Perineum

Front 1

describe what is meant by the perineal compartment

Back 1

shallow compartment, bounded by pelvic outlet

Front 2

describe what is meant by the perineal region

Back 2

diamond shaped area, line goes from mons pubis to lateral thighs, to superior edge of intergluteal cleft

Front 3

what are the boundaries of the pelvic outlet

Back 3

pubic symphsysis
ischiopubic ramus
sacrotuberous ligaments
inferior of sacrum and coccyx

Front 4

what line separates the triangles of the perineum?

Back 4

a transverse line stretching between the anterior ends of the ischial tuberosity

Front 5

which triangle is which?

Back 5

anal triangle posteriorly
urogenital traingle anteriorly

Front 6

what does the anal triangle contain?

Back 6

anal orifice, anal canal, ischioanal fat

Front 7

what is the perineal membrane?

Back 7

thin sheet of tough fascia which closes the urogenital triangle

Front 8

describe the perforations of the perineal membrane?

Back 8

urethral (in male and female)
vaginal

Front 9

what are the attachments of the perineal membrane?

Back 9

stretched between the two ischiopubic rami

Front 10

what is the perineal body made of?

Back 10

connective tissue and convergence of muscle fibres
bulbospongiosus
deep and transverse perineal muscles
external urethral and external anal sphincters
smooth muscle of rectum
levator ani

Front 11

what is the perineal body attached to?

Back 11

anteriorly, with posterior border of perineal membrane
superiorly, with rectovaginal / rectovesical septum

Front 12

what are the two layers of perineal fascia?

Back 12

superficial, fatty layer
deep, membranous layer (colles)

Front 13

describe the superficial layer of perineal fascia

Back 13

continuous with
1) camper fascia
2) ischioanal fat pads
3) dartos muscle
makes up substance of labia majora
diminished in males

Front 14

describe the membranous layer of perineal fascia

Back 14

colles
continuous with
1) fascia lata
2) scarpa fascia
3) dartos fascia
does not extend into anal triangle; attached to perineal membrane

Front 15

where is the superficial perineal pouch?

Back 15

between the perineal membrane and the perineal fascia

Front 16

what is in the superficial perineal pouch?

Back 16

superficial transverse perineal mucsle
bulb and crura of penis
clitoris
bulbospongiosus and ischiocavernosus
bulbs of vestibule
great vestibular glands
deep perineal vessels and nerves
proximal part of urethra in males and females

Front 17

what is in the deep perineal pouch?

Back 17

deep transverse perineal muscle / smooth muscle in females
external urethral sphincter
dorsal neurovasculature
anterior extensions of ischioanal fat pads
bulbourethral glands
proximal part of urethra / intermediate part of urethra in males

Front 18

describe the boundaries of ischioanal fossae

Back 18

medially, the levator ani muscle and external anal sphincter
laterally, the ischium and obturator internus fascia
laterally
posteriorly, sacrotuberous ligament and gluteus maximus
anteriorly: bodies of pubic bones (ischioanal extensions)

Front 19

how do the ischioanal fossae communicate?

Back 19

over the anococcygeal ligament

Front 20

where is the apex of the ischioanal fossa?

Back 20

superior

Front 21

where is the pudenda canal?

Back 21

between obturator fascia and obturator internus, travels forward

Front 22

what travels in pudendal canal?

Back 22

pudendal nerve, internal pudendal vessels, nerve to obturatory internus

Front 23

from where does the pudendal nerve enter the pudendal canal?

Back 23

the lesser sciatic notch

Front 24

what vessel and nerve come off just before the beginning of the pudendal canal

Back 24

inferior rectal nerve and artery

Front 25

what happens to the pudenda/internal pudendal nerve / vessel during the canal?

Back 25

at the end, divide into perineal and dorsal n/a

Front 26

what does the perineal n/a divide into?

Back 26

deep and superficial nerves

Front 27

what does the deep perineal nerve supply

Back 27

muscles of deep and superficial pouch
skin over vestibular bulbs
mucous membrane of inferior most vagina

Front 28

what does the superficial perineal nerve supply

Back 28

posterior scrotal/labial nerve

Front 29

where do the perineal nerves/vessels go?

