Anatomy Perineum And Pelvis Exam 3

Front 1

pelvis

Back 1

the space within the pelvic girdle, has no external surface, composed of the greater pelvis and lesser pelvis, overlapped by the inferior anterolateral abdominal wall anteriorly, the gluteal region of the lower limb posterolaterally and the perineum inferiorly

Front 2

greater pelvis (false pelvis)

Back 2

pelvic in terms of its bony boundaries but abdominal in terms of its contents, provides protection to the inferior abdominal viscera, superior to the pelvic inlet, bounded by the iliac alea posterolaterally and the anterosuperior aspect of the S1 vertebra posteriorly, occupied by the abdominal viscera, superior to the pelvic brim (the circumference of a plane that divides the pelvis into greater and lesser, is the plane from the superior aspect of the pubic sypmphysis to sacral promontory)

Front 3

lesser pelvis (true pelvis)

Back 3

provides the bony framework for the pelvic cavity and deep perineum, inferior to the pelvic brim, between the pelvic inlet and the pelvic outlet, bounded by the pelvic surfaces of the hip bones, sacrum and coccyx, includes the true pelvic cavity and the deep parts of the perineum (ischioanal fossae specifically), of major obstetrical and gynecological significance

Front 4

perineum

Back 4

considered the area between the thighs and buttocks extending from the coccyx to the pubis, inferior to the musculofascial pelvic diaphragm, includes the anus and external genitalia

Front 5

primary functions of the pelvic girdle

Back 5

1. bear the weight of the upper body when sitting and standing
2. transfer that weight from the axial to the lower appendicular skeleton for standing and walking
3. provide attachment for the powerful muscles of locomotion and posture, as well as those of the abdominal wall, withstanding the forces generated by their actions

Front 6

secondary functions of the pelvic girdle

Back 6

1. contain and protect the pelvic viscera (inferior parts of the urinary tracts and the internal reproductive organs) and the inferior abdominal viscera (intestines), while permitting passage of their terminal parts (and fetus) via the perineum
2. provide support for the abdominopelvic viscera and gravid (pregnant) uterus
3. provide attachment for the erectile bodies of the external genitalia
4. provide attachment for the muscles and membranes that assist in these functions by forming the pelvic floor and filling gaps that exist in or around it

Front 7

what bones make up the pelvic girdle?

Back 7

1. right and left hip bone (pelvic bones)-develops from the fusion of the ilium, ischium and pubis
2. sacrum-fusion of five, originally separate sacral vertebrae

Front 8

hip bones

Back 8

consist of three separate bones that are united by a triradiate cartilage (in children, adults are fused) at the acetabulum (a cup-like depression in the lateral surface of the hip bone), joined anteriorly at the pubic symphysis, and articulate posteriorly with the sacrum at the sacroiliac joints to form the pelvic girdle

Front 9

acetabulum

Back 9

formed from body of the ilium, body of the ischium, and superior pubic ramus

Front 10

ilium

Back 10

the superior, fan shaped part of the hip bone

Front 11

auricular surface of the sacropelvic surface of the ilium

Back 11

used for synovial articulation with the sacrum

Front 12

iliac tuberosity

Back 12

used for syndesmotic articulation with the sacrum

Front 13

pelvic inlet

Back 13

superior pelvic aperture, the plane separates the greater and lesser pelvis

Front 14

pelvic brim

Back 14

the bony edge surrounding and defining the pelvic inlet, formed by the:
1. promontory and ala of the sacrum
2. right and left linea terminalis which together form a continuous oblique ridge consisting of the (1) arcuate line on the inner surface of the ilium and (2) pectin pubis (pectineal line) and pubic crest forming the superior border of the superior pubic ramus and body

Front 15

boundaries of the pelvic outlet (inferior pelvic aperture) (which are also the deep boundaries of the perineum)

Back 15

1. pubic arch anteriorly
2. ischial tuberositites laterally
3. inferior margin of the sacrotuberous ligament posterolaterally
4. tip of the coccyx posteriorly

Front 16

orientation of the pelvic girdle when in the anatomical position

Back 16

the right and left ASIS and the anterior aspect of the pubic symphysis lie in the same vertical plane

Front 17

differences between male and female bony pelvis (general structure)

Back 17

males are thicker and heavier, females are thinner and lighter

Front 18

differences between male and female bony pelvis (greater pelvis)

Back 18

males are deep, females are shallow

Front 19

differences between male and female bony pelvis (lesser pelvis)

Back 19

males are narrow and deep, tapering, females are wide and shallow, cylindrical

Front 20

differences between male and female bony pelvis (pelvic inlet)

Back 20

males are heartshaped, narrow, females oval and rounded, wide

Front 21

differences between male and female bony pelvis (pelvic outlet)

Back 21

males are comparatively small, females are comparatively large

Front 22

differences between male and female bony pelvis (pubic arch and subpubic angle)

Back 22

males are narrow (<70), females are wide (> 80)

Front 23

differences between male and female bony pelvis (obturator foramen)

Back 23

males are round, females are oval

Front 24

differences between male and female bony pelvis (acetabulum)

Back 24

males are large, females are small

Front 25

differences between male and female bony pelvis (greater sciatic notch)

Back 25

males are narrow (~70), inverted V, females are almost 90

Front 26

dimensions of the femal pelvis

Back 26

conjugate diameter of pelvic inlet: ~11cm
transverse diameter of pelvic inlet: ~13cm
oblique diameter of pelvic inlet: ~12.5cm
transverse diameter of pelvic outlet: ~11cm
anteriorposterior (conjugate) diameter of pelvic outlet: varies from ~9.5-~11.5cm

Front 27

sacroiliac joint

Back 27

strong weight bearing compound joints, links the axial skeleton and the inferior appendicular skeleton, consists of an anterior synovial joint and a posterior syndesmosis

Front 28

anterior synovial sacroiliac joint

Back 28

differ from most synovial joints in that limited mobility is allowed bec. of their role in transmitting the weight of most of the body to the hip bones (standing-axial skeleton to the ilia and then to the femur; sitting-ischial tuberosisties during sitting)

Front 29

posterior and interosseous sacroiliac ligaments

Back 29

suspends the sacrum between the iliac bones

Front 30

anterior sacroiliac ligaments

Back 30

the anterior part of the fibrous capsule of the synovial part of the joint

Front 31

interosseous sacroiliac ligament

Back 31

lies deep between the tuberosities of the sacrum and ilium, primary structures involved in transferring the weight of the upper body to the two ilia of the appendicular skeleton

Front 32

posterior sacroiliac ligaments

Back 32

run obliquely upward causing the ilia inward (medial) so that they compress the sacrum between them, forms the sacrotuberous ligament when its inferior portion joins fibers extending from the posterior margin of the ilium and base of the coccyx

Front 33

sacrotuberous ligament

Back 33

passes from the posterior ilium and lateral sacrum and coccyx to the ischial tuberosity transforming the sciatic notch in the hip bone into a large sciatic foramen

Front 34

sacrospinous ligament

Back 34

passes from lateral sacrum and coccyx to the ischial spine, subdivides the large sciatic foramen into greater and lesser sciatic foramina

Front 35

movement of the sacroiliac joint

Back 35

limited by the interlocking of the articulating bones and the sacroiliac ligaments to slight gliding and rotary movements

Front 36

function of the sacrotuberous and sacrospinous ligament together

Back 36

counterbalance the rotation of the superior sacrum, anchor the inferior end of the sacrum to the ischium, preventing its superior and posterior rotation, prevents a tail from protruding to the back

Front 37

pubic symphysis

Back 37

a secondary cartilaginous joint, consists of a firbrocartilaginous interpubic disc and surrounding ligaments uniting the bodies of the pubic bones in the median plane

Front 38

differences in males and females in the size of the interpubic disk

Back 38

usually wider in women and deeper and taller in men

Front 39

superior pubic ligament

Back 39

connects the superior aspects of the pubic bodies and interpubic disc extending as far laterally as the pubic tubercles

Front 40

inferior pubic ligament

Back 40

a thick arch of fibers that connects the inferior aspects of the joint components, rounding off the subpubic angel as it forms the apex of the pubic arch, strengthened anteriorly by fibers of the rectus abdominis and external oblique

Front 41

joining of L5 and S1

Back 41

articulate at the anterior intervertebral joint formed by the IV disc between their bodies and at two posterior zygapophysial joints, strengthened further by the iliolumbar ligaments radiating from the transverse processes of the L5 vertebrae to the ilia

Front 42

sacrococcygeal joint

Back 42

secondary cartilaginous joint with an IV disc, fibrocartilage and ligaments join the apex of the sacrum to the base of the coccyx, there are anterior and posterior sacrococcygeal ligaments that are long strands that reinforce the joint

Front 43

contents of the pelvic cavity

Back 43

terminal parts of the ureters and the urinary bladder, rectum, pelvic genital organs, blood vessels, lymphatics, and nerves, also contains some abdominal viscera, loops of small and large intestine (mostly ileum and appendix and sigmoid colon)

Front 44

anterioinferior pelvic wall

Back 44

formed primarily by the bodies and rami of the pubic bones and the pubic symphysis, participates in bearing the weight of the urinary bladder

Front 45

lateral pelvic walls

Back 45

formed by the right and left hip bones, each of which includes an obturator foramen closed by an obuturator membrane, padded by the obturator internus muscles

Front 46

obturator internus

Back 46

fibers converge posterioly, become tendinous and turn sharply laterally to attach to the greater trochanter of the femur, covered by obturator fascia, provides attachment for the pelvic diaphragm

Front 47

posterior wall

Back 47

consists of a bony wall and roof in the midline (formed by the sacrum and coccyx) and musculoligamentous posterolateral walls (formed by the ligaments associated with the sacroiliac joints and piriformis muscles

Front 48

piriformis muscles

Back 48

arise from the superior sacrum, lateral to the pelvic foramina, leeavs the lesser pelvis through the greater sciatic foramen to attach to the superior border of the greater trochanter of the femur, deep to these muscles are the nerves of the sacral plexus

Front 49

pelvic diaphragm

Back 49

consists of the coccygeus and levator ani muscles and the fascias covering the superior and inferior aspects of these muscles

Front 50

coccygeus muscles

Back 50

arise from the lateral aspects of the inferior sacrum and coccyx, their fibers underlie the deep surface of the sacrospinous ligament

Front 51

levator ani

Back 51

larger and more important part of the pelvic diaphragm, attafched to the bodies of the pubic bones anteriorly to the ischial spines posteriorly and to a thickening in the obturator fascia (the tendinous arch of the levator ani) between the two bony sites on each side, there is an anterior gap between the medial borders of the levator ani muscles on each side giving rise to the urogenital hiatus which gives passage to the urethra and in females the vagina

Front 52

parts of the levator ani

Back 52

1. puborectalis-thicker, narrower, medial part of the levator ani, consisting of muscle fibers that are continutous between the posterior aspects of the right and left pubic bodies, forms a U shaped sling that passes posterior to the anorectal junction bounding the urogenital hiatus, maintains fecal continence, voluntary contraction, is the medial part of the pubococcygeus, forms a puborectal sling posterior to the rectum
2. pubococcygeus-wider but thinner intermediate part, lateral to the puborectalis, passes posteriorly in a horizontal plane, lateral fibers attach to the coccyx and its medial fibers merge with those of the contralateral muscle to form a fibrous raphe or tendinous plate (anococcygeal body or ligament) between the anus and coccyx (called the levator plate)
3. illiococcygeus-the posterolateral part, arises from the posterior tendinous arch and the ischial spine, thin and often poorly developed and also blends with the anococcygeal body

Front 53

functions of the levator ani

Back 53

1. forms a dynamic floor for supporting the abdominopelvic viscera
2. tonically contracted most of the time to support the abdominopelvic viscera and to assist in maintaining urinary and fecal continence
3. actively contracted during forced expiration, couging, sneezing, vomiting and fixation of the trunk during strong movements of the upper limbs (weights)
4. relaxes to allow urinationa dn defecation

Front 54

pelvic viscera and peritoneum

Back 54

except for the ovaries (suspended by mesentery but are not covered by peritoneum, instead cuboidal cells cover them) and uterine tubes (intraperitoneal and suspended by a mesentery), the pelvic viscera are not completely ensheathed by the peritoneum, lying inferior to it for the main part, only their superior and superolateral surfaces are covered

Front 55

where is the peritoneum not firmly bound to the underlying structures?

