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Perineum and Pelvis AZCOM
Perinum and Pelvis
116
Anatomy
Post-Graduate
12/10/2011

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Term
What prevents body weight from rotating the sacrum anteriorly?
Definition
Sacrotuberous and Sacrospinous ligaments
Term
What provides access for a caudal epidural anesthesia?
Definition
Sacrial Hiatus into the Sacral Canal
Term
What travels through the greater and lesser sciatic and obturator canals?
Definition
Greater and Obturator- neurovasculature to the lower limb
Lesser- pelvic neruovasculature to the perineum
Term
What defines the pelvic brim?
Definition
Linea terminalis, (2parts- arcuate line of the ileum, pectineal line of the pubis
Term
What is the tilt of the pelvis from horizontal?
Definition
55 deg
Term
Diagonal vs obstetric conjugate
Definition
Obstetric is from the inferior border of the pubic symphisis, diagonal is from middle of pubic symphisis
Term
What are the male and female subpubic angles?
Definition
male <70 female>80
Term
What makes up the sacral plexus, and it is anterior to what M?
Definition
Anterior rami and is ant to piriformis
Term
Obturator Internis Origin and Insertion
Definition
O-Obturator Fascia, I-through the lesser sciatic foramen to the greater trochanter of the femur.
Term
The Pelvic diaphragm is made up what two muscles?
Definition
Coccygeous and levator Ani
Term
What is the vestigial tail M
Definition
Coccygeous
Term
What are the two openigns in the Levator Ani?
Definition
Anterior- Urogenital Hiatus, Posterior- Anal Aperture
Term
What three MM make up the levator ani?Antmedial to Midlaterally
Definition
Puborecatlis, pubococcygeous, Iliococcygeous.
Term
The midline raphe is what superficially?
Definition
The anococcygeal ligament
Term
What happens in pelvic MM during deficatino?
Definition
Puborectalis relaxes, levator ani contract
Term
What can result from a weak pelvic diaphragm?
Definition
Urinary incontinence, bowel incontinence, prolapse of the pelvic viscera through the perineum
Term
What are the three N projecting laterally from the Sacral plexus, AKA "posterior division"?
Definition
Superior Gluteal, Inferior Gluteal, Nerve to Piriformis
Term
What are the three N projecting medially from the Sacral plexus? AKA "anterior divisions"?
Definition
N to Obterator Internis, Pudendal N, N to Levator Ani
Term
Obturator N is from what level, goes to what plexus, and innervates what?
Definition
L2-4, Lumbar Plexus, Medial M of the thigh
Term
The lumbosacral Trumk is from what level? and has what end?
Definition
inf 1/2 of Anterior ramus of L4 and Anterior Ramus of L5, it enters into the sacral plexus
Term
What causes "Back Labor?"
Definition
Compression of the Sacral Plexus by childbirth or Pelvic tumors.
Term
What is the level and innervation of the Superior Gluteal N?
Definition
L4 to S1 to the Lesser Gluteal MM
Term
What is the level and innervation of the Inferior Gluteal N?
Definition
L5-S2 to the Gluteus Maximus
Term
What is the level of the posterior cutatneous N of the thigh?
Definition
S1-3, exits inferior to piriformis
Term
What two N make up the Sciatic and they are comprised of what levels?
Definition
L4-S3 tibial and fibular N
Term
What is the level of the Pudendal N? What landmark does it cross?
Definition
S2-4, crossesl the iscial spine, deep to the sacrotuberous lig.
Term
What levels are the nerves to the Levator Ani and obturator Internis?
Definition
LA-S3-4, OI-L5-S2
Term
Nerves from t12
Definition
Subcostal N
Term
Nerves from L1
Definition
Iliohypogastric/Ilioinguinal
Term
Nerves from L1-2
Definition
Genitofemroal Nerve
Term
Nerves from L2-3
Definition
Lateral Femoral Cutaneous N.
Term
Nerves from L2-4
Definition
Obturator N, Femoral N
Term
Nerves from L4-5
Definition
Lumbar Sacral N
Term
Nerves from L4-S1
Definition
Superior Gluteal N.
Term
Nerves from L5-S2
Definition
Inferior Gluteal, Obturator Internis
Term
Nerve from S1-S3
Definition
Posterior Cutaneous N of the Thigh
Term
Nerve from S2-4
Definition
Pudendal N
Term
Nerve from S3-4
Definition
Levator Ani
Term
Levels of Nerves to Sciatic N
Definition
L4-S3
Term
Where does the common Iliac Artery branch?
Definition
at the pelvic brim
Term
What are the differing courses of Gonadal Arteries?
Definition
Laterally through the deep ring for testes, Medial to ovaries in Female.
Term
What are the three branches of the posterior division of the internal Iliac?
Definition
Superior gluteal, iliolumbar, lateral Sacral
Term
Sup. Glut. A courses through what?
