Flashcards in Perineum Deck (56):
What muscle's fascia forms the Alcock's Canal/Pudendal Canal?
fascia of Obterator Interus**
What artery can be accidentally tied off during hernia surgery because it is near the Inferior Epigastric?
Abnormal Obturator A.
What is the anchoring point/ collection of tendons of the UG diaphragm called?
What forms the ejaculatory duct?
Seminal Vesicle + Vas Deferens
What neuromuscular bundle exits through the lesser sciatic foramen? What was this bundle's original course?
Pudendal N. + Internal Pudendal A. + Nerve to Obturator Internus exits through the Greater Sciatic Foramen, loops around SacroSPINOUS ligament, and comes back out through the LESSER SCIATIC FORAMEN
- tendon to OBTERATOR INTERNUS also leaves via LESSER SCIATIC FORAMEN
What is a site of possible infection/tumors in females?
Rectouterine Pouch (behind the uterus)
POUCH OF DOUGLAS*
What muscle covers the BULB? The crura?
What muscles are the components of the DEEP POUCH
1. Deep Transverse Perineal Muscle
2. Sphincter Urethrae Muscle
What two branches does the PUDENDAL N. spit into?
Inferior Rectal N.
Scarpa's fascia becomes _______ fascia in the Perineum
The uterus has 2 rotations
What is it called at the junction of uterus & vagina?
What is the bend between body of uterus & cervix proper?
What muscles form the pelvic diaphragm?
Levator Ani + Coccygeus (Iliococcygeus & Pubococcygeus)
How is the weakness in the anterior portion of the Pelvic diaphragm strengthened?
Where do the inferior Rectal N and Inferior Rectal A. originate from?
Internal Pudendal Artery
What is the order of layers of the UG diaphragm looking up through the legs?
1. Inferior Fascia
2. UG Muscle
3. Superficial Fascia
What is the Bulb of the penis covered with? (Is this present in the female?)
What travels through this?
Bulb covered with CORPUS SPONGIOSUM
- Urethra Travels through this
- no Corpus Spongiosum in female
Where are the bulbourethral glands/ GREAT VESTIBULAR Glands located in the female? Where are the Cowper's glands located in the male?
1. Superficial Pouch
2. DEEP pouch
What is another word for the inferior fascia?
What two muscles are found within the UG Diaphragm Proper (Deep pouch)?
1. Sphincter Urethrae
2.Deep Transverse Perineus Muscle
What is the path the Pudendal Nerve travels? What nerve roots contribute to the Pudendal N.?
(S2, 3 ,4)
- Leaves the inside of pelvis via GREATER SCIATIC FORAMEN
- hooks the Sacrospinous Ligament
- Re-enters the LESSER SCIATIC FORAMEN
-to access the PERINEUM
What is an ectopic pregnancy? Why does this occur?
Implantation in the uterine tube
- Ovulation occurs EXTRA-PERITONEALLY
What are the three subsets of the BROAD Ligament?
1. Mesovarium (mesentery of ovary)
2. Mesosalphinx (of uterine tube)
2. Mesometrium ( of endometrium)
What ligament suspends the ovary laterally to the pelvic wall? What is the blood supply to the ovary? Where does this artery come off of?
- Ovarian Artery (of the AORTA--> Gonadal)
What passes under the Uterine Artery?
-- must be careful off this during Hysterectomy
The inferior vesicle artery of the male is replaced by______ in the female. The uterine Artery is a branch of what?
(textbooks says Uterine A. & Vaginal A can be separate or together)
- Uterine A. is a branch of Anterior Division of Internal Iliac
During a Straddle Injury, trauma can cause blood to pool into what area?
- blood from damage to the spongy urethra (mainly a male thing) can flow up the potential space between:
1. the rectus sheath and
2. Scarpa’s fascia
Where do the ovaries point? What is the course of the ROUND Ligament?
ovaries --> point posteriorly
Round Ligament = inserted on labia major
The true pelvis is found above or below the Arcuate Line?
What are the boundaries of the PERINEUM? (4)
1. Pubic Symphysis
3. TWO Ischial Tuberosities ( on sides)
Who has a shorter urethra and thus a higher risk of bladder infections?
What forms the body of the clitoris?
