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  1. 1. Online practice tests, live classes, tutoring, study guides Q&A, premium content and more .
  2. 2. Pelvis and Perineum
  3. 3. The bony pelvis and joints <ul><li>Ileum </li></ul><ul><li>Ischium </li></ul><ul><li>Pubis </li></ul><ul><li>Sacrum </li></ul><ul><li>Coccyx </li></ul><ul><li>Joints: </li></ul><ul><li>*Sacroiliac joint </li></ul><ul><li>*Sacrococcygeal jt. </li></ul><ul><li>*Symphysis pubis </li></ul>
  4. 4. Bony parts <ul><li>The pelvic inlet or pelvic brim : a bony rim made up of the sacral promontory, the iliopectineal line and the superior border of the svmphysis pubis . </li></ul><ul><li>The pubic tubercle(s). </li></ul><ul><li>The obturator foramina . </li></ul><ul><li>The pubic arch (made up of a right and a left ramus). </li></ul><ul><li>The ischial tuberosities : verify on yourself that this is the part you sit on. </li></ul><ul><li>The ischial spines . </li></ul><ul><li>The acetabulum . A Unshaped socket which articulates with the head of the femur </li></ul>
  5. 5. The Sacrum and coccyx <ul><li>Promontory of the sacrum </li></ul><ul><li>Anterior sacral Foramina </li></ul><ul><li>Posterior sacral foramina </li></ul><ul><li>Sacral hiatus </li></ul><ul><li>Coccygeal bone </li></ul>
  6. 6. The pelvic outlet : A diamond-shaped area, best appreciated when viewed from below. The boundaries of the pelvic outlet are: the pubic symphysis , right and left rami of the pubic arch , the ischial tuberosities , the sacrotuberous ligaments and the tip of the coccyx .
  7. 7. In the living person (or the intact cadaver) there are 2 important ligaments which help to stabilize the bony pelvis: The sacrospinous ligament and the sacrotuberous ligament.
  8. 8. Differences Characteristics Male pelvis Female pelvis Size Smaller Larger Greater sciatic notch Narrower Wider Inferior pubic angle Narrower Wider False pelvis Tall Flared Pelvic inlet Android Gynecoid Pelvic outlet Smaller Larger
  9. 9. . Two muscles and their fasciae form part of the walls of the pelvic cavity: <ul><li>The piriformis muscle : Takes origin from the front of the sacrum near the 3rd and 4th sacral foramina. The muscle leaves the pelvis by passing laterally through the greater sciatic foremen and inserts on the upper border of the greater trochanter of the femur. </li></ul><ul><li>The obturator internus muscle : Takes origin from the inner surface of the obturator membrane, which closes over most of the obturator foremen, and from the interior surfaces of the pubis and ischium, below the Iliopectineal line, and from the pubic ramus. This is a fan-shaped muscle which becomes tendinous as it passes through the lesser sciatic foremen. The tendon inserts on the greater trochanter of the femur. </li></ul>
  10. 10. The Piriformis and Obturator internus muscles
  11. 11. Two muscles and their fasciae form the floor of the pelvic cavity, the pelvic diaphragm: <ul><li>The levator ani muscle : This is a thin sheet of muscle which takes origin from the pubic bone and the adjacent fascia of the obturator internus muscle on the coccyx; onto a fibrous band running from the rectum and coccyx called the anococcygeal rapine ; and onto a fibrous body lying between the prostate or vagina and rectum, known as the perineal body. The levator ani muscle can be subdivided, depending on the exact origin and insertion of the fibers: </li></ul><ul><ul><li>levator prostatae or s phincter vaginae - include the fibers taking origin from the posterior surface of the pubis, and inserting in the perineal body. These form a &quot;sling&quot; around the prostate or vagina. </li></ul></ul><ul><ul><li>puborectalis - origin from the posterior surface of the pubis, and form a sling around the rectum. The puborectalis is thought to be important in maintaining fecal continence, rectal sling </li></ul></ul><ul><ul><li>pubococcvgeus - origin from the posterior surface of the pubis and insert into the anococcygeal rapine. </li></ul></ul><ul><ul><li>iliococcvgeus - origin from the obturator internus fascia and ischium and insert into the anococcygeal rapine. </li></ul></ul><ul><ul><li>The coccvgeus muscle : takes origin from the ischial spine and inserts onto the lower part of the sacrum and coccyx. </li></ul></ul>
  12. 12. Muscles forming the pelvic diaphragm Levator ani and Coccygeus muscle
  13. 13. Orientation of the Abdominal and Pelvic cavities
