Re: Questions for the Pelvic Musculature and Fascia

Comments:
: : : 1. The sacrotuberous ligament is anterior to the sacrospinous ligament. False- it is posterior. : Agree. : : : 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. : True. The urogenital hiatus is of the urogenital diaphragm. The anal canal is of the anal triangle. : : : 3. The piriformis muscle originates from the posterior surface of the sacrum. False- internal surface of S2, S3 and S4 : Agree. But of from sacral nerves. : : : 4. The ischiococcygeus (coccygeus) takes origin from the internal surface of the sacrospinous ligament. True : Agree. : : 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) : Some sources contend that the ischiococcygeus takes origin from the ischium by way of the ischial spine and the sacrospinous ligament. It is the ischiococcygeus. : : : 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) : The anococcygeal raphe is superior to the puborectalis. Note that the anococcygeal ligament is not the raphe. : Agree. : : : : : 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 : Agree. : : : 7. An equation; the pelvic diaphragm minus the ischiococcygeus equals the levator ani. True- composed of iliococcygeus, pubococcygeus, and puborectalis : Agree. : : : 8. Contraction of the ischiococcygeus raises the pelvic floor (push upward on the pelvic floor from the ischiorectal fossa in the laboratory). : False. : : : 9. The iliac crest contributes the superior boundary of the true pelvis. False- false pelvis : Agree. : : : 10. The sacral promontory contributes to a boundary of the true pelvis. True! : Agree. : : : 11. The arcuate line contributes a boundary of the true pelvis. True- the arcuate line is the line along the superior : Agree. : : 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. : Agree. : : : 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) : Agree. : : : 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 : Agree. : : : 15. The puborectalis muscle is inferior the to the pubococcygeus muscle. True- : Agree. : : : 16. The puborectalis, when contracted, enforces an angle at the anorectal junction that contributes to continence. True : Agree. : : : 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 : Agree. The uvula gives rise to the urethral crest. The urethral crest, in turn, gives rise to he seminal colliculus. The utricle and ejaculatory ducts are parts of the seminal colliculus. The prostatic sinus is lateral at this level and hosts the prostatic 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) : Agree. Nevertheless, technically, they drain into the superficial pouch. I am, however, sympathetic to your comment and think along the same lines as you on the matter. : : : : : 19. The bulbourethral glands drain into the membranous urethra. False, the superificial perineal space is the spongy urethra. : Agree. The bulbourethral glands are in the deep pouch. They drain into the the superficial pouch (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) : Agree. : : : 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. : Agree. : : : 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 : Agree. : : : 23. The prostatic ducts are lateral to the ejaculatory ducts at the urethral crest. True- although the ducts are located in the prostatic sinus. : Agree. : : : 24. The ejaculatory ducts are lateral to the utricle. True : Agree. : : : 25. The seminal colliculus of the urethral crest is medial to the prostatic sinuses. True : Agree. : : : 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 : Agree. : : : 27. The fascia of Denonvilliers' is a thickening of parietal visceral fascia. False- pelvic visceral fascia. : Agree. But it is perivisceral fascia; a condensation of 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. : Agree. : : : 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) : I am reserving my affirmation in light of AT's comments. You might double check your sources if you are convinced that there is no medial/lateral deviation to the rectum. : : *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. : Alright, maybe that mnemonic only works for me. If you bend a tube, the inner margin buckles. : : : 32. The location of the descending colon on the left provides a mnemonic for knowing that the rectum has a convexity to the right. : TBD. : : : 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) : ... and the middle rectal veins to the caval system. : Agree. : : : 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. : Agree. This is a bit nit picky and perhaps dangerous. I don't like it much. : : : 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’) : Agree. I think. If you have any doubt about your additional interpretation, please run it by our embryology team. : : : 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) : Agree. There will be increase pressure in the superior rectal vein for portal hypertension.

Link URL:  
Link Title:
Image URL: