PERINEUM and PELVIS Flashcards
(194 cards)
1
Q
Diamond shaped space that has the same boundaries as the inferior aperture of the pelvis.
A
Perineum
2
Q
Perineum
A
- Anterior: Pubic symphysis
- Anterolaterally: Ischiopubic rami
- Lateral: Ischial tuberosity
- posterolateral: sacrotuberous ligaments
- posterior: tip of the coccyx
3
Q
The perineum is divided into _________
A
Anterior urogenital triangle
Posterior anal traingle
4
Q
Lies between the inferior fascias of the urogenital diaphragm (perineal membrane) and the membranous layer of the superficial perineal fascia (Colle’s fascia)
A
Superficial Perineal Space (Pouch)
- Contains
- superficial transverse perineal muscle
- ischiocavernosus muscles
- crus of the penis or clitoris
- bulbospongiosus
- bulb of the penis or the vestibular bulbs
- central tendom of the perineum
- greater vestibular glands
- branches of the internal pudendal vessels
- perineal nerve
5
Q
Deep membranous layer of the superficial perineal fascia and forms the inferior boundary of the superficial perineal pouch
A
Colle’s fascia
- continuous with
- the dartos tunic of the scrotum
- superficial fascia of the penis
- Scarpa’s fascia of the anterior abdominal wall
6
Q
The inferior fascia of the urogenital diaphragm that forms th inferior boundary of the deep perineal pouch of the superior boundary of the superficial pouch
A
Perineal membrane
- between the urogenital diaphragm and the external genitalia
7
Q
Ischiocavernosus muscle
A
- Arise from the inner surface of the ischial tuberosities and the ischipubic rami
- Inserts into the Corpus cavernosum
- Innervated
- perineal branch of the pudendal nerve
- Maintains erection
8
Q
Bulbospongiosus muscles
A
- Arise from the perineal body and fibrous raphe of the bulb of the penis in the male and the perineal body in the female
- Inserts into the corpus spongiosum and the perineal membrane in the male and the pubic arch and dorsum of the clitoris in the female
- Innervated by
- Perineal branch of the pudendal nerve
- Compress the bulb, maintaning erection
- Compress the erectile tissue of the vestibular bulbs, constrict the vaginal orifice
9
Q
Superficial Transverse Perineal Muscle
A
- Arises from the ischial rami and tuberosities
- Inserts into the central tendon (Perineal body)
- Innervated by
- Perineal branch of the pudendal nerve
- Stabilzies the central tendon
10
Q
Fibromuscular mass located in the center of the perineum between the anal canal and the vagina
A
Perineal body (Central tendon of the Perineum)
11
Q
Serves as a sitr of attachment for the superficial and deep transverse perineal, bulbospongiosus levator ani, and external anal sphincter muscles
A
Perineal body (Central tendon of the Perineum)
12
Q
Homologous to the bulbourethral glands
Compressed during coitus and secrete mucus that lubricates the vagina
Ducts open into the vestibule between the labium minora below the hymen
A
Greater vestibular (Bartholin’s) GLands
13
Q
Deep perineal Space (pouch)
A
- Lies between the superior and inferior fasciae of the urogenital diaphragm
- Contains
- Deep transverse Perineal muscle
- sphincter Urethrae
- Urogeenital Diaphragm
- Bulbourethra (Cowper’s glands)
14
Q
Deep transverse perineal muscle
A
- Arise drom the inner surface of the ischial rami
- Inserts into the medial tendinous raphe and the perineal body; it also inserts into the wall of the vagina
- Innervated by the
- perineal branches of the pudendal nerve
- Supports the prostate gland or the vagina
15
Q
Spinchter Urethrae
A
- Arises from the inferior pubic ramus
- Inserts into the median raphe and perineal body
- innervated by:
- Perineal branch of the pudendal nerve
- Encricels and cosntricts the membranous urethra
- Inferior part that is attached to the anterolateral wall of the vagina in the female, forming a urethrovaginal sphincter that compresses both the urethra and vagina
16
Q
Urogenital Diaphragm
A
- Constists of the deep transverse perineal muscle and the Shincter urethrae and is invested by superior and inferior fasciae
- Has inferior fascia
- Provides attachment to the bulb of the penis
- Pierced by the membranous urethra in the male and by urethra and the vagina in the female
17
Q
Bulbourethral (cowper’s) Glands
A
Lie among the fibers of the sphincter urethrae in the deep perineal pouch in the male, on the posterolateral sides of the membranous urethra.
