Recap lectures 11-12 (pelvis + perineum) Flashcards
Pelvis + perineum (134 cards)
1
Q
What are the two main parts of the pelvic cavity? What marks where each begins?
A
1) Greater; Supracristal plane
2) Lesser; pelvic brim
2
Q
What are the two main parts of the lesser pelvic cavity? What structures are located at each?
A
1) Pelvic inlet: Superior pubis to sacral promontory
2) Pelvic outlet: Inferior rami of pubis and Ischial tuberosities anterolaterally; tip of coccyx posterior
3
Q
1) What do the Sacrospinous and sacrotuberous ligaments prevent?
2) What can they be responsible for?
A
1) Excessive lumbar lordosis during weight bearing
2) “Back pain”
4
Q
1) What form the anterior inferior wall of the pelvis?
2) What form the lateral wall?
A
1) Body and rami of pubic bone; pubic symphysis
2) Boney hips, obturator foramen, membrane, muscle, vessels and nerves
5
Q
1) Compare the pubic arches of male and female pelvises
2) Compare the thickness and heaviness of bones of male and female pelvises
A
1) Males have a narrower pubic arch < 70 degrees; females have a wide pubic arch > 80 degrees
2) Male pelvises have thick and heavy bones; females have thin and light boney structure
6
Q
1) Compare the deepness of male and female greater pelvises
2) Compare the deepness of male and female lesser pelvises
A
1) Males’ greater pelvis is deep, females’ is shallow
2) Males’ lesser pelvis is narrow and deep; females’ is wide and shallow
7
Q
1) Compare the inlet shapes of male and female pelvises
2) Compare the outlet shapes of male and female pelvises
A
1) Males’ inlet is heart-shaped; female inlet oval or rounded
2) Males’ outlet is smaller, female outlet larger
8
Q
What is the pelvic floor also called?
A
Pelvic diaphragm
9
Q
What 3 things cover the pelvic diaphragm?
A
Levator ani + coccygeus muscles + fascia
10
Q
1) What forms the tendinous arch of levator ani? Where?
2) What are the two primary muscles that make up the levator ani?
A
1) Obturator fascia (thickened); ~ L5-S4
2) Pubococcygeus and iliococcygeus
11
Q
What provide the blood and innervation to the perineal compartment? Where does the blood flow come from?
A
Pudendal vessels (come off anterior internal iliac) and pudendal nerves (lumbo-sacral nerves)
12
Q
List the 4 main muscles of the pelvic walls.
Which of these makes up the lateral wall? What about the posterior wall?
A
1) Levator ani
2) Coccygeus m.
3) Obturator internus – lateral wall
4) Piriformis – posterior wall
13
Q
What two main nerves are formed by the sacral plexus? What does each innervate?
A
1) Sciatic n.– posterior thigh and leg below knee
2) Pudendal n. – nerve to perineum
14
Q
Besides the two main nerves of the sacral plexus, what else does it form? What does each innervate?
A
1) Superior gluteal n. – glut min, medius, TFL
2) Inferior gluteal n.– glut max
15
Q
Where is the coccygeal plexus?
A
S4-5, Co1 to pelvic floor
16
Q
1) Where does the sciatic nerve come from and where does it exit?
2) Where does the superior gluteal n come from and exit? What 3 muscles does it innervate?
A
1) L4 -S3, exits thru greater sciatic foramen, inferior to pyriformis m.
2) L4-S1, exits via greater sciatic foramen, supplies 3 muscles in glut region: gluteus Medius and Minimus mm., & TFL
17
Q
1) Where does the pudendal nerve come from? What is the it main nerves of?
2) Where does it enter?
A
1) S2-S4, main nerve to the perineum and chief sensory nerve of the external genitalia
2) Enters perineum via lesser sciatic foramen
18
Q
1) Where does the obturator nerve come from?
2) Where does it pass through?
3) What is it the primary nerve to?
A
1) L2-L4
2) Passes thru the pelvis BUT is not a pelvic nerve
3) Medial (adductor group) thigh
19
Q
1) What do structures do at the greater sciatic foramen?
2) What muscle is located here?
3) What 4 nerves are here?
4) What else is located here?
A
1) Exit pelvis
2) Piriformis m. to femur
3) Sciatic nerve, pudendal nerve, superior/inferior gluteal n.
