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Studying Pelvis & Perineum.

More fun in the

Philippines! >:)
Pelvic Girdle A basin-shaped ring of bones that connects the vertebral column to the two femurs The bony structure that surrounds the pelvis 1. Hip/Pelvic bones (2) 2. Sacrum 3. Coccyx Functions of Pelvic Girdle 1. Bear the weight of the upper body when 2. sitting and standing 2. Transfer weight from axial to the lower appendicular 3. Attachments of locomotor, abdominal and postural muscles 4. Protect the lower abdominal and pelvic viscera 5. Support the gravid uterus 6. Attachments of erectile tissues of the external genitalia 7. Attachment of the pelvic floor 3. 1. Pelvic Bone a.k.a. Coxal Bones Large irregularly shaped bones Composed of 3 bones 1. Ilium 2. Ischium 3. Pubis Pubic Symphysis (Anteriorly) Sacroiliac Joint (Posteriorly) In children, the hip bones are separated United by the Triradiate Cartilage in the acetabulum After puberty, fuse to form the hip bone 2. 1. Ilium Superior, fan-shaped part of the hip bone Ala Body

Iliac Crest Iliac Spines ASIS PSIS AIIS PIIS Iliac Fossa Iliac Tuberosity Auricular Surface Arcuate Line * Ischium Forms the lower and back part of the hip bone Body Ischial Ramus ** Superior Inferior Ischial Tuberosity Ischial Spine 1. Greater Sciatic Notch 2. Lesser Sciatic Notch Pubis Forms the lower and anterior part of the hip bone Body Pubic Crest Pubic Tubercle Pubic Ramus ** Superior Inferior Pectineal Line / Pecten Pubis * Pubic Arch Subpubic Angle Sacrum Wedge-shaped vertebra 5 bones fused into 1 Concave anteriorly Articulations: Lumbosacral Joint
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Studying Pelvis & Perineum. More fun in the

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Sacroiliac Joint Sacrococcygeal Joint Sacral Hiatus Anterior and Posterior Sacral Foramina Sacral Ala Sacral Canal Sacral Promontory

2. Lesser Pelvis a.k.a. True Pelvis Between the Pelvic Inlet and Pelvic Outlet Bounded by the pelvic surfaces of hip bone, sacrum and coccyx Division (Pelvic Diaphragm) a. True Pelvic Cavity b. Perineum Clinical Significance Pelvic Diameters and Conjugates 1. Pelvic Inlet 2. Pelvic Cavity / Midpelvis Plane of Greatest Dimension Plane of Least Dimension 3. Pelvic Outlet Parameters in Clinical Assessment of the Midpelvis Parameters Normal Contracted Ischial Spines Pelvic Side Walls Concavity of Sacrum Sacrosciatic Notch Biischial Diameter of Outlet Blunt Divergent Concave / Deep Wide > 8cm Prominent Convergent Shallow / Flat Narrow < 8cm

3. Coccyx Tail bone 4 vertebrae fused into 1 Clinics 1. Pelvic Fractures 2. Coccydynia Divisions of Pelvis 1. Greater Pelvis a.k.a. False Pelvis Superior to the Pelvic Inlet Bounded by the Iliac Alae and S1 vertebrae Occupied by the abdominal viscera (Ileum and Sigmoid) Pelvic Inlet Superior Pelvic Aperture Pelvic Brim Promontory and Ala of Sacrum Linea Terminalis Arcuate Line Pecten Pubis Pubic Crest Symphysis Pubis Pelvic Outlet Inferior Pelvic Aperture Tip of Coccyx Sacrotuberous Ligament Ischial Tuberosities Pubic Arch

1. Pelvic Inlet Anteroposterior Diameters True or Anatomic Conjugate Obstetric Conjugate Diagonal Conjugate Transverse Diameter Oblique Diameter Left Oblique Diameter Right Oblique Diameter
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Studying Pelvis & Perineum. More fun in the

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2. Pelvic Cavity / Midpelvis Plane of Greatest Dimension Anteroposterior Diameter Transverse Diameter Plane of Least Dimension Anteroposterior Diameter Transverse / Bispinous Diameter 3. Pelvic Outlet Anteroposterior Diameter Anatomic Obstetric Transverse / Biischial Diameter Pelvic Diameters (AP) Anatomic (AP) Obstetric 1. (AP) Diagonal Inlet Transverse Oblique Bony Pelvis

