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M2 Anatomy > Reproductive System (Perineum) > Flashcards

Reproductive System (Perineum) Flashcards

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1
Q

State the principal arteries of the PERINEUM and PELVIS

A

Perineum - internal pudendal A
Pelvis - internal iliac A

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2
Q

SCROTUM
- ____ of the lower part of ____ abdominal wall
- Contents:

A

SCROTUM
- OUTPOUCHING of the lower part of ANTERIOR abdominal wall
- Contents: TESTIS + EPIDIDYMIS + SPERMATIC CORD

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3
Q

Explain the descent of testis during embyronic development

A
  1. Testis originally located on POSTERIOR ABDOMINAL WALL
  2. During descent around 12th week - peritoneum evaginates –> processus vaginalis
  3. Around 9th month, testis travels through deep inguinal ring, inguinal canal, superfiical inguinal ring and reaches scrotal sac
  4. Obliteration of processus vaginalis occurs a few weeks before birth
  • Gubernaculum anchors inferior pole of testis to scrotal skin
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4
Q

What is ‘TUNICA VAGINALIS’ and ‘PROCESSUS VAGINALIS’

A

tunica vaginalis - visceral layer further from parietal wall

processus vaginalis - evagination of peritoneum

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5
Q

State the functions of fluid found between the layers of the tunica vaginalis. (3)

A
  1. Lubrication - allows testis to move smoothly within scrotum by reducing friction and preventing damage to delicate tissues
  2. Protection - provides cushion to absorb minor shocks or trauma that might occur due to movement/externa l impact
  3. Temperature regulation - regulates heat to ensure testes are maintained at optimal temperature of spermatogenesis
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6
Q

Define HYDROCELE and state the types of HYDROCELE.

A

Hydrocele = abnormal collection of serous fluid between 2 layers of tunica vaginalis of testis

  1. Communicating hydrocele
  2. Non-commuicating hydrocele
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7
Q

Explain how the 2 types of HYDROCELE occur.

A

COMMUNICATING HYDROCELE
- When obliteration of processus vaginalis fails to occur –> creates potential space that communicates with peritoneum

NON-COMMUNICATING HYDROCELE
- Upper part of processus vaginalis closes –> no connection between abdomninal cavity and sac around testicle in scrotum
- Occurs due to injuries, infections, tumours, systemic disorders (HF, liver disease)

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8
Q

How do we diagnose and differentiate the different types of HYDROCELE

A

DIAGNOSIS = transillumination of testicle upon shining of light (as compared to non-transillumination in the event of other scrotal masses)

DIFFERENTIATE
- Communicating hydrocele = clear history of appearance (at end of day) and disappearance (morning) as fluid enters peritoneal cavity during sleep
- Non-communicating hydrocele = no change in size

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9
Q

Recap: Name the layers of the ANTERIOR ABDOMINAL WALL from most superficial to deepest

A
  1. skin
  2. camper fascia
  3. scarpa fascia
  4. investing (deep) superficial fascia
  5. EOM
  6. investing (deep) intermediate fascia
  7. IOM
  8. investing (deep) deep fascia
  9. TAM
  10. transversalis fascia
  11. extraperitoneal fat
  12. parietal peritoneum
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10
Q

FUSION/CONTINUAITON OF FASCIA OF ANTERIOR ABDOMINAL WALL:
1. Scarpa’s fascia fuses with ____ in the thigh
2. Scarpa’s fascia continues as ____ fascia in the perineal region
3. ____ fascia is attached to the lower part of ____ membrane
4. Camper’s fascia continues as ____ muscle

A

FUSION/CONTINUAITON OF FASCIA:
1. Scarpa’s fascia fuses with FASCIA LATA in the thigh
2. Scarpa’s fascia continues as COLLES’ fascia in the perineal region
3. COLLES’ fascia is attached to the lower part of PERINEAL membrane
4. Camper’s fascia continues as DARTOS muscle

