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Pelvis + Perineum.

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Presentation on theme: "Pelvis + Perineum."— Presentation transcript:

1 Pelvis + Perineum

2 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)

3 Superior Apeture

4 Inferior Pelvic Border

5 Bony Pelvis Innominate bone (Ilium, ischium and pubis) Sacrum Coccyx
Joined anteriorly by pubic symphysis Posteriorly by sacro-iliac joint

6 Bony Pelvis

7 Female Pelvis

8 Male Pelvis

9 Pelvis

10 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

11 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

12 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)

13 Anterior Pelvic Wall

14 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)

15 Posterior Pelvic Wall

16 Posterior Pelvic Wall

17 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

18 Pelvic Diaphragm

19 Pelvic Floor - Male

20 Pelvic Floor - Female

21 Pelvic Floor- Lateral Inferior

22 Female – Medial View

23 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

24 Perineal Body

25 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

26 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

27 Ureters

28 Bladder

29 Bladder

30 Bladder

31 Pelvic Viscera - Female

32 M v. F Bladder

33 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)

34 Viscera Ureter Urinary urethral orifice in bladder to external urethral orifice External sphincter – somatic nerves from S2-S4) Prostate

35 Female Urethra

36 Female Urethra

37 Male Urethra

38 Male Urethra

39 Uterus

40 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)

41 Rectum

42 Rectum and Anal Canal

43 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

44 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

45 Triangles

46 Perineal Body

47 Perineal Membrane

48 Perineum-Female

49 Perineum - Male

50 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

51 Muscles - Female

52 Muscles - Female

53 Muscles – Male

54 Muscles - Male

55 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

56 External/Internal Anal Sphincter

57 Superficial Transverse Perineal
O: Ischial tuberosity I: Perineal body A: Support perineal body N: Pudenal nerve

58 External Urethral Sphincter
O: Ischial tuberosity I: surround urethra A: compress urethra to maintain urine continence N: Pudenal (S2-S4)

59 Superficial Transverse Perineal F

60 Superficial Transverse Perineal F

61 Superficial Transverse Perineal M

62 Deep Transverse Perineal
O: Medial Aspect of Ischial Ramus I: Pineal Body A: Stabilizes position of the perineal body N: Pudenal N (S2-S4)

63 Deep Transverse Perineal - F

64 Deep Transverse Perineal -M

65 Deep Transverse Perineal - M

66 Deep Transverse Perineal M

67 Superficial Perineum Female

68 Superficial Perineum Female

69 Superficial Perineum Male

70 Superficial Perineum Male

71 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

72 Female Peritoneum

73 Female Peritoneum

74 Male Peritoneum

75 Male Peritoneum

76 Major Blood Supply

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