Back 55

only the region superior to the bladder

Front 56

supravesical fossa

Back 56

the level at which the peritoneum reflects onto the superior surface of the bladder, size varies depending on the distension of the bladder

Front 57

rectouterine pouch

Back 57

pocket formed between the uterus and the rectum, the median rectouterine pouch is described as the inferiormost extent of the peritoneal cavity in the female but often its lateral extensions on each side of the rectum (pararectal fossae) are deeper

Front 58

rectouterine folds

Back 58

prominent peritoneal ridges formed by underlying fascial ligaments demarcate the lateral boundaries of the pararectal fossae

Front 59

pelvic fascia

Back 59

connective tissue that occupies the space between the membranous peritoneum and the muscular pelvic walls and floor not occupied by the pelvic viscera, a continuation of the endoabdominal fascia that lies between the muscular abdominal walls and the peritoneum superiorly (parietal and visceral)

Front 60

parietal pelvic fascia

Back 60

membranous layer of variable thickness that lines the inner aspect of the muscles forming the walls and floor of the pelvis, covers the pelvic surfaces of the obturator internus, piriformis, occygeus, levator ani and part of the urethral sphincter muscle, continuous superiorly with the transversalis and iliopsoas fascias, line the intrapelvic surfaces of the muscles lining the walls of the pelvic cavity, is firmly attached to the pelvic brim

Front 61

visceral pelvic fascia

Back 61

includes the membranous fascia that directly ensheathes the pelvic organs forming the adventitial layer of each, continuous with the parietal layer where the organs penetrate the pelvic floor, provieds a fascial covering for the pelvic viscera

Front 62

tendinous arch of pelvic fascia

Back 62

where the parietal and visceral pelvic fascia are continuous, thickened, continuous bilateral band running from the pubis to the sacrum along the pelvic floor adjacent to the viscera, is the fascia of the obturator internus, stretches from ischial spin to pubic bone, gives rise to levator ani

Front 63

puboprostatic ligament

Back 63

in males, the anteriormost part of the tendinous arch of pelvic fascia, connects the prostate to the pubis in the male

Front 64

pubovesical ligament

Back 64

in females, the anteriormost part of the tendinous arch of pelvic fascia, connects the fundus of the bladder to the pubis in the female

Front 65

sacrogenital ligaments

Back 65

the posteriormost part of the band, runs from the sacrum around the side of the rectum to attach to the prostate in the male or the vagina in the female

Front 66

extraperirtoneal (superitoneal) endopelvic fascia

Back 66

the connective tissue between the parietal and visceral layers, continuous with both the parietal and visceral layer, forms a connective tissue matrix or packing material for the pelvic viscera, can be loose areolar tissue or condensed

Front 67

loose extraperitoneal endopelvic fascia

Back 67

relatively devoid of all but minor lymphatics and nutrient vessels, fingers can be pushed in here during surgery creating spaces for blunt dissection, form potential spaces

Front 68

potential spaces formed from the loose extraperitoneal endopelvic fasica

Back 68

1. retorpubic (prevesical)-extended posterolaterally as paravesical, between the pubis and the bladder anteriorly
2. retrorectal (presacral)-between the sacrum and the rectum posteriorly

Front 69

fascial condensations (pelvic ligaments)

Back 69

parts of the endopelvic fascia that have more fibrous consistency containing abundance of collagen and elastic fibers

Front 70

hypogastric sheath

Back 70

a fascial condensation between the retropubic and retrorectal spaces, does not allow for an opening between the two, gives passage to essentially all the vessels and nerves passing from the lateral wall of the pelvis to the pelvic viscera, along with the uterus and ducuts deferens in the male, travels medially and divides into three laminae conveying neurovascular structures and providing support, lateral to the rectum, houses the internal iliac vessels and the ureter

Front 71

lateral ligament of the bladder

Back 71

the anteriormost lamina of the hypogastric sheath, it passes to the bladder conveying the superior vesical arteries and veins

Front 72

lateral rectal ligament of the hypogastrich sheather

Back 72

posteriormost lamina of the hypogastric sheath passes to the rectum conveying the middle rectal artery and vein, connect the rectum to the parietal pelvic fascia at the S2-S4 levels, imbed the middle rectal arteries and rectal nerve plexuses

Front 73

rectovesical septum

Back 73

the middle lamina of the hypogastric sheath in the male, between the posterior surface of the bladder and the prostate anteriorly and the rectum posteriorly, thin

Front 74

transverse cervical (cardinal) ligament (AKA lateral cervical or Mackenrodt ligament)

Back 74

the middle lamina of the hypogastric sheath in the female, markedly more substantial than the other two lamina, passes medially to the uterine cervix and vagina, houses the uterine aretery which runs toward the cervix while the ureters pass immediately inferior to them, provides the main passive support for the uterus by anchroing it to the lateral wall of the pelvis

Front 75

perineal muscles

Back 75

provide support for the uterus by contracting during moments of increased intra-abdominal pressure (sneezing, coughing), helps resist the tendency of the usterus to fall or be pushed through the hollow tube formed by the vagina

Front 76

ischioanal fossae

Back 76

space inferior to the pelvic diaphragm, surgically important

Front 77

pelvirectal space

Back 77

surgically important space in the loose extraperitoneal connective tissue superior to the pelvic diaphragm, divided into anterior and posterior regions by the lateral rectal ligaments

Front 78

neurovascular structures of the pelvis

Back 78

normally the nerves lie most esternal or superficial, with the veins external (lateral) to the arteries (nerve, vein, artery)

Front 79

innervation of the pelvis

Back 79

sacral and coccygeal spinal nerves and the pelvic part of the ANS, receive sympathethic via lumbar splanchnics and parasympathetic from pelvic splanchnics

Front 80

sympathethics in the pelvis

Back 80

vasomotor, also inhibits peristaltic contraction of the rectum and stimulates contraction of internal genital organs during orgasm, producing ejaculation

Front 81

parasympathetics in the pelvis

Back 81

stimulate contraction of the rectum and bladder for defecation and urination, produce erections, also have the visceral afferents (reflexes) running with it

Front 82

lumbosacral trunk

Back 82

formed from the descending part of the L4 nerve that unites with the anterior ramus of the L5 nerve, it passes inferiorly on the anterior surface of the ala of the sacrum and joins the sacral plexus

Front 83

sacral plexus

Back 83

located on the posterolateral wall of the lesser pelvis, closely related to the anterior surface of the piriformis muscle, gives off two main nerves the sciatic and pudendal nerves, lie external to the parietal pelvic fascia leaving through the greater sciatic foramen, give off somatic brances

Front 84

sciatic nerve

Back 84

largest nerve in the body, formed by the anterior rami of spinal nerves L4-S3 which converge on the anterior surface of the piriformis, enters the gluteal region then descends along the posterior aspect of the thigh to supply the posterior aspect of the lower limb, distributes to hip joint and muscular branches to flexors of knee in thigh and all muscles in leg and foot, somatic

Front 85

pudendal nerve

Back 85

the main nerve of the perineum and the chief sensory nerve of the external genitalia, derived from the anterior rami of S2-4, accompanied by the internal pudendal artery, after leaving the greater sciatic foramen it hooks around the ischial spine and sacrospinous ligament and enters the perineum through the lesser sciatic foramen, supplies structures in perineum: sensory to genitalia and muscular branches to perineal mesucles, external urethral sphinchter and external anal sphincter, somatic

Front 86

superior gluteal nerve

Back 86

arises from the anterior rami of spinal nerves L4-S1 and leaves through the greater sciatic foramen, supplies three muscles in the gluteal region: the gluteaus medius and minimus and the tensor of the fascia lata, somatic

Front 87

inferior gluteal nerve

Back 87

areises from the anterior rami of spinal nerves L5-S2 and leaves the pelvis through the greater sciatic foramen, accompanies the inferior gluteal artery and breakes into several branches which supply the overlying gluteus maximus muscles, somatic

Front 88

obturator nerve

Back 88

arises from the anterior rami of spinal nerves L2-L4 of the lumbar plexus in the abdomen and enters the lesser pelvis, goes to the obturator canal through the extraperitoneal fat, divides into anterior and posterior parts and supply the medial thigh muscles, somatic, enters through the obturator canal (superior part of the obturator foramen) with the obturator vessels

Front 89

coccygeal plexus

Back 89

a small network of nerve fibers from S4-S5 and the coccygeal nerves, lies on the pelvic surface of the coccygeus and supplies this muscle, somatic

Front 90

anococcygeal nerves

Back 90

arise from the coccygeal plexus and pierce the coccygeus and anococcygeal ligament to supply a small area of skin between the tip of the coccyx and the anus, somatic

Front 91

autonomic nerves of the pelvic cavity

Back 91

1. sacral sympathetic trunks-primarily provide symphathetic innervation to the lower limbs
2. periarterial plexuses-of superior rectal, ovarian, and internal iliac arteries: postsynaptic, sympathetic, vasomotor fibers to involved artery and its derivative branches
3. hypogastric plexuses-most important route by which sympathetic fibers are conveyed to the pelvic viscera, superior and inferior, network of sympathetic and viscerl afferent nerve fibers
4. pelvic splanchnic nerves-pathway for parasympathetic innervation of pelvic viscera and descending and sigmoid colon, merges with the hypogastric plexus in the pelvis

Front 92

sacral sympathetic trunks

Back 92

inferior continuation of the lumbar sympathethic trunks, each branch usually has four sympathetic ganglia, converge to form the small median ganglion impar (coccygeal ganglion) anterior to the occycx, descend posterior to the rectum and send communicating branches to each of the anterior rami of the sacral and coccygeal nerves, also send small branches to the median sacral artery and the inferior hypogastric plexus, provide postsynaptic fibers to the sacral plexus for sympathetic (vasomotor, pilomotor and sudomotor) innervation to the lower limb

Front 93

periarterial plexus

Back 93

minor routes by which sympathetic fibers enter the pelvis, primary function is vasomotion of the arteries they accompany, sympathetic

Front 94

superior hypogastric plexus

Back 94

prolongation of the intermesenteric plexus, carries fibers from the L3 and L4 splanchnics, enters the pelvis and forms right and left hypogastric nerves which descend on the anterior surface of the sacrum, descend further and merge with the pelvic splanchnic nerves to form the right and left inferior hypogastric plexuses, sympathetic

Front 95

inferior hypogastric plexus

Back 95

continue to the pelvic viscera where they form the pelvic plexuses, mixed autonomic and visceral afferent fibers

Front 96

pelvic plexuses

Back 96

associated with the lateral aspects of the rectum and inferolateral surfaces of the bladder, in the male is also associated with the prostate and seminal glands, in the femal associated with the cervix and the lateral fornices

Front 97

pelvic splanchnic nerves

Back 97

arise in the pelves from the anterior rami of spinal nerves S2-S4, greatest contribution of which is from S3, parasympathetic

Front 98

pelvic pain line

Back 98

corresponds to the inferior limit of the peritoneum
1. visceral afferents superior to this line follow sympathetic fibers retrograde, ascending through hypogastric/aortic plexuses, abdominopelvic splanchnic nerves, lumbar sympathetic trunks and white rami to reach cell bodies in the inferior thoracic/upper lumbar spinal ganglia
2. visceral afferents inferior to this line follow the parasympathetic fibers retrograde through the pelvic and inferior hypogastric plexuses and pelvic splanchnic nerves to reach cell bodies in the spinal sensory ganglia of S2-S4

