Anatomy Clinical Correlates Pelvis And Perineum

Front 1

What muscles can be damaged during childbirth and to what consequence?

Back 1

Levator Ani and pelvic fascia especially the pubococcygeus, resulting in urinary stress incontinence

Front 2

What is the portal caval connection in the pelvis, significant in cases of portal hypertension?

Back 2

superior rectal veins (portal) anastomose with middle and inferior rectal veins (caval)

Front 3

What is an internal anal hemorrhoid and what is at risk of occurring?

Back 3

prolapse of the rectal mucosa containing the dilated veins of the internal rectal venous plexus. So, when the smooth muscle breaks down the internal hemorrhoids move into the anal canal and are compressed and contracted by the sphincter resulting in constricted blood flow and ulceration.

Front 4

What is an external hemorrhoid?

Back 4

blood clots in the veins of the external rectal venous plexus that are covered by skin.

Front 5

What can be disrupted during bladder surgery/ transurethral resection of the prostate, and to what consequence?

Back 5

The internal urethral sphincter, resulting in retrograde ejaculation

Front 6

Why is urethral catheterization preformed, and what about the male urethra do we need to be concerned about when preforming this procedure?

Back 6

The urethra has two curved portions that can cause problems since the urethral wall is thin and prone to rupture. Proximally the prostatic urethra takes a 35 degree angle anteriorly as it crosses the prostate. Distally, the membranous urethra runs inferoanteriorly as it passes through the external urethral sphincter.

Front 7

Why is the passage of catheters easier in females?

Back 7

straight course, and walls have elastic tissue and smooth muscle making it distensible.

Front 8

What is a vasectomy (differentectomy)?

Back 8

Cut the ductus deferens through and incision in the scrotum. Ejaculated fluid from the seminal vesicles, prostate and bulbourethral glands contains no sperm.

Front 9

What are consequences of hypertrophy of the prostate?

Back 9

enlargement can cause the prostate to project into the bladder and impede urination by distortion of the prostatic urethra or obstruction of the internal urethral orifice.

Front 10

How do we examine the prostate?

Back 10

Through digital rectal exam since the posterior surface of the prostate is so close to the rectum.

Front 11

How can prostatic cancer easily spread to the spine?

Back 11

through venous drainage to the vertebral venous plexus.

Front 12

What infections can be caused by the uterine tubes opening into the peritoneal cavity?

Back 12

Peritonitis can be caused by the spread of vaginal, uterine or tubal infections spreading into the peritoneum. Inflamation/ infection of the peritoneum can spread to the uterine tubes causing salpingitis.

Front 13

What is an ectopic tubal pregnancy and what are the risks associated with it?

Back 13

Can be caused by blockage of the uterine tube preventing the zygote from passing into the uterus and implantation of the zygote in the ampulla of the tube.

Front 14

What is an episiotomy and why is it preformed?

Back 14

Deliberate division of the perineal body (the anus can be surgically detached from the perineal body without clinical consequences.) It is preformed to facility delivery during childbirth and to avoid injury to the anal canal, and weakening of the pelvic floor muscles.

Front 15

What occurrs with age or during childbirth to the pelivc viscera?

Back 15

Weakening of the pelvic foor muscles causes prolapse of the viscera.
Weakening of anterior muscles will cause prolapse of the bladder into the vaginal canal.
Posterior weakening will cause prolapse of the rectum towards the vaginal canal.

Front 16

How is a spinal block administered during childbirth?

Back 16

Anesthetic is introduced into the spinal subarahnoid space at the L3/L4 vertebral level. Everything inferior to the waist is anesthesized.
Considerations: mother cannot consciously monitor uterine contractions. If labor is extended it is difficult to readminister. Anesthesia is heavier than CSF, so remains in the lower spinal subarachnoid space while the patient is inclined; however, if the patient lies down a severe headache an occur.

Front 17

How can a pudendal block be performed?

Back 17

Subcutaneously by inserting a needle through the buttock medially to the ischial tuberosity.
or can be blocked with a local anethshetic passed through the lateral wall of the vagina near the ischial spine (preferred), but be careful of the baby's head.

Front 18

Why would perineal analgesia be incomplete with a pudendal block?

Back 18

overlap occurs from genital branch of genitofemoral nerve or illioinguinal nerve. It also does not block pain from uterine contractions that travel via sympathetic afferent nerves.

Front 19

How is a caudal epidural block administered?

Back 19

Before delivery, an indwelling catheter is placed in the sacral canal enabling administration of additional anesthetic for a deeper or more prolonged anesthetic if necessary.

Front 20

What nerves are affected in a caudal epidural block?

Back 20

S2-S4 spinal nerve roots including pain fibers from the uterine cervix and and upper vagina and afferent fibers from the pudendal nerve. Birth canal, pelvic floor and majority of perineum are anesthesized but the lower limbs are not usually affected. Pain fibers from the fundus and body of the uterus ascend through thoracic and upper lumbar levels so the mother is aware of uterine contractions.

Front 21

Why is there not a headache in as caudal epidural block as seen with the spinal epidural block?

Back 21

the vertebral epidural space is not continuous with the spinal epidural space.

Front 22

What innervates the scrotum and why must that be considered during anesthesizing procedures?

Back 22

The anterior scrotum is innervated by the S1 segment and the posterior scrotum is innervated by the S3 spinal segment, so a spinal snesthetic must be injected more superiorly when anesthetizing the anterior surface of the scrotum than when anesthetizing the posterior surface of the scrotum.

Front 23

The female vestibular bulbs are the male......

Back 23

corpus spongiosum

Front 24

The male bulbourethral glands are the female......

Back 24

greater vestibular glands

Front 25

the male prostate gland is homologous to the female....

Back 25

urethral and paraurethral glands

Front 26

the female glans clitoris is homologous to the male....

Back 26

glans penis

Front 27

the female prepuce of clitoris is homologous to the male.....

Back 27

prepuce of penis

Front 28

the male corpus of penis is homologous to the female.....

Back 28

corpus of clitoris

Front 29

the female labia minora is homologous to the male....

Back 29

penoscrotal raphe

Front 30

the female labia majora is homologous to the male....

Back 30

scrotum