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Anatomy of Pelvis
Soft Tissue Anatomy of the Pelvis-WVSOM Class of 2012
| Question | Answer |
|---|---|
| what is the primary source of digestive enzymes to the small intestine? | pancreas |
| what lies directly posterior to the neck of the pancreas? | superior mesenteric vessels |
| main pancreatic duct joins common bile duct at what junction? | hepatopancreatic ampulla |
| the opening of the hepatopancreatic ampulla into the duodenum is called what? | major duodenal papilla |
| bare area of the liver contacts what organ? | diaphragm |
| what 2 things sit within the right saggital fossa of the liver? | IVC and gallbladder |
| what 2 things sit within the left saggital fissure of the liver? | falciform and round ligaments |
| what is contained in the porta hepatis? | portal vein, hepatic artery proper, and right and left hepatic ducts |
| what are the 5 impressions on the liver? | colic, duodenal, pyloric, renal, and gastric |
| what are the 4 impressions on the spleen? | gastric, pancreatic, renal, and colic |
| splenic vessels are held within what two ligaments? | splenorenal (lienorenal) and gastrosplenic |
| right renal artery passes deep to what structure? | IVC |
| each renal artery gives off one or more vessel to the suprarenal glands; what is this vessel? | inferior suprarenal artery |
| middle suprarenal arteries come off of what vessel? | abdominal aorta |
| what arteries are given off inferior to the renal arteries? | gonadal arteries |
| what arteries supply the thoracic diaphragm? what arteries do these anastamose with? | inferior phrenic arteries; pericardiophrenic and musculophrenic arteries |
| what arteries will branch off of the inferior phrenic arteries? | superior suprarenal arteries |
| what arteries supply the posterior wall of the pelvis? what is important about the first one on the left? | lumbar arteries; gives origin to the medullary branches |
| what autonomic structure is found over the iliac arteries? what fibers come off of this structure? what structures does this connect to? | superior hypogastric plexus; sympathetic fibers; mesenteric and intermesenteric plexi |
| where do parasympathetic fibers come from in the pelvis? | pelvic splanchnic nerves |
| inferior epigastric artery supplies what structure? | rectus sheath |
| deep circumflex iliac artery supplies what muscle? | iliacus |
| what 2 vessels supply the skin around the lateral and medial ends of the inguinal ligament? | superficial circumflex iliac and superficial external pudendal arteries |
| what is the only contribution from the peritoneal organs into the IVC? | hepatic veins |
| which renal vein is usually shorter? | the right |
| the left renal vein is usually covered by what artery? | superior mesenteric |
| the gonadal vein usually goes into which renal vein? | left |
| lumbar vein branches are usually joined together by what vein? | ascending lumbar vein |
| the ascending lumbar vein usually joins which of 2 veins? | azygos on right or hemiazygos on left |
| which kidney is slightly lower? | right |
| renal fascia separates what two layers? | pararenal fat (adjacent to body wall) and perirenal fat (adjacent to kidney) |
| what does renal fascia adhere to? | connective tisuue around the renal vessels |
| where does the right kidney sit? | 1.5 cm lower than left; at the level of the transpyloric plane |
| renal artery branches into what? | upper, lower, and posterior branches |
| venous drainage to the suprarenal glands is usually through which possible veins? | IVC or renal veins |
| ureter surgery should be performed from which direction? | laterally |
| what is spatial relationship of renal veins, ureter, and arteries? | vein is anterior; ureter is posterior; arteries are in between and superiorly |
| what are the 3 locations that kidney stones get hung up? | junction of renal pelvis and ureter; where ureter crosses iliac vein; wall of bladder |
| where are glomeruli and convoluted tubules located? | in the renal cortex |
| where are the loops of henle and collecting ducts located? | in the renal medulla |
| what separates renal pyramids from each other? | renal columns |
| renal calyces, pelvis, and blood vessels are located in what space? | renal sinus |
| what is the intermediate mesoderm called? | nephrotome |
| 3 urinary organs during development? | pronephros, mesonephros, and metanephros |
| what structure remains from the mesonephros? | mesonephric (wolffian) duct |
| what does the wolffian duct produce? | ureteric bud |
| ureteric bud will grow into what structure? | metanephros |
| all collecting structures are formed from what tissue? | metanephros |