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11
Q

FUSION/CONTINUATION OF MUSCLES OF ANTERIOR ABDOMINAL WALL:
- EOM continues in testis as ____ fascia
- IOM continues in testis as ____ muscle and fascia
- ____ does not continue into scrotal area
- Transversalis fascia continues as ____ fascia
- Processus vaginalis continues as ____

A

FUSION/CONTINUATION OF MUSCLES OF ANTERIOR ABDOMINAL WALL:
- EOM continues in testis as EXTENAL SPERMATIC fascia
- IOM continues in testis as CREMASTER muscle and fascia
- TAM does not continue into scrotal area
- Transversalis fascia continues as INTERNAL SPERMATIC fascia
- Processus vaginalis continues as TUNICA VAGINALIS

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12
Q

State the structures that continue as
- dartos muscle
- cremaster muscle

A

dartos muscle - continuation of CAMPER FASCIA

cremaster muscle - continuation of IOM

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13
Q

INTERNAL PUDENDAL ARTERY
- Branch of anterior division of ____ A (primary blood supply to ____)
- Exits pelvis inferiorly via ____ foramen and re-enters perineum through ____ foramen
- 3 branches:
- Blood supply:

A

INTERNAL PUDENDAL ARTERY
- Branch of anterior division of **INTERNAL ILIAC A **(primary blood supply to PERINEUM)
- Exits pelvis inferiorly via GREATER SCIATIC foramen and re-enters perineum through **LESSER SCIATIC **foramen
- 3 branches: Inferior rectal A, Perineal A, Dorsal A of penis/clitoris
- Blood supply: Skin, structures of perineum + anal + urogenital regions

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14
Q

PUDENDAL NERVE
- Arises from ____ rami of spinal neres ____ - ____
- Has both ____ and ____ functions
- Carries only ____ autonomic fibers
- Exits pelvis through ____ foramen –> curves around ____ ligament –> enters perineum through ____ foramen

A

PUDENDAL NERVE
- Arises from ANTERIOR rami of spinal neres S2 - S4
- Has both MOTOR and SENSORY functions
- Carries only SYMPATHETIC autonomic fibers
- Exits pelvis through GREATER SCIATIC foramen –> curves around SACROSPINOUS ligament –> enters perineum through LESSER SCIATIC foramen

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15
Q

State the differences between PELVIC SPLANCHNIC NERVES and PUDENDAL NERVES

A

PELVIS SPLANCHNIC N
- Parasympathetic N
- Arises from lateral horn grey matter of spinal cord (S2-S4)

PUDENDAL N
- Somatic N + Sympathetic N
- Arises from ventral horn grey matter of spinal cord (S2-S4)

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16
Q

State the lymphatic drainage of PERINEUM and MALE/FEMALE GENITALIA

A
  1. Most lymph vesels of perineum - SUPERFICIAL INGUINAL NODES
  2. Glans penis and clitoris - DEEP INGUINAL NODES
  3. Testes - PARA-AORTIC LN (Non-inguinal)
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17
Q

What lymph nodes should be checked in TESTICULR CARCINOMA?

A

PARA-AORTIC LYMPH NODES

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18
Q

PUDENDAL/ALCOCK’S CANAL
- Formed by fascia of ____ muscle and ____ fascia
- Contents (3):
- Bony landmark:

A

PUDENDAL/ALCOCK’S CANAL
- Formed by fascia of OBTURATOR INTERNUS muscle and DEEP PELVIC fascia
- Contents (3): Pudendal N, Pudendal A, Pudendal V
- Bony landmark: ISCHIAL SPINE

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19
Q

State the purpose of PUDENDAL NERVE BLOCK (4)

A
  1. analgesia for 2nd stage of labour
  2. repair of episotomy or perineal laceration
  3. outlet instrument delivery (assists pelvic floor relaxation)
  4. minor surgeries for lower vagina and perineum
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20
Q