4) Vessels
20
Q
1) What do structures do at the lesser sciatic foramen?
2) What muscle is located here?
3) What nerve is here?
A
1) Exit pelvis and re-enter perineal compartment
2) Obturator internus m.
3) Pudendal nerve
21
Q
What does sympathetic innervation of the pelvis do? (3 things)
A
1) Vasomotion
2) Inhibit peristalsis of rectum
3) Stimulates contraction of genital organs during orgasm (ejaculation in males)
22
Q
What does parasympathetic innervation of the pelvis do? (2 things)
A
1) Stimulate contraction of bladder and rectum
2) Supply erectile bodies of genitalia resulting in erection
23
Q
What are the 3 main parts of pelvic autonomics?
A
1) Sympathetic
2) Parasympathetic
3) Periarterial plexuses
24
Q
1) Reflex visceral afferents (not aware consciously) of the pelvis are conducted how? Where to?
2) How do pain visceral afferents (aware consciously) differ?
A
1) Via parasympathetic to spinal ganglia S2-3-4
2) Diff. based on “pelvic pain line” that corresponds to the inferior limit of the peritoneum
25
What are the pelvic viscera?
1) Distal parts of GI (rectum)
2) Distal Urinary tract
3) Reproductive system
26
What structures pass through the pelvic diaphragm to reach the perineal compartment? (3)
Rectum
Vagina
Urethra
27
1) Where is the rectum found?
2) Where are the vagina and urethra found?
1) Posterior triangle
2) Anterior urogenital triangle
28
1) _______________________ thru bladder wall acts as sphincter to prevent retrograde urine flow from ureters during voiding along with ___________________ at ureteral orifice at trigone
2) In males the ___________________ is related to the ureters
1) Oblique passage; circular m.
2) ductus deferens
29
1) What is the urinary bladder inferior to?
2) Where does it rest?
3) Where is the apex of the urinary bladder?
1) Peritoneum (subperitoneal)
2) Rests on pelvic floor
3) Anterior toward pubis
30
1) What is the trigone of the bladder?
2) What is the uvula of the bladder?
1) Triangle region with ureters and urethra orifice
2) Slight elevation of the trigone in the internal urethral orifice
31
1) What do the detrusor muscle fibers do near the neck of the male bladder? What does this do?
2) What do some of these detrusor muscle fibers do?
1) Form the involuntary internal urethral sphincter which contracts during ejaculation (sympathetic stimulation)
2) Run radially & assist in opening the internal urethral sphincter.
32
1) What are detrusor muscle fibers in the neck of the bladder continuous with in males?
2) What about in females?
1) Fibromuscular tissue of prostate
2) Muscle fibers of urethra
33
What are at the angles of the trigone of the bladder?
Ureteric orifices and internal urethral orifice
34
1) What supplies the bladder with blood?
2) Describe venous drainage of the bladder and include where they drain
1) Branches of the internal iliac aa.
2) Veins draining bladder correspond to arteries and drain into the internal iliac veins (Caval system)
35
Lymphatics from superior surface of bladder drain into _______________________, while those from the fundus drain into ________________________.
external iliac nodes; internal iliac nodes
36
1) What innervates the bladder sympathetically?
2) Sympathetic innervation that stimulates ejaculation simultaneously causes what? Why?
1) Sympathetic fibers from T11-L2 to pelvic plexus
2) Contraction of the internal urethral sphincter to prevent reflux of semen into the bladder
37
1) What innervates the bladder parasympathetically? (what fibers and plexus?)
2) What do they provide motor innervation to? What do they do in males?
3) When visceral afferent fibers stimulated by stretching, what happens in males? What suppresses this reflex?
1) Parasympathetic fibers from S2-3-4 via pelvic splanchnic n. to inferior hypogastric plexus
2) Motor to detrusor muscle & inhibitor to internal urethral sphincter in males
3) Detrusor m. contracts & the internal urethral sphincter relaxes and urine flows into the urethra; toilet training suppresses this reflex (along with external urethral sphincter)
38
Urethral glands homolog to ______________, common paraurethral duct bilaterally near external urethral orifice.
prostate
39
1) What somatically innervate the female urethra? (plexus and nerve)
2) What nerve viscerally innervates the female urethra? Where?
