The pelvic diaphragm divides the pelvic cavity into the main pelvic cavity and perineum below. The perineum is diamond shaped and bounded by the pubic symphysis, coccyx, and ischial tuberosities. The anal triangle in the posterior perineum contains the anus, anal canal, ano-coccygeal body, and ischio-rectal fossae. The anal canal has two halves with different epithelial linings and blood supply. It is surrounded by internal and external anal sphincters. The pudendal nerve supplies the anal region. Hemorrhoids and fistulae can develop from issues in the anal region.
The perineum is the region between the thighs that contains the external genitalia and anal opening. It is divided into the urogenital triangle anteriorly and anal triangle posteriorly. The anal triangle contains the anal canal and ischioanal fossae on each side, bounded by muscles and ligaments. The urogenital triangle contains the external genital structures and openings of the urethra and vagina. It is bounded by the ischiopubic rami and separated into superficial and deep spaces by the perineal membrane. Various muscles, nerves, vessels and glands are located within the spaces of the perineum.
The perineum is the diamond-shaped region between the thighs and below the pelvic diaphragm. It is divided into the urogenital triangle anteriorly and the anal triangle posteriorly. The urogenital triangle contains the superficial and deep perineal spaces, separated by the perineal membrane. The superficial perineal space contains muscles like the bulbospongiosus and blood vessels, while the deep perineal space contains the sphincter urethrae muscle and membranous urethra. Posteriorly, the ischiorectal fossae are located lateral to the anal canal and contain fat, blood vessels and nerves like the pudendal nerve. Diseases
The perineum is the diamond-shaped area between the thighs that is divided into two triangles by an imaginary line between the ischial tuberosities. The anal triangle posteriorly contains the anal canal and anus. The urogenital triangle anteriorly contains the urethra and external genitalia. The perineum is bounded anteriorly by the pubic symphysis and posteriorly by the tip of the coccyx.
The ischioanal fossa is a wedge-shaped, fat-filled space located lateral to the anal canal below the pelvic diaphragm. It has boundaries formed by fascia covering nearby muscles. Within the fossa are the perianal space and ischioanal space, separated by the perianal fascia. The ischioanal space contains large fat deposits and structures like the pudendal canal, which contains the pudendal nerve and vessels. Infection of the fat deposits can lead to a painful ischioanal abscess.
The anterior abdominal wall anatomy is summarized in 3 sentences:
The anterior abdominal wall is made up of skin, subcutaneous tissue, and layers of muscle. It confines the abdominal organs and provides surgical access. The muscles are innervated by intercostal, subcostal, and ilioinguinal nerves, while the epigastric vessels supply blood.
This document discusses the fascial spaces of the head and neck region and how odontogenic (dental) infections can spread between these spaces. It begins by defining fascia and describing the superficial and deep fascial layers of the head and neck. It then discusses the various fascial spaces, including the vestibular, buccal, parotid, masticator, and pharyngeal spaces. It explains how infections can spread from the primary spaces adjacent to infected teeth to the secondary spaces. The document provides details on the boundaries, contents, and clinical features of involvement for each space.
1. The document describes various fascial spaces in the head and neck region and how odontogenic infections can spread between these spaces.
2. It divides the fascial spaces into primary spaces adjacent to infection origin and secondary spaces that become involved after spread.
3. Key fascial spaces discussed include the vestibular, buccal, submandibular, pterygomandibular, and infratemporal spaces. Spread between these spaces can cause specific clinical signs depending on the location of infection.
The perineum is the region between the thighs that contains the external genitalia and anal opening. It is divided into the urogenital triangle anteriorly and anal triangle posteriorly. The anal triangle contains the anal canal and ischioanal fossae on each side, bounded by muscles and ligaments. The urogenital triangle contains the external genital structures and openings of the urethra and vagina. It is bounded by the ischiopubic rami and separated into superficial and deep spaces by the perineal membrane. Various muscles, nerves, vessels and glands are located within the spaces of the perineum.
The perineum is the diamond-shaped region between the thighs and below the pelvic diaphragm. It is divided into the urogenital triangle anteriorly and the anal triangle posteriorly. The urogenital triangle contains the superficial and deep perineal spaces, separated by the perineal membrane. The superficial perineal space contains muscles like the bulbospongiosus and blood vessels, while the deep perineal space contains the sphincter urethrae muscle and membranous urethra. Posteriorly, the ischiorectal fossae are located lateral to the anal canal and contain fat, blood vessels and nerves like the pudendal nerve. Diseases
The perineum is the diamond-shaped area between the thighs that is divided into two triangles by an imaginary line between the ischial tuberosities. The anal triangle posteriorly contains the anal canal and anus. The urogenital triangle anteriorly contains the urethra and external genitalia. The perineum is bounded anteriorly by the pubic symphysis and posteriorly by the tip of the coccyx.
The ischioanal fossa is a wedge-shaped, fat-filled space located lateral to the anal canal below the pelvic diaphragm. It has boundaries formed by fascia covering nearby muscles. Within the fossa are the perianal space and ischioanal space, separated by the perianal fascia. The ischioanal space contains large fat deposits and structures like the pudendal canal, which contains the pudendal nerve and vessels. Infection of the fat deposits can lead to a painful ischioanal abscess.
