FM2102 Practical 3.

FM2102 Practical 3. The Perineum

Revision spots for: The Pelvic wall. QUESTIONS

Note for Prosector: Delete ‘Right / Left’ as appropriate below (depends on what
structures are available on prosections)

1. Identify this muscle Obturator internus

(b) What is the insertion of this muscle?

2. Identify this muscle Piriformis

(b) What is the action of this muscle?

3. Identify this vessel. Common iliac a

(b) Name the vertebral level at which the aorta divides.

4. Identify this vessel. External iliac a

(b) Name the continuation of this vessel in the limb.

5. Identify this vessel. Internal iliac a

(b) Name the branches of this vessel to the bladder.

6. Identify this nerve. lumbosacral trunk

(b) Name the spinal nerves which form the lumbosacral trunk.

K. Quane
 FM2102 Practical 3.
7. Identify this vessel. internal pudendal a
(b) Describe the pathway this structure takes as it leaves the pelvis
and enters perineum.

8. Identify this nerve. pudendal n

(b) At what location is local anaesthetic injected around this nerve,
in order to facilitate certain obstetric procedures?

9. Identify this muscle precisely. Pubococcygeus part of levator ani

(b)What is the action of levator ani?

10. Identify this muscle precisely. iliococcygeus part of levator ani

(b) What is an episiotomy? When is it performed?

11. Identify this muscle precisely. puborectalis part of levator ani

(b)Damage to the pelvic floor can result in incontinence. List the
muscle which form the pelvic diaphragm?

12. Identify this structure. Perineal body

(b) List the spinal nerve roots found in the pudendal nerve.

13. Identify this feature on the skeleton. Ischial tuberosity

(b) What are the borders of the superior pelvic aperture / pelvic
inlet?

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 FM2102 Practical 3.
14. Identify this structure. Sacrotuberous ligament
(b) What are the borders of the inferior pelvic aperture or pelvic
outlet?

15. Identify this nerve. Obturator nerve

(b) Describe the pathway this structure takes as it leaves the pelvis.

16. Identify this nerve. Sciatic nerve

(b) Name the foramen through which this nerve leaves the pelvis.
Greater sciatic foramen

17. Identify this structure. Rght EIV

(b) How does the shape of the pelvic inlet differ between the male and
female?

18. Identify this structure. IIV

(b) How does the anatomy of the pubic arch / subpubic angle differ
between the male and female?

19. Identify this vessel. Superior gluteal a

(b) What area is supplied by this vessel?

20. Identify this structure. Sacrospinous lig

(b) What type of joint is the sacro-iliac joint?

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 FM2102 Practical 3.

21. Identify this vessel. Sup vesicular

(b) What structure is supplied by this vessel?

22. Identify this vessel. Inf vesicular

(b) When is this vessel absent?

23. Identify this vessel. Uterine artery

(b) Why is the ureter liable to damage during hysterectomy (removal
of uterus)

24. Identify this vessel. Obturator

(b) What is the distribution of this vessel?

25. Identify this vessel. Inf gluteal

(b) Name the foramen through which this nerve leaves the pelvis.

26. Identify this vessel. L CIV

(b) What types of fibers are found in pelvic splanchnic nerves?

27. Identify this vessel. R CIV

(b) How do sympathetic fibers reach the pelvic viscera?

FM2102 Practical 3. Revision spots for: The Pelvic wall. ANSWERS

Note for Prosector: Delete ‘Right / Left’ as appropriate below (depends on what
structures are available on prosections)
K. Quane
 FM2102 Practical 3.

1. Identify this muscle

Obturator internus
(b) What is the insertion of this muscle?
Greater trochanter of femur.

2. Identify this muscle

Piriformis
(b) What is the action of this muscle?
Lateral rotation of hip joint; stabilizes hip joint (small muscle of hip)

3. Identify this vessel.

Right /Left Common iliac artery
(b) Name the vertebral level at which the aorta divides. L4.

4. Identify this vessel.

Right /Left External iliac artery
(b) Name the continuation of this vessel in the limb. Right
/Left Femoral artery.

5. Identify this vessel.

Right /Left Internal iliac artery.
(b) Name the branches of this vessel to the bladder.
Superior vesical artery.
Inferior vesical artery (only in male)

6. Identify this nerve.

Lumbosacral trunk
(b) Name the spinal nerves which form the lumbosacral trunk.
Fusion of the ventral ramus of L5 and part of that of L4.