State the ANATOMICAL RELATIONS of UROGENITAL TRIANGLE and ANAL TRIANGLE

A

UROGENITAL TRIANGLE
- anterior (apex) = pubic symphysis
- laterally = ischial tuberosities

ANAL TRIANGLE
- posteriorly (apex) = coccyx
- laterally = sacrotuberous ligaments

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21
Q

State the content of UROGENITAL TRIANGLE AND ANAL TRIANGLE of females and males

A

ANAL TRIANGLE
- Females and males have the same structural contents
- Anal canal + 2 ischiorectal fossae that lie on either side of the anal canal

UROGENITAL TRIANGLE
- Females = Vaginal orifice, urethral orifice
- Males = Roots of penis, urethral orifice

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22
Q

ISCHIORECTAL FOSSAE
- Wedges shaped spaces filled with ____ and is ____ vascularised
- 2 fossae communicate through ____ space –> clinical application =
- Only ____ side has communication
- Boundaries:

(1) Base of wedge =
(2) Edge of wedge =
(3) Medial wall =
(4) Lateral wall =

A

ISCHIORECTAL FOSSAE
- Wedges shaped spaces filled with FAT and is POORLY vascularised
- 2 fossae communicate through DEEP POSTANAL space –> clinical application = INFECTION EASILY MOVES FROM ONE SIDE TO ANOTHER
- Only POSTERIOR side has communication
- Boundaries:

(1) Base of wedge = skin
(2) Edge of wedge = junction of medial and lateral walls
(3) Medial wall = sloping levator ani + anal canal
(4) Lateral wall = obturator internus + pudendal/alcock’s canal + ischial tuberosity

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23
Q

State the functions of ISCHIORECTAL FOSSAE (2)

A
  1. Passageway for neurovascular structures (pudendal N, pudendal A, pudendal V)
  2. Facilitates defecation (accommodates movement and expansion of anal canal during defecation -> fat-filled space allows expansion without restriction)
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24
Q

ISCHIORECTAL ABSCESS
- Originates in ____ fossa
- Spreads through ____ tissue without any obvious swelling until considerable tension is present
- Spread is limited ____ by ____ fascia which covers the ____ muscle
- Spread is limited ____ by ____ muscle

Study These Flashcards
A

ISCHIORECTAL ABSCESS
- Originates in ISCHIORECTAL fossa
- Spreads through ADIPOSE tissue without any obvious swelling until considerable tension is present
- Spread is limited LATERALLY by OBTURATOR fascia which covers the OBTURATOR INTERNUS muscle
- Spread is limited MEDIALLY by LEVATOR ANI muscle