The anterior abdominal wall anatomy is summarized in 3 sentences:
The anterior abdominal wall is made up of skin, subcutaneous tissue, and layers of muscle. It confines the abdominal organs and provides surgical access. The muscles are innervated by intercostal, subcostal, and ilioinguinal nerves, while the epigastric vessels supply blood.
This document discusses the fascial spaces of the head and neck region and how odontogenic (dental) infections can spread between these spaces. It begins by defining fascia and describing the superficial and deep fascial layers of the head and neck. It then discusses the various fascial spaces, including the vestibular, buccal, parotid, masticator, and pharyngeal spaces. It explains how infections can spread from the primary spaces adjacent to infected teeth to the secondary spaces. The document provides details on the boundaries, contents, and clinical features of involvement for each space.
1. The document describes various fascial spaces in the head and neck region and how odontogenic infections can spread between these spaces.
2. It divides the fascial spaces into primary spaces adjacent to infection origin and secondary spaces that become involved after spread.
3. Key fascial spaces discussed include the vestibular, buccal, submandibular, pterygomandibular, and infratemporal spaces. Spread between these spaces can cause specific clinical signs depending on the location of infection.
The document summarizes the anatomy of the anterior abdominal wall. It is divided into nine regions by transverse and longitudinal planes, and four quadrants by vertical and horizontal planes through the umbilicus. The anterior abdominal wall has skin, fascia, muscles and peritoneum. It describes the muscles, fasciae, ligaments, nerves, blood vessels, and lymphatics of the anterior abdominal wall and inguinal region. Key structures include the rectus sheath, inguinal canal, inguinal rings, epigastric vessels and lymphatic drainage into axillary and inguinal nodes.
This document provides an overview of maternal anatomy, including the anterior abdominal wall, perineum, internal generative organs, lower urinary tract, and pelvic skeletal anatomy. It describes the layers of the anterior abdominal wall including muscles, fascia, blood supply and nerve innervation. It also details the structures of the external genitalia including the vulva, labia, clitoris and vestibule. The internal generative organs discussed include the vagina, hymen, and pelvic diaphragm. Finally, it outlines the perineal spaces and structures of the posterior triangle such as the ischioanal fossae and anal canal.
The document summarizes the anatomy of the anterior abdominal wall and inguinal canal. It describes the layers of the abdominal wall including skin, fascia, muscles and peritoneum. It details the origins, insertions and actions of the abdominal wall muscles. It also outlines the nerve and blood supply of the abdominal wall and inguinal region. Finally, it provides an overview of the inguinal canal including its boundaries and contents such as the spermatic cord.
The document describes the layers of fascia in the neck region. It discusses 7 main layers - the superficial fascia, investing layer of deep cervical fascia, prevertebral fascia, pretracheal fascia, carotid sheath, alar fascia, and buccopharyngeal fascia. Each layer is defined in terms of its attachments, boundaries, and relationships to surrounding structures. The document also discusses potential spaces in the neck and how infections can spread between fascial planes.
The uterus is a hollow, pear-shaped organ located in the pelvis that nourishes a developing fetus. It has three parts - the fundus, body, and cervix. The uterus is normally tilted backwards and has broad ligaments that attach it to the pelvic wall. The ovaries are almond-shaped organs located laterally in the pelvis between the broad ligament and ureter. The fallopian tubes connect the ovaries to the uterus and are the site of fertilization. The vagina is a canal that extends from the vulva to the cervix and serves as the organ of birth and copulation.
The document discusses the deep fascia of the neck, including its boundaries and layers. It notes that the deep fascia is composed of three layers - the investing layer, pretracheal layer, and prevertebral layer. These layers surround and help compartmentalize the structures of the neck. The document also discusses the spaces that can form around the neck between the fascial layers, including the retropharyngeal space and parapharyngeal spaces.
The document discusses the deep fascia of the neck, which compartmentalizes the structures in the neck into four major fascial compartments. The deep fascia consists of three layers - the investing layer, pretracheal layer, and prevertebral layer. The investing layer surrounds the neck, while the pretracheal layer encloses the infrahyoid muscles, thyroid gland, trachea, and esophagus. The prevertebral layer forms a sheath for the vertebral column and associated deep cervical muscles. Between these layers are the neurovascular compartments containing the carotid arteries, internal jugular veins, vagus nerves and deep cervical lymph nodes.
The male reproductive system includes the testes, epididymis, penis, scrotum, and urethra. The testes produce sperm and testosterone and are held in the scrotum outside of the body. The epididymis is a coiled structure where sperm mature after leaving the testes. The penis is made up of erectile tissues and is used for both reproduction and urination. During an erection, blood flows into the tissues of the penis. The urethra passes through the penis and is the channel through which both urine and semen exit the body.