| do kidneys ascend or descend? | ascend from differential growth of the lumbar region |
| which vessels usually remain from the aorta following kidney ascent? | only the most superior usually |
| where is the subcostal nerve? what does it supply? | along lateral margin of quadratus lumborum just inferior to 12th rib; muscle and skin of body wall |
| what is the most inferior of the thoraco-abdominal nerves? | subcostal nerve |
| where does the quadratus lumborum attach? | from 12th rib to iliac crest, then attaches to lumbar vertebrae |
| what is the function of the quadratus lumborum? | unilateral contraction will sidebend the spine to the same side; bilateral contraction will assist in spinal flexion |
| iliohypogastric and ilioinguinal nerves arise from what spinal nerve? | L1 |
| ilioinguinal nerve exits from where? what does it innervate? | superficial inguinal ring; skin of base of scrotum and penis |
| genitofemoral nerve arises from what? | L1 and L2 |
| genitofemoral nerve emerges from where? where does it ascend to? | near origin of psoas major; along its anterior surface |
| where does the femoral branch of the genitofemoral nerve travel? the genital branch? | deep to the inguinal ligament with the femoral artery; enters deep inguinal ring, through canal and superficial ring |
| what does the genital branch of the genitofemoral nerve supply? | cremaster and dartos muscles |
| what is the course of the lateral cutaneous nerve of the thigh? | passes deep to inguinal ligament near ASIS |
| what forms the lumbar plexus? what nerves does it give rise to? | ventral rami or L2-L4; femoral and obturator nerves |
| what is the course of the femoral nerve? | courses deep and lateral to psoas major muscle, visible between iliacus and psoas major |
| what is the course of the obturater nerve? | runs deep and medial to the psoas to the obturator foramen in the pelvis |
| where does the sympathetic trunk terminate? | mid-sacral level |
| what nerves come off of the sympathetic trunk, supplying all spinal nerves, including coccygeal nerves? | grey rami communicantes |
| the central portion of the thoracic diaphragm is what? what is thie a remnant of? | central tendon; septum transversum |
| embryologically, where does the thoracic diaphragm begin? | near occiptal region of the embryo |
| when does the thoracic diaphragm gain its innervation from C3-C4? | when it lies adjacent to the cervical somites |
| how are the pleuroperitoneal membranes formed? | pleuroperitoneal folds grow ventrally and medially to fuse with the septum transversum |
| the central portion of the diaphragm is innervated by what nerve? | phrenic nerve |
| 3 openings of the diaphragm are? | vena caval foramen, esophageal hiatus, and aortic hiatus |
| spatial relationship of the 3 openings of the diaphragm? | vena caval foramen is anterior; esophageal hiatus is to the left of vena caval foramen; aortic hiatus is posterior |
| vena caval foramen is at what level? | TV8 |
| esophageal hiatus is what level? | TV10 |
| what passes through the esophageal hiatus? | esophagus and anterior/posterior vagal trunks |
| level of aortic hiatus? | TV10 |
| GERD can eventually lead to what malady? | esophageal cancer |
| esopohageal hiatus is a complex arrangement of muscle from what two structures? | right and left crura |
| thoracic diaphragm takes what origin? | lumbar vertebra |
| where do the right and left crus attach? | right: LV1-LV3, left LV1-LV2 |
| the crura are united across the midline through what structure? | median arcuate ligament |
| what nerves pierce the crura to gain access to the abdomen? | thoracic splanchnic nerves |
| what anchors the thoracic diaphragm to the iliac crests? | quadratus lumborum |
| thoracic diaphragm is attached to the body wall by what two structures? | medial and lateral arcuate ligaments |
| where does the medial arcuate ligament pass? what muscle runs deep to it? | from vertebral bodies to transverse process of TV12; psoas major muscle |
| what nerve passes deep to the medial arcuate ligament? | sympathetic trunk |
| where does the lateral arcuate ligament pass? what muscle runs deep to it | from transverse process of TV12 to the 12th rib; quadratus lumborum |
| left and right crura extend from what to what? | posterior central tendon to the anterior spine |
| what are the 3 areas of connective tissue reinforcement of the posterior fibers of the central tendon? | lateral arcuate, medial arcuate, and median arcuate ligaments |
| what prevents constriction of the IVC, aorta, and esophagus? | IVC: caval foramen surrounded by noncontractile central tendon; aorta is locted between two crura; esophagus is a space in the left crus |