Of the penis?
1. 2 Crus --> Corpus Cavernosum
2. 2 Corpus Cavernosum + 1 Corpus Spongiosum
Who has a split BULB? Male or females?
FEMALES --> form the vagina
What are the 2 superficial terminal branches of the Pudendal Nerve? What are the 3 deep branches?
1. Perineal N. (becomes Posterior Labial/Scrotul N.)
2. Inferior Rectal
1. Artery to the Bulb
2. Deep Artery to Penis/Clitoris
3. Dorsal Artery to Penis/Clitoris
What muscles are found within the superficial pouch? Which sex has the Greater Vestibular Glands in this pouch?
1. IschioCavernosum (covering CRUS)
2. Bulbospongiosum (covering the Bulb)
3. Superficial Tranvserse Perineus
+ Crura & Bulb = erectile tissue*
- superficial pouch = between Colles' Fascia & Inferior Fascia of UG
What are the layers of the Perineum from the deepest part to the most superficial?
MUST IMAGINE MRI view (through legs)
(at the bottom)
1. Colles Fascia
2. Superficial Pouch
3. Inferior Fascia
4. Deep Pouch
5. Superior* Fascia
- looking through legs --> SEE INFERIOR FASCIA FIRST*
What 3 nerves does the Pudendal Nerve split into after entering the Perineum?
2. inferior Rectal (deep)
3. Dorsal N. of Penis/Clitoris
Where is the superficial pouch?
Between the inferior fascia & Colles' Fascia
What penetrates the SUPERIOR Fascia?
Vagina & Uterus
What is the origin and support for Levator Ani Muscle?
- thickening across Obturator Internus Muscle
What artery enters the Cavernous Bodies of the Penis/Clit?
DEEP Artery of the Penis/Clitoris
What are the origin of the 3 rectal arteries?
1. Superior Rectal
2. middle Rectal
3. Inferior Rectal
1. Superior Rectal = IMA
2. Middle Rectal = ANTERIOR INTERNAL ILIAC
3. Inferior Rectal = Internal Pudendal A.
What muscles attach at the central tendon?
3. Superficial Transverse Perineal
What kind of injury leads to one splitting the urethra? Which pat of the urethra is usually injured? What is likely to occur ?
1. STRADDLE INJURY
- more likely in males (longer urethra)
SPONGY URETHRA can tear
--> blood will move internally through the area between COLLES' Fascia (Scarpa's) &
FROM SUPERFICIAL POUCh (continuous w/ Colles' Fascia & Rectus SHeath)
Arteries to GI structures branch _____. arteries to non go branch____
Parasympathetic innervation of the:
2. Pelvic Splanchnics
increase peristalsis, decrease sphincter
Sympathetic innervation of the:
1. Greater, lesser, least Splanchnics
2. Lumbar Splanchnics
If arteries off of the abdominal aorta are blocked, what are the compensatory anastomoses?
1. Superior Epigastric + Inferior Epigastric
2. Superior Pancreaticoduodenal + Inferior Epigastric
3. Middle Colic --> Left Colic
4. Superior Rectal + Middle/Inferior Rectal
What are the 3 sites of anastomoses of portal & systemic system?
1. Left Gastric & Esophageal
2. Superior Rectal + Inferior & Middle Rectal
3. Paraumbiilcal + Superficial & Inferior Epigastric
Above pectinate line ? Below Pectinate Line
1. Internal hemorrhoids
2. External Hemorrhoids
A landmark for the pudendal nerve block would be what part of the lateral wall of the pelvis?
Peroneal Everts & Dorsiflexes, if injured, FOOT DROP
Tibial Inverts & Plantarflexes, if injured, can't stand on TIP toes
Ear, Tonsils, Bottom to top
- Describe the Brachial Pouch Derivatives
3 Inferior Parathyroid (Bottom)
3 Thymus (to)
4 Superior Parathyroid (Top)
Describe the Brachia Arch Derivatives
1 = Mastication (5)
2 = Facial expression (7)
3 = Stylopharyngeus (9)
4 - Swallow (cricothyroid m.)
6 = speak (all the laryngeal muscles)
Where does the round ligament insert?
What is related to the gubernaculum of the testes?