25
**PERIANAL ABSCESS** - Indication for timely ____ and ____ - ____ administration is inadequate and inappropriate as isciorectal fossa is... - Why can abscesses grow very large?
**PERIANAL ABSCESS** - Indication for timely **INCISION** and **DRAINAGE** - **ANTIBIOTIC** administration is inadequate and inappropriate as isciorectal fossa is **FULL OF FAT AND POORLY VASCULARISED** - Why can abscesses grow very large? - **FATS HAVE LOW DENSITY --> ALLOWS FOR GROWTH OF PUS**
26
**UROGENITAL DIAPHRAGM** - ____-layered tough ____ tissue sheets that fills the ____ triangle - Membrane gives attachment to ____ genitalia - ____ layer of the urogenital diaphragm is thicker and is called the perineal membrane (inferior fascia) --> forms the basis upon which the ____ genital organs are fixed
**UROGENITAL DIAPHRAGM** - **DOUBLE**-layered tough **FIBROUS** tissue sheets that fills the **UROGENITAL** triangle - Membrane gives attachment to **EXTERNAL** genitalia - **INFERIOR** layer of the urogenital diaphragm is thicker and is called the perineal membrane (inferior fascia) --> forms the basis upon which the **EXTERNAL** genital organs are fixed
27
Name the layers of the **UROGENITAL DIAPHRAGM**
1. **superior fascia of urogenital diaphragm** 2. **deep perineal pouch** - houses deep transverse perineal muscle 3. inferior fascia of urogenital diaphragm/**perineal membrane** (thicker for fixation of external genitalia)
28
Name the contents of the **DEEP PERINEAL POUCH** in **MALES** (4)
1. parts of the membranous urethra 2. external urethral sphincter muscle 3. bulbourethral glands 4. deep transverse cervical muscles
29
**EXTERNAL URETHRAL SPHINCTER** - In both men and women, when urethra passes through ____ pouch - Type of muscle: ____ muscle (controlled through ____ nervous system) - Secondary sphincter that controls flow of urine through urethra
**EXTERNAL URETHRAL SPHINCTER** - In both men and women, when urethra passes through **DEEP PERINEAL** pouch - Type of muscle: **SKELETAL** muscle (controlled through **SOMATIC** nervous system) - Secondary sphincter that controls flow of urine through urethra
30
Regarding the **DEEP TRANSVERSE PERINEAL MUSCLE**, state the - Origin: - Insertion: - Action: - Innervation:
Regarding the **DEEP TRANSVERSE PERINEAL MUSCLE**, state the - Origin: **internal surface of ramus of ischium** - Insertion: **perineal body** - Action: **stabilises perineal body --> provides structural support to adjacent pelvic and perineal structures** - Innervation: **Internal pudendal N**
31
**BULBOURETHRAL GLAND** - Accessory sex gland in male reproductive system - Produces ____ fluid to ____ acidic urine residue that remains in ____ (helps in preparation for passage of sperm cells during sexual arousal) - Approximately ____cm long - Opens into ____ urethra - Homologous to ____ gland in females
**BULBOURETHRAL GLAND** - Accessory sex gland in male reproductive system - Produces **PRE-EJACULATORY** fluid to **NEUTRALISE** acidic urine residue that remains in **URETHRA** (helps in preparation for passage of sperm cells during sexual arousal) - Approximately **2.5CM** long - Opens into **SPONGY** urethra - Homologous to **BARTHOLIN'S** gland in females
32
State the contents of **DEEP PERINEAL POUCH** in **FEMALES** (4)
1. part of female urethra 2. part of vagina 3. external urethral sphincter 4. deep transverse perineal muscles
33
State the contents of the **SUPERFICIAL PERINEAL POUCH** in **FEMALES** (3)
1. urethra 2. vagina 3. superficial transverse perineal muscle
34
Regarding the **PENIS**, state - 2 functions: - 3 parts:
**PENIS** - ***Functions*** = *micturition* + *sexual intercourse* - ***Parts*** = *root*, *body*, *glans penis*
35
Explain how glans penis gets its shape.
Gets its shape from **bulbous expansion** of **corpus spongiosum**
36
What are the 2 types of erectile tissue found in **PENIS**
1. corpus cavernosa 2. corpus spongiosum
