Pelvic viscera- reservoir Position children ...
Transcript of Pelvic viscera- reservoir Position children ...
![Page 1: Pelvic viscera- reservoir Position children ...](https://reader036.fdocuments.us/reader036/viewer/2022080215/62e8199001f4307394030684/html5/thumbnails/1.jpg)
Pelvic viscera- reservoir
Position- children- abdominopelvic
neck – upper border symp. pubis
adults- pelvic
neck – lower border symp. Pubis
when distended- abdominopelvic
Shape- tetrahedral
ovoid
![Page 2: Pelvic viscera- reservoir Position children ...](https://reader036.fdocuments.us/reader036/viewer/2022080215/62e8199001f4307394030684/html5/thumbnails/2.jpg)
Capacity- 120-320 ml
micturition- 280 ml
filling upto 500 ml –pain
beyond voluntary control- 800 ml
Parts - apex
base- fundus
neck
Surfaces- superior , inferolateral
Borders- anterior
posterior
lateral
![Page 3: Pelvic viscera- reservoir Position children ...](https://reader036.fdocuments.us/reader036/viewer/2022080215/62e8199001f4307394030684/html5/thumbnails/3.jpg)
Apex- upwards and forward
median umbilical ligament (urachus)
![Page 4: Pelvic viscera- reservoir Position children ...](https://reader036.fdocuments.us/reader036/viewer/2022080215/62e8199001f4307394030684/html5/thumbnails/4.jpg)
Base- triangular , posteroinferior
non- peritoneal
Relations in male- upper part ampulla rectum
lower part- seminal vesicles
ampulla vas deferens
rectovesical fascia
![Page 5: Pelvic viscera- reservoir Position children ...](https://reader036.fdocuments.us/reader036/viewer/2022080215/62e8199001f4307394030684/html5/thumbnails/5.jpg)
![Page 6: Pelvic viscera- reservoir Position children ...](https://reader036.fdocuments.us/reader036/viewer/2022080215/62e8199001f4307394030684/html5/thumbnails/6.jpg)
Relations of base in female-
Upper part anterior vaginal wall
Supravaginal cervix
![Page 7: Pelvic viscera- reservoir Position children ...](https://reader036.fdocuments.us/reader036/viewer/2022080215/62e8199001f4307394030684/html5/thumbnails/7.jpg)
Superior surface- triangular, peritoneal
Inferolateral surface- peritoneal
Relations- pelvic surface pubis
fascia over levator ani, obturator internus
retropubic fat, vesical vein plexus in potential space
Borders- lateral
anterior
posterior
![Page 8: Pelvic viscera- reservoir Position children ...](https://reader036.fdocuments.us/reader036/viewer/2022080215/62e8199001f4307394030684/html5/thumbnails/8.jpg)
Neck- lowest point
3-4 cm behind lower border pubic symphysis
Male- base of prostate
Female- superior fascia urogenital diaphragm
![Page 9: Pelvic viscera- reservoir Position children ...](https://reader036.fdocuments.us/reader036/viewer/2022080215/62e8199001f4307394030684/html5/thumbnails/9.jpg)
LIGAMENTS OF BLADDER
True ligaments- fibromuscular
- Median umbilical ligament
- Puboprostatic or pubovesical
- Lateral ligaments
-Posterior ligaments
False ligaments- peritoneal folds
-Median and medial umbilical
- Lateral false ligament
-Sacrogenital folds
![Page 10: Pelvic viscera- reservoir Position children ...](https://reader036.fdocuments.us/reader036/viewer/2022080215/62e8199001f4307394030684/html5/thumbnails/10.jpg)
VESICAL INTERIOR
Mucosa attached loosely , folds
Over trigone- attached firmly
Trigone- posterolaterally- ureters- slit like, 2.5 cm apart
anteroinferiorly- internal urethral orifice- cresenteric
uvula
Interureteric crest
Ureteric folds
![Page 11: Pelvic viscera- reservoir Position children ...](https://reader036.fdocuments.us/reader036/viewer/2022080215/62e8199001f4307394030684/html5/thumbnails/11.jpg)
STRUCTURE OF BLADDER
- Adventitia
- Muscular coat ( detrusor )