| how does the diaphragm contribute to venous and lymphatic circulation? | by creating thoracic and abdominal pressure gradients |
| spatial relationship of the bladder in the male? in the female? | between rectum and pubis; between uterus and pubis |
| superior surface of bladder is covered by what? | peritoneum |
| body and neck of bladder is covered by what? | pelvic fascia |
| as bladder fills, what happens? | it extends cranially along abdominal wall |
| what are some visceral causes of back pain? | kidney or ureteral disease; prostate or bladder conditions, metastatic cancer of the spine, aortic aneurysm, or cauda equina syndrome |
| apex of bladder meets what area? | anterior abdominal wall |
| u-shaped space created by infolding of the peritoneum between pubis and bladder? | retropubic space |
| in the 4th week of development, the cloaca is divided into what portions? what divides the cloaca? | urogenital and anal; urorectal septum |
| urogenital portion of the cloaca will develop what? what will this give rise to? | urogenital sinus; major portions of the urinary system outside of the kidney |
| superior and largest portion of the urogenital sinus will become what? | bladder |
| the bladder is originally continuous with what structure? | allantois |
| the connection between the bladder and allantois is converted into a fibrous cord called the what? | urachus |
| in the male, inferiorly, the pelvic part of the urogenital sinus will differentiate into what two things? | prostatic and membranous urethra |
| the prostatic urethra will join with the ejaculatory ducts developing from the mesonephros to create the what? | urinary/genital continuum |
| the prostatic portion of the urinary/genital continuum will later form outgrowths into the surrounding mesenchyme that will become what? | prostrate gland |
| in the female, the cranial portion of the urethra will give rise to what things? | urethral and paraurethral glands |
| the distended bladder and uterus can be approached surgically via what route? | through the retropubic space |
| neck of bladder secured how? | pubovesical ligaments in females, puboprostatic ligaments in males |
| what defines the trigone of the posterior aspect of the bladder? | ostia of ureters and urethra |
| what muscle in the bladder maintains urinary continence and prevents retrograde ejaculation? | internal urethral sphincter muscle |
| layers of internal bladder? | mucous membrane, submucosa, smooth muscle |
| smooth muscle of the bladder? | detrusor (urinae) muscle |
| umbilical artery continues along what portion of abdominal wall as the medial umbilical fold? | anterior |
| what portion of the uterus is 2/3? | body |
| dome-like portion of uterus at superior portion of body? | fundus |
| the fundus and 2/3 of body project into peritoneal cavity and are covered by what? | visceral peritoneum |
| 1/3 of the body and cervix inferior to the peritoneum are covered by what? | pelvic fascia |
| space between anterior and superior surface of the uterus is what? | vesicouterine pouch |
| what is the space between the posterior surface of the uterus and the rectum? | rectouterine pouch |
| lateral portions of the peritoneum from the body of the uterus? | broad ligament |
| gonads in both sexes appear initially as what? | gonadal ridge |
| where is the gonadal ridge? | medial to the mesonephros |
| what exactly is the gonadal ridge? | coelomic epithelium and condensation of mesenchyme |
| germ cells influence development of what structures? | primitive sex cords and surface epithelium that constitutes the gonad |
| in females, cells of primitive sex cords disperse into clusters in the portion of the gonad that will become what? what will this then become? | medulla; ovarian medulla |
| surface epithelium of the gonad produces cortical cords which do what? | penetrate the medulla and surround germ cells that migrated there |
| germ cells near the medulla become what? surrounding epithelium becomes what? | primitive oocytes; follicular cells |
| in males, what happens to the primitive sex cords? | proliferate and penetrate the medulla to become testis cords |
| testis cords do what? | break up distally to become the rete testis and seminiferous tubules |
| connection between the sex cords and surface epithelium is lost, and what layer develops? | tunica albuginea |
| seminiferous tubules connect to what derivative? | wolffian duct derivative, the efferent ductules |
| the ovary migrates in which direction? | inferiorly |
| on which side does the ovarian vein drain into the renal vein? | left side |
| what is the peritoneal fold associated with the ovarian artery and vein? | suspensory ligament of ovary |
