Pelvis & Perineum

Front 1

Linea terminalis consists of

Back 1

the arcuate line,
the pecten pubis ((pectineal line),
pubic crest

Front 2

Pelvic inlet

Back 2

Promontory of sacrum and alae of sacrum posteriorly, linea terminalis laterally and pubic symphysis anteriorly

Front 3

Sacrospinous ligament

Back 3

Apex attached to ischial spine, base attached to sacrum and coccyx

Front 4

Sacrotuberous ligament

Back 4

Superficial to the sacrospinous ligament.
Broad base: Posterior superior iliac spine, along dorsal aspect and lateral margin of sacrum, and onto dorsolateral surface of coccyx.
Laterally: Apex --> Ischial tuberosity.

Front 5

Borders of greater sciatic foramen

Back 5

Sacrospinous ligament and ischial spine

Front 6

Lesser sciatic foramen is bordered by:

Back 6

Superiorly: Sacrospinous ligament. Ischial spine
Anteriorly: Lesser sciatic notch.
Posteriorly: Sacrotuberous ligament.

Front 7

Muscles in lateral wall of pelvic cavity:

Back 7

Piriformis and obturatur internus

Front 8

Apertures in the pelvic wall

Back 8

Obturator canal
Greater sciatic
Lesser sciatic foramen

Front 9

Course of obturator internus muscle

Back 9

From deep surface of obturator membrane.
Fibers converge to make a tendon which leaves through the lesser sciatic foramen.
Fibers bend 90 degrees around ischium between ischial spine and ischial tuberosity.
Passes posterior to hip joint and inserts on greater trochanter.

Front 10

Course of piriformis muscle

Back 10

Orginates in bridges of bone between sacral foramina, passes through greater sciatic foramen, crosses hip joint and inserts on greater trochanter. The piriformis separates the GREATER sciatic foramen into two regions, one above and one below the muscle.

Front 11

Borders of obturator canal

Back 11

Obturator membrane, obturator muscles, superior pubis ramus

Front 12

Contents of the obturator canal:

Back 12

Obturator nerve, artery and vein

Front 13

Borders of greater sciatic foramen

Back 13

Greater sciatic notch, sacrospinous and sacrotuberous ligaments, spine of ischium.
Piriformis muscle divides the foramen into two parts.

Front 14

Contents of greater sciatic foramen

Back 14

Above piriformis: Superior gluteal nerves and vessels.
Below piriformis: Inferior gluteal nerves and vessels, sciatic nerve, pudendal nerve, internal pudendal vessels, posterior femoral cutaneous nerves, nerves to obturator internus and quadratus femoris,.

Front 15

Borders of lesser sciatic foramen:

Back 15

Lesser sciatic notch, ischial spine, sacrospinous and sacrotuberous ligaments.

Front 16

Contents of lesser sciatic foramen

Back 16

Tendon of obturator internus muscle
Pudendal nerve
Internal pudendal vessels

Front 17

Boundaries of the pelvic outlet

Back 17

Pubic symphysis, inferior border of body of pubis, inferior ramus of pubis, ramus of ischium, ischial tuberosity, sacrotuberous ligament, coccyx.

Front 18

Components of pelvic floor

Back 18

Pelvic diaphragm (levator ani and coccygeus muscles), perineal membrane and muscles in deep perineal pouch.

Front 19

Attachments of levator ani muscles

Back 19

Originate from each side of pelvic wall, on posterior aspect of body of pubic bone, on tendinous arch and on ischial spine.

Front 20

Ligament/raphe where levator ani muscles come together posteriorly:

Back 20

anococcygeal ligament/body

Front 21

Innervation of the levator ani

Back 21

Ventral ramus of S4
Inferior rectal branch of pudendal nerve (S2 - S4)

Front 22

Function of urogenital hiatus

Back 22

Allows urethra and vagina to pass through pelvic diaphragm

Front 23

Three groups of levator ani muscles:

Back 23

Pubococcygeus (subdivided into puboprostaticus, pubovaginalis, puboanalis)
puborectalis,
iliococcygeus

Front 24

Where's the perineal membrane?