Front 99

main arteries of the pelvis

Back 99

six in the female, four in the male, the internal iliac and ovarian arteries (females) are paired and the median sacral and superior rectal arteries are unpaired

Front 100

internal iliac artery

Back 100

begins as the common iliac artery which bifurcates into the internal and external iliac artery between L5 and S1, descends posteromedially into the lesser pelvis, medial to the external iliac vein and obturator nerve and lateral to the peritoneum, the principal artery of the pelvis, supplies most of the blood to the pelvic viscera and some to the musculoskeletal part of the pelvis and also supplies branches ot the gluteal region, medial thigh regions and the perineum

Front 101

termination of the internal iliac artery

Back 101

usually at the superior edge of the greater sciatic forament by dividing into anterior (visceral supplying the bladder, rectum and reproductive organs and various branches) and posterior divisions

Front 102

anterior division of internal iliac

Back 102

branch of the internal iliac artery
1. course-passes anteriorly along lateral wall of pelvis, dividing into visceral, obturator, and internal pudendal arteries
2. distribution-pelvic viscera, muscles of superior medial thigh and perineum

Front 103

umbilical artery

Back 103

branch of the anterior division of the internal iliac artery, conduct oxygen and nutrient-deficient blood to the placenta
1. course-runs a short pelvic course, gives off superior vesical arteries then obliterates, becoming medial umbilical ligament
2. distribution-superior aspect of urinary bladder and, in some males, ductus deferens
3. anastamoses-occasionally the patent part of the umbilical artery

Front 104

superior vesical artery

Back 104

postnatal, branche of the patent proximal umbilical artery
1. course-usually multiple, pass to superior aspect of urinary bladder
2. distribution-superior aspect of urinary bladder, in some males the ductus deferens
3. anastamoses-inferior vesical in males and vaginal artery in females

Front 105

obturator artery

Back 105

branch of the anterior division of the internal iliac artery, variable origin, can be close to the origin of the umbilical artery
1. course-runs anteroinferilry on obturator fascia of lateral pelvic wall exiting pelvis via obturator canal
2. distribution-pelvic muscles, nutrient artery to ilium, head of femur and muscles of medial comparmtnet of the thigh
3. anastamoses-inferior epigastric, umbilical artery

Front 106

pubic branch of the obturator artery

Back 106

arises just before the obturator artery leaves the pelvis and anastomoses with the pubic branch of the inferior epigastric artery

Front 107

aberrant or accessory obturator

Back 107

20%, arises from the inferior epigastric artier and descends into the pelvis along the usual route of the pubic branch

Front 108

inferior vesical artery

Back 108

in males, branch of the anterior branch of the internal iliac artery
1. course-passes subperitoneally in lateral ligament of bladder, giving rise to prostatic artery and occasionally the artery to the ductus deferens
2. distribution-inferior aspect of male urinary bladder, prostate and seminal glands, occasionally ductus deferens
3. anastamoses-superior vesical artery

Front 109

middle rectal artery

Back 109

may arise independently from the internal iliac artery or it may arise in common with the inferior vesical artery or the internal pudendal artery
1. course-descends in pelvis to inferior part of rectum
2. distribution-seminal glands and inferior part of rectum, prostate (male) or vagina (female)
3. anastamoses-superior and inferior rectal arteries

Front 110

vaginal artery

Back 110

homolog to the inferior vesical artery in males,
1. course-divides into vaginal and inferior vesical branches, the former descending on the vagina, the latter passing to the urinary bladder
2. distribution-vaginal branch: lower vagina, vestibular bulb and adjacent rectum, inferior vaginal branch: fundus of urinary bladder
3. anastomoses-vaginal branch of uterine artery, superior vesical artery

Front 111

uterine artery

Back 111

in females, usually arises separately and directly from the internal iliac artery, homolog to the artery to the ductus deferens in males, gives off a small vaginal branch (supplies the cervix and vagina) and a larger ascending branch (supplies the body and fundus of the uterus)
1. course-runs anteromedially in base of broad ligament, gives rise to vaginal branch then crosses ureter superiorly to reach lateral aspect of uterine cervix
2. distribution-uterus, ligaments of uterus, medial parts of uterine tube and ovary and superior vagina
3. anastamoses-ovarian artery, vaginal artery

Front 112

ascending branch of the uterine artery

Back 112

bifurcates into ovarian and tubal branches which continue within the broad ligament to supply the medial ends of the ovary and uterine tube and anasomose with the ovarian and tubal branches of the ovarian artery

Front 113

relationship of the ureter vs. the uterine artery

Back 113

water (ureter) passes under the bridge (uterine artery)

Front 114

internal pudendal artery

Back 114

larger in males than in females, once in the ischioanal fossa it divides into its terminal branches the deep and dorsal arteries of the penis or clitoris
1. course-exits pelvis via infrapiriform part of greater sciatic foramen, enters perineum via lesser sciatic foarmen, passes via pudendal canal to UG triangle (ischioanal fossa)
2. distribution-main artery of perineum, including muscles and skin of anal and urogenital triangles, erectible bodies
3. anastomoses-umbilical artery: prostatic branches of inferior vesical artery in males

Front 115

inferior gluteal artery

Back 115

1. course-exits pelvis via infrapiriform part of greater sciatic foramen
2. distribution-pelvic diaphragm, piriformis, quadratus femoris, superiormost hamstrings, gluteus maximus and sciatic nerve
3. anastomoses-deep femoral artery (via medial and lateral femoral circumflex arteries)

Front 116

posterior division of the internal iliac artery

Back 116

origininates from the internal iliac artery, gives rise to the superior gluteal artery, iliolumbar artery and lateral sacral arteries
1. course-passes posteriorly and gives rise to parietal branches
2. distribution-pelvic wall and gluteal region

Front 117

superior gluteal artery

Back 117

1. course-exits pelvis via suprapiriform portion of greater sciatic foramen
2. distribution-piriformis, all three gluteal muscles, and tensor of fascia lata
3. anastomoses-lateral sacral, inferior gluteal, internal pudendal, deep circumflex femoral, lateral circumflex femoral

Front 118

iliolumbar artery

Back 118

1. course-ascends anterior to sacroiliac joint and posterior to common iliac vessels and psoas major, dividing into iliac and lumbar branches, runs in recurrent fashion, divides into an iliac branch and lumbar branch
2. distribution-psoas major, iliacus and quadratus lumborum, cauda equina
3. anastomoses-circumflex iliac artery and 4th lumbar artery

Front 119

lateral sacral arteries

Back 119

have superior and inferior branches
1. course-runs on anteromedial aspect of piriformis to send branches into pelvic sacral foramina
2. distribution-piriformis, structures in sacral canal, erector spinae and overlying skin
3. anastomoses-medial sacral arteries

Front 120

ovarian artery

Back 120

originates from abdominal artery inferior to the renal artery, adheres to the parietal peritoneum and runs anterior to the ureter, divides into an ovarian branch (ovary) a tubal branch (uterine tube)
1. course-corsses pelvic brim, descends in suspensory ligament of ovary
2. distribution-abdominal and/or pelvic ureter, ovary, and ampullary end of uterine tube
3. anatomoses-uterine artery via tubal and ovarian branches

Front 121

median sacral artery

Back 121

originates from the posterior aspect of abdominal aorta
1. course-descends close to midline over (L4), L5 vertebrae and sacrum and coccyx
2. distribution-inferior lumbar vertebrae, sacrum and coccyx
3. anatomoses-lateral sacral artery (via medial sacral branches)

Front 122

superior rectal artery

Back 122

continuation of inferior mesenteric artery, divides into two branches that supply it as far inferiorly as the internal anal sphincter
1. course-corsses left common iliac vessels and descends into pelvis between layers of sigmoid mesocolon
2. distribution-superior part of rectum
3. anastomoses-middle rectal artery, inferior rectal artery (internal pudendal)

Front 123

drainage of the lesser pelvis(rectal, vesical, prostatic, uterine and vaginal)

Back 123

mainly through the internal iliac veins, but can also go through the superior rectal vein into the IMV, through the lateral sacral veins into the internal vertebral venous plexus, the parietal median sacral vein, the superior rectal vein or the ovarian veins

Front 124

common iliac vein

Back 124

formed from the merging of the internal iliac veins with the external iliac veins, at L4 or L5 the two common iliac veins merge to form the inferior vena cava

Front 125

umbilical veins

Back 125

there are no umbilical veins accompanying the umbilical arteries between the pelvis and umbilicus

Front 126

iliolumbar veins

Back 126

from the iliac fossae of the greater pelvis, usually drain into the common iliac veins

Front 127

superior gluteal veins

Back 127

are the largest tributares of the internal iliac veins, except during pregnancy when the uterine veins become large

Front 128

testicular veins

Back 128

traverse the greater pelvis as they pass from the deep inguinal ring toward their posterior abdominal terminations

Front 129

external iliac lymph nodes

Back 129

lie above the pelvic brim along the extneral iliac vessels, receive lymph mainly from inguinal lymph nodes but also pelvic viscera, drain into the common iliac nodes

Front 130

internal iliac lymph nodes

Back 130

clustered around the anterior and posterior divisions of the internal iliac artery and the origins of the gluteal arteries, drain the inferior pelvic viscer, deep perineum and gluteal region and drain into the common iliac nodes

Front 131

sacral lymph nodes

Back 131

lie in the sacrum adjacent to the median sacral vessels, receive lymph from posteroinferior pelvic viscera and drain either to internal or common iliac nodes

Front 132

common iliac lymph nodes

Back 132

superior to the pelvis and receive drainage from the three main groups listed above

Front 133

lumbar lymph nodes

Back 133

drain the gonads and associated structures, common iliac nodes

Front 134

inferior mesenteric lymph nodes

Back 134

drain superiormost rectum, sigmoid colon, descending colon, pararectal nodes

Front 135

superifical inguinal lymph nodes

Back 135

drains the lower limb, superficial drainage of inferolateral quadrant of turnk, including anterior abdominal wall inferior to umbilicus, gluteal region and superficial perineal structures

Front 136

deep inguinal lymph nodes

Back 136

glands of clitoris or penis, superficial inguinal nodes

Front 137

pararectal lymph nodes

Back 137

drains superior rectum

Front 138

ureters

Back 138

retroperitoneal, their inferior havles lie in the pelvis, inferior ends of the ureters are surrounded by the vesical venous plexus, obliquely enters the bladder forming a one way flap valve, as the bladder fills, the internal pressure INCs causing the passage to collapse, bladder contractions also act as a sphincter preventing the reflux of urine into the ureters, peristaltic contractions move urine down the ureters with a few drops being transported at intervals of 12-20 secs

Front 139

normal sites of constriction of the ureters

Back 139

1. at the uretopelvic junction
2. crossing iliac vessels and pelvic brim
3. traversing bladder wall

Front 140

what structures lie between the ureter and the peritoneum

Back 140

in males: the ductus deferens
in females: uterine artery crosses it superiorly

Front 141

arterial supply of the ureters

Back 141

from variable branches form the common iliac, internal iliac and ovarian arteries extend to and supply the pelvic parts of the ureters, also from branches of the uterine arteries in the female and the inferior vesical arteries in the male

Front 142

venous supply of the ureters

Back 142

veins accompany the arteries and have corresponding names, lymph drains sequentially from superior to inferior, into the lumbar and common iliac nodes (abdomninal part) and the external and internal iliac nodes (pelvic part)

Front 143

innervation of the ureters

Back 143

derived from adjacent autonomic plexuses (renal, aortic, superior and inferior hypogastric), superior to the pelvic pain line, afferent (pain) fibers from the ureters follow sympathetic fibers in a retrograde direction to reach the spinal ganglia and spinal cord segments of T11-L1 or L2, ureteric pain referred to the ipsilateral lower quadrant of the abdomen, especially to the groin (inguinal region)