| ligament between ovary and uterus is what? | ovarian ligament |
| what is the ligament that is a continuation of the ovarian ligament that passes from the uterus to the internal inguinal ring? | round ligament of the uterus |
| a complete round ligament in the female terminates where? | labia majora |
| the base of the broad ligament passes posteriorly and laterally to the uterus to form what? | rectouterine folds (arc-shaped) |
| attachment of rectouterine folds to sacrum is called what? | uterosacral ligament |
| a second development of pelvic fascia that extends from the lateal sacral wall to vagina and cervis uteri? | lateral cervical (cardinal) ligament |
| what is the function of the uterosacral ligament and the lateral cervical ligament? | maintains uterus in anteverted position; prevent prolapse |
| what are the 3 named parts of the broad ligament? | mesometrium, mesosalpinx, and mesovarium |
| what is the part of the broad ligament that extends laterally from the uterus to the pararectal spaces? | mesometrium |
| these spaces lie alongside the rectum and communicate with one another through the rectouterine pouch: | pararectal spaces |
| the mesentery that suspends the oviduct is what part of the broad ligament? | mesosalpinx |
| mesentery that suspends the ovary from the posterior leaf of the broad ligament is what? | mesovarium |
| funnel of oviduct is what? | infundibulum |
| abdominal ostium presents finger-like projections with roughened appearance on the ovary that are called what? | fimbriae |
| infandibulum leads into what part of oviduct? | ampulla |
| how long is the ampulla of the oviduct? | 2/3 of the duct |
| what narrowed part of the oviduct joins the uterine horn? | isthmus |
| what passes through the uterine wall to enter the uterine cavity? | uterine part of the oviduct |
| what is the only opening into the peritoneal cavity from the external environment in the uterus? | ostium of the oviduct |
| what are the two sex ducts that develop in both sexes? | mesonephric duct and paramesonephric duct |
| what is the paramesonephric duct derived from? | coelomic mesnchyme lateral to the mesonephric duct |
| the paramesonephric duct opens proximally into what cavity? | coelomic |
| the paramesonephric duct meets its partner where? then what? | in the midline; projects into the urogenital sinus at the paramesonephric tubercle |
| the mesonephric ducts open seperately on either side of this tubercle: | paramesonephric tubercle |
| in the female, the uterine tubes will develop from what? | cranial portion of the paramesonephric ducts |
| conjoined caudal parts of the uterine tubes will become what? then what does this become? | uterine canal; body and cervix of the uterus |
| in the male, which ducts persist? what do they form? | mesonephric ducts: efferent ductules, epididymis, ductus deferens, seminal vesicles, and ejaculatory duct |
| what is the constricted portion of the uterus inferior to the body and about 1 cm long? | isthmus of uterus |
| portion of uterus between isthmus and vagina? | cervix |
| cervix communicates with the vagina through what? | uterine ostium (external os) |
| uterine ostium projects into the vagina, forming what? | anterior and posterior cervical lips |
| cavity between the uterine ostium and the vaginal wall is what? | fornix (anterior, posterior, and lateral) |
| which part of the vagina is most closely related to the rectouterine pouch? | posterior fornix |
| what can the posterior fornix be used for surgically? | to drain ascites or visualize abdominal organs |
| what is the course of the uterine artery? | passes medially within the mesometrium to the uterus; passes superiorly along lateral wall of uterus to anastomose with ovarian artery at the ovary |
| in its course to the uterus, the uterin artery passes where in relation to the ureter? | anterior to the ureter, which is closely related to the lateal fornix of the vagina |
| parietal branches of the internal iliac artery are found where? | along the posterior pelvic wall; usually most proximal branches |
| ilio-lumbar artery course? | passes superiorly to supply psoas major muscle through lumbar branch, supplies iliacus through iliac branch |
| course of lateral sacral arteries? | run medially to enter ventral sacral foramina to supply sacral nerve roots and spinal meninges; then they pass through dorsal sacral foramina to supply musculature and skin near posterior sacrum |
| course of gluteal arteries? | pass between roots of sacral plexus to gain access to the greater sciatic foramen |
| what is the course of the superior gluteal artery? what does it supply? | passes through greater sciatic notch superior to piriformis muscle; gluteus medius, minimus, and tensor fascia lata |
