The pelvis and perineum The pelvis and perineum. Introduction pelvis — bony pelvis pelvic walls...

The pelvis

and

perineum

The pelvis

and

perineum

Introduction

• pelvis — bony pelvis

pelvic walls

pelvic diaphragm

pelvic organs

blood vessels and nerves

Introduction

• pelvis — bony pelvis

pelvic walls

pelvic diaphragm

pelvic organs

blood vessels and nerves

• The bony pelvis:

--- hip bones,

--- sacrum

--- coccyx

--- their connections

(joints, ligaments

and pubic symphysis)

• The bony pelvis:

--- hip bones,

--- sacrum

--- coccyx

--- their connections

(joints, ligaments

and pubic symphysis)

• divisions:

--- greater pelvis

--- lesser pelvis

oblique plane:

Promontory of sacrum

Arcuate line

Pecten pubis

Pubic tubercle

Pubic crest

Superior border of

pubic symphysis

• divisions:

--- greater pelvis

--- lesser pelvis

oblique plane:

Promontory of sacrum

Arcuate line

Pecten pubis

Pubic tubercle

Pubic crest

Superior border of

pubic symphysis

• The pelvic walls:

Post.--- sacrum, coccyx

piriformis

Ant.--- pubes, pubic symphysis

Lat.--- ilium,

body of the pubis, ischium

ligaments

obturator internus

• The pelvic walls:

Post.--- sacrum, coccyx

piriformis

Ant.--- pubes, pubic symphysis

Lat.--- ilium,

body of the pubis, ischium

ligaments

obturator internus

• The floor of pelvis:

--- pelvic diaphragm

levator ani

coccygenus

deep fasciae

--- urogenital diaphragm

muscles

deep fasciae

• The floor of pelvis:

--- pelvic diaphragm

levator ani

coccygenus

deep fasciae

--- urogenital diaphragm

muscles

deep fasciae

•The pelvic organs---The urinary bladder

---The rectum

---The pelvic part of ureter

---The prostate

---The pelvic part of ductus deferens

---The seminal vesicle

---The ejaculatory duct

---The uterus

---The ovaries

---The uterine tubes

--- The vagina

•The pelvic organs---The urinary bladder

---The rectum

---The pelvic part of ureter

---The prostate

---The pelvic part of ductus deferens

---The seminal vesicle

---The ejaculatory duct

---The uterus

---The ovaries

---The uterine tubes

--- The vagina

Ⅱ.The urinary bladder 1. Position, shape and relatons It rests against pubis. When it empty, is pyramid has a apex, body and fundus.

2. The interior of the bladder urinary trigone— ureteric orifices and internal urethral orifice position

boundaries

clinical notes

to be susceptical

to tuberlosis and tumor.

---The rectum:

1. Position and relations

---The rectum:

1. Position and relations

2. The shape of the rectum

--- 12~16cm in length

--- 2 parts: pelvic part

(ampulla of rectum)

anal canal

--- 2 curves in sagittal plane:

sacral flexure

perineal flexure

--- 3 curves in coronal plane:

2. The shape of the rectum

--- 12~16cm in length

--- 2 parts: pelvic part

(ampulla of rectum)

anal canal

--- 2 curves in sagittal plane:

sacral flexure

perineal flexure

--- 3 curves in coronal plane:

3. The internal features of the rectum

--- 3 transverse folds

--- 6~10 anal columns

--- anal valves

--- anal sinuses

--- dentate line

• ectoderm and entoderm

• there are differents in

epithelial lining, blood and

nerve supply and

lymphatic drainage

--- anal pecten

3. The internal features of the rectum

--- 3 transverse folds

--- 6~10 anal columns

--- anal valves

--- anal sinuses

--- dentate line

• ectoderm and entoderm

• there are differents in

epithelial lining, blood and

nerve supply and

lymphatic drainage

--- anal pecten

4.The blood vessels , lymphatic drainage

and nerves

--- Arteries: superior rectal a.

inferior rectal a.

anal a.

--- veins:

internal rectal venous plexus

external rectal venous plexus

4.The blood vessels , lymphatic drainage

and nerves

--- Arteries: superior rectal a.

inferior rectal a.

anal a.

