Podcast
Questions and Answers
Which anatomical structure forms the medial boundary of the ischiorectal fossa?
Which anatomical structure forms the medial boundary of the ischiorectal fossa?
- Obturator internus muscle
- Levator ani muscle and external anal sphincter (correct)
- Skin of the perineum
- Posterior border of the perineal membrane
Which of the following structures is NOT found in the contents of the ischiorectal fossa?
Which of the following structures is NOT found in the contents of the ischiorectal fossa?
- Inferior rectal nerve
- Ischiorectal fat
- Superior rectal vessels (correct)
- Transverse perineal vessels
What is the location of the anal canal within the anal triangle?
What is the location of the anal canal within the anal triangle?
- Laterally positioned
- In the middle (correct)
- Inferiorly positioned
- Anteriorly positioned
What is the anterior boundary of the ischiorectal fossa?
What is the anterior boundary of the ischiorectal fossa?
Where is the pudendal canal located in relation to the ischial tuberosity?
Where is the pudendal canal located in relation to the ischial tuberosity?
What forms the main vein draining the pelvis?
What forms the main vein draining the pelvis?
Which artery does NOT branch from the posterior division of the internal iliac artery?
Which artery does NOT branch from the posterior division of the internal iliac artery?
What is the termination point of the median sacral artery?
What is the termination point of the median sacral artery?
What separates the superficial perineal pouch from the deep perineal pouch?
What separates the superficial perineal pouch from the deep perineal pouch?
Which of the following is NOT a boundary of the perineum?
Which of the following is NOT a boundary of the perineum?
The urogenital triangle of the perineum is located between which boundaries?
The urogenital triangle of the perineum is located between which boundaries?
Which structure is attached to the posterior border of the perineal membrane?
Which structure is attached to the posterior border of the perineal membrane?
In females, which of the following is contained in the deep perineal pouch?
In females, which of the following is contained in the deep perineal pouch?
Which nerve provides parasympathetic supply to pelvic organs?
Which nerve provides parasympathetic supply to pelvic organs?
Which muscle is NOT associated with the perineal body?
Which muscle is NOT associated with the perineal body?
Which artery is replaced by the vaginal artery in females?
Which artery is replaced by the vaginal artery in females?
Which structure is formed by the union of the ventral rami of L4 and L5?
Which structure is formed by the union of the ventral rami of L4 and L5?
What is the main component of the superficial fascia in the urogenital triangle?
What is the main component of the superficial fascia in the urogenital triangle?
The internal pudendal artery is primarily responsible for supplying which area?
The internal pudendal artery is primarily responsible for supplying which area?
Which structure lies superior to the perineal membrane?
Which structure lies superior to the perineal membrane?
What structure provides the boundary for the deep perineal pouch's roof?
What structure provides the boundary for the deep perineal pouch's roof?
What separates the urogenital triangle from the anal triangle?
What separates the urogenital triangle from the anal triangle?
Which nerve is present in both the male and female deep perineal pouch?
Which nerve is present in both the male and female deep perineal pouch?
Which of the following is a visceral tributary of the internal iliac vein?
Which of the following is a visceral tributary of the internal iliac vein?
In which anatomical location is the sacral plexus primarily found?
In which anatomical location is the sacral plexus primarily found?
In males, which gland is found in the deep perineal pouch?
In males, which gland is found in the deep perineal pouch?
What structure is NOT a content of the urogenital triangle?
What structure is NOT a content of the urogenital triangle?
Which is NOT a component of the superficial perineal pouch in females?
Which is NOT a component of the superficial perineal pouch in females?
What lies between the vaginal and anal orifices?
What lies between the vaginal and anal orifices?
Which of the following structures is a boundary of the superficial perineal pouch?
Which of the following structures is a boundary of the superficial perineal pouch?
What is the condition called when the perineal body is ruptured during labor?
What is the condition called when the perineal body is ruptured during labor?
What closes the anterior border of the deep perineal pouch?
What closes the anterior border of the deep perineal pouch?
