ligamentum teres in adults
56
male reproductive organs;
testis
ductus deferens
seminal glands
prostate
epididymis
bulbourethral glands
57
what do the testis pass through during development?
inguinal canal
deep and superficial= internal and external inguinal rings
58
layers of spermatic cord:
external spermatic fascia
cremasteric fascia
internal spermatic fascia
59
spermatic cord contents
vas deferens
cremaster muscle
lymph vessels- draining into para-aortic LN's in lumbar region
pampiniform plexus (testicular vein)
testicular artery, cremaster artery, artery to vas deferens
nerves- genital branch of genitofemoral nerve supplying cremaster muscle
60
tough outer fibrous layer of the testis?
tunica albuginea
61
tunica vaginalis
visceral and parietal with viscous fluid between
62
at what vertebral level do the testicular arteries arise from the aorta?
L2
63
how do the testicular arteries travel?
what structures do they cross?
retroperitoneal
i. genitofemoral nerve
ii. ureter
64
venous anastomosing drainage of the testes? function
where do the veins drain?
pampiniform plexus= temp regulation
right testicular vein= IVC
left= left renal vein
65
lymphatic drainage of the testis?
lumbar and para-aortic lymph nodes
66
lymphatics of prostate
internal iliac and sacral LN's
67
lymphatics of seminal vesicles
internal and external iliac LNs
68
lymphatics of scrotum
superficial inguinal LNs (medially)
69
lymphatics of penis
superficial inguinal
(internal iliac, lateral sacral and hypogastric)
70
epididymis role
stores sperm that is produced. attached to the body of the penis
71
vas deferens
muscular tube arising from tail of epididymis
- traverses the inguinal canal
- enters the pelvis by crossing over the external iliac vessels
- crosses over ureter before joining the duct of seminal gland to form the ejaculatory duct
72
seminal gland location and function
either side of the posterior surface of the bladder
produces a thick alkaline fluid that mixes with sperm as they pass into ejaculatory ducts and urethra.
73
prostate gland location and function
fused to the inferior neck of the bladder surrounding the prostatic urethra
prostatic fluid produced; thin and milky
- contains clotting enzymes that coagulate semen after ejaculation
74
prostate venous drainage
prostatic venous plexus. may lead to spread of bone cancer (metastases)
communicates with the internal vertebral venous plexus
- prostate is a vascular organ= risk of bleeding with operations here
75
bulbourethral glands location and function
cowper's glands
small, paired structures
* located in urogenital diaphragm
- empties into the penile/spongy urethra
- secretes clear, colourless mucus-like product prior to ejaculation
it neutralises the acid environment of urethra to protect sperm and adds lubrication
76
venous drainage of pelvis
interplay between portal and systemic circulations
clinical significance in some pathologies e.g. liver cirrhosis, pelvic cancers
venous plexuses e.g. prostatic
77
which part of the rectum drains into portal circulation
superior rectal vein
78
which part of the rectum drains into the systemic circulation
middle and inferior rectal veins
79
significance of rectal venous drainage?
1. pelvic congestion syndrome
2. site of portocaval anastomoses (anastomoses between portal and systemic veins located in anal canal wall)
80
haemorrhoids and liver cirrhosis relation?
liver disease= blood flow block to liver.. backup of drainage
- veins become dilated and cause haemorrhoids
81
somatic nerve supply to reproductive organs?
ilioinguinal
genitofemoral
pudendal
82
ilioinguinal nerve
L1
enters at superficial inguinal ring
supplies skin at root of the penis in male and labia in females
83
genitofemoral nerve
L1-L2
enters the deep inguinal ring
supplies scrotal skin and cremaster muscles in male (motor innervation)
*testicular torsion= cremasteric muscle spasm
84
pudendal nerve
S2-S4
arises from sacral plexus, following course of pudendal artery
innervate sin and muscles of perineum
* nerve block during labour; bony landmarks used= ischial spines
85
autonomic nerve supply
originates from pelvic plexus or inferior hypogastric
86
sympathetic fibres
T10-L2 via hypogastric nerve and terminal aspect of sympathetic trunk
hitchhike on arterial supply
all internal pelvic organs
87
parasympathetic fibres
pelvic splanchnic nerves S2-S4
all internal pelvic organs and erectile tissues in both males and females
88
external iliac LN's drain:
from inguinal LN's
superior parts of anterior pelvic organs
(distal vagina, vulva & gluteal region)
89
internal iliac LN's drain:
inferior pelvic organs, gluteal region and deep perineum
90
sacral LN's drain:
postero-inferior pelvic organs
91
common iliac LN's drain:
external, internal and sacral LN's
92
pelvic arteries blood distribution
to most of the pelvic organs, perineum and gluteal region except the testis, ovary and upper part of the rectum
93
internal iliac branches:
1. superior and inferior vesicle
- bladder, seminal gland and prostate in males
2. uterine artery
- round lig of uterus, uterus, uterine tube, vagina, pelvic part of ureter
3. middle and inferior rectal
- lower 1/3 of rectum, anal skin, musculature and skin of buttock
4. internal pudendal
- main artery to perineum
5. obturator
- pelvic muscles, nutrient artery to ilium and head of femur
94
abdominal aorta
gonadal (testicular or ovarian)
- testicles or ovaries
95
inferior mesenteric a.
superior retal artery
- upper 2/3 of rectum, sigmoid colon
96
uterine artery
vagina
- vagina and branches to inferior (fundus)of urinary bladder
97
which muscles make up the majority of the pelvic floor?
- other muscles
innervation?
function
coccygeus
levator ani (pubococcygeus, iliococcygeus, puborectalis)
- piriformis and obturator internus
pudendal nerve
98
perineal body and anococcygeal body
99
antero-inferior wall of pelvic cavity formed from?
bodies and rami of the pubic bones and the pubic symphysis
100
posterior wall of pelvis:
muscle?
nerve network?
piriformis
sacral plexus
101
male vs female
1. pelvic inlet
2. obturator foramen
3. acetabulum
1. male- heart shaped
female- oval/rounded
2. round
oval
3. large
small
102
narrowest diameter of pelvic inlet and outlet?
103
pelvic outlet boundaries
inferior margin of pubic symphysis
inferior rami of pubis
tip of coccyx
sacrotuberous ligament
104
what type of joint is the SI joint?
synovial anterior
syndesmosis posterior
105
what type of joint is the pubic symphysis?
secondary cartilaginous joint/symphysis
106
bony landmarks making up superior pelvic aperture (pelvic inlet/brim)
sacral promontory
ala of sacrum
pubic tubercle (outside)
pubic crest
arcuate line of ilium
pubic symphysis