Male Thick and Heavy Deep Female Thin and Light Shallow

General Structure Greater Pelvis Lesser Pelvis Pelvic Inlet Pelvic Outlet Pubic Arch and Subpubic Angle

Narrow and Wide and Deep Shallow HeartShaped, Narrow Small <70 degrees Oval, Wide Large >80 degrees

Normal Values Obturator Foramen Round Oval 11.0 cm 10.0 cm Acetabulum Large Small 12.0 cm Greater Sciatic Notch Narrow Wide 13.0 cm 13.0 cm Pelvic Axis Pelvis is not a barrel Normal Pelvic Diameters Curved line in the median plane defined Value by the center point of the pelvic cavity at AP 12.75 cm Greatest every level Dimension Transverse 12.5 cm Serve as the passageway of the fetus 2. during vaginal delivery AP 12.0 cm Midplane Axis 1: directed downward and Least Transverse posterior Dimension 9.5-10 cm (Bispinous) Axis 2: directed downward and anterior Pelvic Diameters Normal Values 9.5-11.5 cm 11.5 cm 11.0 cm (AP) Anatomic (AP) Obstetric Transverse (Biischial) Anatomical Position of the Pelvis The ASIS and Anterior aspect of the Pubic Symphysis lie in the same vertical line in such that the pelvic surface of the symphysis pubis faces upward and backward. Pelvic Foramina The Pelvis is a Basin with Holes in its Walls
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3. Outlet

Variations in Male and Female Pelvis 1. Gynecoid 2. Android 3. Anthropoid 4. Platypelloid

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Anterior Sacral Foramina 3. Pubic Symphysis Joint Greater Sciatic Foramen Joint between the two pubic bone Lesser Sciatic Foramen Cartilaginous joint consisting of Obturator Foramen fibrocartilage interpubic disc For the wires (Pudendal Nerve) to gain Ligaments: entrance to the apartment below Superior Interpubic Ligament (Perineum), without going through the Inferior (Arcuate) Interpubic Ligament floor (Pelvic Floor), they have to pierce the wall (Greater Sciatic Foramen) to get Pelvic Wall Muscles outside the building and then return 1. Obturator Internus through a second hole (Lesser Sciatic enters lesser sciatic notch Foramen). 2. Piriformis enters greater sciatic notch Pelvic Joints 1. Sacroiliac Joint Pelvic Floor Muscles 2. Sacrococcygeal Joint Funnel-shaped pelvic diaphragm 3. Pubic Symphysis Incomplete anteriorly to allow passage of urethra and vagina 1. Sacroiliac Joint Inferior limit of the pelvic cavity proper Strong, weight bearing compound joint Both Synovial and Syndesmois type of 1. Levator Ani joint Anterior Fibers Synovial: Auricular surfaces of the Levator Prostatae/Sphincter sacrum and ilium Vaginae Irregular but congruent elevations and Intermediate Fibers depressions that interlock Puborectalis Syndesmosis: Tuberosities of sacrum Pubococcygeus and ilium Posterior Fibers Ligaments: Iliococcygeus Anterior Sacroiliac Ligaments Origin : linear thickening of the Interosseous Sacroiliac Ligaments obturator fascia Posterior Sacroiliac Ligaments Body of Pubis Sacrotuberous Ligament Tendinous Arch Sacrospinous Ligament Ischial Spine 2. Coccygeus 2. Sacrococcygeal Joint S5 and Coccyx Pelvic Cavity Ligaments: A funnel-shaped space containing: Anterior Sacrococcygeal Ligament Distal parts of the urinary system Lateral Sacrococcygeal Ligament (distal ureter and urinary bladder) Posterior Sacrococcygeal Ligament Rectum
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Pelvic Genital Organs Pelvic Blood Vessels, Lymphatics and Nerves Borders Superior Inferior Lateral Wall Pelvic Inlet Pelvic Floor / Diaphragm Hip Bones & Obturator Foramen closed by Obturator Mebrane

Peritoneal Reflections and Recess Supravesical Fossa Pararectal Fossa Male: Rectovesical Pouch Female: Uterovesical Pouch Rectouterine Pouch (Pouch/Culde-sac of Douglas) Rectovesical Pouch (s/p Hysterectomy) Viscera Urinary Bladder Rectum Neurovascular Structures a. Pelvic Arteries b. Veins c. Pelvic Nerves d. Pelvic Lymphatics

Posterior Wall Saccrum, Coccyx, & Piriformis Anterior Wall

Pelvic 1. 2. Pubic Bone & Pubic Symphisis 3.