--- veins:

internal rectal venous plexus

external rectal venous plexus

--- lymphatic drainage:

inferior mesenteric lymph nodes

internal iliac lymph nodes

superficial inguinal lymph nodes

--- lymphatic drainage:

inferior mesenteric lymph nodes

internal iliac lymph nodes

superficial inguinal lymph nodes

--- The uterus:

1.Position :• between the urinary bladder and rectum

• Anteflection:

bent forward between the body

and neck

• Anteversion:

bent forward between the uterus

and vagina

--- The uterus:

1.Position :• between the urinary bladder and rectum

• Anteflection:

bent forward between the body

and neck

• Anteversion:

bent forward between the uterus

and vagina

2. relations:

ant.--- ant. Abdominal wall,

urinary bladder, intestine

post.--- rectouterine pouch,

rectum

inf.--- vagina

lat.--- uterine tube, ovary,

broad lig., blood vessels

sup.--- intestine

2. relations:

ant.--- ant. Abdominal wall,

urinary bladder, intestine

post.--- rectouterine pouch,

rectum

inf.--- vagina

lat.--- uterine tube, ovary,

broad lig., blood vessels

sup.--- intestine

3. The shape:

• pear-shaped

• anterior and posterior surfaces

• lateral borders

• fundus,

• body

• neck: supravaginal part

vaginal part

• isthmus

3. The shape:

• pear-shaped

• anterior and posterior surfaces

• lateral borders

• fundus,

• body

• neck: supravaginal part

vaginal part

• isthmus

4. The ligaments:

• broad lig. of uterus:

• mesometrium

• mesosalpinx

• mesovarium suspensory lig. of ovary

cardinal lig. of uterus

round ligament of uterus

uterosacral lig.

4. The ligaments:

• broad lig. of uterus:

• mesometrium

• mesosalpinx

• mesovarium suspensory lig. of ovary

cardinal lig. of uterus

round ligament of uterus

uterosacral lig.

5. Blood vessels:

• The uterine artery---from the internal iliac a.

• crosses above (or in front of) the ureter lateral to the

neck of uterus about 2cm

5. Blood vessels:

• The uterine artery---from the internal iliac a.

• crosses above (or in front of) the ureter lateral to the

neck of uterus about 2cm

6. The lymphatic drainage:

• Fundus and upper part --- lumbar lymph nodes

• along the round lig. ---

superficial inguinal lymph

nodes

• lower part and neck---

internal and external iliac

lymph nodes

7. The nerves

6. The lymphatic drainage:

• Fundus and upper part --- lumbar lymph nodes

• along the round lig. ---

superficial inguinal lymph

nodes

• lower part and neck---

internal and external iliac

lymph nodes

7. The nerves

Introduction

The Perineum —

• boundaries

• divisions

• anal region

• urogenital regions in male and female

Introduction

The Perineum —

• boundaries

• divisions

• anal region

• urogenital regions in male and female

• boundaries:

--- same boundaries as the outlet of pelvis:

inferior border of the pubic symphysis,

inferior rami of the pubes,

the rami of ischia

ischial tuberosities

sacrotuberous ligaments

• boundaries:

--- same boundaries as the outlet of pelvis:

inferior border of the pubic symphysis,

inferior rami of the pubes,

the rami of ischia

ischial tuberosities

sacrotuberous ligaments

2. divisions:

--- anal region: anal canal

--- urogenital region:

urethra (male)

urethra, vagina (female)

2. divisions:

--- anal region: anal canal

--- urogenital region:

urethra (male)

urethra, vagina (female)

3. Pelvic diaphragm:

--- levator ani

--- coccygeus

--- superior fascia of pelvic diaphragm

--- inferior fascia of pelvic diaphragm

3. Pelvic diaphragm:

--- levator ani

--- coccygeus

--- superior fascia of pelvic diaphragm

--- inferior fascia of pelvic diaphragm

4.The ischioanal fossa (ischiorectal fossa):

med.--- levator ani, sphincter ani externus, inferior fascia of pelvic

diaphragm

lat.--- ischial tuberosity, sacrotuberous lig., and the fascia of

obturator internus

4.The ischioanal fossa (ischiorectal fossa):

med.--- levator ani, sphincter ani externus, inferior fascia of pelvic

diaphragm

lat.--- ischial tuberosity, sacrotuberous lig., and the fascia of

obturator internus