Back 29

superifical pouch

Front 30

where do the dorsal nerves / vessels go

Back 30

deep pouch

Front 31

what does the inferior rectal nerve communciate with?

Back 31

psoterior scrotal/labial nerves

Front 32

how long is the anal canal?

Back 32

2.5cm

Front 33

where does the anal canal begin?

Back 33

rectoanal junction
U shaped sling of puborectalis muscle
causes narrowing or rectal ampull

Front 34

what is the external outlet of the anus?

Back 34

the anal orifice

Front 35

where is the internal anal sphincter

Back 35

superior 2/3rds of anal canal

Front 36

what is the internal anal sphincter made of

Back 36

thickening of circular muscle layer

Front 37

describe the innervation of the internal anal sphincter

Back 37

parasympathetic: pelvic splanchnic nerves
sympathetic: hypogastric and superiro rectal plexus

Front 38

describe how the internal anal sphincter functions

Back 38

sympathetic provides tonic contraction
distention of rectal ampulla by feces causes parasympathetic inhibition / relaxation
threshold of distention causes continuous relaxation until relieved

Front 39

where is the external anal sphincter

Back 39

inferior two thirds of anal canal, broad band on either side of it.

Front 40

what are the attachments of the external anal sphincter

Back 40

anteriorly: to perineal body
posteriorly; to anococcygeal ligament

Front 41

what are the 3 parts of the external anal sphincter

Back 41

subcutanoues
superficial
deep

Front 42

what other muscle does external anal spincter it join up with

Back 42

puborectalisq

Front 43

what spinal level is EAS supplied by and through which nerve?

Back 43

S4, inferior rectal

Front 44

innervation of external anal sphincter

Back 44

inferior rectal
nerve to levator ani to deep part

Front 45

where are the anal columns

Back 45

superior half of mucous membrane of anus

Front 46

where do anal columns end?

Back 46

at the rectoanal junctions

Front 47

what are the anal valves

Back 47

inferior ends of anal columns

Front 48

what are anal sinuses and what do they do

Back 48

recesses behind anal valves
exude mucous when compressed

Front 49

what is pectinate line

Back 49

margin of anal valves
separation of hindgut derivativ efrom proctodeum derivative

Front 50

arterial supply of anus?

Back 50

inferior rectal
superior rectal
middle is anastomosis

Front 51

veinous drainage of anus

Back 51

above line: superior rectal vein to portal system
below line: inferior rectal vein to caval system

Front 52

innervation of anus

Back 52

superior to pectinate line; vicseral
from inferior hypogastric plexus and splanchinic nerves.
inferior: somatic, sensitive to pain, inferior rectal nerves

Front 53

what are the anal cushions

Back 53

cushions of erectile tissue around rectoanal junction
supplied / allowed by presence of AVAs between superior / middle arteries / veins

Front 54

is the anus below or above the pelvic pain line?

Back 54

below

Front 55

describe intermediate male urethra course

Back 55

from apex of prostate
through deep pouch
through perineal membrane
has external urethral sphincter

Front 56

what accessories does the intermediate urethra have?

Back 56

bulbourethral glands in transverse muscle

Front 57

describe course of spongy urethra

Back 57

from perineal membrane
thorugh corpus spongiosum to glans

Front 58

what are the dilations of the spongy urethra

Back 58

intrabulbar fossa: in bulb
navicular fossa: in glans

Front 59

where is the thinnes part of the male urethra

Back 59

external urethra orifice

Front 60

where are the bulbourethral glands of the spongy urethra?

Back 60

around the bulb

Front 61

what is the arterial supply of male urethra

Back 61

dorsal artery of penis

Front 62

venous drainage of male urethra

Back 62

dorsal vein of penis

Front 63

lymphatic drainage of male urethra

Back 63

intermediate: internal iliac
spongy: deep inguinal

Front 64

innervation of male urethra

Back 64

intermediate: visceral from prostatic plexus
sympathetic: lumbar splanchnic
parasympathetic: pelvic splanchnic. below pelvic pain line
spongy: dorsal nerve of penis, somatic

Front 65

what is the scrotal raphe?