| what is the course of the inferior gluteal artery? what does it supply? | passes through greater sciatic notch inferior to piriformis muscle; gluteus maximus and cranial portion of hamstrings |
| what is the course of the internal pudendal artery? what does it supply? | passes through greater sciatic foramen, around the sacrospinous ligament, entering the lesser sciatic foramen; musculature of pelvic diaphragm and perineum; terminal part of digestive tract; cavernous tissues of clitoris or penis |
| umbilical artery continues as what ligament? | umbilical ligament |
| in addition to the rectum, what does the middle rectal artery supply in males and females? | prostate and seminal vesicles; vagina |
| the uterine artery anastomoses with what artery? | ovarian artery |
| what artery in the female corresponds to the inferior vesicle artery in the male? | vaginal artery |
| in addition to the inferior bladder, what else does the inferior vesicle artery in the male supply? | prostate and seminal vesicles |
| the lumbosacral trunk comes from what nerves? what does it join inferiorly? | L4-L5; S1 |
| what nerves comprise the sacral plexus? | L4-S3 |
| what does the sacral plexus become? | sciatic nerve |
| what nerves form the superior gluteal nerve? where is it located? | L4-S1; superior to piriformis |
| what nerves form the inferior gluteal nerve? where is it located? | L5-S2; inferior to piriformis |
| sciatic, gluteal, and pudendal nerve all exit pelvis how? | through greater sciatic foramen |
| parasympathetics from seacral plexus supply what two general regions? what kind of nerves are these? | external genitalia and bladder; pelvic splanchnic |
| pelvic splanchnic nerves come from which nerves? what kind of nerves do they come from? | ventral rami of S2-S4; parasympathetic preganglionic fibers |
| spatial relationship of the prostate? | between neck of bladder and superior fascia of urogenital diaphragm |
| nerve plexus around the prostate? | prostatic plexus |
| the prostatic plexus contains nerves from where? what kind? | parasympathetics from pelvic splanchnic nerves |
| veins to prostate form what structure? | prostatic venous plexus |
| 3 parts of urethra? | prostatic runs through gland; membranous runs in deep perineal space; penile/spongy is inferior to perineal membrane |
| trans-urethral resection of the prostate destroys what important structure? | ejaculatory duct |
| where does the ductus deferens run? | passes through the deep inguinal ring to enter the pelvis |
| terminal part of ductus deferens is enlarge to form what structure? | ampulla of the ductus deferens |
| what forms the ejaculatory duct? | ampulla of the ductus deferens and the duct of the seminal vesicle |
| ejaculatory ducts empty into the prostatic urethra at what point? | prostatic utricle |
| blood supply of structures inferior to the anal triangle and perineal membrane is provided by what artery? | internal pudendal artery |
| what does the pudendal nerve innervate? | muscles in perineum, sensory nerves to skin and external genitalia |
| pudendal nerve internal pudendal artery and vein exit from pelvis where? | greater sciatic foramen |
| how do the pudendal nerve and vessels run? | pass lateral to sacrospinous ligament and through the lesser sciatic foramen to enter the ischiorectal fossa |
| what is the fat filled space lying inferior to the pelvic diaphragm on either side of the anus? | ischiorectal fossa |
| what is the thickening of the deep fascia of the internal oburator muscle? what vessels run through here? | pudendal canal; pudendal nerve and internal pudendal vessels |
| what is the branch from the pudendal nerve, artery, and vein starting at the pudendal canal? | inferior rectal nerve, artery, and vein |
| what do the inferior rectal nerve, artery and vein supply? | external anal sphincter muscle, anal canal, and skin around the anus |
| collateral circulation occurs between which two veins of the internal iliac and inferior mesenteric veins? which is portal and caval? | middle rectal and superior rectal vein; middle and inferior are caval, superior is portal |
| most superior boundary of the ischiorectal fossa is the origin of what muscle? | levator ani muscle |
| levator ani originates from what? | pubis and arcus tendineus |
| what is the arcus tendineus? | a thickened development of the obturator internus fascia passing between the iliopubic ramus and ischial spine |
| course of levator ani muscle? | runs from pelvic wall to anal canal |