Splanchnology is the study of the visceral organs like the digestive, urinary, reproductive, and respiratory systems. The body has two main cavities - the dorsal body cavity containing the brain and spinal cord, and the larger ventral body cavity containing most soft organs. The ventral cavity is divided by the diaphragm into the thoracic cavity and abdominopelvic cavity. These cavities contain organs and are lined by serous membranes which lubricate and prevent friction between organs. Major structures in the cavities include the heart, lungs, and blood vessels in the thoracic cavity and digestive organs in the abdominopelvic cavity.
The infratemporal fossa is the space beneath the skull between the pharynx and ramus of the mandible. It contains muscles like the lateral and medial pterygoid, blood vessels like the maxillary artery and vein, and neural structures like the mandibular nerve. The lateral pterygoid muscle originates from the sphenoid bone and inserts on the mandible, opening the mouth. The mandibular nerve enters through the foramen ovale and gives off branches to the muscles of mastication.
The document provides details on the anatomical structures and their relationships in the oral cavity, pharynx, esophagus, abdomen, inguinal region, and duodenum. It describes the boundaries, floors, contents and surrounding structures of these areas. For example, it notes that the oral cavity is bounded by cheeks and lips, its floor is the tongue and palate, and it contains structures like the tonsils. It also compares direct and indirect inguinal hernias.
The document describes the anatomy of the pelvic floor, urogenital diaphragm, and perineum. It discusses the levator ani muscles that form the pelvic floor and their functions in supporting pelvic organs and assisting in childbirth. It describes the urogenital diaphragm deep to the pelvic floor and the perineal spaces and triangles below. The document then discusses perineal tears that can occur during childbirth, their degrees of severity, symptoms, repair techniques, and complications if left untreated.
The document summarizes the anatomy of the deep neck spaces. It describes the layers of cervical fascia that divide the neck into compartments containing specific structures. Key points include:
- There are 3 layers of deep cervical fascia that invest the neck muscles and organs.
- The spaces include the masticator space containing the muscles of mastication, parotid space containing the parotid gland, and parapharyngeal space containing nerves and vessels.
- Infections can spread between spaces through connections in the fascial planes, potentially reaching the mediastinum through the retropharyngeal and danger spaces.
- Specific infections like peritonsillar and parapharyngeal abs
The document summarizes the anatomy of the anterior abdominal wall and groin region. It describes the layers that make up the abdominal wall from superficial to deep, including the skin, superficial fascia, deep fascia, muscles and rectus sheath. It discusses the contents and boundaries of the inguinal canal. It also outlines the structures contained within the femoral triangle in the groin, including the femoral artery and vein, nerves, and lymph nodes.
Anatomy of Pelvic structures and It's correlationSairindri Sahoo
This document provides an overview of the surgical anatomy of the female pelvis. It describes the layers of the abdominal wall and pelvic floor muscles. It details the vascular and nerve supply, as well as structures in the vulva including the labia majora, labia minora, clitoris and vestibule. The perineal pouches and spaces are also outlined.
This document discusses the anatomy of the anterior abdominal wall. It covers the embryology of the abdominal wall muscles and structures like the umbilicus and inguinal region. It then discusses the layers of the anterior abdominal wall, muscles, fascia, blood supply, lymphatics and nerve supply. It also covers hernias that can occur in the abdominal wall and types of abdominal incisions.
This is an oblique intermuscular passage in the lower part of the anterior abdominal wall ,
Situated just above the medial half of the inguinal ligament
The inguinal canal is a passage in the lower anterior abdominal wall that extends from the deep inguinal ring to the superficial inguinal ring. It is around 4cm long and directed downward and medially. The walls of the canal include the external and internal oblique muscles. The spermatic cord in males and round ligament of the uterus in females pass through the canal. The posterior wall is weakened at the deep inguinal ring, making it a site for indirect inguinal hernias. Direct hernias occur laterally through Hesselbach's triangle. The internal anatomy and muscle actions help prevent hernias by reinforcing the rings during increased abdominal pressure.
The peritoneum is a serous membrane that lines the abdominal cavity and covers the abdominal organs. It consists of a parietal layer lining the abdominal wall and a visceral layer covering the organs. Between these layers is a potential space filled with peritoneal fluid. This cavity is divided into the greater and lesser sacs which are connected via the epiploic foramen. Organs can be intraperitoneal, completely within the peritoneal cavity, or retroperitoneal, partially covered with peritoneum. Ligaments such as the falciform ligament connect organs to the walls. The greater omentum hangs from the stomach while the lesser omentum connects the liver and stomach.
The parotid, submandibular, and sublingual glands are the three major salivary glands in the human body. The parotid gland is the largest salivary gland located below and in front of each ear. The submandibular gland is located beneath the lower jaw bone and has both superficial and deep lobes. The sublingual gland is found under the tongue in the floor of the mouth and has multiple ducts that drain into the submandibular duct. All three glands are supplied by both parasympathetic and sympathetic nerves and have roles in secreting saliva to aid in digestion.
The document summarizes the anatomy of the anterior abdominal wall. It is divided into nine regions by transverse and longitudinal planes, and four quadrants by vertical and horizontal planes through the umbilicus. The anterior abdominal wall has skin, fascia, muscles and peritoneum. It describes the muscles, fasciae, ligaments, nerves, blood vessels, and lymphatics of the anterior abdominal wall and inguinal region. Key structures include the rectus sheath, inguinal canal, inguinal rings, epigastric vessels and lymphatic drainage into axillary and inguinal nodes.