Front 144

bladder

Back 144

when empty it is located in the lesser pelvis, but when full enters the greater pelvis and may rise superior enough to be at the umbilicus (in adults), in children the bladder is in the abdomen until puberty, slightly posterior and superior to the pubic bones, lies inferior to the peritoneum resting on the pubic bones and pubic symphysis anteriorly and the pelvic floor posteriorly, enveloped by a loose CT visceral fascia

Front 145

retropubic space

Back 145

separates the urinary bladder from the pubic bones, AKA prevesical space, space of Retzius, extends on each side of the bladder, filled with fat and loose areolar tissue that accommodates the expansion of the bladder

Front 146

puboprostatic ligament and the pubovesical ligament

Back 146

puboprostatic ligament (male) and pubovesical ligament (female) hold the anterior part of the bladder firmly in place although the bladder is relatively free within the extraperitoneal subQ fatty tissue

Front 147

parts of the bladder (best seen when empty)

Back 147

1. apex of the bladder-points toward the superior edge of the pubic symphysis)
2. fundus of the bladder-opposite the apex, formed by the convex posterior wall
3. body of the bladder-major portion of the bladder between the apex and fundus
4. neck of the bladder-where the funds and the inferolateral surfaces meet inferiorly

Front 148

bladder bed

Back 148

formed from the structures that directly contact the bladder, only superior surface of the bladder is covered by peritoneum

Front 149

detrussor muscles

Back 149

compose the walls of the bladder

Front 150

internal urethral spinchter

Back 150

found at the neck of the male bladder, contracts during ejaculation to prevent ejaculate from entering the bladder, some run radially in forming the internal urethral orifice

Front 151

internal urethral orifice in men vs. women

Back 151

in males the internal urethral orifice fibers in the neck are continuous with the fibromuscular tissue of the prostate, in females these fibers are continuous with muscle fibers in the wall of the urethra

Front 152

uretic orifices

Back 152

where the ureters empty into the bladder, found in the trigone of the bladder (the trigone is formed by the two orifices of the ureters and the internal urethral orifice, smooth in this triangle area), encircled by loops of detrusor musculature that tighten when the bladder contracts to assist in preventing reflux of urine into the ureter

Front 153

uvula of the bladder

Back 153

a slight elevation of the trigone, more prominent in older men bec. of enlarged prostate (posterior lobe)

Front 154

arterial supply of the bladder

Back 154

branches of the internal iliac arteries, superior vesical arteries supply anterosuperior parts of the bladder, in males the inferior vesical arteries supply the fundus and neck, in females it’s the vaginal arteries, the obturator and inferior gluteal arteries also supply small branches to the bladder

Front 155

venous drainage of the bladder

Back 155

veins correspond to the arteries and are tributaries of the internal iliac veins
1. in males the vesical venous plexus is continuous with the prostatic venous plexus and envelops the fundus and prostate, the seminal glands, the ductus deferens and the inferior end of the ureters, also receives blood from the deep dorsal vein of the penis, vesical venous plexus normally drains through the inferior vesical vein into the internal iliac vein but may drain through the sacral veins into the internal vertebral venous plexuses
2. in females the vesical venous plexus envelops the pelvic part of the urethra and the neck, receives blood from the dorsal vein of the clitoris and communicates with the vaginal or uterovaginal venous plexus

Front 156

lymphatic drainage of the bladder

Back 156

lymphatic vessels in both sexes that come from the superolateral aspects of the bladder pass to the external iliac lymph nodes, those from the fundus and neck pass to the internal iliac lymph nodes, some from the neck can drain into the sacral or common iliac lymph nodes

Front 157

innervation of the bladder

Back 157

1.sympathetic fibers come from the inferior thoracic and superior lumbar spinal cord levels to the vesical (pelvic) plexuses primarily through the hypogastric plexuses and nerves, can cause the internal sphincter to contract (like when standing in front of the urinal with a long line behind you) until the parasympathetic inhibition of the sphincter occurs
2. parasympathetic come from the sacral spinal cord level that are conveyed by the pelvic splanchnic nerves and the inferior hypogastric plexuses, are motor to the detrussor muscles and inhibitory to the internal urethral sphincter of the male bladder

Front 158

male urethra

Back 158

muscular tube that conveys urine from the internal urethral orifice to the external urethral orifice, in the flaccid state has a double curvature, divided into 4 parts (intramural part, prostatic part, intermediate part and spongy urethra)

Front 159

intramural (preprostatic) part

Back 159

extend almost vertically thorugh neck of bladder, surrounded by internal urethral sphincter, diameter and length vary depending on whether bladder is filling or emptying

Front 160

prostatic urethra

Back 160

descends through anterior prostate, forming a gentle, anteriorly concave curve, bounded anteriorly by a vertical trough-like part (rhapdosphincter) of external urethral sphincter, widest and most dilatable part, features urethral crest with seminal colliculus flanked by prostatic sinuses into which prostatic ducts open, ejactulatory ducts open onto colliculus hence urinary and reproductive tracts merge in this part

Front 161

intermediate (membranous) part

Back 161

passes through deep perineal pouch, surrounded by circular fibers of external urethral sphincter, penetrates perineal membrane, narrowest and least distensible part (except for external urethral orifice)

Front 162

spongy urethra

Back 162

courses through corpus spongiosum, initial widening occurs in bulb of penis, widens again distally as navicular fossa, longest and most mobile part, bulbourethral glands open into bulbous part, distally urethral glands open into small urethral lacunae entering lumen of this part

Front 163

prostatic utricle

Back 163

the vestigial remnant of the embryonic uterovaginal canal (constitutes the primordium of the uterus and a part of the vagina

Front 164

arterial supply of the proximal male urethra

Back 164

the proximal two parts of the urethra are supplied by the prostatic branches of the inferior vescial and middle rectal arteries

Front 165

venous drainage of the proximal male urethra

Back 165

veins from the proximal two parts drain into the prostatic venous plexus

Front 166

lymphatic drainage of the proximal male urethra

Back 166

pass mainly to the internal iliac lymph nodes, a few vessels drain into the external iliac lymph nodes

Front 167

innervation of the proximal male urethra

Back 167

derived from the prostatic plexus (mixed), prostatic plexus is one of the pelvic plexusesarising as organ-specific extensions of the inferior hypogastric plexus

Front 168

female urethra

Back 168

runs parallel to the vagina, firmly attached to and indents the anterior vaginal wall centrally and distally, musculature surrounding the internal urethral orifice of the female bladder is not organized into an internal sphincter, the external urethral orifice is located in the vestibule, directly anterior to the vaginal orifice, urethra lies anterior to the vagina, passes with the vagina through the pelvic diaphragm, external urethral sphincter and perineal membrane

Front 169

paraurethral glands

Back 169

homologues to the prostate, have a common paraurethral duct which opens near the external urethral orifice, inferior half of the urethra is located in the perineum

Front 170

arterial supply of the female urethra

Back 170

supplied by the internal pudendal and vaginal arteries

Front 171

venous drainage of the urethra

Back 171

veins follow the arteries and have similar names

Front 172

lymphatic drainage of the urethra

Back 172

pass to the sacral and internal iliac lymph nodes, some drain into the inguinal lymph nodes

Front 173

innervation of the female urethra

Back 173

arise from the vesical plexus and the pudendal nerve, similar to that in the male given the absence of the prostatic plexus and an internal urethra sphincter, visceral afferents run in the pelvic splanchnic nerves from the pudendal nerve, both the visceral and somatic afferent fibers extend from cell bodies in the S2-S4 spinal ganglia

Front 174

ductus deferens

Back 174

the continuation of the duct of the epididymis, closely related to the inferior epigastric vessels, has thick muscular walls and a minute lumen, beings in the tail of the epidiymis, at the inferior pole of the testis, ascends posterior to the testis, medial to the epididymis, primary component of the spermatic cord, penetrates the anterior abdominal wall via the inguinal canal, crosses over the external iliac vessels and enters the pelvis, passes along the lateral wall of the pelvis, where it lies external to the parietal peritoneum, ends by joining the duct of the seminal gland to form the ejaculatory duct

Front 175

arterial supply of the ductus deferens

Back 175

there is a tiny artery to the ductus deferens that arises from a superior (sometimes inferior) vesical artery and terminates by anastomosing with the testicular artery, posterior to the testis

Front 176

venous drainage of the ductus deferens

Back 176

veins from the ductus deferens drain into the testicular vein, including the distal pampiniform plexus, its terminal protion drains into the vesicular/prostatic venous plexus

Front 177

lymphatic drainage of the ductus deferens

Back 177

end in the external iliac lymph nodes

Front 178

seminal glands (vesicles)

Back 178

an elongated structure that lies between the fundus of the bladder and the rectum, superior to the prostate and do not store sperms, secrete a thick alkaline fluid with fructose and a coagulating agent, superior end covered with peritoneum, posterior to the ureters

Front 179

arterial supply of the seminal glands

Back 179

derived from the inferior vesical and middle rectal arteries

Front 180

venous drainage of the seminal glands

Back 180

veins accompany the arteries and have similar names

Front 181

lymphatic drainage of the seminal glands

Back 181

iliac lymph nodes receive lymph from the seminal glands, the external iliac nodes form the superior part and the internal iliac nodes from the inferior part

Front 182

ejaculatory ducts

Back 182

slender tubes that arise by the union of the ducts of a seminal gland with the ductus deferens, arise near the neck of the bladder and run close together as they pass anteroinferiorly through the posterior part of the prostate and along the sides of the prostatic utricle, prostatic secretions join the seminal fluid in the prostatic urethra after the ejaculatory ducts terminated

Front 183

arterial supply of the ejaculatory ducts

Back 183

branches of the superior (but freq/ inferior) vesical arteries

Front 184

venous drainage of the ejaculatory ducts

Back 184

veins join the prostatic and vesical venous plexuses

Front 185

lymphatic drainage of the ejaculatory ducts

Back 185

drain into the external iliac lymph nodes

Front 186

prostate

Back 186

largest accessory gland of the male reproductive system, glandular part makes up 2/3 of prostate, the other 1/3 is fibromuscular, walnut-shaped, surrounds the prostatic urethra

Front 187

fibrous capsule of the prostate

Back 187

dense and neurovascular, incorporates the prostatic plexuses of veins and nerves, surrounded by the visceral layer of the pelvic fascia forming a fibrous prostatic sheath that is thin anteriorly, continuous anterolaterally with the puboprostatic ligaments and dense posteriorly where it blends with the rectovesical septum

Front 188

lobes of the prostate

Back 188

1. isthmus of the prostate (anterior lobe)-anterior to the urethra, fibromuscular, muscle fibers representing a superior continuation of the urethral sphincter muscle and contains little, if any, glandular tissue
2. inferoposterior lobe (posterior)-inferior to the ejaculatory ducts, readily palpable by digital rectal examination
3. right and left lobes (lateral)-on either side of the urethra form the major part of the prostate
4. middle lobe (median)-lies between the urethra and the ejaculatory ducts and is closely related to the neck of the bladder, enlargement of the middle lobe is partially responsible for uvula that may project into the internal urethral orifice

Front 189

prostatic ducts

Back 189

open chiefly into the grooves (prostatic sinuses) that lie on either side of the seminal colliculus, prostatic fluid is a thin milky fluid (~20% volume of semen), plays a role in activating the sperm

Front 190

arterial supply of the prostate

Back 190

branches of the inferior vesical arteries but also the internal pudendal and middle rectal arteries

Front 191

venous drainage of the prostate

Back 191

join to form a plexus around the sides and base of the prostate (prostatic venous plexus), found between the fibrous capsule and the prostatic sheath, drains into the internal iliac veins, continuous superiorly with the vesical venous plexus and communicates posteriorly with the internal vertebral venous plexus

Front 192

lymphatic drainage of the prostate

Back 192

terminate in the internal iliac lymph nodes, but also may pass to the sacral nodes

Front 193

bulbouretrhal glands (Cowper glands)

