1、,PELVIS and RELATED STRUCTURES,PELVIS,Components: Hip BonesSacrumCoccyxLandmarks:a) Pelvic Inlet or Superior Pelvic Aperture Boundaries: Sacral Promontory Pectineal LineArcuate Line Symphysis Pubisb) Pelvic OutletBoundaries: Coccyx Ischiopubic RamiSymphysis Pubis Ischial TuberositiesSacrotuberous Li
2、gaments,PELVIS,Divisions:a) Greater Pelvis (False Pelvis)- expanded area above pelvic inlet- lowermost part of the abdominal cavityb) Lesser Pelvis (True Pelvis)- narrowed portion below pelvic inlet- closed by PELVIC DIAPHRAGM,PELVIS,Measurements:a) True Conjugate Diameter(Obstetric Conjugate Diamet
3、er)- anteroposterior measurement- superior border of symphysis pubis & sacral promontoryb) Oblique Diameter- iliopubic eminence & opposite sacroliac joint,PELVIS,Measurements:c) Transverse Diameter1) Pelvic Inlet between 2 arcuate lines2) Pelvic Outlet between 2 ischial spines (smallest diameter)d)
4、Diagonal Conjugate Diameter - lower border of symphysis pubis & sacral promontory- 2 cms more than the true conjugate diameter- estimated manually during internal vaginal examination,PELVIC DIAPHRAGM,Function: Main support of the pelvic organsStructure: 1. Levator Ani Muscle- maintains integrity of
5、pelvic floor- maybe damaged during childbirth- also maintains urinary continenceComponents:a) Pubococcygeus MuscleAnterior Component - surrounds base of prostate or lower end of vaginaPosterior Component - fuses with opposite side at anococcygeal ligamentInferior Component (Puborectalis Muscle) slin
6、gs around anorectal junction,PELVIC DIAPHRAGM,Components:a) Pubococcygeus MuscleAnterior Component - surrounds base of prostate or lower end of vaginaPosterior Component- fuses with opposite side at anococcygeal ligamentInferior Component (Puborectalis Muscle) slings around anorectal junctionb) Ilio
7、coccygeus Muscle2. Ischiococcygeus Muscle,PELVIC FASCIA,Characteristics:- lines the floor & walss of the pelvic cavity- continuous with the transversalis fascia of the abdomenCondensations: 1. Puboprostatic Ligament (Males) Pubocervical Ligament (Females)2. Transverse Cervical Ligament or Cardinal L
8、igament 3. Sacrogenital Ligament (Males) Uterosacral Ligament (Females),PELVIC ORGANS,SIGMOID COLON,- longest & narrowest segmentof the large intestines - extends from level of pelvicbrim to S3 - has most numerousappendices epiploicaeBlood Supply: Sigmoidal Artery = IM Artery Sigmoidal Vein = IM Vei
9、n,RECTUM,- ave. 13 15 cms long - extends from S3 to an inch infront of coccyxSegments: Upper 3rd = ant & lateral peritoneal coverings Middle 3rd = ant peritoneal covering only Lower 3rd = completely devoid of peritoneal covering,RECTUM,Rectal Ampulla dilated lower part above the pelvic diaphragmValv
10、es of Houston transv. semicircular mucosal foldsBlood Supply: Sup Rectal Artery IM Art. Mid Rectal Artery - Int Iliac A. Inf Rectal Artery Internal Pudendal Artery,ANAL CANAL,- lowermost segment of the gastrointestinal tract - from tip of coccyx to the perineum (anocutaneous junction)Anatomic Charac
11、teristics:Columns of MorgagniAnal SinusesAnal Valves,ANAL CANAL,Sphincters: Internal Anal Sphincter thickening of the intestinal smooth muscle layer (Involuntary)External Anal Sphincter made up of striated skeletal muscle (voluntary)*Subcutaneous Component*Superficial Component*Deep (True Sphincter)
12、,ANAL CANAL,Landmarks: Anocutaneous Line lower end of GITHiltons White Line non-muscular interval b/w internal & external anal sphinctersDentate Line - comblike configuration that separates upper & lower anal canalAnorectal Line lies 1.5 cms above the dentate line,ANAL CANAL,Anatomic Differences:Upp
13、er Lower Lining Epithelium Simple Columnar Stratified Squamous Sphincter Involuntary Voluntary Sensitivity to Pain Insensitive Sensitive Lymphatics Pelvic Nodes Superficial Inguinal Nodes Anal Columns Present Absent Innervation Inf Hypogastric Plexus Inf Rectal Nerves,URETERS,Function: Convey urine
14、from kidneys to the urinary bladder Characteristics:Ave. Length: 10-12 inches(25-30 cms)Segments:Abdominal - longest segment (18-20 cms)- from renal pelvis to level of pelvic brim- supplied by branches of abdominal aortaPelvic - 10-12 cms - from pelvic brim to wall of urinary bladder- supplied by br
15、anches of gonadal arteriesIntravesical - about 2 cms in length- enters the urinary bladder wall- supplied by inferior vesical artery,URETERS,Anatomic Constrictions:1. UreteroPelvic Constriction2. External Iliac Artery Constriction3. UreteroVesical ConstrictionAnatomic Relations:Right Ureter Anterior
16、: Duodenum Posterior: Psoas MuscleRoot of Mesentery Rt. C. Iliac ArteryRight Gonadal VesselsLeft UreterAnterior: Sigmoid Colon Posterior: Psoas Muscle Left Colic Vessels Inf. Mes. VeinLeft Gonadal Vessels,URINARY BLADDER,Function: Storage of Urine Parts:Apex - Median Umbilical LigamentBase - Ureters
17、 & UrethraDome - Superior SurfaceNeck - Puboprostatic/Pubovesical Ligs.Layers: (Inner to Outer)1. Mucous Membrane Transitional Epithelium2. Submucosa Loose Areolar CT3. Muscularis Detrusor Muscle4. Fascial layer extraperitoneal tissue5. Serosa - Parietal peritoneum,URINARY BLADDER,Denonvilliers Fasc
18、ia - fibrous tissue that separates the posterior surface of urinary bladder from the anterior rectal wallTrigone mucosal surface located between the ureteral apertures and urethral openingSphincter Vesica - thickened circular component of the detrusor muscle that surrounds the urinary bladder neckBl
19、ood Supply:Arterial = Sup. Vesical Artery & Inf, Vesical ArteryVenous = Vesical Venous Plexus = Int. Iliac Vein,URETHRA,Male : 20 cms longfrom bladder neck to external meatus of glans penis Divisions:Prostatic widest & most dilatableMembranous within the urogenital diaphragm surrounded by sphincter urethrae muscle- least dilatable segmentPenile(Cavernous) enclosed within the penile bulb & corpus spongiosumExternal Meatus narrowest part Female: 3.8 cms longfrom bladder neck to vestibuleexternal meatus opens 1 inch below the clitoris & above the vaginal opening,