Ducts pass through the inferior fascia of the urogenital diaphragm to open into the bulbous portion of the spongy (penile) urethra
18
Q
Is the potential space on either side of the anorectum and is separated from the pelvis is by the levator ani and its fasciae
A
Ischiorectal fossa
19
Q
The ischiorectal (Ischioanal) fossa contains
A
-
Ischioanal fat
- allows distention
-
inferior rectal nerves and vessels
- branches of the internal pudendal vessels and the pudendal nerve
- perineal branches of the posterior femoral cutaneous nerve
-
pudendal (Alcoks’s) canal
- Fascia;l canal formed by a split in the obturator internus fascia and transmits the pudedal nerve and internal pudendal vessels
20
Q
Boundaries of the ischiorectal (Ischianal) Fossa
A
-
Anterior
- Sphincter urethrae and the deep transverse perineal muscles
-
Posterior
- The gluteus maximus muscle and the sacrotuberous ligament
-
Superomedial
- The sphicter ani externus and levator ani muscles
-
Lateral
- The obturator fascia covering the obturator internus muscle
-
Floor
- Skin over the anal triangle
21
Q
Obturator Internus
A
- Arises from the inner surface of the obturator membrane
- Has a tendon that passes around the lesser sciatic notch into the medial surface of the greater trochanter of the femur
- Innervated
- nerve to the obturator
- Laterally rotates the thigh
22
Q
Sphincter Ani Externus
A
- Arises from the tip of thecoccyx and the anococcygeal ligament, inserts, inserts into the central tendon of the perineum
- innervated by the
- inferior rectal nerve
- Closes the anus
23
Q
The Sphincter Ani Externus is composed of 3 parts
A
- Subcutaneous
- superficial (main part)
- atatched to the coccyx and central tendin
- Deep
24
Q
thin stratum of smooth muscle fiber radiating from the superficial part of the sphincter to the deep aspect of the perianal skin, causing puckering of that skin, which contributes to the air/water tight seal of the anal canal
A
Corrugator cutis ani
25
Levator Ani Muscle
* Arises from the body of the pubis, the arcus tendineus of the levator ani (thickened part of the obturator fascia), and the ischial spine
* Inserts into the coccyx and the anococcygeal raphe or ligament
* Innervated by
* Branches of fourth and fifth sacral nerves
* Supports and raises the pelvic floor
26
Arises from the linea alba and the membranous layer of the superficial fascia of the abdomen
Splits into left and right parts, encircles the body of the penis and blends with the superficial penile fascia
Fundiform ligament of the penis
27
Arises form the pubic symphysis and the arcuate pubic ligament and inserts into the deep fascia of the penis or into the body of the clitoris
Lies deep to the fundiform ligaments
Suspensory Ligament of the Penis (or the Clitoris)
28
Continuation of the deep perineal fascia
COntinuous with the fascia covering the external oblique muscle and the rectus sheath
Deep Fascia of the Penis (Buck's Fascia)
29
Dense fibrous layer that envelops the both the corpora cavernosa and the corpus spongiosum
Very dense around the corpora cavernosa
More elastic around the corpus spongiosum
Tunica Albuginea
30
serous sac of the peritoneum that cover the frontand sides of the tetis and epididymis
Consists of a parietal layer that forms the inenrmost layer of the scrotum and a visceral layer adherent to the testis and epididymis
Tunica Vaginalois
31
Embryonic diverticulum of the peritoneum that traverses the inguinal canal, accompanying the round ligament in the female or the testis in its descent into the scrotum and closes forming the tunica vaginalis in the male
Processus vaginalis
32
The Processus vaginalis forms the _________ if it does not close in females
Canal of Nuck
33
Persistence of the entire processis vaginalis develops a congenital \_\_\_\_\_\_\_\_\_\_\_\_
Indirect inguinal hernia
* If its middle portion perists, it develops a congenital hydrocoele
34
Fibrous cord that connects the fetal testis to the floor of the developing scrotum. and its homologues in the female are the ovarian and round ligaments
Gubernaculum
35
The scrotum is innervated by the \_\_\_\_\_\_\_
Anterior scrotal branch of the ilioinguinal nerve
genital branch of the genitofemoral nerve
perineal branch of the pudendal nerve
perineal branch of the posterior femoral cutaneous nerve
36
Penis consists of 3 mases of vascular tissue
* Paired corpora cavernosa
* midline corpus spongiosum
37
Terminal dialted part of the urethra in the glans is the \_\_\_\_\_\_\_\_-
Fossa navicularis
38
small sebaceous glands of the corona, the neck of the glans penis, and the inner surface of the prepuce, which secrete an odoriferous substance called smegma
Preputial glands
39
2 longitudinal folds of skin that run downward and backward from the mons pubis and are joined anteriorly by the naterior labial commissure