Back 193

two of them, are pea-sized, embedded within the deep perineal musculature of the external urethral sphincter

Front 194

ducts of the bulbourethral gland

Back 194

pass through the perienal membrane with the intermediate urethra and open thourgh minute apertures into the proximal part of the spongy urethra in the bulb of the penis, secreate a mucus-like secretion that enters the urethra during sexual arousal

Front 195

innervation of the internal genital organs of the male pelvis

Back 195

richly innervated by sympathetic nerve fibers, presynaptic sympathetic fibers originate from cell bodies in the intermediolateral cell column of the T12-L2 (or L3) spinal cord segments, presynaptic parasympathetic fibers from S2 and S3 spinal cord segements traverse pelvic splanchnic nerves which also join the inferior hypogastric/pelvic plexuses

Front 196

vagina

Back 196

a musculomembranous tube, extends from the cervix of the uterus to the vestibule, serves as a canal for menstrual fluid, forms the inferior part of the pelvic (birth) canal, receives the penis and ejaculate during sexual intercourse, communicates superiorly with the cervical canal and inferiorly with the vestibule, posterior to the urethra, anterior to the rectum (passing between the medial margins of the levator ani muscles

Front 197

vaginal fornix

Back 197

the recess around the cervix, has an anterior, posterior and lateral parts

Front 198

posterior vaginal fornix

Back 198

the deepest part and is closely related to the rectouterine pouch

Front 199

muscles of the vagina

Back 199

pubovaginalis, external urethral sphincter, urethrovaginal sphincter and bulbospongiosus

Front 200

relations of the vagina

Back 200

anteriorly: the fundus of the urinary bladder and urethra
laterally: the levator ani, visceral pelvic fascia and ureters
posteriorly (inferior to superior): the anal canal, rectum and retrouterine pouch

Front 201

arterial supply of the vagina

Back 201

superior part of the vagina derive from the uterine arteries, middle and inferior parts of the vagina derive from the vaginal and internal pudendal arteries

Front 202

venous drainage of the vagina

Back 202

vaginal veins form vaginal venous plexuses along the sides of the vagina and within the vaginal mucosa, these are continuous with the uterine venous plexus as the uterovaginal venous plexus and drain into the internal iliac veins through the uterine vein, also communicates with the vesical and rectal venous plexuses

Front 203

lymphatic drainage of the vagina

Back 203

superior part-to the internal and external iliac lymph nodes
middle part-to the internal iliac lymph nodes
inferior part-to the sacral and common iliac nodes
external orifice-to the superficial inguinal lymph nodes

Front 204

uterus (womb)

Back 204

a thick-walled, pear-shaped, hollow muscular organ, embryo and fetus develop here, usually lies in the lesser pelvis with its body on the bladder and cervix between the bladder and rectum,

Front 205

body of the uterus

Back 205

forms the superior two thirds of the organ, includes the fundus of the uterus (rounded part that lies superior to the orifices of the uterine tubes), lies between the layers of the broad ligament and is freely moveable, demarcated from the cervix by the isthmus of the uterus

Front 206

cervix of the uterus

Back 206

cylindrical, relatively narrow inferior third of the uterus, two parts: a supravaginal part (between the isthmus and vagina) and a vaginal part (protrudes into the vagina), less muscular than the uterus, mostly fibrous, composed mainly of collagen with a small amount of smooth muscle and elastin

Front 207

vaginal part of the uterus

Back 207

surrounds the external os of the uterus, surrounded in turn by the vaginal formix

Front 208

supravaginal part of the uterus

Back 208

separated from the bladder anteriorly by loose connective tissue and from the rectum posteriorly by the rectouterine pouch

Front 209

layers of the wall of the body of the uterus

Back 209

1. perimetrium-the serose or ouoter serous coat, consists of peritoneum supported by a thin layer of connective tissue
2. myometrium-the middle coat of smooth muscle, becomes greatly distended during pregnancy, house the main branches of the blood vessels and nerves of the uterus, can contract during childbirth (hormonally stimulated)
3. endometrium-the inner mucous coat, firmly adhered to the underlying myometrium, actively involved in the menstrual cycle, blastocyst is implanted here, inner coat of this layer is shed during menstruation

Front 210

ligament of the ovary

Back 210

external, it attaches to the uterus posteroinferior to the uterotubal junction

Front 211

round ligament of the uterus

Back 211

attaches anteroinferiorly to this junction

Front 212

ovarian gubernaculums

Back 212

the ligament of the ovary and the round ligament of the uterus are vestiges of the ovarian gubernaculums, related to the descent of the gonad from its developmental position on the posterior abdomninal wall

Front 213

broad ligament of the uterus

Back 213

double layer of peritoneum, extends from the sides of the uterus to the lateral walls and floor of the pelvis, assists in keeping the uterus in position, separates the vesicouterine pouch from the rectouterine pouch

Front 214

suspensory ligament of the uterus

Back 214

superior prolongation of the peritoneum of the broad ligament

Front 215

mesosalpinx

Back 215

small mesentery that holds the uterine tube (it lies in the anterosuperior border of the broad ligament

Front 216

mesovarium

Back 216

houses the ovary, on the posterior aspect of the broad ligament

Front 217

mesometrium

Back 217

the largest part of the broad ligament, inferior to the mesosalpinx and mesovarium, serves as the mesentery for the uterus itself

Front 218

pelvic diaphragm and support of the uterus

Back 218

acts as the dynamic support of the uterus, its tone during sitting and standing and active contraction during periods of INC intraabdominal pressure is transmitted through the surrounding pelvic organs and the endopelvic fascia in which they are embedded

Front 219

passive support of the uterus

Back 219

provided by its position, the way in which the normally anteverted and anteflexed uterus rests on top of the bladder, when pressure INC it is pushed against bladder

Front 220

transverse cervical (cardinal) ligaments

Back 220

extend from the cervix and lateral parts of the formix of the vagina to the lateral walls of the pelvis

Front 221

uterosacral ligaments

Back 221

pass superiorly and slightly posteriorly from the sides of the cervix to the middle of the sacrum, are palpable during a rectal exam

Front 222

peritoneal covering of the uterus

Back 222

covered anteriorly and superiorly, except for the cervix

Front 223

vesicouterine pouch

Back 223

separates the uterine body from the urinary bladder, is where the peritoneum is reflected from the uterus onto the posterior margin of the superior surface of the bladder

Front 224

rectouterine pouch

Back 224

posterior, separates the uterine body and suprvaginal part of the cervix from the sigmoid colon

Front 225

arterial supply of the uterus

Back 225

derives mainly from the uterine arteries, with potential collateral supply from the ovarian arteries

Front 226

venous drainage of the uterus

Back 226

uterine veins enter the braod ligaments with the arteries and form a uterine venous plexus on each side of the cervix, these then drain into the internal iliac veins

Front 227

lymphatic drainage of the uterus

Back 227

drain in many directions, coursing with the blood vessels that supply it and the ligaments that are attached to it
1. fundus and superior uterine body: pass along the ovarian vessels to the lumbar lymph nodes, but some run along the round ligament of the uterus to the superficial inguinal lymph nodes
2. uterine body and some from the cervix: pass within the broad ligament to the external iliac lymph nodes
3. uterine cervix: pass along the uterine vessels within the transverse cervical ligaments to the internal iliac lymph nodes and along uterosacral ligaments to the sacral lymph nodes

Front 228

innervation of the vagina

Back 228

only the inferior 1/5 to ¼ is somatic (from the deep perineal nerve, conveys sympathetic and visceral afferent), only this part is sensitive to touch and temperature, the superior portion is visceral (derived from the uterovaginal nerve plexus which comes from the inferior hypogastric plexus, is truly mixed)

Front 229

innervation of the uterus

Back 229

same as the inervation of the superior portion of the vagina

Front 230

uterine tubes

Back 230

conduct the oocyte (ovum) from the periovarian peritoneal cavity to the uterine cavity, usual site of fertilization, open into the peritoneal cavity near the ovaries, lie in the mesoalpinx

Front 231

parts of the uterine tubes

Back 231

1. infundibulum-the funnel-shaped distal end of the tube that opens into the peritoneal cavity through the abdominal ostium, the fimbriae spread over the medial surface of the ovary
2. ampulla-the widest and longest part of the tube, usually the site of fertilization
3. isthmus-the thick-walled part of the tube, which enters the uterine horn
4. uterine part-short intramural segment of the tube that passes through the wall of the uterus and opens via the uterine ostium into the uterine cavity at the uterine horn

Front 232

ovaries

Back 232

endocrine glands as well as reproductive organs, located near the attachment of the broad ligament to the lateral pelvic walls, suspended from both by peritoneal folds, attach to the uterus by the ligament of the ovary, not covered by peritoneum

Front 233

suspensory ligament of the ovary

Back 233

house the ovarian vessels, lymphatics and nerves that pass to and from the superolateral aspect of the ovary, constitutes the lateral part of the mesovarium of the broad ligament

Front 234

ligament of the ovary

Back 234

a remnant of the superior part of the ovarian gubernaculums of the fetus, connects the proximal end of the ovary to the lateral angle of the uterus

Front 235

arterial supply of the ovaries

Back 235

ovarian arteries which arise from abdominal aorta and descend along the posterior abdominal wall, enter the suspensory ligament, bifurcates into ovarian and tubal branches, (these anastomose providing a collateral circulation from abdominal and pelvic sources)

Front 236

arterial supply of the uterine tubes

Back 236

uterine arteries that branch from the internal iliac arteries, course along the lateral aspects of the uterus to approach the medial aspects of the ovaries and tubes, bifurcates into ovarian and tubal branches (these anastomose providing a collateral circulation from abdominal and pelvic sources)

Front 237

venous drainage of the ovaries and uterine tubes

Back 237

form a vine-like pampiniform plexus of veins in the broad ligament near the ovary and uterine tubes, merge to form an ovarian vein which leaves the lesser pelvis with the ovarian artery, right ovarian vein enters the IVC and left ovarian vein enters the left renal vein

Front 238

lymphatic drainage of the ovaries and uterine tubes

Back 238

lymphatic vessels of the ovary join those from the uterine tubes and fundus and follow the ovarian blood vessels as they ascend to the right and left lumbar lymph nodes

Front 239

innervation of the ovaries and uterine tubes

Back 239

derives partly from the ovarian plexus and uterine plexus, superior to the pelvic pain line

Front 240

rectum

Back 240

pelvic part of the alimentary tract and is continuous proximally with the sigmoid colon

Front 241

rectosigmoid junction

Back 241

lies anterior to the S3 vertebra, where the teniae of the sigmoid colon spread out to form a continuous outer longitudinal layer of smooth muscle

Front 242

sacral flexure of the rectum

Back 242

where the rectum follows the curvature of the sacrum and coccyx

Front 243

anorectal flexure of the anal canal

Back 243

a sharp posteroinferior angle where the rectum ends, occurs as the gut perforates the pelvic diaphragm, 80 degrees

Front 244

lateral flexures of the rectum

Back 244

three of them (superior, intermediate and inferior), formed in relation to three internal foldings (transverse rectal folds), two on the left and one on the right

Front 245

ampulla of the rectum

Back 245

dilated terminal part of the rectum, receives and holds an accumulating fecal mass until it is expelled during defecation, can relax to accomodoate the initial and subsequent arrivals of fecal material

Front 246

where does peritoneum cover the rectum

Back 246

the anterior and lateral surfaces of the superior 1/3, the anterior surface of the middle 1/3, inferior third is subperitoneal

Front 247

rectovesical pouch

Back 247

found in males where the peritoneum reflects from the rectum to the posterior wall of the bladder

Front 248

rectouterine pouch

Back 248

in females, where the peritoneum reflects from the rectum to the posterior part of the fornix of the vagina

Front 249

pararectal fossae

Back 249

found in both sexes, are lateral reflections of peritoneum from the superior third of the rectum, permit the rectum to distend as it fills with feces