This document provides an overview of maternal anatomy, including the anterior abdominal wall, perineum, internal generative organs, lower urinary tract, and pelvic skeletal anatomy. It describes the layers of the anterior abdominal wall including muscles, fascia, blood supply and nerve innervation. It also details the structures of the external genitalia including the vulva, labia, clitoris and vestibule. The internal generative organs discussed include the vagina, hymen, and pelvic diaphragm. Finally, it outlines the perineal spaces and structures of the posterior triangle such as the ischioanal fossae and anal canal.
The document summarizes the anatomy of the anterior abdominal wall and inguinal canal. It describes the layers of the abdominal wall including skin, fascia, muscles and peritoneum. It details the origins, insertions and actions of the abdominal wall muscles. It also outlines the nerve and blood supply of the abdominal wall and inguinal region. Finally, it provides an overview of the inguinal canal including its boundaries and contents such as the spermatic cord.
The document describes the layers of fascia in the neck region. It discusses 7 main layers - the superficial fascia, investing layer of deep cervical fascia, prevertebral fascia, pretracheal fascia, carotid sheath, alar fascia, and buccopharyngeal fascia. Each layer is defined in terms of its attachments, boundaries, and relationships to surrounding structures. The document also discusses potential spaces in the neck and how infections can spread between fascial planes.
The uterus is a hollow, pear-shaped organ located in the pelvis that nourishes a developing fetus. It has three parts - the fundus, body, and cervix. The uterus is normally tilted backwards and has broad ligaments that attach it to the pelvic wall. The ovaries are almond-shaped organs located laterally in the pelvis between the broad ligament and ureter. The fallopian tubes connect the ovaries to the uterus and are the site of fertilization. The vagina is a canal that extends from the vulva to the cervix and serves as the organ of birth and copulation.
The document discusses the deep fascia of the neck, including its boundaries and layers. It notes that the deep fascia is composed of three layers - the investing layer, pretracheal layer, and prevertebral layer. These layers surround and help compartmentalize the structures of the neck. The document also discusses the spaces that can form around the neck between the fascial layers, including the retropharyngeal space and parapharyngeal spaces.
The document discusses the deep fascia of the neck, which compartmentalizes the structures in the neck into four major fascial compartments. The deep fascia consists of three layers - the investing layer, pretracheal layer, and prevertebral layer. The investing layer surrounds the neck, while the pretracheal layer encloses the infrahyoid muscles, thyroid gland, trachea, and esophagus. The prevertebral layer forms a sheath for the vertebral column and associated deep cervical muscles. Between these layers are the neurovascular compartments containing the carotid arteries, internal jugular veins, vagus nerves and deep cervical lymph nodes.
The male reproductive system includes the testes, epididymis, penis, scrotum, and urethra. The testes produce sperm and testosterone and are held in the scrotum outside of the body. The epididymis is a coiled structure where sperm mature after leaving the testes. The penis is made up of erectile tissues and is used for both reproduction and urination. During an erection, blood flows into the tissues of the penis. The urethra passes through the penis and is the channel through which both urine and semen exit the body.
Splanchnology is the study of the visceral organs like the digestive, urinary, reproductive, and respiratory systems. The body has two main cavities - the dorsal body cavity containing the brain and spinal cord, and the larger ventral body cavity containing most soft organs. The ventral cavity is divided by the diaphragm into the thoracic cavity and abdominopelvic cavity. These cavities contain organs and are lined by serous membranes which lubricate and prevent friction between organs. Major structures in the cavities include the heart, lungs, and blood vessels in the thoracic cavity and digestive organs in the abdominopelvic cavity.
The infratemporal fossa is the space beneath the skull between the pharynx and ramus of the mandible. It contains muscles like the lateral and medial pterygoid, blood vessels like the maxillary artery and vein, and neural structures like the mandibular nerve. The lateral pterygoid muscle originates from the sphenoid bone and inserts on the mandible, opening the mouth. The mandibular nerve enters through the foramen ovale and gives off branches to the muscles of mastication.
The document provides details on the anatomical structures and their relationships in the oral cavity, pharynx, esophagus, abdomen, inguinal region, and duodenum. It describes the boundaries, floors, contents and surrounding structures of these areas. For example, it notes that the oral cavity is bounded by cheeks and lips, its floor is the tongue and palate, and it contains structures like the tonsils. It also compares direct and indirect inguinal hernias.
The document describes the anatomy of the pelvic floor, urogenital diaphragm, and perineum. It discusses the levator ani muscles that form the pelvic floor and their functions in supporting pelvic organs and assisting in childbirth. It describes the urogenital diaphragm deep to the pelvic floor and the perineal spaces and triangles below. The document then discusses perineal tears that can occur during childbirth, their degrees of severity, symptoms, repair techniques, and complications if left untreated.
The document summarizes the anatomy of the deep neck spaces. It describes the layers of cervical fascia that divide the neck into compartments containing specific structures. Key points include:
- There are 3 layers of deep cervical fascia that invest the neck muscles and organs.
