Re: Questions for the Pelvic Musculature and Fascia

Comments:
: : 1. The sacrotuberous ligament is anterior to the sacrospinous ligament. False- it is posterior. : : 2. The urogenital hiatus includes the urethra as an effluent but not anal canal. False- the hiatus includes the urethra, vagina, and anus in females. : : 3. The piriformis muscle originates from the posterior surface of the sacrum. False- internal surface of S2, S3 and S4 : : 4. The ischiococcygeus (coccygeus) takes origin from the internal surface of the sacrospinous ligament. True : Disagree. The coccygeus muscle originates from the lateral aspects of the inferior sacrum and coccyx and is deep to the sacrospinous ligament. see p 369 Moore and Dalley, Clinically Oriented Anatomy, 5th Ed. (AT) : : 5. The puborectalis muscle attaches to the anococcygeal raphe and, thus, is tethered to the coccyx. False- this makes a ‘sling’ around the anal canal : Agree, but wondering, is the anococcygeal raphe superficial to the puborectalis (anal canal versus margin of the anus)? (AT) : : : 6. The inferior fascia of the pelvic diaphragm blends with the superior fascia of the urogenital diaphragm at the urogenital hiatus. True- mostly filled by pubococcygeus : : 7. An equation; the pelvic diaphragm minus the ischiococcygeus equals the levator ani. True- composed of iliococcygeus, pubococcygeus, and puborectalis : : 8. Contraction of the ischiococcygeus raises the pelvic floor (push upward on the pelvic floor from the ischiorectal fossa in the laboratory). : : 9. The iliac crest contributes the superior boundary of the true pelvis. False- false pelvis : : 10. The sacral promontory contributes to a boundary of the true pelvis. True! : : 11. The arcuate line contributes a boundary of the true pelvis. True- the arcuate line is the line along the superior : Agree, but additionally, the arcuate line is immediately inferior to the iliac fossa and the iliacus muscle. (AT) : : 12. The ischial spines in the female are oriented more laterally than in the male. True- during labor a baby exits oriented anteriorly/posteriorly through the pelvic outlet. However, to enter the pelvic inlet the baby is transversely oriented. : : 13. The fifth lumbar vertebra couples the weight of the upper body to the sacrum. True- the sacrum then transfers this weight to those laterally placed ischial tuberosities : Agree, but additionally, weight to ischial tuberosities when sitting, weight to acetabulum when standing. (AT) : : 14. The topography of the female, pelvis relative to the male pelvis, accounts for the higher incidence of femoral hernias in the female. True- we have wider pelvis : : 15. The puborectalis muscle is inferior the to the pubococcygeus muscle. True- : : 16. The puborectalis, when contracted, enforces an angle at the anorectal junction that contributes to continence. True : : 17. The urethral crest is a raised part of the anterior membranous urethra. False- prostatic urethra, posterior portion that holds the utricle medially and laterally the ejaculatory ducts : : 18. The bulbourethral glands drain into the prostatic sinuses. False. These sit in the deep perineal pouch but actually drain into the superficial pouch. : Mostly agree, but the bulbourethral glands drain into the spongy urethra, not directly into the superficial pouch. (AT) : : : 19. The bulbourethral glands drain into the membranous urethra. False, the superificial perineal space is the spongy urethra. : : 20. The arcus tendineus is a specialization of the obturator externus muscle that provides a site of attachment for the iliococcygeus muscle. False- this is the obturator internus muscle. : Mostly agree, but the arcus tendineus is condensed obturator internus fascia, not a specialization of the muscle fibers. (AT) : : 21. The transversalis fascia of the pelvis, know as parietal pelvic fascia, is applied to the superior fascia of the pelvic diaphragm. True. It medial to the thick arcus tendineous. : : 22. The parietal pelvic fascia covers the inferior fascia of the pelvic diaphragm and lines the walls of the ischiorectal fossa. False- The ischio rectal fossa is lined superiorly by the thin inferior fascia of the pelvic diaphragm which is investing fascia of the levator ani muscle : : 23. The prostatic ducts are lateral to the ejaculatory ducts at the urethral crest. True- although the ducts are located in the prostatic sinus. : : 24. The ejaculatory ducts are lateral to the utricle. True : : 25. The seminal colliculus of the urethral crest is medial to the prostatic sinuses. True : : 26. The utricle and and the ejaculatory ducts, but not the prostatic ducts, are topographies of the seminal colliculus. True- the ducts are located in the prostatic sinus : : 27. The fascia of Denonvilliers' is a thickening of parietal visceral fascia. False- pelvic visceral fascia. : : 28. The perivisceral fascia of the rectum is opposed to the fascia of Dennonvilliers'. True- the rectal fascia blends anteriorly with the retrovesical fascia of Denonvillier. : : 29. The rectum has a convexity with the outside wall toward the right side. : False, rectum from Latin rectus meaning "straight." Viewed anterior-posterior the rectum shold descend directly. However, viewed laterally, the rectum is S-shaped, pushing anteriorly from the rectosigmoid junction, returning posteriorly along the curve of the sacrum and the coccyx, and angling anteriorly a second time under the actions of the puborectalis sling at the rectoanal junction. (AT) : *revisited, confused in light of statements 31 & 32. Anyone know this mnemonic? (AT) : : 30. There is one transverse rectal fold on the right and two transverse rectal folds on the left. True- the one on the right is the one you get : : 31. The convexity to the right of the rectum provides a mnemonic for which side has two transverse rectal folds and which side has one rectal fold. : : 32. The location of the descending colon on the left provides a mnemonic for knowing that the rectum has a convexity to the right. : : 33. The venous drainage of the rectum is partly to the portal system and mostly to the caval system. True- the superior rectal vein drains to the portal system via the inferior mesenteric vein, joining with the splenic vein posterior to the pancreas and inferior to the splenic artery. : ...and the caval system receives venous return from the internal pudendal (via middle reectal vein), to the internal iliac, and on to the inferior vena cava (AT) : : 34. The levator ani muscle blends with the internal anal sphincter muscle.False. It does blend with the deep portion of the external anal sphincter. : : 35. The pectinate line is located at the inferior margin of the anal valves. True- this divides the portion of the anus that came from the cloaca (endoderm) vs. proctadeum (ectoderm derived- cranially, ectoderm of the stomatodeum is the primitive ‘mouth’) : : 36. Internal hemorrhoids, more so the external hemorrhoids, may develop during portal hypertension. True- external hemorrhoids form as a result of increased pressure in the internal pudendal : ...which drains into the internal iliac and onto the inferior vena cava. external hemorrhoids are not involved with the portal system. (AT)

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