Front 250

rectovesical septum

Back 250

lies between the fundus of the bladder and the ampulla of the rectum and is closely associated with the seminal glands and prostate, in males

Front 251

rectovaginal septum

Back 251

separates the superior half of the posterior wall of the vagain from the rectum, in females

Front 252

arterial supply of the rectum

Back 252

superior rectal artery (continuation of the IMA) supplies the proximal part of the rectum, right and left middle rectal arteries (from the inferior vesical arteries) supply the middle and inferior parts of the rectum, the inferior rectal arteries (from the internal pudendal arteries) supply the anorectal junction and anal canal, there are anatomoses between all these

Front 253

venous drainage of the rectum

Back 253

drains through the superior, middle and inferior rectal veins, superior rectal vein drains into the portal venous system and the middle and inferior rectal veins drain into the systemic system, anatomose with each other, rectal venous plexus consists of two parts, the internal rectal venous plexus (deep to the mucosa of the anorectal junction) and the external rectal venous plexus (external to the muscular wall of the rectum)

Front 254

lymphatic drainage of the rectum

Back 254

superior half of the rectum passes to the pararectal lymph nodes and then ascend to the inferior mesenteric lymph nodes via the sacral lymph nodes or through the nodes along the superior rectal vessels, the inferior mesenteric lymph nodes drain into the lumbar lymph nodes, inferior half of the rectum drain to the sacral lymph nodes or follow the middle rectal vessels to drain into the internal iliac lymph nodes

Front 255

perineum

Back 255

bounded by the pelvic outlet and is separated from the pelvic cavity by the pelvic diaphragm

Front 256

boundaries of the perineum

Back 256

1. pubic symphysis anteriorly
2. inferior pubic rami and ishcial rami anterolaterally
3. ischial tuberosities laterally
4. sacrotuberous ligaments posterolaterally
5. inferiormost sacrum and coccyx posteriorly

Front 257

anal triangle

Back 257

lies posterior to the plane from the anterior ends of the ischial tuberosities, composed of the anal canal, its orifice, and the anus, is an open triangle

Front 258

urogenital triangle

Back 258

anterior to the plane from the anterior ends of the ischial tuberosities, a closed triangle, closed by the perineal membrane (between the two sides of the pubic arch covering the anterior part of the pelvic outlet)

Front 259

perineal membrane

Back 259

fills the anterior gap in the pelvic diaphragm but is perforated by the urethra in both sexes and the vagina in the female, attaches to the ischiopubic rami and forms the foundation for the erectile bodies of the external genitalia (penis and scrotum or vulva of females)

Front 260

central point of the perineum

Back 260

the midpoint of the line joining the ischial tuberosities, where the perineal body can be found

Front 261

perineal body

Back 261

an irregular mass, variable in size and consistency and containing collagenous and elastic fibers and both skeletal and smooth muscle, posterior to the vestibule of the penis and anterior to the anus and anal canal, site of convergence of the bulbospongiosus, external anal sphincter, superficial and deep transverse perineal muscles, smooth and voluntary slips of muscle from the external urethral sphincter, levator ani and muscular coats of the rectum

Front 262

subQ tissue of the perineum (superficial perineal fascia)

Back 262

consists of a superficial fatty layer and a deep membranous layer (Colles fascia), in females the fatty later makes up the labia major and mons pubis and is continuous with Camper’s fascia, in males, the fatty layer is greatly diminished in the UG triangle being replaced with smooth muscle in the penis and scrotum, in both sexes the fatty part is continuous with the ischioanal fat pad in the anal region

Front 263

membranous layer of subQ tissue of the perineum

Back 263

does not extend into the anal triangle, attached posteriorly to the posterior perineal membrane and the perineal body, laterally attached to the fascia lata of the superiormost medial aspect of the thigh, in males it is continuous with dartos fascia and Scarapa fascia, in females passes superior to the fatty layer forming the labia majora and continuous with Scarpa fascia, continuous with dartos fascia, not continuous with fascia lata of the thigh so extravasation would not enter the thigh

Front 264

dartos fascia

Back 264

fascia of the penis and scrotum

Front 265

deep perineal fascia

Back 265

intimately invest the ischiocavernosus, bulbospongiosus and superficial transverse perineal muscles, attached laterally to the ischiopubic rami, fused to the suspensory ligament of the penis or clitoris anteriorly and the deep fascia of the abdomen

Front 266

superficial perineal pouch

Back 266

a potential space between the membranous layer of subQ tissue and the perineal membrane, bounded laterally by the ischiopubic rami

Front 267

contents of the male superficial perineal pouch

Back 267

1. root (bulb or crura) of the penis and associated muscles (ischiocavernosus and bulbospongiosus)
2. proximal (bulbous) part of the spongy urethra
3. superficial transverse perineal mescles
4. deep perineal branches of the internal pudendal vessels and pudendal nerves

Front 268

contents of the female superficial perineal pouch

Back 268

1. clitoris and associated muscles (ischiocavernosus)
2. bulbs of the vestibule and surrounding muscle (bulbospongiosus)
3. greater vestibular glands
4. superficial transverse perineal muscles
5. related vessels and nerves (deep perineal branches of the internal pudendal vessels and pudendal nerves)

Front 269

deep perineal pouch

Back 269

bounded inferiorly by the perineal membrane, superiorly by the inferior fascia of the pelvic diaphragm and laterally by the inferior portion of the obturator fascia

Front 270

conetns common to both sexes of the deep perineal pouch

Back 270

1. part of the urethra, centrally
2. the inferior part of the external urethral sphincter muscle
3. anterior extension of the ischioanal fat pads

Front 271

contents specific to the male deep perineal pouch

Back 271

1. intermediate part of the urethra (narrowest part of the urethra)
2. deep transverse perineal muscles
3. bulbourethral glands
4. dorsal neurovascular structures of the penis
at this point is where the penis takes an almost 90 degree turn

Front 272

contents specific to the female deep perineal pouch

Back 272

1. proximal part of the urethra
2. mass of smooth muscle tissue in place of deep transverse perineal muscles, associated with the perineal body
3. dorsal neurovasculature of the clitoris

Front 273

traditional view of the UG diaphragm

Back 273

consists of the perineal membrane (inferior fascia of the UG diaphragm) inferiorly and a superior fascia of the UG diaphragm superiorly, deep pouch occupies the space between these two membranes, composed of smooth musculature

Front 274

ischioanal fossae

Back 274

a feature of the anal triangle, found between the skin of the anal region and the pelvic diaphragm, the apex of each fossa lies superiorly where the levator ani muscle arises from the obturator fascia, filled with fat and loose CT, the two fossae communicate with each other via deep postanal space over the anococcygeal ligament, structures that pass through the lesser sciatic foramen enter the ischioanal fossa, right and left can communicate with each other via the deep postanal space (posterior to the anus between the deep and superficial external anal sphincter)

Front 275

boundaries of th eischioanal fossae

Back 275

1. laterally by the ischium and obturator internus
2. medially by the external anal sphincter and roof formed by the levator ani
3. posteriorly by the sacrotuberous ligament and gluteus maximus
4. anteriorly by the bodies of the pubic bones

Front 276

purpose of having fat in the ischioanal fossae

Back 276

support the anal canal but are also readily displaced to permit descent of the anal canal during the passage of feces

Front 277

pudendal canal

Back 277

passageway within the obturator fascia that covers the medial aspect of the obturator internus and lines the lateral wall of the ischioanal fossa, the internal pudendal artery and vein, the pudendal nerve and the nerve to the obturator internus enter here

Front 278

inferior rectal artery and nerve

Back 278

arise from the internal pudendal artery and pudendal nerve as they enter the canal, supply the external anal sphincter and the perianal skin, bifurcates to give the perineal nerve (distributes to the superficial pouch) and artery and dorsal artery and nerve of the penis or clitoris (runs in the deep pouch)

Front 279

branches of the perineal nerve

Back 279

1. superficial perineal nerves-give rise to posterior scrotal and labial branches
2. deep perineal nerve-supplies the muscles of the deep and superficial perineal pouches, the skin of the vestibule and the mucosa of the inferiormost part of the vagina

Front 280

dorsal nerve of the penis or clitoris

Back 280

runs in the deep pouch, is the primary sensory nerve serving the male or femal organ, especially the sensitive glans at the distal end

Front 281

anal canal

Back 281

the terminal part of the large intestine, extends from the superior aspect of the pelvic diaphragm to the anus, surrounded by internal and external anal sphincters, both sphincters must relax before defecation can occur

Front 282

internal anal sphincter

Back 282

is an involuntary sphincter surrounding the superior two thirds of the anal canal, its contraction is stimulated by sympathetic fibers from the superior rectal and hypogastric plexuses, inhibited by parasympathetic fibers

Front 283

external anal sphincter

Back 283

large voluntary sphincter that forms a broad band on each side of the inferior two thirds of the anal canal, attached anteriorly to the perineal body and posteriorly to the coccyx via the anococcygeal ligament, blends with the puborectalis muscle, has subQ (encircles the anal orifice), superficial (anchros the anus to the perineal body and coccyx) and deep (fused with the levator ani) parts, supplied mainly by S4 thourhg the inferior rectal nerve but can also receive some from the nerve that supplies levator ani

Front 284

anal columns

Back 284

longitudinal ridges that are found on the superior half of the mucous membrane of the anal canal, they contain the terminal branches of the superior rectal artery and vein, this is where the superior rectal veins of the portal system anastomose with the middle and inferior ractal veins of the caval system, this is the site of internal hemorrhoids caused by portal hypertension and the reversal of blood flow from the superior rectal vein into anastomoses with the middle and inferior rectal vein

Front 285

pectinate line

Back 285

limit of the anal valves, indicates the junction of the superior part of the anal canal (derived from hindgut) and the inferior part (derived from protodeum)

Front 286

arterial supply of the anal canal

Back 286

superior rectal artery supplies the anal canal superior to the pectinate line, the two inferior rectal arteries supply the inferior part of the anal canal as well as the surrounding muscles and perianal skin, the middle rectal arteries assist with the blood supply to the anal canal by forming anastomoses with the superior and inferior rectal arteries

Front 287

venous drainage of the anal canal

Back 287

internal rectal venous plexus drains in both directions from the level of the pectinate line, superior to the line the internal rectal plexus drains into the superior rectal veins and the portal system, inferior to the line, drains into the inferior rectal veins, middle rectal veins draint the muscularis externa of the ampulla and form anastomoses with the superior and inferior rectal veins, can also receive multiple arteriovenous anastomoses form the superior and middle rectal arteries

Front 288

lymphatic drainage of the anal canal

Back 288

superior to the pectinate line, lymph drains into the internal iliac lymph nodes and then into the common iliac and lumbar lymph nodes, inferior to the line the lymph drain into the superficial inguinal lymph nodes

Front 289

innervation of the anal canal

Back 289

superior to the pectinate line is visceral innervation from the inferior hypogastric plexus, sympathetic maintains the tonus of the internal anal sphincter, parasympathetic inhibit the tonus and evoke peristaltic contraction for defecation, sensitive to only stretching, inferior to the line is somatic innervation derived from the inferior anal (rectal) nerves, branches of the pudendal nerve, this part is sensitive to pain, touch and temperature, somatic efferent fibers stimulate contraction of the voluntary external anal sphincter

Front 290

internal pudendal artery

Back 290

1. origin-anterior division of internal iliac artery
2. course-leaves pelvis through greater sciatic foramen, hooks around ischial spine to enter perineum via lesser sciatic foramen, immediately enters pudendal canal
3. distribution-primary artery of perineum and external genital organs

Front 291

inferior rectal aretery

Back 291

1. origin-internal pudendal artery
2. course-arises at entrance to pudendal canal, traverses ischioanal fossa to anal canal
3. distribution-anal canal inferior to pectinate line, anal sphicters, perianal skin