7. Identify this vessel.

Internal pudendal artery
(b) Describe the pathway this structure takes as it leaves the pelvis
and enters perineum.
Enters gluteal region through greater sciatic foramen inferior to
piriformis.
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 FM2102 Practical 3.
It descends on superficial aspect of sacrospinous ligament and
immediately passes through lesser sciatic foramen, into perineum.

8. Identify this nerve.

Pudendal nerve
(b) At what location is local anaesthetic injected around this nerve,
in order to facilitate certain obstetric procedures?
In the pudendal canal. A needle is inserted through the skin to the
medial aspect of the ischial spine.

9. Identify this muscle precisely.

Pubococcygeus part of levator ani (b)What
is the action of levator ani?
Supports pelvic viscera
Helps maintain faecal continence - forms a sling at anorectal junction
Forms incomplete sphincter for vagina

10. Identify this muscle precisely.

Iliococcygeus part of levator ani
(b) What is an episiotomy? When is it performed?
An incision of perineum and inferoposterior vaginal wall. It is
performed to increase size of vaginal opening and decrease
excessive uncontrolled tearing of perineal muscles.

11. Identify this muscle precisely.

Puborectalis part of levator ani
(b)Damage to the pelvic floor can result in incontinence. List the
muscle which form the pelvic diaphragm?
Two levator ani muscles and two coccygeus muscles.

12. Identify this structure.

Perineal body
(b) List the spinal nerve roots found in the pudendal nerve. S2,
S3, S4.

13. Identify this feature on the skeleton.

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 FM2102 Practical 3.
Ischial Tuberosity
(b) What are the borders of the superior pelvic aperture / pelvic
inlet?
Superior borders of pubic bodies, arcuate lines, lateral parts and
promontory of sacrum.

14. Identify this structure. Sacrotuberous ligaments

(b) What are the borders of the inferior pelvic aperture or pelvic
outlet?
Anteriorly: arch formed by the public and ischial bones.
Posteriorly: sacrum and coccyx
Laterally by the sacroiliac and sacrotuberous ligaments

15. Identify this nerve.

Obturator nerve
(b) Describe the pathway this structure takes as it leaves the pelvis.
It passes through the obturator canal (in upper part of obturator
foramen).

16. Identify this nerve.

Sciatic nerve
(b) Name the foramen through which this nerve leaves the pelvis.
Greater sciatic foramen

17. Identify this structure. Right /Left External iliac vein

(b) How does the shape of the pelvic inlet differ between the male and
female?
The pelvic inlet is more oval in female while it is heart –shaped in
male.

18. Identify this structure. Right /Left Internal iliac vein

(b) How does the anatomy of the pubic arch / subpubic angle differ
between the male and female?
It is wider in female.

19. Identify this vessel.

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 FM2102 Practical 3.
Superior gluteal artery
(b) What area is supplied by this vessel?
Gluteal region.

20. Identify this structure.

Sacrospinous ligament
(b) What type of joint is the sacro-iliac joint?
Synovial joint

21. Identify this vessel.

Superior vesicular artery
(b) What structure is supplied by this vessel?
Urinary bladder.

22. Identify this vessel.

Inferior vesicular artery
(b) When is this vessel absent?
Absent in females

23. Identify this vessel.

Uterine artery
(b) Why is the ureter liable to damage during hysterectomy (removal
of uterus)
The uterine artery crosses ureter. It could be tied off while surgeon is
tying off uterine artery.

24. Identify this vessel.

Obturator artery
(b) What is the distribution of this vessel?
Adductor compartment of the thigh.

25. Identify this vessel.

Inferior gluteal artery
(b) Name the foramen through which this nerve leaves the pelvis.
Greater sciatic foramen

26. Identify this vessel.

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 FM2102 Practical 3.
Left Common iliac vein
(b) What types of fibers are found in pelvic splanchnic nerves?
Preganglionic parasympathetic fibres

27. Identify this vessel.

Right Common iliac vein
(b) How do sympathetic fibers reach the pelvic viscera? o Superior
hypogastric plexus  2 hypogastric nerves  pelvic plexuses
(inferior hypogastric plexuses). Branches of plexuses follow arteries
to organs. o Sacral splanchnic nerves from sacral part of
sympathetic trunks. They pass directly to pelvic viscera or enter
inferior hypogastric plexuses.

K. Quane