Definition
The lumbar trunk and first branch of the Sacral Plexus.
Term
Name the 8 Anterior branches of the Internal Iliac using general pattern lateral to medial.
Definition
Obturator-Umbilical (which splits to medial umbilical Lig and Su. Vessical A)-Inferior Vessical or Uterine-Middle Rectal- Internal Pudendal- Inferior Gluteal Artery
Term
What is an obturator Abberant artery?
Definition
Artery off internal epigastric that runs over the pubic ramus, have to "super watch out for this" during surgeries.
Term
What A supplies the superior bladder?
Definition
A branch of the Umbilical A
Term
What travels in Alcock's canal?
Definition
Internal Pudendal A and N
Term
Name the 4 arteries to the female reproductive system Superiorly to inferiorly
Definition
Ovarian A, Uterine A, Vaginal A, Internal Pudendal A
Term
The inferior Vessicle A in males supplies what 4 organs?
Definition
Inferior Bladder, ductus deferens, seminal vessicles, prostate.
Term
Trace the path of lymph in the pelvis
Definition
Internal Iliac Nodes- Common iliac nodes- lumbar node- lumbar lymphatic trunk- cysterna chyli- thoracic duct
Term
How do the gonads drain lymph?
Definition
odd man out, Abodminal structures in disguise, Drain to Lumbar Nodes.
Term
What is the 1 pelvic pouch in males and the two peritoneal pouches in females?
Definition
rectovesical, rectouterine and vesicouterine
Term
Is the rectum Retroperitoneal? What causes the anterior flexure?
Definition
Yes, Puborectalis contraction
Term
What are the valves of Houston?
Definition
Transverse folds in the rectum, give feces shape, allow movement and prevent pain.
Term
Where does the superior rectal vein drain?
Definition
Portal Vein
Term
The three anastomosing rectal veins drain where?
Definition
IVC
Term
What creates the ureter/bladder valve?
Definition
Ureters enter posterior superior angle and the oblique passage creates a valve that closes w/pressure
Term
What is water under bridge? why is it important?
Definition
Ureters pass inferior to the Uterine AA, ureters can be damaged during a hysterectomy
Term
What separates the bladder from the pelvic bone?
Definition
Retropubic space of Retzius
Term
What are the 4 parts of the bladder?
Definition
Fundus, Apex, Trigone and Neck
Term
Which urethral sphincter is voluntary?
Definition
External
Term
What contacts the bladder in males?
Definition
Rectovesical septum, seminal glands, ampuallae of D.Def.
Term
What contacts the bladder in females?
Definition
Superior and anterior wall of the vagina
Term
How could you insert an exterior catheter w/o entering the peritoneal cavity?
Definition
the space of retzius
Term
What three parts make up the round ligament?
Definition
Mesosaplinx (around the uterine tube), Mesovarium (around the ovaries), mesometrium (the rest, contains the round ligament)
Term
Define ovarian A, V, Lymph drainage
Definition
A of abdominal Aorta, V return to IVC, L goes to renal vein. Lymph to lumbar nodes.
Term
Why is PID common in females?
Definition
Uterine tubes are open to Peritoneal Cavity
Term
What are the three layers to the uterus?
Definition
Perimetrium- visceral peritoneum, Myometrium- Smooth muscle, Endometrium- lining of glandular mucosa.
Term
What is the site of papsmear
Definition
external os
Term
What is normal Uterine position?
Definition
Anteflexed
Term
What are the two major Uterine Ligaments?
Definition
Uterosacral (posterior to sacrum) and Cardinal or transverse cervical lig (contains A V)
Term
What is the fornix? What are the sides called?
Definition
Cervical projection into the vagina, Ant, Post, 2Lat
Term
What is the correlation of the posterior fornix and endoscopic exams?
Definition
It is the inferiormost portion of the peritoneal cavity
Term
What is the male vagina called? Where does muscle obliteration stop when correcting for BHP?
Definition
Prostatic Utricle
Term
what are the four things that make up semen?
Definition
Sperm, Secretions of Seminal Vessicles, Prostate, bulbourethral glands
Term
What is the traditional definition of prostatic lobes?
Definition
Anterior, Posterior (inferior to E.D.), Median (superior to E.D.), R,L lobes
Term
What is the new difinition/names of prostatic lobes?
Definition
ASII, Anteriomedial, Superiomedial, Inferolateral, Inferoposterior
Term
What lobe causes BHP?
Definition
Superomedial, Median
Term
Why can prostate cancer quickly reach the CNS?
Definition
Inferior veins have no valves and anastomose with the vertebral plexes
Term
What are the soft tissue boundaries of the perineum
Definition
Later Walls- Obt. Internus, Roof- Pelvic Diaphragm (with UG hiatus and Anal Aperture
Term
What are the three spaces in the perineum?