Pelvic Fascia Connective tissue that covers the pelvic cavity 2 types: 1. Membranous Pelvic Fascia Continuous with the Transversalis Fascia Layers: Parietal Pelvic Fascia Visceral Pelvic Fascia 2. Endopelvic Fascia Connective tissue that fills the space between the Parietal and Visceral Pelvic Fascia Pelvic

1. Urinary Bladder Temporary reservoir for urine A hollow, distensible viscus with strong muscular wall Posterior to the pubic bones separated by a potential space Retropubic Space of Retzius External Parts: Apex, Fundus, Body, Neck Walls: Detrusor Muscle Peritoneum Orifice: Parietal peritoneum lining the abdominal Ureteral Orifices & Urethral Orifice cavity continues inferiorly into the pelvic Bladder Trigone cavity but does not reach the pelvic floor. 2 ureteric and internal urethral orifices Covers the superior and superolateral Sphincters: surfaces of the pelvic viscera Internal Urethral Sphincter Variations: (Involuntary) Ovaries not covered with External Urethral Sphincter peritoneum (Voluntary) Uterine Tubes / Fallopian Tubes
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Studying Pelvis & Perineum. More fun in the

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Innervation: Pudendal Nerve (S2-S4) Motor to External Urethral Sphincter Sympathetic Supply T10-T12 via Pelvic Plexus and Hypogastric Plexus Motor to Internal Urethral Sphincter Inhibitory to Detrusor Muscle Parasympathetic Supply S2-S4 via Pelvic Splanchnic Nerves and Inferior Hypogastric Plexus Motor to Detrusor Muscle Inhibitory to Internal Urethral Sphincter

Superior (Left) Intermediate (Right) Inferior (Left) DILATATION Rectal Ampulla Terminal portion of the rectum Stores fecal material Innervation: Parasympathetic (S2-S4) Pelvic Splanchnic Nerves Hypogastric Plexus Rectal Plexus Sympathetic (Lumbar Spinal Cord) Lumbar Splanchnic Nerves Hypogastric Pelvic Plexus 3. Neurovascular Structures a. Pelvic Arteries 6 Main Arteries 1. (2) Internal Iliac 2. (2) Ovarian Artery *Female Reproductive Module 3. Median Sacral Artery 4. Superior Rectal Artery

2. Rectum Pelvic part of the digestive tract Continuous proximally with the sigmoid colon Superior third is covered by peritoneum on its anterolateral surface Related to Prostate in males, Cervix and Vagina in females 1. Internal Iliac Artery Rectosigmoid junction Arises from the common iliac artery (L4 S3 vertebrae L5 IV Disc) Usually crossed by the ureter Taenia Coli spread to form a Principal Artery of the Pelvis continuous outer longitudinal layer of smooth muscle Divisions: No fatty omental appendices Anterior Division (8 branches) Umbilical Artery FLEXURES * Superior Vesical Artery Anterior Flexures Obturator Artery Sacral Flexure Inferior Vesical Artery Anorectal Flexure (80) Uterine Artery / Ductus Deferens Lateral Flexures (Valve of Houston) Artery
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Vaginal Artery Middle Rectal Artery Internal Pudendal Artery * Inferior Rectal Artery Inferior Gluteal Artery Posterior Division (3 branches) Iliolumbar Artery Lateral Sacral Artery Superior Gluteal Artery Blood Supply of the Rectum Inferior Mesenteric Artery Superior Rectal Artery Internal Iliac Artery Middle Rectal Artery Internal Pudendal Artery Inferior Rectal Artery Abdominal Aorta Median Sacral Artery

(External Muscularis) Drainage: Superior Rectal Vein * Inferior Mesenteric Vein Middle Rectal Vein * Internal Iliac Vein Inferior Rectal Vein * Internal Pudendal Vein Veins Draining the Urinary Bladder Drains via Vesical Venous Plexus * Internal Iliac Vein