Front 292

perineal artery

Back 292

1. origin-terminal branch of perineal artery
2. course-arises within pudendal canal, passes to superficial pouch on exit
3. distribution-supplies superficial perineal muscles and scrotum of male/vestibule of female

Front 293

posterior scrotal or labial artery

Back 293

1. origin-terminal branch of perineal artery
2. course-runs in superficial fascia of posterior scrotum or labia majora
3. distribution-skin of scrotum or labia majora and minoar

Front 294

artery of bulub of penis or vestibule

Back 294

1. origin-terminal branch
2. course-pierces perineal membrane to reach bulb of penis or vestibule
3. distribution-supplies bulbe of penis and bulbourethral gland or bulb of vestibule and greater vestibular gland

Front 295

deep artery of penis or clitoris

Back 295

1. origin-terminal branch
2. course-pierces perineal membrane to enter crura of corpora cavernosa of penis or clitoris, branches run proximally and distally
3. distribution-supplies most erectile tissue of corpora cavernosa of penis or clitoris via helicine arteries

Front 296

dorsal artery of penis or clitoris

Back 296

1. origin-terminal branch
2. course-passes to deep pouch, pierces perineal membrane and traverses suspensory ligament of penis or clitoris to run along dorsum of penis or clitoris to glans
3. distribution-deep perineal pouch, skin of penis, fascia of penis or clitoris, distal corpus spongiosum of penis, including spongy urethra, glans of penis or clitoris

Front 297

external pudendal, superficial and deep branches, artery

Back 297

1. origin-femoral artery
2. course-pass medially from thigh to reach anterior aspect of the urogenital triangle of perineum
3. distribution-anterior aspect of scrotum and skin at root of penis of male, mons pubis and anterior aspect of labia of female

Front 298

contents of the male perineum

Back 298

external genitalia (urethra, scrotum and penis), perineal muscles and anal canal

Front 299

intermediate (membranous) part of the urethra

Back 299

begins at the apex of the prostate and traverses the deep perineal pouch surrounded by external urethral sphincter, ends as the urethra enters the bulb of the penis, posterolateral to this are the bulbourethral glands

Front 300

spongy urethra

Back 300

bulbouretrhal glands open at the distal end of this, begins at the end of the intermediate part of the urethra, ends at the external urethral orifice, also has mucus-secreting urethral glands (Littre glands) that empty into the spongy urethra, also has a dense sensory nerve plexus (G spot)

Front 301

arterial supply of the distal male urethra

Back 301

both the intermediate and spongy parts of the urethra are supplied by the dorsal artery of the penis

Front 302

venous drainage of the distal male urethra

Back 302

veins accompany the arteries and have the same names

Front 303

lymphatic drainage of the distal male urethra

Back 303

lymph vessels from the intermediate part of the urethra drain into the internal iliac lymph nodes, lymph from the spongy urethra pass to the deep inguinal lymph nodes, but some to the external iliac nodes

Front 304

innervation of the distal male urethra

Back 304

intermediate part is innervated by autonomic (efferent) innervation via the prostatic nerve plexus arising from the inferior hypogastric plexus, sympathetics from lumbar spinal cord levels via the lumbar splanchnic nerves, parasym from the sacral levels via the pelvic splanchnic nerves, spongy part has somatic innervation from the dorsal nerve of the penis (branch of the pudendal nerve)

Front 305

scrotum

Back 305

cutaneous fibromuscular sac for the testes

Front 306

scrotal raphe

Back 306

midline, indicates the bilateral embryonic formation of the scroum, continuous on the ventral surface of the penis with the penile raphe and posteriorly with the perineal raphe

Front 307

septum of the scroum

Back 307

prolongation of the dartos fascia, separates the scrotum into two compartments

Front 308

arterial supply of the scrotum

Back 308

anterior scrotal arteries (terminal branches of the external pudendal arteries) supply the anterior aspect of the scrotum, posterior scrotal arteres (terminal branches of the superficial perineal branes of the internal pudendal arteries) supply the posterior aspect, also some from the cremasteric arteries (branches from the inferior epigastric arteries

Front 309

venous drainage of the scrotum

Back 309

drain primariloy to the external pudendal veins

Front 310

lymphatic drainage of the scrotum

Back 310

carry lymph to the superficial inguinal lymph nodes, exception is the gonads, migrated so acquired lymphatic vessels prior to migration, follows along testicular vessels to lumbar nodes, do not drain into pelvic nodes, they go into the lumbar nodes

Front 311

innervation of the scrotum

Back 311

anterior aspect is supplied by derivatives fo the lumbar plexus: the anterior scrotal nerves (from ilioinguinal nerve) and the genital branch of the genitofemoral nerve, posterior aspect supplied by derivatives of the sacral plexus: posterior scrotal nerves (from the superficial perineal branches of the pudendal nerve) and the perineal branch of the posterior femoral cutaneous nerve, sympathetics responsible for thermoregulation stimulating contraction of the dartos muscle in response to cold and stimulating scrotal sweat glands in response to warmth

Front 312

components of the penis

Back 312

consists of the root, body and glans, also composed of three cylindrical bodies of erectile cavernous tissue (the paired corpora cavernosa dorsally and a single corpus spongiosum ventrally)

Front 313

tunica albuginea

Back 313

an outer fibrous covering of the cavernous body

Front 314

deep fascia of the penis (Buck’s fascia)

Back 314

superificial to the outer covering, the continuation of the deep perineal fascia that forms a strong membranous covering for the corpora cavernosa and corpus spongiosum, holds the erectile tissue components toegther

Front 315

root of the penis

Back 315

consists of the crura, bulb and ischiocavernosus and bulbospongiosus muscles, located in the superficial perineal pouch, between the perineal membrane superiorly and the deep perineal fascia inferiorly

Front 316

erectile tissue

Back 316

found in the crura and bulb of the penis

Front 317

body of the penis

Back 317

free pendulous part that is suspended from the pubic symphysis, has no muscles except for a few fibers of the bulubospongiosus near the root of the penis and the ischiocavernosus that embrace the crura

Front 318

glans of the penis

Back 318

the head of the penis, expansion of the corpus spongiosum,

Front 319

suspensory ligament of the penis

Back 319

a condensation of deep fascia that arises from the anterior surface of the pubic symphysis, forms a sling that is attached to the deep fascia of the penis at the junction of its root and body, anchor the erectile bodies of the penis to the pubic symphysis

Front 320

fundiform ligament of the penis

Back 320

an irregular mass of collagen and elastic fibers, splits to surround the penis and then utnites and blends inferiorly with the dartos fascia

Front 321

arterial supply of the penis

Back 321

mainly through branches of the internal pudendal arteries
1. dorasal arteries of the penis-runs in the dorsal groove between the corpora cavernosa, the corpus spongiosum and spongy urethra, and the penile skin
2. deep arteries of the penis-peirece the crura, runs near the center of the corpora cavernosa supplying the erectile tissue in these structures
3. arteries of the bulb of the penis-supply the posterior part of the corpus spongiosum and the urethra within it as well as the bulouretrhal gland
4. superficial and deep branches of the external pudendal arteries-supply the penile skin, anastomosing with branches of the internal pudendal arteries
5. helicine arteries of the penis-supply blood to the cavernous spaces in the erectile tissue of the corpora cavernosa, when penis is flaccid, the arteries are coiled, restricting blood flow

Front 322

venous drainage of the penis

Back 322

blood from cavernous spces is drained by a plexus that joins the deep dorsal vein of the penis, this drains into the prostatic venous plexus, superficial coverings of the penis drain into the superficial dorsal veins which drain into the superficial external pudendal vein or the internal pudendal vein

Front 323

lymphatic drainage of penis

Back 323

lymph from skin of penis drains initially to the superficial inguinal lymph nodes which then drain into the deep inguinal and external iliac nodes, from the cavernous bodies and proximal spongy urethra drain to the internal iliac nodes

Front 324

innervation of the penis

Back 324

nerves derive from S2-S4 spinal cord segments and spinal ganglia passing thorugh the pelvic splanchnic and pudendal nerves respectively, dorsal nerve of the penis supplies sensory and sympathetic innervation, ilioinguinal nerve supply the skin at the root of the penis, cavernous nerves convey the parasympathetic fibers to the helicine arteries

Front 325

superficial perineal muscles

Back 325

located in the superficial perineal pouch, include the superficial transverse perineal, bulbospongiosus and ischiocavernosus muscles

Front 326

external anal sphincter

Back 326

1. origin-skin and fascia surrounding anus, coccyx via anococcygeal ligament
2. course and distribution-passes around lateral aspects of anal canal, insertion into perineal body
3. innervation-inferior anal (rectal) nerve, a branch of pudendal nerve (S2-S4)
4. main action-constricts anal canal during peristalsis, resisting defecation, supports and fixes perineal body and pelvic floor

Front 327

male bulbospongiosus

Back 327

1. origin-median raphe on ventral surface of bulb of penis, perineal body
2. course and distribution-surrounds lateral aspects of bulb of penis and most proximal part of body of penis, inserting into perineal membrane, dorsal aspect of corpora spongiosum and cavernosa, and fascia of bulb of penis
3. innervation-muscular (deep) branch of perineal nerve, a branch of pudendal nerve (S2-S4)
4. main action-supports and fixes perineal body/pelvic floor, compresses bulb of penis to expel last drops of urine/semen, assists erection by compressing outlow via deep perineal vein and by pushing blood from bulb into body of penis, (from corpus spongiosum to corpus cavernosum)

Front 328

female bulbospongiosus

Back 328

1. origin-perineal body
2. course and distribution-passes on each side of lower vagina, enclosing bulb and greater vestibular gland, inserts into pubic arch and fascia of corpora cavernosa of clitoris
3. innervation-muscular (deep) branch of perineal nerve, a branch of pudendal nerve (S2-S4)
4. main action-supports and fixes perineal body/pelvic floor, sphincter of vagina, assists in erection of flitoris and perhaps bulb of vestibule, compresses greater vestibular gland

Front 329

ischiocavernosus

Back 329

1. origin-internal surface of ischiopubic ramus and ischial tuberosity
2. course and distribution-embraces crus of penis or clitoris, inserting onto the inferior and medial aspects of crus and to perineal membrane medial to crux
3. innervation-muscular (deep) branch of perineal nerve, a branch of pudendal nerve (S2-S4)
4. main action-maintains erection of penis or clitoris by compressing outflow veins and pushing blood from the root of penis or clitoris into the body of penis or clitoris, (from crus to corpus cavernosum)

Front 330

superficial transverse perineal

Back 330

1. origin-internal surface of ischiopubis ramus and ischial tuberosity
2. course and distribution-passes along inferior aspect of posterior border of perineal membrane to perineal body
3. innervation-muscular (deep) branch of perineal nerve, a branch of pudendal nerve (S2-S4)
4. main action-supports and fixes perineal body/pelvic floor to support abdominopelvic viscera and resist increased intra-abdominal pressure

Front 331

deep transverse perineal

Back 331

1. origin-internal surface of ischiopubis ramus and ischial tuberosity
2. course and distribution-passes along superior aspect of posterior border of perineal membrane to perineal body and external anal sphincter
3. innervation-muscular (deep) branch of perineal nerve, a branch of pudendal nerve (S2-S4)
4. main action-supports and fixes perineal body/pelvic floor to support abdominopelvic viscera and resist increased intra-abdominal pressure

Front 332

external urethra sphincter

Back 332

1. origin-internal surface of ischiopubis ramus and ischial tuberosity
2. course and distribution-surrounds urethra superior to perineal membrane, in males it also ascends anterior aspect of prostate, in females some fibers also enclose vagina (urethrovaginal sphincter)
3. innervation-dorsal nerve of penis or clitoris, the terminal branch of the pudendal nerve (S2-S4)
4. main action-compresses urethra to maintain urinary continence, in females urethrovaginal sphincter portion also compresses vagina