1) Vesicle nerve plexus and pudendal nerve (somatic)
2) Pelvic splanchnic n; most below pelvic pain line
40
1) The intramural part of the male urethra is surrounded by what?
2) What is this area's innervation?
3) What does this area prevent?
4) ____________________ fibers are inhibitory to internal urethral sphincter resulting in relaxing of sphincter during voiding
1) Internal urethral sphincter
2) Sympathetic innervated smooth muscle
3) Retrograde ejaculation
4) Parasympathetic fibers
41
1) What part of the male urethra is surrounded by external urethral sphincter?
2) What primarily controls continence?
1) Intermediate (membranous)
2) Tonic and phasic contraction of external urethra sphincter
42
What are the 4 parts of the male urethra?
1) Intramural
2) Prostatic urethra
3) Intermediate (membranous)
4) Spongy urethra
43
1) What does parasympathetic stimulation do during micturition?
2) The _______________________ is under somatic control and is inhibited during micturition
1) Causes the detrusor muscle to contract & inhibits the internal urethral sphincter.
2) external urethral sphincter
44
To gain voluntary control over micturition, infants must learn to suppress and stimulate what?
1) Suppress: the visceral afferent urge to void
2) Stimulate: the somatic motor of external urethral sphincter
45
1) What muscle is in the wall of the bladder and is involved in micturition?
2) What form the “involuntary” internal urethral sphincter?
3) What is the “voluntary” (Somatic) sphincter and where is it?
1) Detrusor muscle in wall of bladder
2) Neck of bladder muscles
3) External urethral sphincter; above perineal membrane
46
1) What is stress incontinence?
2) What causes it?
3) Who is it more common in?
4) How is it treated?
1) Leakage when cough, sneeze, run, jump
2) Weak external sphincter/pelvic floor
3) Older parous women - post vaginal deliveries
4) Manage with PT
47
1) What is urge incontinence?
2) What causes it?
3) How it it managed?
1) "GOTA GO NOW!!!!”
2) Detrusor instability
3) With Rx
48
1) What is the ductus deferens?
2) Where does it ascend? Where does it pass through?
3) Where does it cross over to enter the pelvis? What does it pass retroperitoneally?
4) Where does it end?
1) Continuation of the duct of epididymis from inferior pole of testis
2) In the spermatic cord; passes through the inguinal canal
3) External iliac vessels; passes along the lateral pelvic wall
4) By joining the duct of the seminal gland to form the ejaculatory duct
49
1) Where are the seminal glands (vesicles)?
2) What fluid do they secrete? What does it do?
3) What part of the seminal glands is covered in peritoneum?
1) Lie obliquely between the fundus of bladder and rectum
2) Alkaline fluid, mixes with sperm, major contributor to volume of semen ~ 75%
3) Superior aspect
50
1) What are ejaculatory ducts?
2) Where do they pass through?
3) Where do they open and how?
1) Tube arising from union of vas deferens and seminal gland duct
2) Posterior prostate
3) By slit like apertures on or within the prostatic utricle
51
What are the two divisions of the prostate? Define each.
Which one incorporates the prostatic plexus?
1) Glandular part 2/3
2) Fibromuscular 1/3: dense fibromuscular capsule
-Incorporates the prostatic plexus of nerves and veins
52
1) What part of the prostate contributes to the external urethral sphincter?
2) What part of the prostate is palpable via DRE?
1) Muscular anterior surface (AMZ)
2) Posterior surface related to the ampulla of the rectum
53
1) How many prostatic ducts open into prostatic sinuses?
2) Where are the prostatic sinuses?
1) 20+
2) On either side of seminal colliculus on posterior wall of the prostatic urethra
54
1) Prostatic fluid accounts for ~____% of volume of semen
2) Where are the Bulbourethral glands (Cowper’s glands)?
3) Where do the Bulbourethral glands open to?
1) ~25%
2) Lie posterolateral to the intermediate part of the urethra embedded in external urethral sphincter
3) Proximal spongy urethra
55
What are the 2 categories of LUTS (lower urinary tract symptoms)? List what's in each
1) Irritative symptoms
-Frequency
2) Obstructive symptoms
-Dribbling
-Push harder
-Nocturia
-Repeat voiding
56
What is BPH?
Middle lobe (CZ) hormonally induced enlarged prostate & uvula projects into bladder which impedes urination by distorting the prostatic urethra
57
1) Where are most adenocarcinoma of the prostate cases?
