Perineum & Surface Anatomy Flashcards
(115 cards)
1
Q
what shape do the pelvic outlet and perineum make?
A
Diamond Shape
2
Q
Where is the Perineum located?
A
Below the pelvic outlet (pelvic diaphragm)
3
Q
The Perineum diamond shape is divided into 2 triangles called…
A
- Urogential Triangle
- Anal Triangle
4
Q
Urogenital Triangle
A
Opening for Urinary and reproductive systems
urethra and vagina
5
Q
Anal Triangle
A
Opening for GI system
anus
6
Q
Are the Urogenital and Anal triangles on the same plane?
A
NO- urogenital is more horizontal in the anatomical position and the anal triangle is more on a posterior oblique direction
7
Q
What are the borders of the perineum
A
Anteriorly: Pubic symphysis
Laterally: Coccyx
Posteriorly: Iscial Tuberosity
8
Q
What divides the ischial tuberosities between the triangles
A
Imaginary line between ischial tuberosities divide the triangles
9
Q
Because the pelvic diaphragm is curved over the pelvic outlet, but the perineal membrane and ligaments run across at straight planes…what is formed?
A
- Ischio-anal fossae
- Recesses
10
Q
What fills the
- Ischio-anal fossae
- Recesses
A
fat but infections can form too
11
Q
Ischio-anal fossae
A
larger space on the posterior side where anal opening is
-Space is filled with fat because as fecal material moves down, you want fat so it can easily be pushed out instead of having bone/ligaments there
12
Q
Recesses
A
Small anterior recess going to the urogenital triangle- filled with fat
-Alot smaller than anal triangle
13
Q
Perineal Body
A
- Connective tissue which serves as an important attachment point for muscles in the pelvic floor and perineum
- Between perineal membrane and external anal sphincter
14
Q
Perineal Membrane
A
-Associated with Urogential Triangle ONLY in the front
-Thick connective tissue attached to ischiopubic rami
-erectile tissue anchor here
-has opening for urethra and vagina
-
15
Q
what seperates the deep and superficial perineal pouches?
A
Perineal membrane
16
Q
Borders of Anal Triangle
A
“line” between ischial tuberosities, cocyx, and sacrotuberous ligaments
17
Q
Muscular Content on anal triangle
A
External anal sphincter
18
Q
What is external anal sphincter innervated by
A
Pudenendal Nerve (inferior rectal branch)
19
Q
What surrounds anal opening
A
The fat of the ischio-anal fossa
20
Q
What is in the anal triangle?
A
- Anal Opening
- External anal aphincter (voluntary sphincter)
- The rest is full with fat
21
Q
Perineal pouch borders
A
- Pubic Symphasis
- “line” from ischiial tuberosities, pubic rami
22
Q
Location of deep pouch
A
Between pelvic diaphragm and perineal membrane
23
Q
Describe Deep Pouch in Males
A
- Muscles (deep transverse perineal, external urethral sphincter)
- Membranous Urethra
- Cowper’s glands (bulbo-urethral glands)
24
Q
Describe Deep Pouch in Females
A
- Muscles (deep transverse perineal, external urethral sphincter)
- Urethra
- Vagina
25
Superficial Pouch Location
Between perineal membrane and superficial fascia of the perineum
26
Describe Superficial Pouch in Males
- Muscles (ischiocavernous and bulbospongiosus, Superficial transverse perineal muscle)
- Erectile Tissue: Crura and bulb of penis (root)
- Part of spongy urethra
27
Describe Superficial Pouch in females
- Muscles (ischiocavernous and bulbospongiosus, superficial transverse perineal muscle)
- Erectile tissue: Crura and bulbs of clitoris
- Bartholin's Glands (greater vestibular glands)
28
Muscles of Urogenital Diaphragm
- Deep Transverse Perineal Muscle
| - External Urethral Sphincter
29
Deep Transverse Perineal Muscle
Together the pair spans distance between ischial rami; in females, lies posterior to vagina
30
Origin and insertion of Deep Transverse Perineal Muscle
O- Ischial Rami
| I- Midline central tendon of perineum; some fibers into vaginal wall in females
31
Action of Deep Transverse Perineal Muscle
Supports Pelvic Organs; steadies central tendon
32
Deep Transverse Perineal Muscle nerve supply
Pudendal Nerve
33
External Urethral Sphincter description
Muscle encircling urethra and vagina (in females)
34
External Urethral Sphincter Origin and Insertion
O-Ischiopubic Rami
| I-Midline raphe
35
External Urethral Sphincter Action
Constricts Urethra; allows voluntary inhibition of urination; helps support pelvic organs
36
External Urethral Sphincter nerve supply
Pudendal Nerve
37
What tissues is erectile tissue composed of?
- Corpora Cavernosa
| - Corpus Spongiosum
38
What structures does Corpus Spongiosum make?
- Glands of penis
| - Shaft arounf Urethra on the ventral side
39
What is the shaft also composed of?
