Wu Notes Pelvis Week

Question 1

What two nerves are vulnerable in a indirect inguinal hernia?

Answer 1

Ilioinguinal nerve is inside the inguinal canal

Genital branch of the genitofemoral in the spermatic cord

Question 2

What nerve innervates the perineum?

Answer 2

Ilioinguinal nerve

Question 4

Inguinal region

Answer 4

Area around the inguinal ligament from ASIS to pubic tubercle

Question 5

If the processes vaginalis doesn’t close, what can happen?

Answer 5

Indirect inguinal hernia (more common in men) Hydrocele in men

Question 6

Inguinal canal contents

Answer 6

• Round ligament in women/ Spermatic cord in men
• Ilionguinal nerve: groin/anterior perineum pain
• Genital branch of genitofemoral nerve: scrotal pain + loss of cremaster reflex

Question 7

Lack of cremaster reflex (ipsilateral testicle contracts if you scratch the inner thigh) is a sign of a testicle issue or hernia.

What nerve is associated with the cremasteric reflex?

Answer 7

Genitofemoral nerve (L1/L2)

Question 8

Ligaments maintaining anteversion of uterus

Answer 8

• Round ligament
• Cardinal/Transverse Cervical ligament - carries uterine vessels; most supportive

Question 9

Ovary ligaments

Answer 9

Suspensory ligament

Ovarian ligament

Question 10

Analogous structure of gubernaculum in females

Answer 10

Ovarian ligament + round ligament.

They first anchor the ovary to the uterus and then comes out again to anchor them ot the labia (female scrotum)

Question 11

Site of sperm production

Answer 11

Seminiferous tubules (pockets in the testes)

Question 12

In a hysterectomy, don’t forget…

Answer 12

To take out the uterus, you have to take out the blood supply –> be careful not to cut the ureter.

Question 13

The relationship of the uterine vessels to the ureter has a greater clinical significance (“water under the bridge”)

Answer 13

Ureter is under the uterine vessels.

Question 14

Both iliohypogastric and ilioinguinal pierce

Answer 14

internal oblique

Question 15

Lymphatic drainage of gonads (testes and ovaries)

Answer 15

Para-aortic nodes/lumbar nodes

Question 16

Contents of spermatic cord

Answer 16

• Fascia:
  
  • Ext spermatic fascia (from ext oblique)
  • Cremaster fascia (from int oblique)
  • Int spermatic fascia (from transversalis fascia)
  • Tunica vaginalis (from parietal peritoneum)
• Artery:
  
  • Testicular artery
  • Cremaster artery
  • Deferential artery
• Veins:
  
  • Pampiniform plexus
  • Testicular, cremaster, and deferential vein
• Genital branch of genitofemoral nerve
• Vas deferens

Question 17

Tunica albuginea vs Tunica vaginalis

Answer 17

Tunica albuginea covers the testis. Thicker capsule you would see if you cut the testicle open.

Tunica vaginalis is the wrapping around the testis. (parietal and visceral layer). Covers the individual corpus spongiosum and the two corpus cavernosa. It is an extension of parietal peritoneum

Question 18

Contents of inguinal canal

Answer 18

Question 19

Analogous structures in male and female genitalia

Answer 19

Question 20

Water under the bridge

Answer 20

The uterine vessels lie on top of the ureter. In hysterectomies, it’s easy to damage the ureter if you’re not careful.

Question 21

Why are men so much more likely to get an indirect inguinal hernia?

Answer 21

Their inguinal canal is bigger to accomodate the spermatic cord, which is much larger than teh round ligament.

Question 22

SEVENUP: Sperm passage

Answer 22

Seminiferous tubules

Epididymus

Vas deferens

Ejaculatory duct

Urethra

Penis

Question 23

True pelvis vs false pelvis vs perineum

Answer 23

True pelvis: area under the peritoneum and above pelvic floor

False pelvis: abdominopelvic area; all abdominal things in the convines of the pelvis,. Ex) Sigmoid colon

Perineum is under the pelvic floor

Question 24

Borders of perineum

Answer 24

Question 25

Male urethra- posterior and anterior

Answer 25

**Posterior urethra** * Membranous * Prostatic **Anterior urethra** * Spongy urethra (bulbous + penile) * Fossa navicularis

Question 26

Pelvic fractures are associated with what type of urethra injury

Answer 26

Posterior injury --\> bleed into pelvis

Question 27

**Straddle injuries** are associated with what type of urethra injury - where is extravasation?

Answer 27

Straddle injuries are an **anterior urethra injury** where **Buck's fascia** and the **bulbospongiosus** is ruptured. Blood goes into **superficial perineal space** because dartos fascia is continuous with scarpas fascia May damage bulbo-urethral glands, which is in the **deep perineal space**

Question 28

Internal urethral sphincter

Answer 28

* **Involuntary; visceral efferent** * **Tonic contraction** to hold in the urine * Made of **smooth muscle**

Question 29

External urethral sphincter

Answer 29

* **Voluntary** via **pudendal nerve** * **Skeletal muscle** * Located in the **urogenital diaphragm**

Question 30

Internal iliac artery- branches

Question 31

Borders of superficial and deep perineal pouch

Answer 31

Question 32

Which fascia are continuous in the penis

Answer 32

Scarpa's, Dartos, and Colles (technically colles and dartos split at the scrotum though)

Question 33

Which fascia overlies the deep dorsal vein of the penis? the dorsal arteries?

Answer 33

deep (buck's) fascia

Question 34

In peeing, Parasympathetic = Sympathetic = Pudendal =

Answer 34

Parasympathetic = pee sympathetic = don't pee pudendal = whatever, i'll do what I want

Question 35

Peeing process

Answer 35

* V**isceral afferent** on the bladder tells the brain that the bladder is stretched * Parasympathetic gets activated * Contract detrusor muscle * Relax (?) Internal urethral sphincter * Pudendal allows you to decide

Question 36

Patient gets a straddle injury and is extravasting urine and blood from a torn bulbar urethra into the superficial perineal cleft. What fascia provide the boundaries for this space? * Camper's and Scarpa's fascia * Perineal membrane and external perineal fascia of Gallaudet * Colles fascia nd external perineal fascia of Gallaudet * Perineal membrane and superior fascia * The urogenital diaphragm and apex of UG diaphragm

Answer 36

**Colles fascia and external perineal fascia of Gallaudet.** Gallaudet = superficial perineal fascia = inferior fascia of UG diaphragm

Question 37

A man has a hematoma in perineum spreading to his abdominal wall beneath the superficial fascia. Where should be initial extravasation be located?

Answer 37

Rupture of spongy urethra -\> furine first invades between Buck's and dartos layer