Labia Majora
40
The labia majora are homologous to the _____ of the male
Scrotum
41
Hairless and contain no fat
Divided into upper (lateral) parts, which, above the clitoris, fuse to form the precpuce of the clitoris and lower (medial) parts,which fuse below to form the frenulum
Labia minora
42
space or cleft between the labia minora
has openings for the urethra, the vagina and the ducts of the greater vestibular glands in its floor
Vestibule of the Vagigna (Urogenital Sinus)
43
homologous to the penis in the male, consists of erectile tissue
Clitoris
44
Consists of two crura, 2 corpora cavernosa, and a glans but no corpus spongiosum
Clitoris
45
The glans clitoris is derived from the ___________ and is covered by a sensitive epithelium
Corpora cavernosa
46
are the homologues of the bulb of the penis of the corpus spongiosum, a paired mass of erectile tissue on each side of the vaginal orifice
Covered by the bulbospongiosus muscle and each bulb is joined to one another and to the undersurface of the glans clitoris by a narrow band of erectile tissue
Bulbs of the Vestibule
47
Pudendal Nerve (S2-S4)
* Passes through the **Greater sciatic foramen** between the piriformis and cocygeus
* Crosses the ischial spine and enters the perineum with the internal pudendal artery t**hrough the leser scriatic foramen**
* Enters the pudendal canal gives rise to the **inferior rectal nerve and the perineal nerve and termiantes as the dorsal nerve of the penis (or clitoris)**
48
Inferior Rectal Nerve
* Arises within the pudendal canal, crosses the ischiorectal fossa,
* innervates
* the sphincter ani externus
* skin around the anus
* Communicates in the ischiorectal fossa with perineal branch of the **posterior femoral cutaneous nerve**
* Scrotum
* labium majus
49
Perineal nerve
* Arises within the pudendal canal
* divides into
* deep branch
* supplies all of the perineal muscles
* superficial (posterior scrotal or labial) branch
* Supplies scrotum or labia majora
50
Dorsal nerve of the penis (or clitoris)
* Pierces the perineal membrane
* Runs between the **2 layers of the suspensory ligament** of the penis or clitoris
* runs deep to the deep fascia on the fascia on the dorsum of the penis or clitoris
* skin
* prepuce
* glans
51
Internal Pudendal Artery
* Arises from the **internal iliac artery**
* **Leaves** the pelvis by the **greater sciatic foramen** between the piriformis and coccygeus
* **enters** the perineum through the **lesser sciatic foramen** by hooking around ischial spine
* accompanied by the pudendal nerve
* Gives rise
* Inferior rectal artery
* Perineal arteries
* Artery of the bulb
* Urethral artery
* Deep arteries of the Penis or Clitoris
* Dorsal Arteries of the Penis or clitois
52
Arises within the pudendal canal, pierces the wall of the pudendal canal, and breaks into sevreal branches, which cross the ischiorectal fossa to **muscles and skin around the anal canal**
Inferior Rectal Artery
53
Supply the superficial perineal muscles and give rise to transverse perineal branches and posterior scrotal (or labial) branches
Perineal Arteries
54
Arises within the deep perineal space, pierces the perineal membrane, and supplies the bulb of the penis and the bulbourethral glands (in the male) and the vestibular bulbs and the greater vestibular gland (in the female)
Artery of the Bulb
55
Pierces the perineal membrane and enters the corpus spongiosum of the penis, and continues to the glans penis
Urethral Artery
56
Terminal branches of the internal pudendal artery
Pierce the perineal membrane, run through the center of the corpus cavernosum of the penis or clitoris, and supply its erectile tissue
Deep arteries of the Penis or Clitoris
57
Pierce the perineal membrane and pass through the suspensory ligament of the penis or clitoris
Run along its dorsum on each side of the deep dorsal vein and deep to the deep fascia (Buck's fascia) and superficial to the tunica albuginea to supply the glans and prepuce
Dorsal Arteries of the penis or Clitoris
58
Arises from the femoral artery, emerges through the saphenous ring, and passes medially over the spermatic cord or the round ligament of the uterus to supply the **skin above the pubis, penis and scrotum or labium majus**
External Pudendal Artery
59
Veins of the penis
Deep Dorsal Vein of the Penis
Superficial Dorsal Vein of the Penis
60
Deep Dorsal Vein of the Penis
* **Unpaired vein** that lies in the dorsal midline deep to the deep (Buck's) fascia and superficial to the tunica albuginea
* Leaves the perineum between the **arcuate ligament** and the **transverse perineal ligament**
* Drains into the prostatic and pelvic venous plexuses
61
Superficial Dorsal Vein of the Penis
* Runs toward the pubic symphysis between the superficial and deep fasciae
* Terminaes in the **external (superficial) pudendal veins**
