Perineum

Question 1

what is the perineum

Answer 1

the region that lies below the levator ani (pelvis diaphragm) and medial to the sacrotuberous ligament

Question 2

the levator ani forms the ___ of the pelvis and the ___ of the perineum

Answer 2

floor of the pelvis and the roof of the perineum

Question 3

blood supply and innervation of the perineum

Answer 3

• internal pudendal artery

- pudendal nerve

Question 4

the internal pudendal a. and pudendal n. leave the pelvis via what structure to briefly enter the gluteal region?

Answer 4

greater sciatic foramen

Question 5

the internal pudendal a. and pudendal n. pass through the ______ to the enter the perineum

Answer 5

lesser sciatic formen

Question 6

once the internal pudendal artery and pudendal n. pass through the lesser sciatic foramen, they lie on the ___ wall of the perineum and are covered by ___ ___ forming the ___ ___

Answer 6

lateral; deep fascia forming the pudendal canal

Question 7

greater sciatic foramen location

Answer 7

• in front of hip bone
• behind sacrotuberous ligament
• above sacrospinous ligament

Question 8

lesser sciatic foramen location

Answer 8

• in front of hip bone
• behind sacrotuberous ligament
• below sacrospinous ligament

Question 9

the anatomical perineum is roughly what shape

Answer 9

diamond

Question 10

boundaries of the perineum

Answer 10

• pubic symphysis
• left and right ischiopubic ramus
• sacrotuberous ligament
• left and right ischial tuberosities
• the coccyx

Question 11

an imaginary line passing between the ischial tuberosities divides diamond shaped perineum into two triangular regions called

Answer 11

• the urogenital triangle anteriorly

- anal triangle posteriorly

Question 12

due to the anterior tilt of the pelvis, the urogenital triangle is ____ to the floor while the anal triangle is ___ in orientation

Answer 12

horizontal; vertical

Question 13

2 regions of the urogenital triangle

Answer 13

1. UG diaphragm (deep pouch)

2. superficial pouch

Question 14

what is the UG diaphragm

Answer 14

a diaphragm structure comprised of muscle, connective tissue, and neurovascular branches of the pudendal n.

Question 15

what is the inferior boundary of the deep pouch (UG diaphragm)

Answer 15

perineal membrane; external genitalia hang off here

Question 16

the superficial is located where

Answer 16

below the deep pouch

Question 17

in the male, the UG diaphragm fills the deficit of the levator ani muscle ____ but does not extend ___

Answer 17

anteriorly but does not extend posteriorly

Question 18

in the male what structure is related to the top of the UG diaphragm

Answer 18

prostate

Question 19

all structures below the perineal membrane are in the ____ pouch of the urogenital triangle (external genitalia and vulva)

Answer 19

superficial

Question 20

the anal canal is or is not in the superficial pouch

Answer 20

IS NOT as it is located in the anal triangle of the perineum

Question 21

what structure is associated with the tip of the UG diaphragm in the female

Answer 21

bladder

Question 22

contents of the UG diaphragm in males

Answer 22

• deep transverse perineal m.
• membranous urethra
• external urethral sphincter m.
• bulbourethral glands (males only)
• branches of pudendal n/a/v

Question 23

contents of the UG diaphragm in females

Answer 23

• deep transverse perineal m.
• membranous urethra
• external urethral sphincter m.
• compressor urethra (females only)
• branches of pudendal n/a/v

Question 24

muscles of the UG diaphragm are innervated by what nerve

Answer 24

pudendal nerve

Question 25

the region inferior to the perineal membrane is the ____ ____ ____

Answer 25

superficial perineal membrane

Question 26

structures of the superficial pouch

Answer 26

- crura of penis and crura of clitoris - bulb of the penis (males)/vestibular bulbs (females) - ischiocavernosus muscle - bulbospongiosus muscle - vestibular gland (female) muscles - superficial transverse perineal muscle

Question 27

what is the perineal body

Answer 27

a mass of connective tissue located at the midpoint of the line connecting the ischial tuberosities

Question 28

the perineal body serves as the attachement point for muscles of the pelvis and the perineum, those muscles are:

Answer 28

- the levator ani - deep perineal m. - superficial perineal m. - bulbospongiosus mm. - external anal sphincter

Question 29

tears of the perineal body may lead to what

Answer 29

may compromise structural integrity of the pelvis and perineum and lead to prolapse of organs and urinary incontinence

Question 30

the superficial fascia of the perineum and abdomen are ____ with each other but are given regional names

Answer 30

continuous

Question 31

what is the camper's fascia

Answer 31

superficial fatty layer under skin

Question 32

scarpa's fascia

Answer 32

superficial fascia located in the abdominal (infraumbilical region)