2) Are they palpable via DRE?
3) Where does metastatic disease go?
1) Posterior PZ
2) Yes
3) To iliac and sacral nodes
58
What are the 4 female internal genital organs?
1) Uterus
2) Uterine tubes
3) Ovary
4) Vagina
59
List and define the 3 parts of the body of the uterus
1) Fundus: rounded part superior to orifices of uterine tubes
2) Isthmus: just superior to the cervix
3) Uterine horns: where uterine tubes enter
60
1) The rounded part of the uterus superior to orifices of uterine tubes is called what?
2) What part of the uterus is just superior to the cervix?
1) Fundus
2) Isthmus
61
List and define the 3 layers of the wall of the uterus
1) Perimetrium: outer serous coat, peritoneum + connective tissue
2) Myometrium: middle muscular coat of smooth muscle – majority of vessels and nerves course within this coat
3) Endometrium: inner mucous coat, firms adheres to myometrium
62
1) What part of the wall of the uterus is actively involved in the menstrual cycle? What does it do?
2) Where does implantation occur with conception?
1) Endometrium differs in structure with each stage of cycle, inner surface is shed during menstruation
2) Endometrium (within fundus of uterus)
63
1) What does the ligament of the ovary do? Where?
2) What does the the round ligament of the uterus attach?
3) What does the round ligament enter and where does it end?
1) Connects the ovary to the uterus; near the uterotubal jct.
2) Attaches close to above, vestiges of the ovarian gubernaculum related to decent of ovary from the posterior abdominal wall
3) The internal/deep inguinal ring and ends within the inguinal canal
64
1) What is prolonged laterally over ovary vessels as the suspensory ligament of the ovary?
2) What keeps uterus relatively centered in the pelvis?
1) Broad ligament of the uterus
2) Broad ligament of the uterus
65
What 3 things make up the broad ligament?
1) Mesovarium
2) Mesosalpinx
3) Mesometrium
66
What 4 things are found between layers of the broad ligament bilaterally?
1) Uterine tubes
2) Ligament of the ovary
3) Round ligament of the uterus
4) Suspensory ligament of the ovary
67
1) What extend laterally and open into the peritoneal cavity near the ovaries?
2) What part of this is intramural?
1) Oviducts or fallopian tubes
2) Uterine part
68
1) Where are the oviducts or fallopian tubes?
2) Define and describe the infundibulum
3) List the last 3 parts of the fallopian tubes
1) Lie in mesosalpinx of the free edge of the broad ligament
2) Funnel shaped distal end of fallopian tube, fimbriae spread over the surface of the ovary, one large ovarian fimbria is attached to the ovary
3) Ampulla, isthmus, and uterine part (intramural, uterine ostium)
69
1) What are the ovaries near?
2) What are they suspended by?
1) The attachment of the broad ligament to the lateral pelvic walls
2) Mesovarium (both peritoneal folds) and the suspensory ligament of the ovary
70
What is the significance of "fill and spill"?
How to tell if the fimbriae open into the peritoneal cavity
71
1) Is the vagina retroperitoneal, intraperitoneal, or something else?
2) Where does it extend from and to?
1) Mostly subperitoneal
2) From posterior fornix to the vestibule of the vagina
72
1) Superior end of vagina surrounds what?
2) The recess around the protruding cervix is called what?
3) What are the 3 recesses called?
4) Which recess is deepest? What is it related to?
1) Cervix
2) Vaginal fornix (3)
3) Anterior, postural, and lateral recesses
4) Posterior fornix is deepest, related to rectum
73
What other vessel is near the ureter and uterine artery?
Internal iliac
74
What 6 structures can be palpated vaginally?
1) Uterus: Size and position, composition (fibroids), gravid, cervix & CMT
2) Bilateral “adnexa”: Ovaries, uterine tubes
3) Bladder
4) Anterior rectum
5) Sacral promontory (pelvic inlet)
6) Ischial spine (for pudendal nerve block)
75
1) Where is lymph drained from female pelvic viscera to?
2) Where is it drained from the female perineum to?
1) Internal, external, common iliac nodes & sacral node
2) Perineum to superficial inguinal nodes
76
1) Where is the rectum?
2) What shape is it in lateral views?
3) What can be seen in A-P view?