* Drian into the greater saphenous vein
62
Occurs via the superficial inguinal lymph nodes, which receive the lymph from the lower abdominal wall, buttocks, penis, scrotum, labium majus, and lower parts of the vagina
Lymphatic Drainage of the Perineum
* Drain primarily into the **external iliac nodes** and ultiamtely **lumbar (aortic) nodes**
* Lymph vessels from the glans penis (or clitoris) and labium minus pass to the deep inguinal and external iliac nodes
63
Lymphatic Drainage of the Pelvis
* Follows the internal iliac vessels to the internal iliac nodes and subsequently to the lumbar (aortic) nodes
* **Internal Iliac nodes** receive lymph from the upper part of the rectum and vagina and other pelvic organs
* drain into the common iliac and then to the lumbar (aortic) nodes
* lymph from the uppermost part of the rectum drains into the inferior **mesenteric nodes and then aortic nodes**
* Lymph from the testis and epididymis or ovary drains along the **gonadal vessels** directly into the **aortic nodes**
64
Basin shaped ring of bone formed by the 2 hip bones, the sacrum, and the coccyx
Pelvis
65
The pelvis is divided by the ________ into pelvis major (False pelvis) above the and pelvis minor (true pelvis) below
Pelvic brim
66
The pelvis has an outlet that is closed by the _____ and \_\_\_\_\_\_, ehich form the floor of the pelvis
Coccygeus and levator ani
67
The pelvis is normally tilter in anatomic position. Thus:
* Anterior-superior iliac spine and the pubic tubercles are in the same vertical plane
* Coccyx is in the same horizontal plane as the upper margin of the pubic symphysis
* Axis of the pelvic cavity running through the central point of the inlet and the outlet almost parallels the curvature of the sacrum
68
superior rim of the pelvic cavity
Upper pelvic aperture (Pelvic inlet or Pelvic Brim)
* Bounded by:
* **Posterior**: promontory of the sacrum (sacral part)
* **Lateral**: arcuate or iliopectineal line of the ilium (iliac part)
* **Anterior:** Pectineal line, pubic crest, and the superior margin of the pubic symphysis (pibic part)
69
Diamond-shaped aperture
Lower pelvic aperture (Pelvic Outlet)
* bounded by:
* posterior: sacrum and coccyx
* lateral: ischial tuberosity
* anterior: pubic symphysis, arcuate ligament, and rami of the pubis and ischium
* Closed bu the pelvic and urogenital diaphragms
70
Expanded portion of the bony pelvis, above the pelvic rim
Pelvis major (false pelvis)
71
Cavity of the pelvis below the pelvic brim (or superture aperture) and above the pelvic outlet (or inferior aperture)
Pelvis Minor
(Has an outlet that is closed by the coccygeus and levator ani muscles) and the parietal fascia, which form the pelvis
72
Joint between vertebra L5 and the base of the sacrum, joined by an intervertebral disk and supported by iliolumbar ligaments
Lumbosacral joint
73
Sacroiliac Joint
* Synovial joint
* covered by cartilage and is supported by the anterior, posterior, and interosseus sacroiliac ligaments
* Transmits the weight of the body to the hip bone
74
Cartilaginous joint between the sacrum and coccyx, reinforced by the anterior, posterior, and lateral sacrococcygeal ligaments
Sacrococcygeal ligaments
75
Forms the pelvic floor and supports all the pelvic viscera
Formed by the levator ani and coccygeus muscles and their fascial coverings
Pelvic Diaphragm
76
Contraction of the pelvic diaphragm \_\_\_\_\_\_\_\_\_\_\_
raises the entore pelvic floor
77
Consists of 2 layers of peritoneum, extends from the lateral margin of the uterus to the lateral pelvic wall, and serves to hold the uterus in position
Broad ligament
78
the broad ligament does not contain the ovary but gives attachement tot he ovary through the **\_\_\_\_\_\_\_\_**
mesovarium
79
The borad ligament has a posterior layer that curves from the isthmus of the uterus
Rectouterine fold
80
Fold of peritoneum that conencts the anterior surface of the ovary
Mesovarium
81
fold of the broad ligaemnt that suspends the uterine tube
Mesosalpinx
82
Major part of the braod ligament below the mesosalpinx and mesovarium
Mesometrium
83
The round ligament is attached to the uterus in front of and below the attachment of the uterine tube and represents the remains of the lower part of the \_\_\_\_\_\_\_\_\_
gubernaculum
84
Round ligament
* runs within the layers of the braod ligament, contains smooth muscle fibers, and holds the fundus of the uterus forward, keeping the uterus anterverted and anteflexed
* Enters the inguinal canal at the deep inguinal ring, emerges from the superficial inguinal ring, and becomes lost in the subcutaneous tissue of the labium majus
85
fibromuscular cord that extends from the ovary to the uterus below the uterine tube, running within the layers of the broad ligament
Ovarian ligament
86
