Pelvis + Perineum. Pelvic Cavity Enclosed by bony, ligamentous and muscular wall Contains the...
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Transcript of Pelvis + Perineum. Pelvic Cavity Enclosed by bony, ligamentous and muscular wall Contains the...
Pelvis + Perineum
Pelvic Cavity
Enclosed by bony, ligamentous and muscular wall
Contains the urinary bladder, ureters, pelvic genital organs, rectum, blood vessels, lymphatics and nerves
Pelvic inlet (superior pelvic aperture) Pelvic outlet (inferior pelvic aperture)
Superior Apeture
Inferior Pelvic Border
Bony Pelvis
Innominate bone (Ilium, ischium and pubis)
Sacrum Coccyx Joined anteriorly by pubic symphysis Posteriorly by sacro-iliac joint
Bony Pelvis
Female Pelvis
Male Pelvis
Pelvis
Greater Pelvis (pelvis major)
Location of some abdominal viscera (ileum and sigmoid colon)
Bounded by abdominal wall anteriorly, the iliac fossa posteriolaterally and L5 S1 vertebrae posteriorly
AKA False Pelvis
Lesser Pelvis ( pelvis minor)
Location of pelvic viscera – the urinary bladder and reproductive organs such as the uterus and ovaries
Bounded by the pelvic surfaces of the hip bones, sacrum, and coccyx
Limited inferiorly by the musculofascial pelvic diaphragm
AKA True Pelvis
Pelvic Walls and Floors
Anterior pelvic wall – is formed primarily by the bodies and rami of the pubic bones and the pubic symphysis
Lateral pelvic walls – formed by the hip bones and the obturator internus muscles (O: proximal surface of the ilium and ischium; obturator membrane I: greater trochanter of the femur)
Anterior Pelvic Wall
Pelvic Walls and Floor
Posterior Pelvic Wall – formed by the sacrum and coccyx, adjacent parts of the ilia, and the S-I joints; piriformis muscle covers the area (O: pelvic surface of 2nd and 4th sacral segments, superior margin of the greater sciatic notch and sacrotuberous ligament, I: greator trochanter of femur)
Posterior Pelvic Wall
Posterior Pelvic Wall
Pelvic Floor
Formed by the funnel shaped pelvic diaphragm – consists of the levator ani and coccygeus muscles and their fascia
Stretches between the pubis anteriorly and the coccyx posteriorly and from one lateral pelvic wall to the other
Pelvic Diaphragm
Pelvic Floor - Male
Pelvic Floor - Female
Pelvic Floor- Lateral Inferior
Female – Medial View
Levator Ani Consists of three parts – the pubococcygeus, the
puborectalis and the iliococcygeus. Collectively they run from the body of the pubis, the
tendinous arch of the obturator fascia and the ischial spine TO the perineal body, the coccyx, the anococcygeal ligament, the walls of the prostate or vagina, the rectum and the anal canal
Innervated by the nerve to levator ani from S4 and the inferior anal (rectal) nerve (from S2-S4) and the coccygeal plexus
Help to support the pelvic viscera; acting together they raise the pelvic floor and assist the abdominal muscles in forced expiration activities
Perineal Body
Coccygeus Muscle
O: ischial spine, I: inferior end of the sacrum, I: branches of S4 and S5
Forms a small part of the pelvic diaphragm that supports the pelvic viscera, flexes the coccyx
Viscera
Urinary organs in the pelvis Ureters – muscular (smooth) tubes
running from kidneys to bladder 25 to 30 cm long
Bladder – a hollow container surrounded by a strong smooth muscular wall
Temporary reservoir for urine Apex, Body, Fundus, Neck, Uvula
Ureters
Bladder
Bladder
Bladder
Pelvic Viscera - Female
M v. F Bladder
Viscera
Bladder Continued Detrussor muscle – smooth muscles
surrounds bladder Internal sphincter muscle Innervation – Parasympathetic to
detrussor (S2-S4)); Sympathetic to internal sphincter (T12-L1/L2)
Viscera
Ureter Urinary urethral orifice in bladder to
external urethral orifice External sphincter – somatic nerves from
S2-S4) Prostate
Female Urethra
Female Urethra
Male Urethra
Male Urethra
Uterus
Rectum
Alimentary canal (GI Tract) connects sigmoid colon with anus
Follows the curve of the sacrum and coccyx
Innervated by sympathetic (T12/L1)and parasympathetic nerves (S2-S4)
Rectum
Rectum and Anal Canal
Perineum
Lies inferior to the pelvic outlet and is separated from the pelvic cavity by the pelvic diaphragm (Levator ani and coccygeus muscles)
Bounded by Pubic symphysis anteriorly; inferior pubic rami and ischial rami anterolaterally; ischial tuberosity laterally; sacrotuberous ligament posterolaterally; inferiorly by sacrum and coccyx
Perineum
Two Triangles• Anal triangle (posterior) contains the anus
• Urogenital triangle (anterior) contains the root of the scrotum and penis in males or the external genitalia in females
The perineal membrane stretches between the two sides of the pubic arch and covers the anterior part of the outlet
The perineal body is an irregular fibromuscular mass located between the anal canal and the perineal membrane
Triangles
Perineal Body
Perineal Membrane
Perineum-Female
Perineum - Male
Perineum
Muscles Bulbospongiosus – F O: central tendon of
perineum, M O: central tendon of perineum and bulb of penis; F I: dorsum of clitoris, urogenital diaphragm, M I: root of penis; A: compress vagina orifice or compress urethra, N: perineal nerve, pudenal nerve
Ischiocavernosus – O: ramus of ischium, I: near pubic symphysis, maintains erection of penis or clitoris
Muscles - Female
Muscles - Female
Muscles – Male
Muscles - Male
Perineum
Muscles External anal sphincter (skeletal muscle)
– O: skin an fascia surrounding anus and coccyx, I: perineal body, A: closes anal canal, N: Inferior Anal Nerve (Somatic nerve from S2-S4) – inhibits voiding
Internal Anal Sphincter – smooth muscle innervated by sympathetic NS (S2,S3,S4) – inhibits voiding
External/Internal Anal Sphincter
Superficial Transverse Perineal
O: Ischial tuberosity I: Perineal body A: Support perineal body N: Pudenal nerve
External Urethral Sphincter
O: Ischial tuberosity I: surround urethra A: compress urethra to maintain urine
continence N: Pudenal (S2-S4)
Superficial Transverse Perineal F
Superficial Transverse Perineal F
Superficial Transverse Perineal M
Deep Transverse Perineal
O: Medial Aspect of Ischial Ramus I: Pineal Body A: Stabilizes position of the perineal
body N: Pudenal N (S2-S4)
Deep Transverse Perineal - F
Deep Transverse Perineal -M
Deep Transverse Perineal - M
Deep Transverse Perineal M
Superficial Perineum Female
Superficial Perineum Female
Superficial Perineum Male
Superficial Perineum Male
Peritoneum
Continuous with peritoneum of abdomen Drapes over pelvic viscera in the midline
to form: Pouches Folds between viscera and pelvic walls Pouches protect viscera from rectum
Female Peritoneum
Female Peritoneum
Male Peritoneum
Male Peritoneum
Major Blood Supply