| shape of ischiorectal fossa? what are the borders? | triangular; apex is arcus tendineus; lateral wall is obturator internus muscle; medial wall is levator ani; base is skin of perineum |
| left and right ischiorectal fossae communicate posteriorly through what space? | retrorectal space |
| what separates the ischiorectal fossae? | anal canal and elements of the urogenital system anteriorly |
| what is the extension of the ishirectal fossa that lies between the pelvic diaphragm and urogenital diaphragm? | anterior recess |
| what does the perineal nerve supply? | musculature of the superficial perineal pouch (ischiocavernosus m., bulbospongiosus m., and superficial transverse perineus m.; deep transverse perineus and sphincter urethrae m. |
| what is the course of the dorsal nerve of the penis? female dorsal nerve of clitoris? | goes through anterior recess of ischiorectal fossa and pierces the sphincteric urethre muscle and perineal membrane to emerge on dorsal surface of the penis; same path |
| what is the course of the posterior scrotal nerves? female posterior labial nerves? | emerge from termination of pudendal canal and cross posterior edge of deep perineal pouch to skin of scrotum; same path |
| internal pudendal artey emerges from the pudendal canal and gives off what branches? what do they supply? | transverse perineal artery and posterior scrotal/labial artery; perineal body and musculature; skin of scrotum/labia |
| what does the deep artery of the penis/clitoris supply? via what route? | cavernous tissue of corpus cavernosum penis/clitoris; enters crus of penis/clitoris |
| dorsal artery of the penis/clitoris follows what route? | follows dorsal nerve of penis/clitoris to supply corpus cavernosum of penis/clitoris |
| what artery supplies blood to corpus spongiosum in male? vestibular bulb in female? | artery to the urethral bulb; artery to the vestibular bulb |
| what comprises the pelvic diaphragm? | coccygeus and levator ani muscle and their fascia |
| spatial relationship of the coccygeus muscle? | more posterior, lies on superior surface of the sacrospinous ligament |
| what are attachments of coccygeus muscle? | ventrolateral surface of sacrum and coccyx, and ischial spine |
| levator ani is subdivided into what 3 muscles? | iliococcygeus, pubococcygeus, and puborectalis muscles |
| spatial relationship of iliococcygeus muscle? | most posterior of levator ani; originates from arcus tendineus and inserts on anococcygeal ligament |
| where does the anococcygeal ligament pass? | between anus and coccyx |
| pubococcygeus muscle origin and attachment? | originates from iliopubic ramus and inserts on anococcygeal ligament |
| describe the puborectalis muscle: | u-shaped sling passing posteriorly from pubis, around anal canal, where it intermingles with external anal sphincter muscle, to the opposite pubis |
| tension in what muscle is essential for fecal continence? | puborectalis muscle |
| in the male, some fibers of the puborectalis pass between the prostate gland and anus to form what muscle? | levator prostatae muscle |
| in female, fibers from puborectalis pass between vagina and uterus to form what muscle? | pubovaginalis muscle |
| two levator ani muscles are fused at midline posteriorly, but are separated anteriorly to allow passage of urethra or vagina. what separates them? | urogenital hiatus |
| junction between sigmoid colon and rectum? what indicates this junction? | rectosigmoid junction; taenia coli enlarge to create continuous outer layer |
| upper end of rectum is at what level? | SV2 |
| which portions of rectum lack peritoneum? | inferior 1/3 |
| what are the folds in the lumen of the rectum? what is the spatial relationship? | transverse rectal folds; upper from right side; middle from left side; larger lower at level of bladder from anterior side |
| where does the rectum terminate? | anorectal flexure (anteior to coccyx) |
| origination and termination of anal canal? | pelvic diaphragm and anus |
| longitudinal elevations on surface of anal canal? what is in them? depressions? | anal columns; terminal branches of the superior rectal arteries and veins; anal sinuses |
| terminal branches of the superior rectal arteries and veins connect with what? | somatic inferior rectal vessels |
| what demarcates the proximal end of the anal columns? | anorectal line |
| distal ends of anal columns have what folds? | anal valves |
| line marked by anal valves? significance? | pectinate line; columnar to stratified epithelium, visceral to somatic nerve (pelvic plexus to pudendal nerve) |
| 3 parts of external anal sphincter? | deep, superficial, subcutaneous |
| deep part of external anal sphincter info? | encircles anal canal, fuses with puborectalis m. |