1) Sigmoid colon to anal canal
2) S-shaped
3) 3 lateral flexures
77
1) 3 _________________ of rectum are formed in relation to 3 Transverse rectal folds.
2) Puborectalis m. helps create what? At what angle? What does it perforate?
3) Resting state is by what?
1) lateral flexures
2) Anorectal flexure; ~ 80-degree, perforates the pelvic diaphragm as the anal canal
3) Tonus of the puborectalis m
78
What are the two main arterial supplies of the rectum and anus?
1) IMA's superior rectal artery
2) Branches of internal iliac
79
What does the superior rectal artery from the IMA do?
Supplies proximal rectum
80
1) What do the middle rectal arteries drain?
2) What branch off the internal pudendal arteries? What do they supply?
1) Middle and inferior rectum
2) Inferior rectal arteries; anorectal jct. and anal canal
81
What are the 4 main venous supplies of the rectum and anus? List what each drains to
1) Rectal venous plexuses:
-Internal (just deep to epithelium)
-External (to muscular wall of rectum)
2) Superior rectal veins
-Drains into portal veins
3) Middle rectal v.
-Drain into systemic veins
4) Inferior rectal v.
-Drains into systemic veins
82
1) What causes internal hemorrhoids?
2) What causes external hemorrhoids?
1) Prolapses of rectal mucosa
2) Thrombi
83
1) What veins are involved in internal hemorrhoids?
2) What veins are involved in external hemorrhoids?
1) Veins of internal rectal venous plexus
2) External rectal venous plexus
84
1) What do internal hemorrhoids do?
2) What do external hemorrhoids do?
1) Strangulate, ulcerate, bleed
2) Increase portal or abdominal pressure
85
1) Are external hemorrhoids painful or painless? Why?
2) What innervation is responsible in this area?
1) Painful, b/c they're below pectinate line
2) Somatic fibers from inferior rectal nerves
86
In the intrinsic defecation reflex:
1) What is the stimulus?
2) What are the receptors?
3) What are the afferents?
4) What center is involved?
5) What are the efferents?
6) What are the effectors?
7) What is the response?
1) Feces enters the rectum, distention of rectal wall
2) Stretch receptors in the rectal wall
3) Sensory fibers terminating in the MYENTERIC plexus
4) MYENTERIC plexus
5) Motor signals to smooth muscles
6) Smooth muscle cells of descending, sigmoid colon, and rectum
7) Peristaltic waves forcing feces towards rectum; relaxation of internal anal sphincter.
87
What are the 6 palpable structures rectally? (in males)
1) Posterior prostate: CZ and PZ*
2) Seminal glands
3) Pelvic surface of sacrum and coccyx*
4) Ischial spines and tuberosities
5) Enlarged Internal iliac LN
6) Inflamed appendix
88
1) Where is the pelvic compartment?
2) What is the perineal surface/ region? What shape is it with the legs abducted/ in lithotomy position?
3) What is the perineal body?
1) Inferior to pelvic diaphragm (levator ani and coccygeus mm.)
2) Narrow area between the thighs with legs adducted, diamond shaped
3) Fibromuscular “center of” mass of perineum
89
What are the 3 layers preventing the abdomen/ pelvis from the outside?
1) Pelvic floor
2) Pelvic compartment
3) Perineal body
90
What are the triangles of the perineum connected by?
Transverse line connecting anterior ends of ischial tuberosities
91
1) What triangle does the perineal membrane cover?
2) What part of the pelvic outlet does it cover?
3) What perforates it in males and females?
1) Covers UG triangle
2) Covers anterior part of pelvic outlet
3) Urethra and vagina in females, urethra in males
92
What muscle of the perineum is NOT involved in the perineal body?
Ischiovernosus muscle
93
List 2 perineal muscles that meet at the midline
1) Bulbopspongiosus m.
2) Ischiocavernosus m.
94
1) The perineal body receives smooth and voluntary slips of muscle from what 3 places?
2) List 2 muscles involved in the perineal body
3) What sphincter does it contain?
1) Ext urethral sphincter, levator ani, and muscular coats of rectum
2) Bulbospongiosis m. and Superficial and deep transverse perineal m.
3) External anal sphincter
95
1) What is the ischo-anal fossa?
2) Where is it?
3) What 2 things is it filled with?