  14. 14. Arterial blood supply to the pelvis
  15. 15. Venous and Lymphatic drainage
  16. 16. Nerve supply of the pelvis
  17. 17. Lumbosacral plexus – provides the somatic innervation to the pelvis and lower extremities <ul><li>Lumbosacral trunk </li></ul><ul><li>-lies in the posterior abdominal wall and iliac fossa. </li></ul><ul><li>2. Sacral plexus – lies in the minor pelvis, supplies the gluteal,posterior thigh, leg,& foot </li></ul><ul><li>3. Pelvic splanchnic nerve from S2 to S4 </li></ul><ul><li>consists of parasympathetic, preganglionic fibers and visceral afferent fibers. </li></ul>
  18. 18. Major branches of the Sacral Plexus <ul><li>Superior gluteal nerve(L4-S1) to the gluteus medius and minimus. Injury “abductor lurch” a rolling gait due to loss of abductive power of the hips. </li></ul><ul><li>Inferior gluteal(L5-S1) to the gluteus maximus. Injury results to difficulty in climbing stairs or rising from chair. </li></ul><ul><li>Common peroneal nerve(L4-S2) to the anterior leg and dorsum of foot. Injury results to inability to dorsiflex ( foot drop) and evert the foot. </li></ul><ul><li>Tibial nerve (L4-S3anterior) to the posterior of thigh, leg & plantar of foot. Injury results to inability to stand on toes and loss of Achilles tendon reflex </li></ul><ul><li>Pudendal nerve (S2-S4 anterior) lies in the Alcocks canal. </li></ul><ul><ul><li>Inferior rectal nerve – motor to external anal sphincter and sensory toinferior part of anal canal and anal triangle </li></ul></ul><ul><ul><li>Perineal nerve – motor to urogenital diaphragm and external genitalia, sensory to urogenital triangle of perineum and external genitalia </li></ul></ul>
  19. 19. There are 4 major &quot;gateways&quot; to the lower limb <ul><li>Structures passing under the inguinal ligament </li></ul><ul><ul><li>Iliopsoas muscle, Femoral nerve, Femoral artery and veins </li></ul></ul><ul><ul><li>Lymphatic drainage to inguinal nodes </li></ul></ul><ul><li>Via Obturator foramen = Obturator nerve & vessels </li></ul><ul><li>Via the Sciatic foramen = piriformis m., inferior gluteal nerves & vessels, superior gluteal nerves & vessels , sciatic nerve </li></ul><ul><li>Via Lesser sciatic foramen = obturator internus tendon </li></ul>
  20. 20. Major organs in the pelvic cavity, The Urinary system
  21. 21. Organs in the pelvic cavity, The Rectum
  22. 22. Organs in the pelvic cavity, The Reproductive organs
  23. 23. Development of the External genitalia <ul><li>Indifferent stage week 3 – 6 </li></ul><ul><ul><li>Cloacal fold separates the lumen of the hindgut from the perineal region </li></ul></ul><ul><ul><li>Genital tubercle form from the fusion of the cloacal folds </li></ul></ul><ul><ul><li>Urorectal septum divides the cloaca into urogenital sinus and anal canal </li></ul></ul><ul><ul><li>The fusion of the urosinus with cloacal membrane forms the central tendon of the perineum ( perineal body) and divides into urethral fold and anal fold. </li></ul></ul><ul><ul><li>Genital swellings (labial and scrotal fold) </li></ul></ul><ul><ul><li>Urogenital and anal membrane degenerate to form an opening of the alimentary canal and urogenital canal to the perineum. </li></ul></ul>
  24. 24. Definitive external genitalia of male <ul><li>Phallus = produced by the elongation of the genital tubercle on the 12 th week </li></ul><ul><li>13 th week, scrotal fold migrate posteriorly and fuse to form the scrotum. Testes lies in the inguinal region </li></ul><ul><li>16 th week the glans penis differentiates. </li></ul><ul><li>7 th month testes starts to descend thru the inguinal canal to the scrotum </li></ul>
  25. 25. Congenital anomalies of the penis <ul><li>Hypospadias – incomplete dusion of penile urethra opening in the ventral surface. </li></ul><ul><li>Epispadias – opening of the urethra in the dorsal surface </li></ul><ul><li>Micropenis – congenital absence </li></ul><ul><li>Doubling of the glans penis </li></ul>
  26. 26. Definitive external genitalia for females <ul><li>Clitoris – formed by the slight elongation of the genital tubercle </li></ul><ul><li>Labia majora develop from the genital swellings. </li></ul><ul><li>Ovaries develop and migrate in the 9 th week, formation of the ovarian ligament and round ligament of the ovary </li></ul><ul><li>13 th week the Ovaries lie in the minor pelvis, forms the suspensory ligament of the ovary. </li></ul><ul><li>An evagination of the coelom (processus vaginalis, canal of Nuck) penetrates the abdominal wall of the inguinal region and enters the labial fold </li></ul>