Band of peritoneum that extends upward from the ovary to the pelvic wall and transmits the ovarian vessels, nerves, and lymphatics
Suspensory Ligament of the Ovary
87
Fibromuscular condensations of pelvic fascia from the cervix and the vagina to the pelvic walls, extend laterally below the base of the broad ligament, and support the uterus
Lateral or Transverse Cervical (Cardinal or Mackerondt's) Ligaments of the Uterus
88
firm bands of connective tissue that extend from the posterior surface of the pubis to the cervix of the uterus
Pubocervical Ligaments
89
Condendsations of the pelvic fascia that extend from the neck of the bladder (or the prostate gland in the male) to the pelvic bone
Pubovesical (female) or Puboprostatic (male) ligaments
90
Frim fibromuscular bands of pelvic fascia that extend from the lower end of the sacrum to the cervix and the upper end of the vagina
Sacrocervical ligaments
91
Arches across the inferior aspect of the pubic symphysis and attaches to the medial borders of the inferior pubic rami
Inferior Pubic (arcuate) ligament
92
Hold the cervix back and upward and sometimes elevate a shelf-like fold of the peritoneum (rectouterine fold) which passes from the isthmus of the uterus to the posterior wall of the pelvis lateral to the rectum
Rectouterine (Sacrouterine) ligaments
* Corresponds to the sacrogenital (rectoprostatic) fold
93
sac or recess formed by a fold of the peritoneum dipping down between the rectum and the uterus
Lies behind the posterior fornix of the vagina and contains peritoneal fluid and some of the small intestine
rectouterine pouch ( Cul-de-sac of Douglas)
94
Peritoneal recess between the bladder and the rectum in males
Rectovesical Pouch
95
Peritoneal sac between the bladder and the uterus in females
Vesicouterine pouch
96
Muscular tube that transmits urine by peristaltic waves
Ureter
97
3 constrictions of the ureters
* Origin where the pellvis of the ureter joins the ureter
* where it crosses the pelvic brim
* junction with the bladder
98
The ureter crosses the _______ in front of the bifurcation of the common iliac artery; descend retroperitoneally on the lateral pelvic wall; and runs medial to the umbilical artery and the obturator vessels and posterior to the ovary
Ureter
99
The ureter passes ___________ to the ductus deferens and lies in front of the seminal vesicle beofre entering the posterolateral aspect of the bladder in males
Posterior and Inferior
100
The Ureter receives blood from the \_\_\_\_\_\_\_
* Aorta
* renal
* gonadal
* common iliac
* internal iliac
* umbilical
* suoerior and inferior vesical
* middle rectal
101
Urinary Bladder
* Situated belowe the peritoneum and is slightly lower in the female than in male
* Extends upward above the pelvic rim as it fills
* Apex: Anterior end
* Fundus or base: posteroinferior triangular portion
102
small eminence at the apex of its trigone, projecting into the orifice of the urethra
Uvula
103
The urinary bladder has smooth muscle fibers known as the
Detrussin muscle of the bladder
104
The Urinary bladder receives blood from\_\_\_\_\_\_
* Superior and inferior vesical arteries
* Vaginal arteries in females
105
The urinary bladder venous blood is drained by the \_\_\_\_\_\_\_\_\_\_\_\_\_
Prostatic (or vesical) plexus of veins
| (empties into the internal iliac vein)
106
The Urinary bladder is innervated by nerve fibers from \_\_\_\_\_\_\_\_
vesical and prostatic plexuses
* Parasymathetic : contractions
* Sympathetic: relaxes the detrussor muscles
107
serves as a passage for urine from the urinary bladder to the exterior
Urethra
108
Male urethra consists of 3 parts
* Prostatic
* membranous
* lowest
* liable to rupture or to penertation by a catheter
* spongy
109
Micturition
* Sympathetic (GVE)
* inhibits emptying (constrict internal sphincter)
* GVA impulses arise from stretch receptors in the bladder wall
* enters the spinal cord via pelvic splanchnic nerves
* Parasympathetic (GVE)
* enhancing micturition
* GSE in the pudendal nerve cause volunatary relaxation of the external rethral sphincter and the bladder begins to void
* At the end
* external urethral sphincter contract, and the bulbospongiosus in the male expel the last few drops
110
The testis receives blood from the testicular artery from the \_\_\_\_\_\_\_\_
Abdominal aorta
(Darined by veins of the pampiniform plexus)
111
The testis has lumph veseels that ascend with the testicular vessels and drain into the \_\_\_\_\_\_
Lumbar (aortic) nodes
* lymphatic vessels in the scrotum drain into the superficial inguinal nodes
112
consists of a head, body and tail, and contains a convoluted duct (6m) long
Functions in the maturation and storage of spermatozoa in the head and body and propulsion of the spermatozoa into the ductus deferens
Epididymis
113
Thick walled tube that enters the pelvis at the deep inguinal ring at the lateral side of the inferior epigastric artery