1) Fascia lined wedge-shaped space between the skin of the anal region and the pelvic diaphragm
2) Around the wall of the anal canal
3) Fat and loose connective tissue
96
What exit to the perineum at the pudendal canal?
Internal pudendal vessels and nerve
97
What is the pudendal canal and what does it contain? (2 vessels and 2 nerves)
Canal in obturator fascia containing:
1) Internal pudendal artery and vein
2) Pudendal nerve
3) Nerve to obturator internus m.
98
What does the pudendal canal provide neurovascular supply/innervation for?
Perineum
99
1) What does the internal iliac artery branch into? Where?
2) What does that divide into?
3) What supplies most of the perineal viscera?
1) Internal pudendal artery thru canal
2) Divide into posterior and anterior branch
3) Anterior branch
100
After the Pudendal nerve (S2-3-4) enters canal, what 3 things does it branch into?
1) Inferior rectal/anal n.
2) Perineal nerve (has 2 branches)
3) Dorsal n. of the penis/clitoris
101
1) As the internal pudendal vessels and pudendal nerve enter [pudendal] canal, they give rise to what artery and nerve?
2) What do these supply?
3) What happens at the distal end of the canal?
1) Inferior rectal a. & n.
2) External anal sphincter and perianal skin
3) Both vessels and nerves bifurcate
102
At distal end of the pudendal canal, both vessels and nerves bifurcate into what?
1) Perineal nerve and artery
2) Dorsal artery and nerve to penis/clitoris
3) Central vein of the penis and clitoris (drains the erectile tissue)
103
Describe the 2 perineal nerve branches; what does one give rise to and where does the other go?
1) Superficial perineal n.: give rise to posterior scrotal and labial cutaneous branches
2) Deep perineal n.: to muscles of the deep and superficial pouches, vestibule of vagina, mucosa of inferior most part of vagina
104
1) What is the anal canal?
2) What are its two sphincters?
1) Continuation of rectal ampulla & anorectal flexure/puborectalis sling
2) Internal and external anal sphincter
105
1) Is the external anal sphincter voluntary? What does it surround and what does it blend with?
2) What innervates it?
1) Voluntary; surrounds inferior 2/3 of anal canal, blends superiorly with puborectalis
2) S4 via inferior anal (rectal) nerves (from pudendal nerve)
106
1) What makes up the internal anal sphincter? What does it surround?
2) What stimulates its tone?
3) What inhibits (relaxes) it?
1) Smooth muscle; superior 2/3 of anal canal
2) Sympathetic fibers from hypogastric plexus
3) Parasympathetic fibers
107
Voluntary control can usually override the involuntary reflex caused by what?
Fecal distention of rectal ampulla
108
1) What structures do the anal columns contain the terminal branches of?
2) Where is the anorectal junction?
3) What forms the pectinate line?
1) Superior rectal artery and vein (IMA)
2) At superior ends of anal columns
3) Inferior limit of anal sinuses form
109
1) What do anal valves join?
2) What do they form?
3) What do these do when compressed?
1) Inferior ends of anal columns
2) Anal sinuses
3) Exude mucous (anal glands in dogs)
110
1) What is the mons?
2) What is the labia majora? What is it bound to?
3) What does the labia major protect?
1) Fatty eminence anterior to pubic symphysis, fat increases at puberty and covered in hair
2) Prominent folds of skin, bound the pudendal cleft (between labia majora)
3) Urethral and vaginal orifice
111
What structure of the labia major often disappears after vaginal birth?
Anterior commissure from mons pubis to posterior commissure or fourchette
112
1) What are the labia minor? What do they contain a core of?
2) What encloses the labia minor?
3) What does it surround?
1) Fat free folds, hairless, core of erectile tissue and vessels
2) Pudendal cleft/labia majora
3) The vestibule into which the urethra, vagina, & vestibular glands open
113
The labia minor anteriorly form 2 lamina; what are they? What do they each unite to form?
1) Medial laminae unite to form frenulum of the clitoris
2) Lateral laminae unite to form the prepuce of the clitoris
114
1) What type of tissue makes up the clitoris?
2) What make up its root and body? What 2 things do these transition into?
1) Erectile tissue
2) 2 crura; corpora cavernosa and glans
115
1) What are the bulbs of the vestibule?
2) What are they deep to?
3) What are they covered by?