Front 333

female perineum

Back 333

the female external genitalia, perineal muscles and anal canal

Front 334

female external genitalia

Back 334

include the mons pubis and labia majora, labia minora, clitoris, bulbs of the vestibule and greater and lesser vestibular glands

Front 335

vulva (AKA pudendum)

Back 335

include all the female external genitalia, serves as sensory and erectile tissue for sexual arousal and intercourse, to direct the flow of urine, to prevent entry of foreign material into the urogenital tract

Front 336

mons pubis

Back 336

rounded, fatty eminence anterior to the pubic symphysis, pubic tubercles and superior pubic rami, amount of fat INC at puberty and DEC after menopause, continuous with the anterior abdominal wall, covered with coarse hair

Front 337

labia majora

Back 337

prominent folds of skin that provide protection for the urethral and vaginal orifices

Front 338

pudendal cleft

Back 338

house the labia minora and vestibule

Front 339

anterior commisure of the labia

Back 339

where the labia are thicker anteriorly, the two join here

Front 340

labia minora

Back 340

rounded folds of fat-free hairless skin, surround the vestibule into which both the external urethral and the vaginal orifices open, have a core of spongy CT containing erectile tissue at their base and many small blood vessels, form two laminae anteriorly, contains many sebaceous glands and sensory nerve endings

Front 341

frenulum of the clitoris

Back 341

the medial laminae of the labia minora unite to form this

Front 342

prepuce of the clitoris

Back 342

formed from the lateral laminea uniting anterior to the glans of the clitoris

Front 343

frenulum of the labia minora

Back 343

found in virgins, connect the labia minora posteriroly

Front 344

clitoris

Back 344

an erectile organ located where the labia minora meet anteriorly, consists of a root and a body, which are composed of two crura, two corpora cavernosa and the glans of the clitoris, acts solely as an organ of sexual arousal, is highly sensitive and enlarges on tactile stimulation, glans of the clitoris is the most highly innervated part of the clitoris and is densely supplied with sensory endings

Front 345

vestibule

Back 345

space surrounded by the labia minora, the orifices of the urethra and vagina and the ducts of the greater and lesser vesitublar glands open

Front 346

paraurethral glands

Back 346

found on each side of the external urethral orifice

Front 347

bulbs of the vestibule

Back 347

paired masses of elongated erectile tissue, lie along the sides of the vaginal orifice, superior or deep to the labia minoar, immediately inferior to the perineal membrane, homologous with the bulb of the penis of the corpus spongiosum

Front 348

greater vestibular glands

Back 348

about 0.5 cm in diameter, located on each posterior side of the vestibule, are in the superifical perineal pouch, partly overlapped posteriorly by the bulbs of the vestibule, open into the vestibule on each side of the vaginal orifice, secrete mucus into the vestibule during sexual arousal

Front 349

lesser vestibular glands

Back 349

small glands on each side of the vestibule, open into the vestibule between the uretrhal and the vaginal orifices, secrete mucus into the vestibule, moistens the labia and vestibule

Front 350

arterial supply of the vulva

Back 350

external and internal pudendal arteries, internal pudendal artery supplies most of the skin, external genitalia and perineal muscles, labial and clitoral branches from the internal pudendal

Front 351

venous drainage of the vulva

Back 351

labial veins are tributaries of the internal pudendal veins and accompanying veins of the internal pudendal artery, venous engorgement occurs during sexual arousal

Front 352

lymphatic drainage of the vulva

Back 352

the vulva contain a rich network of lymphatic vessels that pass laterally to the superficial inguinal lymph nodes, glans of the clitoris and anterior labia minora may also drain to the deep inguinal nodes or directly to the internal iliac nodes

Front 353

innervations of the vulva

Back 353

anterior aspect of the vulva (mons pubis and anterior labia) is supplied by derivatives of the lumbar plexus: the anterior labial nerves (from the ilioinguinal nerve) and the genital branch of the genitofemoral nerve, posterior aspect of the vulva is supplied by derivatives of the sacral plexus: perineal branch of the posterior cutaneous nerve of the thigh laterally and the pudendal nerve centrally, labia supplied by the posterior labial nerves (terminal superficial branches of the perineal nerve), the orifice of the vagina and superficial perineal muscles supplied by the deep and muscular branches of the perineal nerve, deep perineal muscles and sensation to the clitoris supplied by the dorsal nerve of the clitoris, parasympathetic fibers to the bulb of the vestibule and erectile bodies from the vavernous nerves from the uterovaginal plexus

Front 354

functions of parasympathethic nerves to the vulva

Back 354

INC vaingal secretion, erection of the clitoris, and engorgement of erectile tissue in the bulbs of the vestibule

Front 355

perineal muscles of the female

Back 355

superficial perineal muscles include the superficial transverse perineal, ischiocavernosus

Front 356

anterior sacral foramina

Back 356

foramen found on the anterior surface of the sacrum where ventral nerve rami S1-S4 enter

Front 357

gluteus maximus

Back 357

1. proximal attachment-ilium posterior to posterior gluteal line, dorsal surface of sacrum and coccyx, sacrotuberous ligament
2. distal attachment-most fibers end in iliotibial tract, which inserts into lateral condyle of tibia, some fibers insert on gluteal tuberosity
3. innervation-inferior gluteal nerve (L5, S1-S2)
4. main action-extends thigh (especially from flexed position) and assists in its lateral rotation, steadies thigh and assists in rising from sitting position

Front 358

gluteus medius

Back 358

1. proximal attachment-external surface of ilium between anterior and posterior gluteal lines
2. distal attachemtn-lateral surface of greater trochanter of femur
3. innervation-superior gluteal nerve (L5, S1)
4. main action-abduct and medially rotate thigh, keep pelvis level when ipsilateral limb is weight bearing and advance opposite (unsupported side during its swing phase)

Front 359

gluteus minimus

Back 359

1. proximal attachment-external surface of ilium between anterior and inferior gluteal lines
2. distal attachemtn-anterior surface of greater trochanter of femur
3. innervation-superior gluteal nerve (L5, S1)
4. main action-abduct and medially rotate thigh, keep pelvis level when ipsilateral limb is weight bearing and advance opposite (unsupported side during its swing phase)

Front 360

tensor of fascia lata

Back 360

1. proximal attachment-anterior superior iliac spine, anterior part of iliac crest
2. distal attachemtn-anterior superior iliac spine, anterior part of iliac crest
3. innervation-superior gluteal nerve (L5, S1)
4. main action-abduct and medially rotate thigh, keep pelvis level when ipsilateral limb is weight bearing and advance opposite (unsupported side during its swing phase)

Front 361

piriformis

Back 361

1. proximal attachment-anterior surface of sacrum, sacrotuberous ligament, passes through the greater sciatic foramen
2. distal attachment-superior border of greater trochanter of femur
3. innervation-branhces of anterior rami S1, S2
4. main action-laterally rotate extended thigh and abduct flexed thigh

Front 362

obturator internus

Back 362

1. proximal attachment-pelvic surface of obturator membrane and surrounding bones
2. distal attachment-medial surface of greater trochanter (trochanteric fossa) of femur
3. innervation-nerve to obturator internus (L5, S1)
4. main action-laterally rotate extended thigh and abduct flexed thigh

Front 363

coccygeus (ischio-coccygeus)

Back 363

1. proximal attachment-ischial spine
2. distal attachemtn-inferior end of sacrum
3. innervation-branhces of S4 and S5 spinal nerves
4. main action-forms small part of pelvic diaphragm that supports pelvic viscera, flexes coccyx

Front 364

levator ani (pubococcygeus and iliococcygeus)

Back 364

1. proximal attachment-body of pubis, tendinous arch of obturator fascia, ischial spine
2. distal attachment-perineal body, coccyx, anococcygeal ligament, walls of prostate or vagina, rectum and anal canal
3. innervation-nerve to levator ani (branches of S4), inferior anal (rectal) nerve, and coccygeal plexus
4. main action-helps support pelvic viscera and resists increases in intraabdominal pressure

Front 365

deep dorsal vein

Back 365

supplies the found near the surface of the penis, on the side of the corpus cavernosum, passes inferior to the pubic symphysis, drains most of the blood from the penis drainig into the prostatic venous plexus, is unpaired unlike the paired dorsal arteries and nerves

Front 366

corona of penis

Back 366

extension from the glans of the penis, between the glans and shaft

Front 367

sigmoid mesocolon

Back 367

formed from the peritoeneum that wraps around the anus and meets at the third sacral vertebrae

Front 368

which structures in the male does the peritoneum adhere to?

Back 368

rectum, ureter, ductus deferens and bladder

Front 369

which structures in the female does the peritoneum adhere to?

Back 369

rectum, bladder, ureter, ovarian vessels, round ligament of the uterus, uterus

Front 370

rectorectal space (presacral space)

Back 370

posterior to the rectum, anterior to the sacrum and coccyx, limited inferiorly by the fascia investing the levator ani, abscesses here cannot pass inferiorly so actually can protrude through the posterior wall of the rectum

Front 371

puborectal sling

Back 371

responsible for the curvature at the anorectal junction, during defecation the puborectal sling relaxes, the anorectal junction is straightened and the expulsion of fecal matter is facilitated

Front 372

ureterovesical junction

Back 372

junction between bladder and ureter, ureter traverses bladder wall obliquely into an opening (ostium), this slit-like ostium acts as a one-way valve that can close by both the lbadder being partially full and the muscle fibers contracting it close

Front 373

anal valves

Back 373

semilunar folds that unite the lower ends of the anal columns, can be torn by hard fecal matter leading to an infection and spread from the injured anal valves into the wall of the anal canal

Front 374

adnexa

Back 374

refers to all the uterine appendages including the ovaries, uterine tubes and ligaments of the uterus

Front 375

parametrium

Back 375

the loose fatty and areolar tissues enclosed between the two layers of the broad ligament

Front 376

sacrouterine ligament

Back 376

anchor the uterus to the sacrum

Front 377

ilioinguinal nerve

Back 377

gives sensation to the anterior labia and scrotum

Front 378

example of only time that parasympathetics leave the body cavity

Back 378

prostate subplexus and vaginal subplexus can pass through the UG diaphragm and enter the external genitalia

Front 379

anteversion

Back 379

the 90 degree angle between the cervix and the vagina, this is the normal position between the vaginal and cervical canals

Front 380

retroverstion

Back 380

when the angle INCs toward 180 degrees, the uterus is straight up with the vagina, may have an affect on implantation

Front 381

anteflexion

Back 381

the angulation between the internal os and the cervical canal, normally 160-170 degrees

Front 382

retroflexion

Back 382

occurs when there is a discrepancy in the angle found in anteflexion

Front 383

what factors help maintain the position of the utereus

Back 383

1. broad ligament-minor
2. round ligament-minor
3. integrity of the pelvic floor-major

Front 384

Male Sex Response

Back 384

1. Erection-engorgement of erectile tissue, contraction of perineal muscles
2. Emission-contration of smooth muscle in vas deferens, prostate gland, seminal vesicles, contraction of itnernal urethral sphincter, release of secretions of testes, prostate gland, seminal vesicles and bulbourethral glands
3. ejaculation-rhythmic, spasmodic contraction of perineal muscles, levator ani, external anal sphincter, gluteal muscles, propulsion of semen along penile urethra, initiated by secretions entering penile urethra
4. detumesence/resolution-return of erectile tissues to flaccid state, invovles a refractory period

Front 385

Female Sex Response

Back 385

1. arousal/excitement-increased secretions, vestibular and vaginal, erection of clitoris
2. plateau (mins to hrs)-general vascular engorgement (clit, labia, breast and lower vagina), erection of nipples, sex flush (reddish vascular flushing of skin over breasts, chest), dilation of upper vagina, uterine tenting
3. orgasm-rhytmic contractions of perineal muscles, number of and intensity of rhythmic contractions are highly variable, dilation of cervix, uterine contractions, uterine dipping
4. resolution-return to pre-excitement stage, no refractory period