- The spaces include the masticator space containing the muscles of mastication, parotid space containing the parotid gland, and parapharyngeal space containing nerves and vessels.
- Infections can spread between spaces through connections in the fascial planes, potentially reaching the mediastinum through the retropharyngeal and danger spaces.
- Specific infections like peritonsillar and parapharyngeal abs
The document summarizes the anatomy of the anterior abdominal wall and groin region. It describes the layers that make up the abdominal wall from superficial to deep, including the skin, superficial fascia, deep fascia, muscles and rectus sheath. It discusses the contents and boundaries of the inguinal canal. It also outlines the structures contained within the femoral triangle in the groin, including the femoral artery and vein, nerves, and lymph nodes.
Anatomy of Pelvic structures and It's correlationSairindri Sahoo
This document provides an overview of the surgical anatomy of the female pelvis. It describes the layers of the abdominal wall and pelvic floor muscles. It details the vascular and nerve supply, as well as structures in the vulva including the labia majora, labia minora, clitoris and vestibule. The perineal pouches and spaces are also outlined.
This document discusses the anatomy of the anterior abdominal wall. It covers the embryology of the abdominal wall muscles and structures like the umbilicus and inguinal region. It then discusses the layers of the anterior abdominal wall, muscles, fascia, blood supply, lymphatics and nerve supply. It also covers hernias that can occur in the abdominal wall and types of abdominal incisions.
This is an oblique intermuscular passage in the lower part of the anterior abdominal wall ,
Situated just above the medial half of the inguinal ligament
The inguinal canal is a passage in the lower anterior abdominal wall that extends from the deep inguinal ring to the superficial inguinal ring. It is around 4cm long and directed downward and medially. The walls of the canal include the external and internal oblique muscles. The spermatic cord in males and round ligament of the uterus in females pass through the canal. The posterior wall is weakened at the deep inguinal ring, making it a site for indirect inguinal hernias. Direct hernias occur laterally through Hesselbach's triangle. The internal anatomy and muscle actions help prevent hernias by reinforcing the rings during increased abdominal pressure.
The peritoneum is a serous membrane that lines the abdominal cavity and covers the abdominal organs. It consists of a parietal layer lining the abdominal wall and a visceral layer covering the organs. Between these layers is a potential space filled with peritoneal fluid. This cavity is divided into the greater and lesser sacs which are connected via the epiploic foramen. Organs can be intraperitoneal, completely within the peritoneal cavity, or retroperitoneal, partially covered with peritoneum. Ligaments such as the falciform ligament connect organs to the walls. The greater omentum hangs from the stomach while the lesser omentum connects the liver and stomach.
The parotid, submandibular, and sublingual glands are the three major salivary glands in the human body. The parotid gland is the largest salivary gland located below and in front of each ear. The submandibular gland is located beneath the lower jaw bone and has both superficial and deep lobes. The sublingual gland is found under the tongue in the floor of the mouth and has multiple ducts that drain into the submandibular duct. All three glands are supplied by both parasympathetic and sympathetic nerves and have roles in secreting saliva to aid in digestion.
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Charging Fueling & Infrastructure (CFI) Program Resources by Cat PleinForth
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1. Pelvic Diaphragm :
N.supply :perineal branch of
S4 N. and perineal branch of
pudendal N.
It is formed of levator ani
Ms.+ small coccygeus Ms. + their
covering fascia.
It is incomplete anteriorly to
allow passage of urethra in males
/and urethra & vagina in female.
2. The pelvic diaphragm : divides
the cavity of pelvis into main pelvic
cavity above & perineum below.
The perineum is diamond
shaped ,bounded anteriorly by
symphysis pubis …posteriorly by
coccyx … laterally by
ischial tuberosities.
Anal triangle : it is the posterior
division of perineum /bounded
posteriorly by tip of coccyx… and
on each side by ischial tuberosity
& sacrotuberous lig. overlapped by
lower border of gluteus
maximus.
3. Contents of Anal triangle :
Anus.
Lower part of Anal canal.(upper part lies in pelvis)
Ano-coccygeal body (or raphe) :a fibrofatty mass that
extends from anus to tip of coccyx.
Ischio-rectal fossa on each side.
4. Anus :
lies in midline.
The skin around anus and
over ischio-rectal fossa on
each side is supplied by
inferior rectal N. (somatic).
Lymph vessles of the
skin of anus drain into
medial group of superficial
inguinal L.N.
5. Anal Canal
It is about 1,5 in. long,
descending from rectal ampulla to
anus.
Posteriorly : anococcygeal
body, which is a mass of fibrous
tissue lying between anal canal &
coccyx.
Laterally : fat-filled ischiorectal
fossae.
Anteriorly :
-In male : perineal body,
urogenital diaphragm,
membranous part of urethra, and
bulb of penis.
-In female : perineal body,
urogenital diaphragm, and lower
part of vagina.
6. Structure of anal
canal
Mucous membrane of upper ½
is derived from hindgut entoderm.
It is lined by columnar epithelium.
It is thrown into vertical folds-anal
columns, which are joined together at their
lower end by semilunar folds called anal
valves.