37
**CORPORA CAVERNOSA** - Pair of ____-shaped corpora cavernosa are seen on each side of ____ triangle - Each ____ is attached to ____ membrane and ____
**CORPORA CAVERNOSA** - Pair of **CYLINDRICAL**-shaped corpora cavernosa are seen on each side of **UROGENITAL** triangle - Each **CRUS** is attached to **PERINEAL** membrane and **ISCHIOPUBIC RAMUS**
38
**CORPORA SPONGIOSUM** - ____ erectile tissue - Anchored at its base to ____ membrane - Base part is known as ____ - Distal ends expand as ____
**CORPORA SPONGIOSUM** - **SINGLE** erectile tissue - Anchored at its base to **PERINEAL membrane** - Base part is known as **BULB** - Distal ends expand as **GLANS PENIS**
39
**FORESKIN** / ____ - ____-layered structure that includes the outer layer of skin and inner ____ membrane - Provides ____ to glans penis and maintains its sensitivity by keeping it ____ - Lacks ____ and ____ --> smoother than body skin
**FORESKIN** / **PREPUCE** - **DOUBLE**-layered structure that includes the outer layer of skin and inner **MUCOUS** membrane - Provides **PROTECTION** to glans penis and maintains its sensitivity by keeping it **MOIST** - Lacks **HAIR FOLLICLES** and **SEBACEOUS GLANDS** --> smoother than body skin
40
**PHIMOSIS** - Definition: - Common complications: - Treatment:
**PHIMOSIS** - Definition: **inability to retract the skin covering the glans penis** - Common complications: **Foreskin inflammation**, **UTI**, **Poor hygiene**, **Penile cancer** (long-standing phimosis) - Treatment: **Circumcision**
41
Name the 2 types of **MUSCULATURE** found in **PENIS**
1. ischiocavernous muscle 2. bulbospongiosus muscle
42
State the functions and innervation of **ISCHIOCAVERNOUS** and **BULBOSPONGIOSUS** muscles
**Innervation** = *pudendal nerve* (S2-S4 somatic motor + sympathetic) **Ischiocavernosus** - *spirals over corpora cavernosa* --> support and *movement* of erect organ **Bulbospongiosus** - *spirals over corpora spongiosum* --> *emptying of urethra* (last few drops) + *expulsion of semen* during ejaculation
43
Explain the mechanism of **ERECTION** and **EJACULATION**
1. male stimulated erotically 2. **paraysmpathetic fibers stimulated** and **relaxes smooth muscles** in fibrous trabeculae and **dilates arteries** 3. **cavernous spaces fill** with blood 4. blood-filled space **compresses veins against tunica albuginea** 5. **blocks backflow of blood** which leads to pool of blood int he penis - **ERECTION** (PARASYMPATHETIC) 6. **internal urethral sphincter closes** to **prevent backflow of semen into bladder** - **EJACULATION** (SYMPATHETIC)
44
**STRUCTURES OF THE VULVA:** 1. ***Mons Pubis*** - mound of ____ skin and ____ located in front of the ____ 2. ***Labia Majora*** - 2 hair beairng external skin folds filled with ____ tissues and terminal part of the ____ ligament 3. ***Labia Minora*** - 2 hairless thin folds of skin lying within ____ 4. ***Vestibule*** - Area enclosed by labia minora containing openings of vagina and urethra 5. ***Clitoris*** - ____ structure homologous to male ____
**STRUCTURES OF THE VULVA:** 1.***Mons Pubis*** - mound of **HAIR** skin and **SUBCUTANEOUS FAT** located in front of the **PUBIC SYMPHYSIS** 2. ***Labia Majora*** - 2 hair beairng external skin folds filled with **SUBCUTANEOUS** tissues and terminal part of the **ROUND** ligament 3. ***Labia Minora*** - 2 hairless thin folds of skin lying within **LABIA MAJORA** 4. ***Vestibule*** - Area enclosed by labia minora containing openings of vagina and urethra 5. ***Clitoris*** - **ERECTILE** structure homologous to male **PENIS**
45
Label the **VULVA**
46
State the structures that the **CLITORIS** contains
1. **2 corpora cavernousa** 2. **glans clitoris** (area where thin strand of spongiosum ends into clitoris after bilateral vestoibular bulbs unite)
47
Regarding the **CORPORA CAVERNOSA**, - It is a pair of ____ shaped erectile tissues seen on each side of the ____ triangle - Each crus of clitoris is attached to ____ membrane and _____