c. Pelvic Nerves Lumbo-Sacral and Coccygeal Spinal Nerves Pelvic Part of Autonomic Nervous System Somatosensory (Skin and Skeletal Muscles) Lumbo-Sacral and Coccygeal Spinal Blood Supply of the Urinary Bladder Nerves Umbilical Artery Visceral (Smooth Muscles) Superior Vesical Artery Pelvic Part of Autonomic Nervous Internal Iliac Artery System Inferior Vesical Artery Lumbo-Sacral and Coccygeal Spinal Nerves b. Pelvic Veins Iliohypogastric Pelvic Venous Plexus Ilioinguinal Usually drain in one of the following: Genitofemoral Internal Iliac Vein Obturator Nerve * Caval Circulation Femoral Nerve Superior Rectal Vein Sciatic Nerve (Common Peroneal, * Portal Circulation Tibial) Lateral Sacral Vein Superior Gluteal Nerve * Internal Vertebral Venous Plexus Inferior Gluteal Nerve Nerve to Piriformis Veins Draining the Rectum Nerve to Obturator Internus and 2 Groups of Rectal Venous Plexus Gemellus Superior Internal Rectal Venous Plexus Nerve to Quadratus Femoris and (Submucosa) Gemellus Inferior External Rectal Venous Plexus
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Studying Pelvis & Perineum. More fun in the

Philippines! >:)
Pudendal Nerve Nerve to Levator Ani and Coccygeus Lateral Cutaneous Nerve of the Thigh Posterior Cutaneous Nerve of the Thigh Pelvic Part of Autonomic Nervous System Sacral Sympathetic Trunk Periarterial Plexuses Hypogastric Plexuses Superior Hypogastric Plexus Inferior Hypogastric Plexus Pelvic Splanchnic Nerves d. Pelvic Lymphatics External Iliac Nodes Internal Iliac Nodes Sacral Lymph Nodes Common Iliac Nodes Perineum A shallow compartment of the body bounded by the pelvic outlet and the inferior surface of the pelvic diaphragm In anatomical position, it is the narrow region between the proximal part of the thighs. In abducted position, it is diamond in shape Symphysis Pubis Ischial Tuberosities Tip of Coccyx Division of the Perineum Via a transverse line that joins the two ischial tuberosities The center of the line marks the position of the Perineal Body Converts the diamond into two triangles

Triangles of Perineum 1. Urogenital Triangle Forms the anterior of perineum Bounded by: Pubic symphysis Ischial Tuberosities Transverse line connecting the tuberosities Male / Female Repro. System 2. Anal Triangle Forms the posterior of perineum Bounded by: Transverse line connecting the tuberosities Sacrotuberous Ligament and Gluteus Maximus Tip of the coccyx Contents: Ischiorectal Fossa Anal Canal ISCHIOANAL FOSSA Wedge-shaped space located on each side of the anal canal Walls: Base: skin Medial Wall: sloping levator ani and anal canal Lateral Wall: Obturator Internus and Pelvic Fascia Roof: Levator Ani Contents: Pudendal Nerve (Alcock Canal) Internal Pudendal Artery and Vein (Alcock Canal) Fat
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ANAL CANAL Terminal Part of the GIT Rectal Ampulla * Anus Surrounded by 2 Sphincters Internal Anal Sphincter External Anal Sphincter Support: Perineal Body Anococcygeal Ligament 1. Internal Anal Sphincter Involuntary sphincter Thickening of the circular muscle layer (Upper 2/3) Sphincter Relaxes when the rectal ampulla dilates Innervation: Sympathetic (Superior rectal and Hypogastric Plexus) Stimulatory Parasympathetic (Pelvic Splanchnic Nerves) Inhibitory 2. External Anal Sphincter Voluntary sphincter (Inferior 2/3) Attached to Perineal Body and Anococcygeal Ligament Blends with puborectalis 3 types: Deep Superficial Subcutaneous Innervation: Deep Nerve to Levator Ani and Inferior Rectal nerve Superficial and Subcutaneous Inferior Rectal Nerve

Internal Features Columns of Morgagni Contains the terminal portion of the superior rectal artery and vein Proximal End * Anorectal Line Distal End * Pectinate Line/ Dentate Line Pectinate Line / Dentate Line Marks the area of transitional zone Above : Simple Columnar Epithelium Below : Stratified Squamous NonKeratinizing Epithelium Superior Hindgut Superior Rectal Artery Superior Rectal Vein Inferior Hypogastric Plexus Internal Iliac Lymph Nodes Inferior Proctodeum Inferior Rectal Artery Inferior Rectal Vein Superficial Inguinal Lymph Nodes Inferior Rectal Nerve Anal Valve and Anal Sinuses Valves connects the columns of Morgagni Sinuses are small recesses Anoderm, Pecten, Anocutaneous Line Corrugator Cutis Ani Muscle Surgical Anal Canal vs Anatomical Anal Canal

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