Back 24

Attached to the pubic arch, and directly under the deep perineal pouch.

It has a free posterior margin. The anterior margin leaves a small gap between it and the inferior pubic ligament.

Front 25

What and where is the deep perineal pouch?

Back 25

It's bordered by the perineal membrane below. The deep perineal pouch is open above.

The parts of the perineal membrane and the structures in the deep perineal pouch contribute to the pelvic floor.

Front 26

Contents of the deep perineal pouch in women

Back 26

Part of the urethra
Part of the vagina
Sphincter urethrae
Deep transverse perineal muscles
Internal pudendal vessels
Dorsal nerves of the clitoris

Front 27

Contents of the deep perineal pouch in men:

Back 27

Membranous part of the urethra
Sphincter urethrae
Bulbourethral glands
Deep transverse perineal muscles
Internal pudendal vessels
Dorsal nerves of the penis

Front 28

The muscles forming the muscle sheet within the deep perineal pouch:

Back 28

Anteriorly: External urethral sphincter.
Parallel to free margin of perineal membrane: Deep transverse perineal muscle.

Additionally, IN WOMEN:
Originating on the perineal body: Sphincter urethrovaginalis, which surrounds urethra and vagina as a unit.
Laterally: Compressor urethra.

Front 29

Muscles attached to the perineal body:

Back 29

Deep transverse perineal muscles
Sphincter urethrovaginalis
External anal spinchter
Superficial transverse perineal muscles
Bulbospongiosus muscles

Front 30

Relations of rectum

Back 30

Posteriorly: Sacrum, coccyx, piriformis, coxxygeus, levator ani, sacral plexus, sympathetic trunks.

Anteriorly:
MALE: Sigmoid colon, ileum, bladder, vas deferens, seminal vescicles, prostate.
FEMALE: Sigmoid colon, ileum, vagina.

Front 31

Relations of uterus:

Back 31

Anteriorly: Uterovescical pouch, bladder.
Posteriorly: Rectouterine pouch (Douglas' pouch), ileum, sigmoid colon
Laterally: Broad ligament, uterine artery and vein

Front 32

Location of vagina

Back 32

Upper half above pelvic floor, lower half within perineum.

Front 33

Relations of vagina

Back 33

Anteriorly: Bladder above, urethra below.
Posteriorly: Upper third - rectouterine pouch. Middle third - Ampulla of rectum. Lower third - perineal body.
Laterally: Upper part: Ureter. Middle part: Levator ani. Lower part: Urogenital diaphragm, bulb of vestibule.

Front 34

Urogenital triangle, boundaries

Back 34

Bounded in front by pubic arch, laterally by ischial tuberosities

Front 35

Fascia inside the urogenital triangle

Back 35

Superficial fascia: Can be divided into two layers, fatty layer (Camper's fascia) and membranous layer (Colles' fascia).
Urogenital diaphragm: a superior and an inferior layer of fascia enclose the sphincter urethrae and the deep transverse perineal muscles. The inferior layer = Perineal membrane.

Front 36

Superficial perineal pouch is bounded by:

Back 36

Inferiorly: Membranous layer of superficial fascia.
Superiorly: Urogenital diaphragm.
Laterally: Attachment of membranous layer of superficial fascia and urogenital diaphragm to the pubic arch.
Anteriorly: Communicates freely with the potential space between superficial fascia of ant abd wall and ant abd muscles.

Front 37

Urogenital diaphragm is formed by

Back 37

Sphincter urethrae and deep transverse perineal muscles, enclosed between superior and inferior (perineal membrane) layers of fascia.

Front 38

The root of the clitoris is made up of

Back 38

three masses of erectile tissue called the bulb of the vestibule and the right and left cruca of the clitoris

Front 39

The bulb of the vestibule is attached/located:

Back 39

It's divided into two halves because of the vagina. It's attached to the underside of the urogenital diaphragm (=perineal membrane) and is covered by the bulbospongiosus muscles.