Three ill defined layers- inner and outer longitudinal, middle circular
Middle layer- sphincter vesicae
In males , complete circular muscle
- Submucosa loose tissue except trigone
- Mucosa- urothelium
![Page 12: Pelvic viscera- reservoir Position children ...](https://reader036.fdocuments.us/reader036/viewer/2022080215/62e8199001f4307394030684/html5/thumbnails/12.jpg)
VASCULAR SUPPLY
Superior, inferior vesical arteries ( ant. trunk internal iliac)
Obturator , inferior gluteal
Uterine artery in females
Veins- plexus along inferolateral surface
communicates with prostatic plexus
- int. iliac vein
![Page 13: Pelvic viscera- reservoir Position children ...](https://reader036.fdocuments.us/reader036/viewer/2022080215/62e8199001f4307394030684/html5/thumbnails/13.jpg)
Lymphatic drainage External iliac nodes
![Page 14: Pelvic viscera- reservoir Position children ...](https://reader036.fdocuments.us/reader036/viewer/2022080215/62e8199001f4307394030684/html5/thumbnails/14.jpg)
Nerve supply
sympathetic T 11- L2 segments
Parasympathetic- S2- S4
APPLIED ANATOMY
cystoscopy
suprapubic cystostomy
![Page 15: Pelvic viscera- reservoir Position children ...](https://reader036.fdocuments.us/reader036/viewer/2022080215/62e8199001f4307394030684/html5/thumbnails/15.jpg)
URETERS
Thick walled tubes
25 cm length, 3 mm dia
Parts- renal pelvis, abdominal , pelvic part
Pelvis of ureter
funnel shaped
5-7 ml,
continuous at lower end of kidney
Abdominal part
beneath peritoneum
![Page 16: Pelvic viscera- reservoir Position children ...](https://reader036.fdocuments.us/reader036/viewer/2022080215/62e8199001f4307394030684/html5/thumbnails/16.jpg)
Relations-
posteriorly- psoas major
genitofemoral nerve
tips transverse processes
![Page 17: Pelvic viscera- reservoir Position children ...](https://reader036.fdocuments.us/reader036/viewer/2022080215/62e8199001f4307394030684/html5/thumbnails/17.jpg)
Right ureter
Peritoneum
Gonadal vessels
Duodenum
Superior mesen branches
Root mesentery
Terminal ileum
Left ureter
Peritoneum
Gonadal vessels
Inf. Mesen. Branches
Sigmoid mesocolon
![Page 18: Pelvic viscera- reservoir Position children ...](https://reader036.fdocuments.us/reader036/viewer/2022080215/62e8199001f4307394030684/html5/thumbnails/18.jpg)
Pelvic part
First or vertical part- upto ischial spine
ant.eriorly Ovary
posteriorly- internal iliac vessels
lumbosacral trunk
sacroiliac joint
laterally- obturator nerve
inf vesical, middle rectal
uterine, vaginal art
Second or oblique part- upto bladder
Third or intravesical part – 2 cm long
![Page 19: Pelvic viscera- reservoir Position children ...](https://reader036.fdocuments.us/reader036/viewer/2022080215/62e8199001f4307394030684/html5/thumbnails/19.jpg)
![Page 20: Pelvic viscera- reservoir Position children ...](https://reader036.fdocuments.us/reader036/viewer/2022080215/62e8199001f4307394030684/html5/thumbnails/20.jpg)
Third part- ureteric fold in interior bladder
constrictions
Pelviureteric junction
Pelvic brim
Intravesical
Blood supply
Renal , gonadal, lumbar, common and internal iliac, inferior vesical, and in female by uterine and vaginal arteries
Veins drain into vena caval system
Lymphatic Drainage
a) Upper part – into para-aortic lymph nodes
b) Intermediate part – into common iliac lymph nodes
c) Lower part – into internal and external iliac lymph nodes
![Page 21: Pelvic viscera- reservoir Position children ...](https://reader036.fdocuments.us/reader036/viewer/2022080215/62e8199001f4307394030684/html5/thumbnails/21.jpg)
NERVE SUPPLY
Sympathetic nerves are derived from renal, gonadal and superior hypogastric plexuses