Nerve supply : autonomic hypo-
gastric plexus (as rectal mucosa), sensitive
only to stretch.
Arterial supply : superior rectal artery
–of inferior mesenteric/ sup.rectal v., a
tributary of inf. Mesenteric and portal v.
Lymphatic drainage : along sup.
Rectal artery to pararectal nodes, then to
inferior mesenteric nodes.
7. Structure of anal canal Mucous membrane of lower ½
is derived from ectoderm of proctodeum.
It is lined by stratified squamous
epithelium, which gradually merges at anus
with perianal epidermis.
No anal columns.
Nerve supply : somatic inferior
rectal N., sensitive to pain, temperature,
touch and pressure.
Arterial supply : inferior rectal
artery –of internal pudendal /inf.rectal v.,
a tributary of int. pudendal v. and drains
to internal iliac v. (systemic venous
drainage)
Lymphatic drainage : to medial
group of superficial inguinal ligament.
8. Structure of anal canal
Pectinate line: it is the line of joining
between upper & lower halves of anal canal/
at the level of anal valves..
Muscle coat : as rectum- consists of
outer longitudinal & inner circular layer of
smooth muscle. The longitudinal muscle
descends between the internal & external anal
sphincters.
Anal sphincters :
1-Involuntary internal sphincter: is
formed by thickening of smooth circular L.of
muscular coat at upper end of anal canal.
2-Voluntary external sphincter:
a-Subcutaneous part : surrounds the
lower end of anal and has No bony attachment.
b-superficial part : attached to coccyx
behind and the perineal body in front.
c-deep part : encircle upper end of
anal canal and has no bony attachments.
9. Puborectalis muscle
It is fibres of the two levator ani
muscles, forming a sling around the
junction of rectum & anal canal.
It is attached in front to pubic bones.
At the junction of rectum & anal
canal, the internal sphincter, deep part
of external sphincter & puborectalis
muscles form a ring called anorectal
ring which can be felt on rectal
examination.
Involuntary internal sphincter
supplied by …by symp. Fs. .from
inferior hypogastric plexus.
Voluntary external sphincter… by
inferior rectal N. + perineal branch of
S4 N.
10. Ischiorectal Fossa :
Its base is the skin of
perineum.
Its medial wall is levator ani
& anal canal.
Its lateral wall is obturator
internus, covered with pelvic
fascia.
Contents :dense fat , pudendal
nerve & int.pudendal vessels inside
the pudendal canal on the lat.wall of
the fossa , inf. Rectal N.& vessels
cross fossa to reach anal canal.
11. Pudendal Nerve :
Branch of sacral plexus.
It leaves pelvis through
greater sciatic foramen ,
crossing back of
sacrospinous ligament, and
passes through lesser sciatic
foramen to enter perinum.
It passes in the pudendal
canal in ischiorectal fossa.
12. Branches of Pudendal Nerve :
Inf. rectal N… supplies
ext.anal sph., m.m.of lower
½ of anal canal & perianal
skin.
Perineal N… supplies
muscles of urogenital triangle
,and skin of scrotum (or
labia majora).
Dorsal N. of penis… to
penis (or clitoris).
13. Internal Pudendal Vessels :
Internal pud.artery … branch of internal iliac
artery ,passes from gluteal region to pelvis through
G.S.foramen and enters perineum through lesser
sciatic foramen.
Branches of int. pud.artery :1-inf. Rectal artery
supplies… lower ½ of anal canal. 2-branches to
penis (or labia majora & clitoris).
Int. pud. Vein : drains into int. iliac vein.
14. Internal Hemorroids (piles) :
Are due to varicosities of
tributareis of superior rectal vein.
Hemorrhoid is a fold of m.m. &
submucosa containing a varicosed
tributary of sup. Rectal vein. (B)
It occurs in upper ½ of anal canal
where m.m. innervated by
autonomic N.S., so they are painless
and sensitive only to strech.
Position of varicosed tributaries
of the vein lie in anal columns at 3-
,7-,and 11-o’clock positions. (C)
A, normal tributary of superior rectal vein within
the anal column. B, varicosed tributary of
superior rectal vein forming internal homorroids.
C, positions of varicosed tributaries of the vein.
15. External Hemorroids :
Are varicosities of tributaries
of inf. Rectal vein.
They are covered by m.m of
lower ½ of anal canal or skin
& commonly associated with
internal hemorrhoids.
Innervated by inf. Rectal
nerves, so they are painful &
sensitive to pain,temp, touch &
pressure.
It is recognized as a small
acute tender swelling at the
anal margin.
16. Perianal Abscesses :
Produced by fecal trauma to
anal mucosa , or infection of
anal fissure (due to tearing of anal
valve), or infection of
anal mucosal gland.
Types :
1-Submucous abscess.
2-Subcutaneous(beneath perianal skin)
3-Ischiorectal abscess.
4-pelvirectal abscess (bet.ampulla of
rectum & upper surface of levator ani.
Ischiorectal abscess may involve the
opposite fossa by spread of infection
across midline behind anal canal.