Regarding the **CORPORA CAVERNOSA**, - It is a pair of **CYLINDRICAL** shaped erectile tissues seen on each side of the **UROGENITAL** triangle - Each crus of clitoris is attached to **PERINEAL** membrane and **ISCHIOPUBIC RAMUS**
48
Regarding the **CORPUS SPONGIOSUM**, - It splits into two --> forms ____ bodies of ____ tissue called bulbs of ____ to make way for vagina and urethra - Bilateral vestibular bulbs unite ____ to urethral orifice --> forms thin strands of ____ erectile tissue that ends into ____ as glans
Regarding the **CORPUS SPONGIOSUM**, - It splits into two --> forms **TWO** bodies of **ERECTILE** tissue called bulbs of **VESTIBULE** to make way for vagina and urethra - Bilateral vestibular bulbs unite **VENTRAL** to urethral orifice --> forms thin strands of **SPONGIOSUM** erectile tissue that ends into **CLITORIS** as glans
49
State the functions of the two muscles in the **CLITORIS**
**ISCHIOCAVERNOSUS** - Compresses citoral crura --> maintains clitoral erection by compressing veins and preventing outflow of blood --> enahcnes clitoral engorgement and sensitivity **BULBOSPONGIOSUS** - Contributes to clitoral erection
50
**PERINEAL BODY** - Central tendon of ____ - Precise location = - Structures attached to perineal body (2) - Muscles attached to perineal body (4) - Contains ____ muscles, ____ fibres and nerve endings
**PERINEAL BODY** - Central tendon of **PERINEUM** - Precise location = **Midline of perineum situated at junction of anus and urogenital triangle in both females and males** - Structures attached to perineal body (2) = **Rectum** + **Vaginal slips** - Muscles attached to perineal body (4) = **Bulbospongiosus muscle** + **Deep/superficial transverse perineal muscles** + **External anal sphincter muscle** + **Levator ani** - Contains **SMOOTH** muscles, **ELASTIC** fibres and nerve endings
51
State the structures that are incised in **EPISOTOMY** (5)
1. subcutaneous tissue 2. superficial and deep transverse perineal muscles 3. bulbospongiosum 4. part of levator ani 5. posterior vaginal wall
52
State the 3 parts of the urethra in **MALES**
1. prostatic urethra 2. membranous urethra 3. spongy/penile urethra
53
**MEMBRANOUS URETHRA** - About ____cm long surrounded by ____ sphincter - Formed from ____ muscle and therefore under ____ control - Innervation of external urethral sphincter =
**MEMBRANOUS URETHRA** - About **1-2CM** long surrounded by **EXTERNAL URETHRAL** sphincter - Formed from **SKELETAL** muscle and therefore under **VOLUNTARY** control - Innervation of external urethral sphincter = **PUDENDAL NERVE**
54
In **RUPTURE OF SPONGY URETHRA IN MALES**, will there be pooling of urine in - Thigh? - Anal triangle? - Anterior abdominal wall?
**Thigh** - No urine as colles' fascia fuses with fascia lata **Anal triangle** - No urine as colles' fascia also fuses with perineal membrane **Anterior abdominal wall** - Yes urine as urine enters superfiical perineal pouch --> scrotum --> accumulates around penis
55
State the number of fornices in VAGINA
4 - 1 anterior, 1 posterior, 2 lateral
56
State the blood supply and lymphatic drainage of vagina and uterus
**BLOOD SUPPLY** - ***Uterine A*** (from internal iliac A) - Upper 4/5 - ***Vaginal A*** (from internal iliac A) - Lower 1/5 - ***Internal pudendal A*** (from internal iliac A) **LYMPHATIC DRAINAGE** - Upper 4/5 - ***iliac nodes*** - Lower 1/5 - ***superficial inguinal nodes***
57
State the nerve supply of VAGINA AND UTERUS.
Upper 4/5 - **inferior hypogastric plexus** (***autonomic*** plexus) --> sensitive only to *stretch* Lower 1/5 - **pudendal nerve** (***somatic*** innervation) --> sensitive to *touch and temperature*
58
State the male homologue of **BARTHOLIN'S GLAND** in **FEMALES**
cowper's/ bulbourethral gland

M2 Anatomy (22 decks)

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