Crosses the medial side of the umbilical artery and obturator nerve and vessels, passes superior to the ureter near the wall of the bladder, and is dilated to become the **ampulla** at its terminal part
Ductus Deferens
114
formed by the union of the ductus deferens with the ducts of the seminal vesicles
Opens into the prostatic urethra on the seminal colliculus just lateral to the blind prostatic utricle
Ejaculatory ducts
115
Enclosed by dense endopelvic fascia and are lobualted glandular structures that are diverticula of the ductus deferens
Lie inferior and lateral to the ampullae of the ductus deferens against the fundus of the bladder
Seminal Vesicles
116
The seminal vesicles have lower ends that become narrow and form ducts, which join the ampullae of the ductus deferens to form the \_\_\_\_\_\_\_\_\_
Ejaculatory ducts
117
5 lobes of the prostate gland
* **Anterior**: infront of the urethra and is devoid of glandular substance
* **Middle:** lies bertween the urethra and the ejaculatory ducts
* prone to benign hypertrophy
* **Posterior**: behind the urethra and below the ejaculatory duct. Contains glandular tissue
* prone to carinomatous transformation
* **Right and left lateral lobes**: either side of the urethra and form the main mass of the gland
118
Located on the posterior wall of the prostatic urethra and has numerous openings of the prostatic ducts on either side
Urethral crest
119
The urethral crest has an ovoid-shaped enlargement called the \_\_\_\_\_\_\_\_on which the 2 ejaculatory ducts and the prostatiic utricle open
Seminal colliculus (verumontanum)
120
Groove between the urethreal crest and the wall of the prostatic urethra and receives the ducts of the prostate gland
Prostatic sinus
121
Erection is maintained by contraction of the
Bulbospongiosus and ischiocavernous muscles
122
Ovaries lie on the the ________ aspect of the broad ligament
Posterior
123
The ovaries have a surface that is covered by _______ which is modiefied from the developmental peritoneal covering of the ovary
Germinal (columnar) epithelium
124
Ovaries are supplied primarity by the \_\_\_\_\_\_\_
Ovarian arterties
(contained in the suspensory ligament and anastomose with branches of the uterine cavity)
125
The right ovarian vein joins the \_\_\_\_\_\_\_\_\_
IVC
126
The left ovarian vein joins the \_\_\_\_\_\_\_\_\_\_\_
left renal vein
127
Uterus is normally
Anterverted and anteflexed
128
The uterus is supplie by
Primarily by the uterine artery
Secondarily by the ovarian artery
129
The Uterus has an anterior surface that rests on the posterosuperior surface of the bladder and is divided into 4 parts namely \_\_\_\_\_\_
* Fundus
* Body
* Isthmus
* Cervix
* Internal os
* Cervical Canal
* External os
130
The vagina has ____ that forms the recess between the cervix and the wall of the vagina
Fornix
131
The Vagina receives blood from the \_\_\_\_\_\_\_\_\_\_\_\_-
Vaginal brnaches of the uterine artery
Internal iliac artery
132
The lymphatic drainage of the vagina has 2 directions
* Fromthe upper 3/4 : iliac nodes
* fro, the lower 1/4, below the hymen : superficial inguinal nodes
133
Nerve supply of the vagina
* Ureterobvaginal plexus for the upper 3/4
* deep perineal branch of the pudenda; nerve for the loer 1/4
134
Part of the large intestine that extends from the sigmoid colod to the anal canal and follows the curvature of the scarum and coccyx
Rectum
135
The rectum has a lower dialted part called the\_\_\_\_ which lies immediately above the pelvic diaphragm
Ampulla
136
The rectum has mucous membrane and circular muscle layer that forms 3 permanent transverse folds called
Houston's valves
137
The rectum receives blood from the
* Superior, middle, and inferior rectal arteries
* Superior: peirces the muscular wall and courses in the submucosal layer and anastomoses with branches of the inferior rectal
* Middle: posterior part of the rectum
* Middle sacral artery
138
The venous blood of the rectum returns to the portal venous system via the ________ and tothe caval system bia the \_\_\_\_\_\_\_\_\_\_
Superior rectal
Middle and inferior rectral
139
\_\_\_\_\_\_\_ primarily drains the muscular layer of the lower part of the rectum and upper part of the anal canal
Middle rectal veins
140
The rectum receibe parasympathetic nerve fibers by the way of the \_\_\_\_\_\_\_\_\_\_\_
Pelvic splahnic nerve
141
The anal canal lies below the pelvic diaphragm and ends at the anus. It is divided into \_\_\_\_-
* Visceral portion: Upper 2/3
* Somatic portion: lower 1/3
* perineum
142
5 to 10 longitudinal folds of mucosa in the upper half of the anal canal
Anal columns
143
Crescent shaped mucosal folds that connect the lower ends of the anal columns
Anal valves
144
series of pouch like recesses at the lower end of the anal column in which anal glands open