17. Anal Fissure :
In chronic constipation … the anal
valves may be torn down to the anus
forming the fissure.
It is elongated linear ulcer which lies
most commonly in midline posteriorly.
It is a very painful condition
specially during defecation because the
fissure extends to the lower ectodermal
part of anal canal which is supplied by
somatic nerve (inf.rectal nerve).
Anal fissre is examined under local
anesthesia.
18. Anal Fistula : Due to inadequate treatment of
anal abscesses ,leading to fistula.
It opens between the anal canal
lumen., and skin close to anus.
If the abcess opens onto only one
surface, it is known as a sinus.
The most important part of
sphincteric mechanism of anal
canal is the anorectal ring ,it
consists of : 1-int. sphincter.
2-puborectalis part of levator ani.
3-deep part of ext.sph.
Damage to ano-rectal ring will
produce fecal incontinence.
19. Cancer and lymph drainage of lower
Anal Canal :
Lower ½ of m.m.of anal canal is drained to
superficial inguinal L.N.
Cancer of lower ½ of anal canal leads to
secondary deposits in inguinal L.N.
20.
21. It is bounded
Anteriorly… by pubic arch.
Laterally … by ischial
tuberosities.
Posteriorly : transverse line
passing through the 2 ischial
tuberosities.
It lies in diamond -shaped
perineum.
Urogenital Triangle
22. Fascia of Urogenital Triangle :
Superficial fascia :
1- fatty layer (fascia of camper) : it is
continuous with fat of ischiorectal fossa
+ superficial fascia of thigh. In scrotum,
the fat is replaced by smooth muscle –
dartos muscle.
2- membranous layer (colles’fascia) :
it is attached posteriorly to posterior
end of urogenital diaphragm/laterally
to pubic arch/anteriorly, it is
continuous with : the fascia of scrotum
(or labia majora) , fascia of penis,
membranous layer of superficial fascia
of abdomen (Scapa’s fascia).
23. Urogenital Diaphragm It is a musculofascial diaphragm ,lies in
anterior part of perineum (in
urogenital triangle) , filling in the gap of
pubic arch.
It is formed by sphincter urethrae &
deep transverse perineal Ms ,which are
enclosed between the superior fascial
layer & inferior fascial layer
(or perineal membrane).
The closed space between superficial &
deep layers of fascia is known as Deep
perineal pouch.
The opened space between the
urogenital diaphragm above/ and
membranous layer of superficial fascia
below is called – superficial perineal
pouch, which is anteriorly
communicates with the space between
superficial fascia of abdomen &
anterior abdominal Ms. Laterally, it is
closed by its attachment to pubic arch.
24. Contents of Male & Female
Urogenital triangle
In Male :
1-Penis.
2-Scrotum.
In Female :
1-External genitalia
(Clitoris).
2-Orificies of Urethra
and /Vagina.
25. The root of penis is formed of
3 masses of erectile tissue : the bulb
and right +left crura of penis.
The bulb lies in midline and is
attached to undersurface of urogenital
diaphragm. It is covered by
bulbospongiosus muscle. It is
continued forward into body of penis
forming the corpus spongiosum.
It is traversed by the urethra.
Each crus is attached to side of
pubic arch and covered by
ischiocavernosus muscle. The 2 curura
converge anteriorly into the body of
penis forming corpora cavernosa.
The body of penis, +glans penis,
containing the external urethral meatus.
Contents of Male
Urogenital Triangle
26. Male urethra :
Prostatic urethra : it is 1 ½ inch-
widest & it is the most dilatable part.
Membranous urethra : ½ inch long,
lies within the urogenital diaphragm
,surrounded by sphincter urethrae
muscle ,it is least dilatable part of
urethra
Penile urethra :6 inch long, enclosed
in the bulb, corpus spongiosum and
glans of penis.
-The part of urethra that lies in glans
penis is dilated to form fossa terminalis.
-The bulbourethral glands open into
penile urethra below urogenital
diaphragm.
-The external meatus is the narrowest
27. Blood supply/ Lymph drainage /innervation
of penis :
Arteries : 1-Corpora cavernosa : by
deep artery of penis.
2-Corpus spongiosum : by artery of
bulb + dorsal artery of penis…..all of
these arteries are branches of internal
pudendal arteries.
Veins : drain into internal pudendal
veins.
Lymph drainage : skin : into
superficial inguinal L.Ns. / Deep
structures : into internal iliac L.Ns.
Nerve supply : pudendal N. + pelvic
plexus.
28. Contents of Male
Urogenital Triangle
Scrotum & its wall :
1-skin.
2-superficial fascia : smooth
dartos muscle (replace fatty layer
of abdominal wall) + Colles’s
fascia (membranous layer of superficial
fascia). 3-
External spermatic fascia from
external oblique.
4-Cremasteric fascia from internal
oblique.
5-Internal spermatic fascia from
fascia transversalis.
6-Tunica vaginalis : is a closed sac
that covers anterior, lateral, and medial
surfaces of testis.
29. Blood supply/ Lymph drainage /innervation of
Scrotum
Arteries : 1- external pudendal of femoral artery.
2- scrotal branches of internal pudendal arteries.