| superficial part of external anal sphincter info? | oval, attaches to anococcygeal ligament posteriorly and perineal body |
| perineal body is located where? what does it connect? | central point of perineum; bulbospongiousus m., external anal sphincter, superficial and deep transverse perineal mm., muscle slips from levator ani and rectum |
| what contains the structures lying between the perineal membrane and superficial fascia of the perineum? | superficial perineal pouch |
| superficial fascia of penis contains what? | superficial dorsal vein of the penis |
| superficial fascia of penis is continuous at inferior abdominal wall with what? | suspensory ligament of the penis |
| what tissue completely envelops all of the functional structures of the penis? | deep fascia of the penis |
| deep to deep fascia in dorsal midline of penis are what vessels? | deep dorsal vein of the penis; dorsal arteries of the penis(2), dorsal nerves of the penis |
| deep fascia of penis is continuous with what layers of fascia? | scarpa's and colle's fascia |
| how does erection happen? | dorsal arteries fill with blood, engorge spongy corpora cavernosa, smooth muscle of corpora relax, outflowing veins are pressed up against tunica albuginea closing them off |
| what forms the shaft of the penis? | left and right corpus cavernosum penis |
| proximally, the corpus cavernosa separate to form what? | crura of the penis |
| what do the crura of the penis attach to? | inferior aspect of the ischiopubic remus and perineal membrane |
| each crus of the penis are covered inferiorly by what? | ischiocavernosus muscle |
| cavernous tissues of corpus cavernosa are enclosed by what? | tunica albuginea |
| as crura of penis come together, the tunica albuginea forms what? | septum penis |
| septum penis is fenestrated where? | proximally |
| penile urethra as surrounded by what? | corpus spongiosum |
| which tunica albuginea is more elastic, the corpus spongiosum or cavernosum? | spongiosum |
| why is the urethra in the male subject to rupture? | change in direction between the membranous and penile urethra |
| what happens if urethra is ruptured? | extravasation of urine into superficial perineal pouch |
| if deep layer of fascia is intact, where does extravasated urine go? | in deep perineal space between perineal membrane and deep fascial layer |
| if deep layer of fascia is torn, where does extravasated urine go? | superficial perineal pouch, limited by colle's and scarpa's fascia |
| when deep layer of fascia is torn, where will extravasated urine continue on to? | perineum and scrotum to lower abdominal wall |
| proximally, corpus spongiosum is enlarge to form what? | urethral bulb |
| what does the urethral bulb fuse with? | perineal membrane of the deep perineal space |
| midline urethral bulb is covered by a pair of what? | bulbospongiosus muscles |
| where do the bulbospongiosus muscles originate and attach in the male? | originate from perineal membrane and meet in midline raphe |
| posteriorly, the bulbospogiosus muscles blend with the superficial part of the what? at what point? | external anal sphincter; perineal body |
| what muscles attach to the ischiopubic ramus laterally and the perineal body medially to form a triangle? | superficial transverse perinei muscles |
| where do the superficial transverse perinei muscles lie? | posteriorly in the deep perineal space |
| by 6th week of development, embryos of both sexes have developed a cloacal membrane subdivided into what membranes? | urethral and anal membranes |
| in the embryo, the urethral membrane is flanked by what? | urethral folds |
| in the embryo, the anal membrane is surrounded by what folds? | anal folds |
| a pair of what are present on the lateral aspect of the urethral folds? | genital swellings |
| what develops cranially to the urethral membrane and folds? | genital tubercle |
| what elongates to form the phallus in the embryo? | genital tubercle |
| the two urethral folds are pulled ventrally when the phallus grows; what will these form? | penile urethra |
| what will the urethral swellings form? | scrotum |
| in the female, the genital tubercle elongates slightly to become what? | clitoris |
| in the female, neither the genital folds or genital swellings fuse along the midline; instead, what do they form? | labia minora and majora |
| what are the structures of the vulva (pudendum) | mons pubis, labia majora, labia minora, clitoris, vestibule, and greater vestibular glands |
| exit point of the urethra is called what? | external urethral orifice |
| crura from the corpora cavernosa clitoridis attach where? come together where? | attach to ischiopubic rami and perineal membrane proximally, come together anteriorly to form body of clitoris |