Anal sinuses
145
Thickening of the circular smooth muscle in the lower part of the rectum
Intenal anal sphincter
146
The external anal sphincter has 3 parts
* Subcutaneous
* Superficial
* Deep
147
The internal and external anal sphincter is separated by rhe \_\_\_\_\_\_\_\_\_
Intermuscular (intersphicnteric groove) called the Hilton's white line
148
The epithelium is \_\_\_\_\_\_\_\_\_\_\_above the pectinate line
Columnar or cuboid
| (Stratified squamous below it)
149
Venous drainage above the pectinate line goes into the PORTAL VENOUS SYSTEM mainly via the \_\_\_\_\_\_\_
Superior rectal vein
150
The lymphatic vessels of the anal canal drain into the __________ above the line and into the _____ below it
Internal iliac nodes
Superficial inguinal nodes
151
When the -\_\_\_\_\_\_ relaxase,there is a decrease in angle between the ampulla of the rectum and the upper portion of the anal canal
Puborectalis
152
Internal Iliac artery
* Arises from the bifurcation of the common iliac artery, infront of the sacroiliac joint
* crossed infront by the ureter at the pelvic brim
* Divided into
* **Posterior division**
* iliolumbar
* lateral
* sacral
* superior gluteal
* **Anterior Division**
* inferior gluteal
* internal pudendal
* umbilical
* obturator
* inferior vesical
* middle rectal
* uterine arteries
153
Iliolumbar artery
* Runs superolaterally to the iliac fossa, deep to the psoas major
* Dividies into
* Iliac branch
* iliacus muscle
* ilium
* Lumbar branch
* psoas major
* quadratus lumborum muscle
154
Lateral sacral artery
* passes medially infront of the sacral plexus
* gives rise to
* **spinal branches**
* **ente**r the anterior sacral foramina
* spinal meninges and the roots of sacral nerves
* **emerge** through the psoterior sacral foramina
* muscles and skin overlying the sacrum
155
Superior Gluteal Artery
* Usually runs between the lumbosacral trunck and the first sacral nerve
* Leaves the pelvis bis **greater sciatic formen** above the pirifromis muscle
* muscles in the buttocks
156
Inferior Gluteal artery
* Runs between the 1st and second or between the second and 3rd sacral nerves
* Leaves via the **greater sciatic foramen**
* **inferior** to the piriformis
157
Internal Pudendal Artery
* Leaves throug the **greater sciatic foramen** passing between the piriformis and coccygeus muscles
* Enter through the **lesser sciatic foramen**
158
Umbilical Artery
* Runs forward along the alteral pelvic wall and along the side of the bladder
* Proximal part
* Superior vesical artery
* artery of the ductus deferens
* Distal part
* obliterated and continues as the **medial umbilical ligament**
159
Obturator artery
* Arise from the internal iliac artery
* 20-30% = arise from the inferior epigastric artery
* passes close to or across the femoral canal
* Divides into
* anterior branch
* posterior branch
* forms a posterior branch that gives rise to
* acetabular branch = head of the femur
160
Inferior Vesical Artery
* Occurs in male
* corresponds to the **vaginal artery** in the female
* supplies
* fundus of the bladder
* prostate gland
* seminal veiscles
* ductus deferens
* lower part of the ureter
161
Vaginal artery
* Arise from the uterine or internal iliac artery
* gives rise to numerous branches
* makes longitudinal anastomoses in the median plane to form
* anterior and posterior azygos arteries of the vagina
162
Middle rectal artery
* Runs medially to supply the muscular layer of the lower part of the rectum and the upper part of the anal canal
* also supplies
* prostate
* seminal vesicles (or vagina)
* ureter
163
Uterine artery
* Homologous to the artery of ductus deferens
* arises form the internal iliac or in common with the vaginal or middle rectal
* Runs medially in base of the broad ligament
* Divides into
* Superior branch
* body and fundus
* vaginal branch
* smaller
* cervix and vagina
* Takes a tortuous course along the lateral margin of the uterus
* ends by anastomosisng with the ovarian artery
164
Median Sacral artery
* Unpaired
* from the posterior aspect of the abdominal aprta just before its bifurcation
* descends in front of the sacrum
* posterior portion of the rectum
* ends in the coccygeal body
165
Superior Rectal Artery
* direct continuation of the IMA
166
Ovarian artery
* Arises from the abdominal aorta
* crosses the proximal end of the external iliac
167
Sacral Pelxus
* formed by the 4th and 5th lumbar ventral rami and the first 4 sacral ventral rami
168
Superior Gluteal nerve (L4-S1)
* Leaves the pelvis through **greater sciatic foramen** above the piriformis
* innervates
* gluteus medius
* gluteus minimus
* tensor fascia lata
169
Inferior gluteus nerve (L5-S2)
* Leaves via the **greater sciatic foramen** below the piriformis
* innervates
* gluteus maximus
170
Sciatic Nerve (L4-S3)
