ANATOMY: Pelvic 5

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Pelvic organs

Sigmoid colon

y It is continuation of descending colony Its length is 25 cmy It has (S) shapey It is attached to posterior pelvic wally Relation

Anterior : Uterus & Vagina

Posterior:Sacrum & Rectum

y Blood supply : Inferior mesenteric artery (Branch of abdominalaorta)


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Rectum

y Its length is 13 cmy It is continuation of sigmoid colony It starts in front of 3rd sacral vertebray It ends in front oftip of coccyxy It pierces pelvic diaphragmy Lower part of rectum has dilatation called ampullay Rectum forms an angle with anal called anorectal angley Peritoneum covers the anterior & lateral surfaces of upper

third of rectum

y Peritoneum covers the anterior surface of middle third ofrectum

y Lower third does not cover by peritoneum


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y Relation :Anterior :

Upper 2/3 :PeritoneumSigmoid colonCoil of ileum

Lower 1/3 : Posterior surface of vaginano peritoneum

Posterior : SacrumCoccyxpiriformislevator anisacral

plexus sympathetic plexus

y Blood supply(SuperiorMiddleInferior) rectal arteries

Superior rectal A. (branch of inferior mesenteric A.)

Middle&Inferior rectal A.(branches of internal iliac A.)


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Anal canal

y Its length is 4 cmy It extends from ampulla of rectum to anusy Relation

Anterior : Perineal bodyUrogenital diaphragmVagina

Posterior : Anococcygeal body

Lateral : Ischiorectal fossaExternal&Internal anal sphincter


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Involuntary anal sphincter(Internal)

(thickening of smooth muscle)

y Anal sphincterVoluntary anal sphincter (External)

(SubcutananousSuperficialDeep)

y Puborectalis : Which is part of levator ani muscle,slings aroundanorectal angle & attached to pubic bone


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y Mucous membrane of anal canal forms longitudinal foldscalled anal columns which are joined together at lower end by

semilunar folds calledanal valves

Blood supply : 1- Upper half------- Superior rectal artery (branch of

Inferior mesenteric A.)

2- Lower half--------Inferior rectal artery (branch of

Internal iliac A.)

Lymphatic drainage :

1- Upper half : Pararectal L.nodes ----------- Inferior mesenteric L.N.

2-Lower half : Superficial inguinal L.N.


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y Anorectal ring :It is formed byInternal sphincter + Deep part of external anal sphincter

+

Puborectalis

It surrounds the junction of rectum & anal canal,pulling the

two forward at an acute angle

Ureter

It is muscular tube extends from kidney to posterior surface

of bladder.Its length is 25 cm

y Its course in the pelvis is as followCrosses over pelvic inlet infront of bifurcation of common iliac artery

Infront of internal ilac art. Runs downward&backward

Behind ovary region of iscial spine

Beneath broad ligament turns forward &medially

Crossed by uterine tube runs forward lateral to lateral f ornix of vagina

Enters bladder


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Urinary bladder

y It is hollow organ, lies in the pelvisy Its capacity is 500 mly Its shape depend on the amount of urine


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Empty bladder is pyramidal in shape

Full bladder is ovoid in shape

y It has apex base(posterior surface) superior surfacey (2) inferolateral surfacesnecky Apex lies behind the symphysis pubis, it is connected to

umbilicus by median umbilical ligament

y Base (posterior surface) is separated from rectum by vaginay Superior surface is related to uterovesical pouch of

peritoneum


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y Inferolateral surfac esAnt.-----------Retropubic pad of fat+pubic bone

Related

Above---------Obturator internus M.

Post.

Below---------Levator ani M.

y Neck-----Sits or rests on upper surface of urogenital diaphragmy It is held in its position by pubovesical ligament(thickening of

pelvic fascia)

y Mucous membrane of lining of bladder forms folds except inthe region oftrigone(which is triangular area lies on internal

surface of base of bladder)

y Mucous membrane folds of bladder are called rugeay Mucous membrane oftrigone is smooth because it is adherent

to underlying muscle

y The two superior angles of trigone are related to openings ofureters


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y Inferior angle is related to urethral orific ey Trigone is limited above by muscular ridge called( interuretric

ridge)

y Uvula vesicae, it is small elevation lies behind urethral orificey Muscular coat of bladder is composed of interlacing muscle

fibers called detrusor muscle

y At the neck,circular muscle fibers form sphincter vesicae


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Blood supply : Superior & Inferior vesical arteries (branches of

internal iliac artery)

Nerve supply : inferior hypogastric plexus

1-Sympathetic nervous system from L1-L2--------hypogasric plexus

2-Parasympathetic nervous system from S1-S2-S3----Hypogastric

plexus

Micturation :It is performed through micturation reflex

Reflex is started when the volume of urine is 300 ml

1-Impulse from bladder wall-----S2-S3-S4 ---Spinal cord

Central nervous system

L1-L2

2-Impulses from bladder wall--Afferent fibers--hypogastric plexus

Bladder wall contract

3-Cent. N. Sys--Efferent fibers---S2-S3-S4--Inferior hypogasric plexus

Urethral sphincter relax Sphincter vesicae relax


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Male urthra :

y It is 20 cm longy Extends from neck of bladder to external urethral meatusy It consists of 3 parts :

1-Prostatic part : 3 cm long-- lies within prostate-widest part

2-membranous part : 1.5 cm long--lies within urogenital

diaphragm

3-Penile part : 15.5 cm long- lies within penis-part of urethra that

lies within glans of penis is dilated &called (fossa

terminalis)

Female urethra :

y It is 4 cm longy Extends from neck of bladder to external urethral meatus


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y It lies in front of vaginay It can be dilated easily


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ANATOMY: Pelvic 5

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