1) Paired masses of elongated erectile tissue
2) Deep to the vestibule of the vagina
3) Bulbopspongiosus m.
116
List and define the two types of vestibular glands
1) Greater (Bartholin gland): each side of vestibule, open on each side of the vaginal orifice, secrete mucous during sexual arousal
2) Lessor glands: smaller, bilateral, between urethral and vaginal orifice, secrete mucous
117
1) What artery supplies the vulva? What does it supply specifically?
2) What is the venous drainage of the vulva?
3) What does venous engorgement during sexual arousal cause?
1) Internal pudendal; most of skin, external genitalia, perineal m.
2) Tributaries of internal pudendal veins
3) Increase in size and consistency of clitoris and bulbs of the vestibule
118
1) Where do the vulva lymphatic drain initially?
2) What innervates the vulva anteriorly, laterally, and posteriorly?
3) What is the main nerve of the perineum?
1) To superficial and deep inguinal nodes
2) Anteriorly: ilio-inguinal and genitofemoral nerves,
-Laterally: pudendal nerves
-Posteriorly by posterior cutaneous n. of the thigh.
3) Pudendal nerve
119
1) What is the anatomic position of the penis?
2) What are its 3 parts?
3) What does it contain 3 cylinders of?
1) Anatomical position is erect
2) Root, body, glans
3) Erectile tissue (corpora)
120
List and describe the 3 cylinders of erectile tissue (corpora) of the penis
1+2) Paired corpora cavernosa: Fused in median plane, except posteriorly where they separate and form crura of penis
3) Single corpora spongiosum ventrally: Contains spongy urethra
121
1) What forms the crura of penis?
2) What contains spongy urethra?
1) Corpus cavernosa are fused in median plane except posteriorly where they separate and form crura of penis
2) Single corpora spongiosum ventrally
122
What does the root of the penis contain? What 3 things does this contain?
Paired Crus (Crura) and unpaired Bulb:
1) Proximal parts of corpora
2) Crus attached near ischial tuberosities
3) Bulb pierced by the urethra
123
What 2 muscles and 1 covering cover the root of the penis?
1) Ischiocanvernosus and Bulbopspongiosus muscles
2) Tunica albuginea (fibrous covering)
124
1) What is the glans of the penis?
2) What is a distinct structure of the glans? Describe this structure
3) What does the neck of the glans delineate?
1) Expanded corpus spongiosum
2) Corona; projects beyond end of corpora cavernosa and over hangs the neck of the glans
3) Glands from body
125
What opening does the glans of the penis contain?
External urethral opening of spongy urethra
126
1) What supplies the anterior scrotum with blood?
2) What about the posterior scrotum?
1) Anterior scrotal arteries via External pudendal artery
2) Posterior scrotal arteries via terminal br. Internal pudendal artery
127
The pudendal n and posterior femoral cutaneous n. are both involved in innervating what?
Posterior scrotum
128
1) What is the arterial supply of the penis?
2) What does the venous plexus drain? What does this plexus become?
1) Branches of internal pudendal artery
2) Blood from cavernous spaces of the corpora cavernosa; becomes dorsal vein of penis
129
What make up the perineal body? (4 groups of things)
1) Superficial and deep transverse perineal m
2) Ext anal sphincter
3) Bulbospongiosis
4) Slips of muscle
130
1) Where would you block the pudendal nerve for the lateral perineum?
2) What type of nerve block works for the anterior perineum?
1) Near ischial spine
2) Ilioinguinal nerve block
131
1) What is the landmark for local infiltration of anesthetic for the perineal region?
2) What part wouldn't be blocked from this type of nerve block? Why?
1) Ischial spine
2) Anterior perineum; innervated by ilioinguinal nerve
132
List 4 results of parasympathetic stimulation during female sexual response
1) Increased vaginal secretions
2) Erection of the clitoris
3) Engorgement of erectile tissue in the bulbs of the vestibule
4) Bulbospongiosus and ischiocavernosus muscles reflexively contract to decrease venous drainage
133
What 3 things cause ejaculation?
1) Sympathetic stimulation closes the internal urethral sphincter
2) Parasympathetic stimulation contracts urethral muscles
3) Pudendal n. stimulation contracts the bulbospongiosus muscles
134
What does the Central vein of the penis and clitoris do?
Drains the erectile tissue