* Largest nerve
* Composed of
* Peroneal and tibial parts
* Leaves the pelvis visa **greater sciatic foramen** below the piriformis
* Enter the thigh between the **ischial tuberotity** and the **greater trochanter of femur**
171
Nerve to Obturator Internus Muscle (L5-S2)
* Leaves via the **greater sciatic foramen** below the piriformis
* Enters the perinuem via **lesser sciatic foramen**
* Innervates
* obturator internus
* superior gemellus muscles
172
Nerve to the Quadratus Femoris Muscls (L5-S1)
* Leabes via **greater sciatic foramen** below the piriformis
* Descends feep to the gemelli and obturator internus
* supplies
* quadratus femoris
* inferior gemellus muscles
173
Posterior femoral Cutaneous Nerve (S1-S3)
* Leaves therough the **greater sciatic foramen** below the piriformis
* Lies alongside the sciatic nerve and descends on the back of the knee
* Gives rise
* Inferior cluneal nerves
* perineal nerves
174
Pudendal nerve (S2-S4)
* Leaves via **greater sciatic foramen** below the piriformis
* Enters through the **lesser sciatic** **foramen** and **pudendal canal** in the lateral wall of the ischio rectal fossa
175
Branches distributed to the Pelvis
* Neve to piriformis (S1-S2)
* nerves to the levator ani and coccygeus (S3-S4)
* Nerve to the sphincter ani externus muscle
* Pelvic splanchnic nerves (S2-S4)
176
Autonomic Nerves
* Superior hypogastric plexus
* Hypohgastric nerve
* Inferior hypogastric (pelvic) plexus
* Sacral Splanchnic Nerves
* Pelvic Splanchnic nerves (nervi erigentes)
177
Superior hypogastric Plexus
* continuation of the aortic plexus below the aortic bifurcation and receives the 2 lower splanchnic nerves
* behind the peritoneum
* bifurcates into the
* Right and left hypogastric nerves in front of the sacrum
* Contains
* Preganglionic and postaganglionic sympathetic fibers
* Visceral Afferent fibers
* parasympathetic fibers
178
Hypogastric nerve
* Lateral extension of the superior hypogastric plexus
* lies in the extraperitoneal connective tissue lateral to the rectum
* Provides branches to the
* sigmoid colon
* descending colon
* Joined by the pelvic splanchnic nerves to form the **inferior hypogastic or pelvic plexus**
179
Inferior hypogastric nerve
* Formed by the union of **hypogastric, pelvic, splanchnic, and sacral nerves**
* lies against the posterolateral pelvic wall, lateral to the rectum, vagina, and base of the bladder
* Contains pelvic ganglia
* both sympathetic and parasympathetic preganglionic
* Gives rise to subsidiary plexuses
* middle rectal plexus
* uterovaginal plexus
* vesical plexus
* differential plexus
* prostatic plexus
180
Sacral Splanchnic Nerves
* Consists primarily of preganglionic sympathetic fibers that come off the chain and synapse in the inferio rhypogastric (pelvic) plexus
181
Pelvic Splanchnic Nerves (Nervi Erigentes)
* Arise from the sacral segment of the spinal cord (S2-S4) and are the only splanchnic nerves that carry parsympathetic fibers
* Contribute to the formation of the
* pelvic plexus
* supply the
* descending colon
* sigmoid colon
* other viscera in the pelvis and perineum
182
The endodermal claoca is divided by the urorectal septum into
* Anterior part
* becomes the primitive bladder and the urogenital sinus
* Posterior part
* anorectal canal, which forms the rectum, and the upper half of the anal canal
* the lower half: ectoderm of the protodeum
183
Gives origin to the ureteric bud, which forms the ureter, renal pelvis, major and minor calyces and collecting tubules
Mesonephric (wolffian) Duct
184
Forms the epididymal duct, vas deferens, ejaculatory ducts, and seminal vesicles in the male
Mesonephric (wollfian duct)
(In the female, it largely degenerates, and small remnants persist as the **duct of epoophoron (Gartner's) and the duct of the paroophoron )**
185
The membranous and penile urethra form from the\_\_\_\_\_\_\_\_\_
Urogenital sinus
186
Male and female characteristics of the external genitalia can be recoginized by week\_\_\_\_
12
187
Phenotypic differentiation is completed by week \_\_\_\_\_\_\_\_
20
188
\_\_\_\_\_\_\_\_ form uterine tubes and the uterus, cervix, and upper vagina in females and form the prostatic utricle and appendix of testes in males
Paramesonephric (mullerian) ducts
189
for the epoophoron (vestigial) in females and efferent ductules, epididymal duct, ductus deferens, ejaculatory duct, and seminal vesicles in males
Mesonephric (wolffian) ducts
190
Forms the urinary bladder, urethra, urethral and paraurethral glands, greater vestibular glands and lower vagina
urogenital sinus
191
Forms the clitoris and penis
Genital tubercle or phallus
192
Form the labia minora and the spongy urethra
Urogenital folds
193
form the labia majora and scrotum
Labioscrotal (genital) swellings
194
forms the ovarian ligament and round ligament
Gubernaculum