| body of clitoris terminates at what point? | glans clitoris |
| crura of corpora cavernosa clitoridis are where spatially? | on either side of the urogenital triangle |
| clitoris is capped by fold of tissue originating from labia minora called: | prepuce of the clitoris |
| inferior surface of each crus of the corpora cavernosa clitoridis is covered by what muscle? | ischiocavernosus muscle |
| corpus spongiosum in females splits to form what? | vestibular bulbs |
| where are the vestibular bulbs? | on either side of the vaginal orifice just posterior to the labia minora |
| what is found at the inferior ends of the vestibular bulbs? | greater vestibular glands |
| on each side of the vestibular bulb and greater vestibular gland are covered by what muscle in the female? | bulbospongiosus muscle |
| what is the course of the bulbospongiosus muscle in the female? | they fuse with fibers of the superficial part of the external anal sphincter muscle and the superficial transverse perinei in the perineal body |
| an episiotomy cuts through what sections? | posterior vaginal wall and perineal skin into central tendon |
| what muscles must be avoided from being cut in an episiotomy? | external anal sphincter, puborectalis, and levator ani |
| fascia that bounds superficial perineal pouch is continuous with what fascia? | lower abdominal wall |
| superficial perineal fascia has how many layers? | 2: fatty and membranous |
| in males, which fascial layer is not present in the male perineum? | camper's fascia |
| posteriorly, colle's fascia continues beneath the skin or the urogenital triangle and attaches where? | to posterior edgs of perineal membrnae |
| deep perineal fascia of the shaft of the penis is also called what? | buck's fascia |
| what does buck's fascia cover? | shaft, ischiocavernous muscle, and bulbospongiosus muscle |
| bucks' fascia is continous with what other fascia? | deep fascia of external abdominal oblique and rectus abdominis muscles |
| the deep perineal space allows passage of what structure in males and females? | urethra in both, vagina in females |
| what forms the boundaries of the deep perineal space? | superior- inferior fascia of pelvis; inferior-perineal membrane |
| what defines the deep perineal space in both sexes? | space between the inferior fascia of pelvis and perineal membrane |
| in male, what are structures in the deep pouch? | deep transverse perineus muscles; fibers of the deep transverse perinei that encircle the membranous urethra, and bulbourethral glands |
| deep transverse perineus muscles in male attach where? | right and left ischiopubic rami and meet in the midline |
| fibers of the deep transverse perinei encircle what? what will this form? | membranous urethra; sphincter urethrae muscle |
| bulbourethral ducts pass where? | inferior to the glands, pierce the perineal membrane to empty into penile urethra |
| in female, deep perineal space consists of: | sphincter urethrae muscle and deep transverse perineus muscles |
| how do the fibers of the sphincter urethre muscle run in females? | only covers anterior surface of urethra |
| what reinforces the pubic symphysis superiorly? inferiorly? | superior pubic ligament; arcuate pubic ligament |
| two pubic bones are connected over joinot surface by what fibrocartilage? | interpubic disc |
| which is broader, anterior or posterior longitudinal ligament? | anterior |
| what connects the spinous processes of LV5 and the sacrum? | supraspinous ligament |
| what ligament runs from transverse processes of LV5 to adjacent iliac crest? | iliolumbar ligament |
| what connects the posterior sacrum with the ischial tuberosity? | sacrotuberous ligament |
| what connects the posterior sacrum with the ischial spine? | sacrospinous ligament |
| what do the sacrotuberous and sacrospinous ligament prevent? | upward rotation of the lower end of the sacrum (nunation) |
| the posterior sacroiliac ligament attaches wherre? | posterior to sacroiliac joint between posterior ilium and 3rd and 4th segments of the sacrum |
| dura mater runs where? | from foramen magnum of occiput to CV2; inferiorly to SV2 and coccyx |
| what is an important indicator of coxal shear, where one ox coxa is higher or lower than the other? | sacrotuberous ligament |
| what is a transversly-oriented sheet of fibers that run from ala of sacrum to anterior surface of ilium? | anterior sacroiliac ligament |
| where does the anterior sacroiliac ligament run? | ala of sacrum to anterior surface of ilium |
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mhassan
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