Definition
Deep and superficial perineal pouches and the Perineal cleft
Term
Vaginal Prolapse can result from the weakening of what?
Definition
Perineal Body
Term
Where do the R and L points of the Ischioanal Fossae communicate?
Definition
Posteriorly, superior to the ancocccygeal ligament
Term
What is the inferiormost site of portal-caval anastomoses?
Definition
Anal Canal
Term
What forms the division of endodermal and ectodermal parts of the rectum?
Definition
Pectiate line
Term
What are the three physical characteristics of the pectinate line?
Definition
Columns, Valves (crescent shaped), Sinuses
Term
What is the A and N to the superior Anal Canal?
Definition
Superior Rectal A, ANS innervation/ Inferior rectal A, Inferior rectal N (somatic)
Term
What is the site of external hemmorhoids?
Definition
Anal canal inferior to the pectinate line
Term
What are the contents of the superficial perineal pouch?
Definition
erectile tissues and associated muscles
Term
What are the two types of erectile bodies?
Definition
Corpus spongiosum, corpora cavernosa
Term
What secures the clittoris into place (there is no "bulb")
Definition
Suspensory Ligament of the Clittoris
Term
What binds the corpus spongiosum to the corpora cavernosa?
Definition
Deep (Bucks) fascia
Term
What lies between the deep fascia and the skin?
Definition
Superior Fascia of penis
Term
the dorsal N of Clittoris, Penis passes through which pouch?
Definition
Deep pouch
Term
What landmark is used for pudendal N block?
Definition
Ishcial Spine
Term
The internal pudendal A travels on what side of the pudendal N?
Definition
lateral to the pudendal N
Term
What are the 5 branches of the internal pudendal A?
Definition
Dorsal/Deep AA of Clittoris/Penis. Perineal A, Inferior rectal A, A of bulb.
Term
What is the exception in normal venous return patterns in the perineum?
Definition
There is only one dorsal V of clittoris/Penis w/2 AA
Term
What Venous plexes are at risk during pelvic fracture?
Definition
The prostatic plexus, includes veins and autonomic plexes.
Term
What is the difference in lymphatic drainage b/t deep and superficial perineal tissues?
Definition
Deep= Internal Pudendal Vessels to Internal iliac nodes. Superficial to Superficial inguinal nodes, GONADs to lumbar!!
Term
Where does the straddle injury take place? Location? Space?
Definition
Inferior to the perineal Membrane, in the membranous urethra, space b/t perineal membrane and deep perineal fascia
Term
Where does the bloody urine from a straddle injury go?
Definition
Forced to break through the corpus spongiosum to enter the perineal cleft
Term
Where does the bloody urine from a straddle injury go ifthe injury is superior to the perineal membrane?
Definition
The urine will be restricted to the deep pouch and abdominopelvic diaphragm
Term
What are the 5 major plexuses of the Pelvis/perineum
Definition
Sup. Hypo, Inf. Hypo, Vesical, prostatic, rectal pelvic plexuses
Term
Sacral and Pelvic Splanchnic N are from what system and originate from what N?
Definition
Sacral-sypathetic, from sympathetic chain, Pelvic splanchnic- parasympathetic from sacral Rami
Term
What is the pelvic pain line?
Definition
where the change in course of visceral nociceptive fibers return.
Aboce: along sympathetic, Below: parasympathetic
Term
how is the suprarenal gland innervated?
Definition
Pre-Symp from t10-L1 through the celiac plexus to chrommafin cells in the medulla. Pos-Symp from celiac to blood vessels
Term
What is the sensory innervation to the ureters?
Definition
Generally in superiro direction vi alumbar and throacic sympathetic splanchnics to T11-12 (hence pain w/stones) spinal cord.
Term
Weakness of what ligaments contribute to uterine prolapse?
Definition
the three ligaments of the uterus, Transverse cervical (Cardinal), the uterosacral, and possibly the vessicouterine
Term
What N innervates the site of anal columns/valves?
Definition
Inferior rectal (branch of pudendal (S2-4)
Term
Lymph above/below pectinate line goes where?
Definition
Above-Internal Iliac
Below-Superficial inguinal
Term
When incising an abcess in the rectal iliorectal fossa, what structures must be avoided?
Definition
Inferior rectal NAV
Term
If the R thigh swells with a straddle injury, what fascial layers could have been injured?
Definition
Fascia lata/colles fasica
Term
The perineal cleft is not continuous with what three areas?
Definition
Anal triangle, Medial thigh, the back
Term
Name the continuous fasces anterior to posterior begininign with EAO Aponeurosis
Definition
EAO Apo- Suspensory ligament of the penis- buck's fascia-external spermatic fascia- Deep perineal fascia

S-B-E-D
Term
Name the continuous fasces anterior to posterior begininign with Superficial fascia of the penis
Definition
SupFasica Penis- dartos- Scarpas- Colles

S-D-S-C
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