2 columns of corpus cavernosum (dorsal)
40
Dorsal VS Ventral Orientation
(anatomical position-Erect penis)
41
What is the root attachment of penis
stuff attached to perineum membrane
42
What are the the root attachments of the penis
-Crura of Penis attached to ischiopubic ramis and perineal membrane and they continue distally and to shaft of penis and they are composed of corpora cavernosa (going to be on dorsal side of shaft of penis)
43
Corpous spongiosum makes the __
Bulb of penis (part that attaaches to perineal membrane) and continues to shaft as one column of corpus spongiosum tissue and it also makes up the glans penis
44
Urethra passes thru... and goes out the...
Urethra passes thru corpus spongiosum and goes out at gland as external urethral opening
45
Lubricating glands is deep to...
perineal membrane (not in bulb, on deep side of perineum membrane)
46
What makes up root of penis?
- bulb-attached to perineal membrane
| - Cura
47
Erection occurs when...
Parasympathetic Signals dilate specific vessels to allow corpura cavernosa to fill with blood
48
Erectile tissue is composed of what set of tissues
- Corpora Cavernosa
| - Corpus Spongiosum (bulbs of the vestibule in females)
49
Clitoris parts
- Glans-Open in the perineum
- Clitoris Body-superiorly
- Crus
- Bulbs
50
Do females have a single bulb or 2?
No singular bulb because vaginal opening in midline- so bulb is split in 2. made up of same tissue as in male (called bulbs of vestibule)
51
Another name for Bartholin's Glands
Greater Vestibular Glands
52
Bartholin's Glands
Glands on posterior-lateral side of vaginal opening
| -Secrete lubrication
53
What are Bartholin's Glands homologous to in men?
Bulbourethral Glands
54
Difference between erectile tissue in men and women
-precursoer tissue of male erectile tissue is similar to female erectile tissue but testosterone makes the male erectile tissue bigger.
55
Can Bartholin's Glands be infected?
Yes-Glands can be infected and enlarge- its on the bottom side of vaginal opening
56
Muscles in Superficial Perineal Pouch
- Ischiocavernosus
- Bulbospongiosus
- Superficial transverse perineal
57
Ischiocavernosus- Position and Function
- Run over crus of erectile tissue near pubic rami
| - Function: help direct blood into erctile tissue
58
Bulbospongiosus-Position and Function
- From perineal body around vaginal opening and clitoris in women and bulb of the penis in men
- Function: blood flow direction and responsible for pulsatile ejaculation in men and clearing urine from urethra after urination
59
Bulbospongiosus difference in male and female
Muscles that sits over bulband spongy tissue- in men its 2 muscles coming together at midline, in female they don’t go to midline, they surround the bulb of vestibule
-Much more developed in male perineum but very thin in females
60
Superficial transverse perineal Position and Function
- On posterior side of perineal membrane
- 2 muscles coming togehr, When attached together, have a stornger function then when they are not
- Function: Support perineal body
61
The Urethra extends from the base of the bladder to the...
External opening
62
Urethra in Women
- Short
- Passes through pelvic floor
- Has internal and external urethral sphincters
- Urinary function only
63
Urethra in Men
-longer, bends 2x, passes through erectile tissue (corpus spongiosum)
64
Male Urethra Labeled
- Pre-prostatic
- Prostatic
- Membranous
- Penile (spongy)
65
-Pre-prostatic part of Urethra
Has INTERNAL URETHRAL SPHINCTER which is smooth muscle
| -Passes thru bladder before entering prostate
66
-Prostatic Urethra
Passes through the prostate, enterance of reproductive system
-Where Urethra joins reproductive system, and ejaculate enters urethra
67
Membranous Urethra
Contains EXTERNAL URETHRAL SPHINCTER: skeletal muscle voluntary control
68
Association of Urethra and erectile tissue in males and females
In females: urethra is not associated w/ erectile tissue, just opens up in perineum- doesn’t go thru erectile tisssue
In males: urethra is associated w/ erectile tissue. It DOES goes thru erectile tissue, goes thru column made up of corpus spongeosum tissue (called spongy/ penile urethra)
69
Urinary catheter in males and females
easy in females since it is short but in men have to consider that the bends, and in older men- the prostate, and then into the bladder, but the first bend- you can unfold the hanging penis; bbut the second bend you cant and if too forceful cause injusy to root
70
The bladder is innervated by...
Sensory nerves that sense stretch
71
Bladder wall contains a layer of...