Question 33

dartos fascia

Answer 33

located in the region of the scrotum and the penis (superficial fatty fascia is gone here)

Question 34

colles fascia

Answer 34

located in the region of the urogenital triangle (superficial fatty fascia is gone here)

Question 35

in general, there is a ____ ____ between the superficial fascia and the deep investing fascia of muscles and structures

Answer 35

facial plane

Question 36

in certain places, the superficial fascia fuses with the ___ ___ ___

Answer 36

deep investing fascia

Question 37

scarpa's fascia will fuse to the investing fascia of the ___ ___

Answer 37

lower limb (fascia lata)

Question 38

the lateral and posterior edges of colles fascia will fuse to the ___ ___

Answer 38

perineal membrane

Question 39

the fusing of the fascia has clinical implications why?

Answer 39

it prevents fluid from spreading between the regions

Question 40

when can you have perforation of the spongy urethra?

Answer 40

during straddle injury

Question 41

what is the region located posterior to the imaginary line between the ischial tuberosities

Answer 41

anal triangle

Question 42

what divides the anal triangle into two fat filled spaces

Answer 42

anal canal

Question 43

the fat filled spaces formed by the anal canal are called what

Answer 43

ischioanal fossae

Question 44

borders of the ischioanal fossa

Answer 44

1. superior- sloping of the levator ani (pelvic diaphragm) 2. medial- sloping of the levator ani (pelvic diaphragm) 3. lateral- obturator internus m. 4. inferior/posterior- skin around the anus

Question 45

what forms the pudendal canal

Answer 45

the obturator fascia

Question 46

what does the pudendal canal contain

Answer 46

internal pudendal artery, vein, and pudendal n.

Question 47

what arteries and nerves supply the anal canal

Answer 47

inferior rectal arteries and nerves as they emerge from the pudendal canal

Question 48

where does the rectum end

Answer 48

at the floor of the pelvic cavity where the puborectalis m. encircles it

Question 49

what is the continuation of the rectum

Answer 49

the anal canal that extends inferoposteriorly to terminate at the anus

Question 50

the wall of the anal canal is composed of what

Answer 50

external and internal anal sphincters

Question 51

what is the internal anal sphincter

Answer 51

thickened continuation of the inner circular layer of smooth muscle from the rectum

Question 52

what is the external anal sphincter

Answer 52

composed of skeletal (voluntary) muscle

Question 53

superficial portion of the external anal sphincter is attached anteriorly to what and posteriorly to what

Answer 53

attached anteriorly to the perineal body and posteriorly to the coccyx

Question 54

what attaches the superficial portion of the external anal sphincter to the perineal body and coccyx

Answer 54

anococcygeal raphe

Question 55

the lining of the anal canal exhibits vertical folds of mucous membrane called

Answer 55

anal columns

Question 56

the recesses between the anal columns are called what

Answer 56

anal sinuses

Question 57

the anal columns are joined at their inferior ends by horizontal folds called

Answer 57

anal valves

Question 58

the anal-valves have a __ __ morphology

Answer 58

cup-like

Question 59

the spaces behind the anal valves are called the

Answer 59

anal crypts

Question 60

what is the clinical importance of the anal crypts

Answer 60

they can serve as a point for infection that may lead to fistula into the ischioanal fossa

Question 61

the lower margins of the anal valves form the tooth-like ___ ___

Answer 61

pectinate line (dentate line)

Question 62

what happens below the pectinate line

Answer 62

important changes including changes in the epithelial lining, arterial supply, venous drainage, and lymphatic drainage

Question 63

arterial supply above the pectinate line

Answer 63

superior rectal a. and middle rectal a.

Question 64

arterial supply below the pectinate line

Answer 64

inferior rectal aa.

Question 65

venous drainage above the pectinate line

Answer 65

hepatic portal system and caval system

Question 66

venous drainage below the pectinate line

Answer 66

caval system via inferior rectal vv.

Question 67

lymphatic drainage above the pectinate line

Answer 67

internal iliac lymph nodes (deep)

Question 68

lymphatic drainage below the pectinate line

Answer 68

inguinal lymph nodes (superficial)

Question 69

innervation above the pectinate line

Answer 69

autonomic fibers (poor localization)

Question 70

innervation below the pectinate line

Answer 70

pudendal nerve (precise location)

Question 71

describe the relationship between the anterior recess of the ischioanal fossa and the ischioanal fossa

Answer 71

the anterior recess is continuous with the fossa as it passes anterior to the ischial tuberosities

Question 72

the boundaries of the anterior recess of the ischioanal fossa are similar to that of the ischioanal fossa, but what is different?

Answer 72

the inferior wall is the UG diaphragm