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Study Notes
Perineal Membrane
- A fibrous membrane separating the 2 spaces of the urogenital triangle
- Stretched between the 2 pubic arches, leaving a space anteriorly
- Has 2 free borders: anterior and posterior
- Lies horizontally in the standing position
- Separates the superficial perineal pouch from the deep perineal pouch
- Posterior border attached to Colle’s fascia to close superficial perineal pouch
- Anterior and posterior borders attached to the pelvic fascia of urogenital diaphragm to close deep perineal pouch
Structures Piercing the Perineal Membrane
- Female: Urethra, vagina, internal pudendal artery, artery of the bulb, dorsal nerve of clitoris
- Male: Urethra, ducts of bulbo-uretheral gland, internal pudendal artery, artery of the bulb, dorsal nerve of penis
Perineal Pouches
- Superficial Perineal Pouch
- Open space continuous with the space deep to the lower part of the anterior abdominal wall
- Roof: perineal membrane
- Floor: Colle's fascia
- Posterior and on each side: roof and floor fuse together
- Anterior: open and continuous with the space deep to the membranous layer of the superficial fascia
- Deep Perineal Pouch
- Completely closed space between the superior and inferior fascia of the urogenital diaphragm
- Roof: superior fascia of urogenital diaphragm
- Floor: perineal membrane
- Anterior, posterior, and on each side: roof and floor fuse together
Contents of Deep Perineal Pouch
- Female: Urethra, vagina, internal pudendal vessels, vessels of the bulb, dorsal nerve of clitoris, sphincter urethrae, deep transverse perineal muscles
- Male: Membranous urethra, bulbo-uretheral gland, internal pudendal vessels, vessels of the bulb, dorsal nerve of penis, sphincter urethrae, deep transverse perineal muscles
Contents of Superficial Perineal Pouch
- Female:
- Root of clitoris (2 bulbs and 2 crura)
- Muscles: ischiocavernosus, bulbo-spongiosus, superficial transverse perineal muscles
- Arteries: 3 branches of internal pudendal artery (2 terminal branches & labial artery)
- Nerves: dorsal nerve of clitoris, labial nerves
- Vein: deep dorsal vein of the clitoris
- Greater vestibular gland
- Male:
- Root of penis (a bulb and 2 crura)
- Muscles: ischiocavernosus, bulbo-spongiosus, superficial transverse perineal muscles
- Arteries: 3 branches of internal pudendal artery (2 terminal branches & scrotal artery)
- Nerves: dorsal nerve of penis, scrotal nerves
- Vein: deep dorsal vein of the penis
Perineal Body (Central Perineal Tendon)
- A fibro-muscular mass in the center of the perineum (or center of the posterior border of the perineal membrane)
- Lies between the vaginal and anal orifices
- Serves for attachment of 10 perineal muscles:
- Urethral sphincter
- External anal sphincter
- Right and left levator ani
- Right and left superficial and deep transverse perineal muscles
- Right and left bulbo-spongiosus
- Liable to rupture during labor, leading to pelvic uterine prolapse
Anal Triangle
- Posterior division of the perineum
- Boundaries:
- Anterior: imaginary line connecting the 2 ischial tuberosities
- Posterior: tip of the coccyx
- On each side: sacro-tuberous ligament
- Contents:
- Lower part of anal canal
- Ischio-anal (Ischio-rectal) fossa
Ischiorectal Fossa
- Filled with fatty tissue to accommodate a distended anal canal during defecation
- Contents:
- Ischiorectal fat
- Nerves: inferior rectal nerve, scrotal or labial nerve, perineal branch of S4
- Vessels: inferior rectal vessels, scrotal or labial vessels, transverse perineal vessels
Boundaries of Ischiorectal Fossa
- Anterior: posterior border of the perineal membrane, superficial and deep transversus perineal muscles
- Posterior: sacrotuberous ligament
- Inferior: skin of perineum on each side of anus
- Superior: linear origin of levator ani (white line)
- Medial: levator ani muscle and external anal sphincter
- Lateral: obturator internus muscle, obturator fascia, and pudendal canal
Pudendal Canal
- Tunnel formed by splitting of obturator fascia on the lateral wall of ischiorectal fossa, about 1.5 inches above the ischial tuberosity
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