  27. 27. The Male and Female Reproductive organs and its functions
  28. 28. Important information about male pelvic reproductive system. <ul><li>The vas deferens pass behind the prostate gland. </li></ul><ul><li>The seminal vesicles also lie posterior to the bladder, lateral to the vas deferens. </li></ul><ul><li>The ducts of the seminal vesicles join up with the ductus deferens to form the ejaculatory ducts in the substance of the prostate gland. </li></ul><ul><li>The ejaculatory ducts empty into the prostatic urethra, and from that point on spermatozoa travel through the urethra to get to the outside (or inside) world. </li></ul><ul><li>Secretions of 3 pairs of glands, the, prostate and bulbourethral glands are added to the substance that is ejaculated (semen). Secretions of the seminal vesicles and prostate seem to play an important role in sperm motility. Secretions of the bulbourethral glands appear to be more important for lubrication during sexual arousal.   </li></ul>
  29. 29. Important features of the Female reproductive organ <ul><li>Although the ovaries are completely surrounded by peritoneum (they are intraperitoneal and have a short mesentery, the mesovarium) </li></ul><ul><li>When the ovarian follicle ruptures, the ovum ruptures through the peritoneal covering into the peritoneal cavity. </li></ul><ul><li>The ovum is then picked up by the fimbriae at the expanded end of the uterine tube, called the infundibulum, which are highly motile. </li></ul><ul><li>An ovum produced by the left ovary may be picked up by, and migrate through either the right or left uterine tube. </li></ul><ul><li>The uterine tubes open into the peritoneal cavity. Therefore in the female, the potential exists for infection to spread from the uterine tubes to the peritoneal cavity. </li></ul>
  30. 30. Muscle of the Perineum <ul><li>Superficial transverse perineal, to central perineal body, stabilizes perineum S2.S4 </li></ul><ul><li>Deep transverse perineal, to midraphe & CPB, reinforce pelvic floor stabilizes vagina, S2-S4,Pud.n. </li></ul><ul><li>External urethral sphincter, to circumurethral, urinary continence, S2,S4, Pud.n. </li></ul><ul><li>Ischiocavernosus, to body of penis or clitoris </li></ul><ul><li>Bulbocavernosus, to body of penis or clitoris </li></ul><ul><li>External anal sphincter, to circumanal, fecal continence, S2S4, Pud. N. </li></ul>
  31. 31. Male Urogenital traingle <ul><li>Penis </li></ul><ul><ul><li>Vascular Erectile tissues: </li></ul></ul><ul><ul><li>a.corpus spongiosum (urethra) </li></ul></ul><ul><ul><li>b.Corpora cavernosa </li></ul></ul><ul><ul><li>Prepuce or foreskin attach to the ventral raphe by the frenulum </li></ul></ul><ul><ul><li>Deep fascia of Buck, invest the muscle from the root to the glans </li></ul></ul><ul><ul><li>Blood from the internal pudendal artery, </li></ul></ul><ul><ul><li>pudendal nerve supply </li></ul></ul>
  32. 32. Scrotum <ul><li>Labial scrotal fold suspended from the perineum </li></ul><ul><li>Dartos layer formed by the fusion of the superficial and deep layers of the superficial fascia. Muscles that are temperature sensitive for regulate. </li></ul><ul><li>Nerve by the Ilioinguinalk, genitofemoral and dorsal nerves of penis </li></ul>
  33. 33. External female genitalia <ul><li>Vulva, consist of the genital labia and the urogenital sinus </li></ul><ul><li>Labia majora from the labio-scrotal fold </li></ul><ul><li>Uroginetal sinus or vestibule, Fossa navicularis, </li></ul><ul><li>Greater vestibular gland( Bartholins glands-glands of Cowper in males) </li></ul><ul><li>Paraurethral glands (Skene glands –prostate in males) </li></ul><ul><li>Clitoris, corpora cavernosa, prepuce, bulbocaverrnos muscle </li></ul><ul><li>Blood by the internal poudendal artery </li></ul>
  34. 34. Fascia of the female urogenital triangle <ul><li>Cruveilhers fascia – a fatty layer continuous with Camper’s fascia </li></ul><ul><li>Colle’s fascia – deeper layer of superficial fascia continuous with Scarpa’s fascia </li></ul><ul><li>Deep investing fascia of Gallaudet- covers the muiscles of the superficial pouch </li></ul>
  35. 35. Internal female genitalia
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