Detrusor Muscle
72
Detrusor Muscle
-activated by the parasympathetic nervous system to contract and expel urine
- when it squeezes, pushes on bladder causing it to
Same thing: sympathetic would relax muscle and para could contract muscle to squeeze it for urine to exit
73
Effect of PNS on Internal sphincter
PNS relaxes the internal sphincter and contracts detrusor muscle
74
Effect of SNS on internal sphincter
SNS inhibits urination: relaxes detrusor muscle and contracts internal sphincter
75
Describe urinary reflex we have as babies
As babies- we only have reflex control of urine so as we get bigger, we can control external so we can urinate when appropriate
76
Vulva
Female external genitalia
77
Labia Majora
Surrounds labia minora and forms mons pubis anteriorly, posteriorly labia are seperated by posterior commissue (over the perineal body)
-came from same precursor tissue as scrotum in males and with testosterone- precursor tissue instead of forming 2 separate tissues, it forms 1 tissue (becoming the scrotum)
78
Labia Minora
Tissue fold forming frenulum and hood (prepuce) of the cliitoris anteriorly. The body of the clitoris is found under the prepuce
79
Inside the labia minora is the...
Vestibule
80
Vestibule
Opening for vagina (covered by hymen) and urethra (anterior to vagina)
81
Where do Labia Majoras connect in the front and the back
- Labias majora come together in the front and back
- In the front, come together: near mons pubis
- in the back, come together: by where perineal body is (called posterior commissure)
82
Where do Labia Minoras connect in the front and the back
- Labia minora also meet anteriorly and posteriorly
- In the front, come together: covering of clit (part of erectile tissue that can be seen externally in women- just the head)
* *foreskin of slit is same as foreskin in men but just a lot smaller
- in the back, come together: Foresha. L
83
Speculum Exam
Into vag canal and see bottom of uterus and cervix on external surface
84
Labia minora surrounds...
Labia minora -surrounds vestibule, vestibule contains opening for urethra, externeal urethral opening, and opening of vagina (entroitus)
85
What can the Vagina opening be covered by
Vag opening can be covered by hymen (remnant tissue from embryological development where 2 tubes merged, purpose- no purpose)
86
Scrotum has a midline embryonic fusion called...
Raphe- runs from anus to penis
87
Parts of the Penis
- Root
- Body
- Glans
- External urethral Orifice
88
Root of penis
attachment to perineal membrane: crura and bulb
89
Body of penis
Shaft
90
Glans of Penis
Head, covered by prepuce (foreskin-removed during circumcision)
91
External urethral orifice of penis
for opening of urethra
92
Superficial fascia of the UG triangle is continuous with...
Superficial fascia of the anterior abdominal wall
93
Deeper Membranous layer (scarpas fascia) continues as...
Colles' Fascia in the perineum
94
Colles' Fascia in the perineum defines...
Superficial border of superficial perineal pouch
95
Colles' Fascia ends at...
Fascia lata of the thigh and also does NOT continue into the anal triangle
96
Smooth Muscle rich area covering scrotum/labia majora is...
Dartos Fascia- Wrinkling of scrotum
97
Superficial layer of superficial fascia continues over the...
thigh
98
What is superficial fascia
The Fascia underneath the skin before you get to organs or anything else
99
In the abdomen below the umbilicus- there are 2 layers of superficial fascia called...
- Campers Fascia
| - Scarpus Fascia
100
What does Dartos Fascia do
Controls thermoregulation like cremaster ligament, dartos doess same thing but more under autonomic control
101
What happens where theres Urethral trauma/ urine leakage
there is urine leakage , urine collects deep to superficial fascia and doesn’t go to thigh or inguinal triangle- just around perineum could go up to umbilicus but not higher than there since that’s where that fascia ends
102
Pudendal Nerve
Somatic (motor and sensory) innervation from S2-4
103
Pudendal Nerve course
Exits pelvic cavity through the greater sciatic foramen and reenters through the lesser sciatic foramen
104
Branches of Pudendal Nerve
- Inferior Rectal
- Perineal Nerve
- Dorsal Nerve of the penis (travels down dorsal aspect/clitoris->skin)
105
Inferior Rectal
external anal sphinter and part of pelvic diaphragm, anal triangle
106
Perineal Nerve
- Muscles of the superficial and deep perineal pouch
| - Main Nerve of UG triangle
107
Cavernous Nerves
Parasympathetic to Erectile tissue
- DIlates blood vessels so blood reaches that area
- As skeletal muscles tense, theyre going to constrict blood vessels and wont allow blood to leave
108
Internal Pudendal Artery
From anterior trunk of internal iliac artery
- Travels with pudendal nerve and supplies similar structures
- Main artery of perineum
109
Internal Pudendal Artery branches-
- Inferior rectal-anal canal below pectinate line
- Perineal
- Deep and dorsal arteries of penis/clit
110
External Pudendal Artery
Supplies skin over perineum (branch of femoral artery)
111
Femoral artery comes from...
External iliac artery
112
Lymphatics
Structures drain along lymph channels accompanying supplying blood vessels
113
Most perineal and pelvic structures drain into...
Superficial/deep inguinal nodes and internal/external iliac nodes
114
Gonads drain...
up to the abdominal cavity to thenodes around the abdominal aorta
115
Are asis and pubic symphysis on the same plane?
yes