Back 65

where the 2 halfs of the scrotum meet

Front 66

what is the scrotal septum

Back 66

lies underneath raphe
continuation of dartos fascia

Front 67

what is the arterial supply to scrotum

Back 67

anterior scrotal arteries from external pudendal from femoral
posteiror scortal arteries from superficial perineal from internal pudendal

Front 68

what is lypmhatic drainage os scortum

Back 68

superficial inguinal nodes

Front 69

what is the innervation of scrotum

Back 69

anterior: anterior scrotral nerves from ilioinguinal (L1) and genital branch of genitofemoral
posterior:
posterior scrotal nerves from superficial perineal branch of pudenal
also perineal branch of psoterior cutaneous nerve of thigh

Front 70

what do sympathetic fibres do in the scrotum

Back 70

sweat, contract dartos

Front 71

what are the three parts of the penis?

Back 71

root, body and glans

Front 72

what are the three erectile bodies of the penis

Back 72

2 copora cavernosa
1 corpus spongiosum

Front 73

what covers each copora cavernosa?

Back 73

tunica albuginea

Front 74

where is the deep fascia of the penis?

Back 74

between skin and tunica albuginea / glans, holds all three columns together

Front 75

what are the corpora cavernosa separated by?

Back 75

the septum penis - fusion of the two tunica albuginea

Front 76

what is the crura of the penis?

Back 76

formed by back end of corpora cavernosum, consists of erectile tissue, located in superfiical perineal pouch

Front 77

what is the each crus of the penis attached to?

Back 77

ischial ramus

Front 78

what is the glans penis?

Back 78

extension of corpus spongeosum

Front 79

what is the margin of the glans penis?

Back 79

the corona of glans

Front 80

what is the prepuce of the penis?

Back 80

foreskin: double layer of skin which covers the glans

Front 81

what is the frenulum of prepuce?

Back 81

thin layer of skin, passes from prepuce to urethral (bottom) surface of glans

Front 82

what is the suspensory ligament of the penis?

Back 82

condesnation of fascia that arises fron anterior surface of pubic symphysis

Front 83

arterial supply of penis

Back 83

branches of internal pudendal
1) dorsal arteries
- supply skin
- supply spongiosum
2) deep arteries
- run in corpus cavernosa
- end in helicine arteries
3) arteries of bulb of penis
- supply bulb

Front 84

innervation of penis

Back 84

sensory: dorsal nerve of penis, and ilioinguinal nerve at root
parasympathetic: by cavernous nerves from prostatic nerve plexus
sympathetic: by ganglia through pudendal nerves

Front 85

what spinal cord segments innervate the penis

Back 85

S2-4

Front 86

what does the parasympathetic innervation of the penis do?

Back 86

innervates helicine arteries and gives erection by causing vasodilation

Front 87

what part of the penis does ilioinguinal nerves innervate?

Back 87

skin at root of penis

Front 88

where does the lymph from the skin of the perineum drain?
what is the exception?

Back 88

superficial inguinal nodes
exception = glans penis

Front 89

where does the glans penis drain lymphatically?

Back 89

deep inguinal nodes
(remember - like proximal urethra)

Front 90

where does lymph from the cavernous bodies drain?

Back 90

internal iliac - like the intermediate urethra

Front 91

describe erection

Back 91

parasympathetic response S2-4
1) AVA closure to force blood into corpora
2) helicine arteries relax
3) bulbospongiosum and ischiocavernosa contract, stopping venous exit

Front 92

describe emission

Back 92

peristalsis of fluid in ductus deferens and seminal vesicles
prostatic releases prostatic fluid
sypmathetic response L1-2

Front 93

describe ejaculation

Back 93

mixed resonse
sympathetic: closure of internal urethra sphincter
parasympathetic side
contraction urethral muscle and bulbospongiosum

Front 94

describe remission

Back 94

sympathetic
constriction of helicine arteries
relaxation of ischiocavernosum and bulbospongiosum