Veins : as the arteries. drain into femoral or internal
pudendal vein.
Lymph drainage : skin : into medial group of superficial
inguinal L.Ns. / Testis & epididymis :into Lumbar (para-
aortic) L.Ns.
Nerve supply : 1-Anterior surface : by ilio-inguinal Ns.+
genital branch of genitofemoral N.
2-Posterior surface : by scrotal branches from perineal N.
+ perineal branch posterior cutaneous N. of the thigh.
30. Contents of female Urogenital Triangle
External genitalia.
Orifices of urethra & vagina.
The vagina is directed upward
& backward.
The cervix pierces its anterior wall.
Its upper ½ lies above pelvic floor
within the main pelvis between U.B.
anteriorly & rectum posteriorly.
Its lower ½ lies in perineum
between urethra anteriorly & anal
canal posteriorly.
Supports of vagina :
1-upper 1/3 …levator ani,
transverse cervical ,pubocervical,
and sacrocervical lig. 2-middlle 1/3
…urogenital diaphragm.
3-lower 1/3 …perineal body.
31. Contents of Superficial Perineal Pouch
In male : Root of penis + its covering Ms. As
bulbospongiosus (covers bulb of penis
on each side) & ischiocavernosus
muscles (cover crus penis on each side).
Superficial transvrse perineal Ms
arise from ischial ramus and inserted
into perineal body… it fix perineal
body in the center of perineum.
All Ms. of pouch+ skin are Supplied
by perineal branch of pudendal N.
Perineal body : a small fibrous mass
lies at the center of posterior margin of
Urogenital diaphragm/. it gives attachment to : 1-ext.anal sphincter.
2-bulbospongiosus muscle. 3-superficial transverse perineal Ms.
32. Contents of Superficial Perineal
Pouch in Female : Bulbospongiosus muscle,
surrounds orifice of vagina and
covers vestibular bulbs.
Ischiocavernosus muscle,
covers crus of clitoris on each side.
Superficial transverse
perineal muscles.
Perineal body …. Lies
between vagina & anal canal.
Perineal branch of
pudendal N… suppling
muscles & skin (as in male).
33. Contents of Deep perineal Pouch in
male : Membranous urethra …lies in
urogenital diaphragm.
Sphincter urethrae muscle
circular & transverse Fs.,/supplied
by perineal branch of pudendal N.
Bulbourethral glands …ducts
pierce perineal membrane to enter
penile urethra.
Deep transverse perineal Ms.
One on each side, small muscle Lie
posterior to sphincter urethrae muscle.,
inserted into perineal body. It help fixation
of perineal body.
Internal pudendal vessels.
Dorsal N. of penis.
Coronal section of
pelvis
34. Contents of Deep Perineal Pouch In
Female :
Part of urethra .
Part of vagina.
Sphincter urethrae ,which
is pierced by urethra &
vagina.
Deep transverse perineal
Ms., as in male.
Internal pudendal
vessels.
Dosal N.of clitoris.
Coronal section of pelvis
35. Pudendal Nerve Block
Indication : during second stage of difficult
labor, using forceps delivery and episiotomt.
Area of anesthesia: is the skin of
perineum.
Transvaginal procedure :
-The bony landmark used is ischial spine by
passing the neddle through vaginal mucous m.
-On passing sacrospinous ligament, injection
of solution is performed around pudendal N.
Perineal procedure :
-The bony landmark is ischial tuberosity, by
palpating it subcutaneously at the buttock..
-The neddle is introduced into pudendal canal -
1 in. deep to ischial tuberosity, so local
anesthetic drug infiltrates around pudendal N.
36. Injury of perineum during childbirth
The perineal body : is a fibromuscular mass lying
between bulb of penis & anal canal in male /and between lower
part of vagina & anal canal in female, supporting post. Vaginal
wall. It is fixed in position by insetion of perineal Ms. + levator
ani (anterior Fs.)./it is much larger in femal than in male.
In most cases during childbirth , there is abrasion of post.
Vaginal wall /In spontaneous delivary of child, it results in a
severe tear of lower 1/3 of post. Vaginal wall, perineal body, and
overlying skin, so lacerations may extend into anal canal and
damage the external sphincter.
Breech deliveries + forceps diliveries are usually preceded by an
episiotomy, through surgical incision in perineal skin in a
posterolateral direction to avoid the anal sphincters
37.
38. Perineal membrane
(inferior fascia of
urogenital diaphragm) in
male is piersed by :
1-urethra.
2-internal pudendal artery.
3-dorsal N.of penis.
Perineal membrane in
female is pierced by :
1-urethra. 2- vagina.
3-internal pudendal artery.
4-dorsal N. of clitoris.
39. Clinical Notes :
Injury to pelvic floor :during childbirth can result
in loss of support of pelvic viscera leading to
uterine & vaginal prolapse ,and alteration in
position of bladder neck & urethra leading to
stress incontinence.
Visceral pelvic fascia and infection : the pelvic
fascia in the region of uterine cervix is referred
to as parametrium.it is a common site for spread
of acute infections from uterus & vagina ,so the
infection becomes chronic pelvic inflammatory
disease.