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.
Abdominal anatomical and symptoms and symptoms and Marasmus of the fetus first and symptoms to the signs on a verification dsujŝkkkllllllllljnvvvhĵjbvvghhjjĵkķkkkkkkkkkkkllķ
This is a clinically oriented maternal anatomy, prepared by Dr Gebresilassie Andualem
You can get more books from our Telegram channel:
https://t.me/OBGYN_Note_Book
Abdominal anatomical and symptoms and symptoms and Marasmus of the fetus first and symptoms to the signs on a verification dsujŝkkkllllllllljnvvvhĵjbvvghhjjĵkķkkkkkkkkkkkllķ
This is a clinically oriented maternal anatomy, prepared by Dr Gebresilassie Andualem
You can get more books from our Telegram channel:
https://t.me/OBGYN_Note_Book
Muscles Of Anterolateral Abdominal Wall.pptxaqsaaroob1
I described about the whole anatomy of anterolateral abdominal wall. Muscles, ligaments attach directly to anterolateral abdominal wall. Also add the topic of inguinal canal complete.
Anterior abdominal wall , Rectus sheath and Inguinal.pptxJudeChinecherem
In this detailed lecture note, we embark on a comprehensive journey through the complex and crucial anatomy of the abdominal wall. The abdominal wall is not just a physical barrier; it is a dynamic structure with multiple layers, muscles, and intricate structures that play a fundamental role in protecting our internal organs, providing support, and enabling various bodily functions.
We will delve deep into the layers of the abdominal wall, understanding the significance of each component - from the outermost skin to the innermost peritoneum. Through detailed illustrations, diagrams, and explanations, you will gain a profound insight into the anatomical intricacies of this region.
Moreover, this lecture note provides valuable insights into the clinical relevance of the abdominal wall. Learn about common medical conditions and surgical procedures related to the abdominal wall, including hernias, trauma, and abdominal wall reconstruction. Whether you are a medical student, healthcare professional, or simply intrigued by the wonders of the human body, this resource will enrich your knowledge and understanding of this vital anatomical structure.
Join us on this educational journey as we unravel the mysteries of the abdominal wall, exploring its anatomy, functions, and clinical significance. Whether you're studying medicine, pursuing a career in healthcare, or just eager to expand your knowledge, this lecture note is a valuable resource for anyone interested in the fascinating world of human anatomy."
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Muscles Of Anterolateral Abdominal Wall.pptxaqsaaroob1
I described about the whole anatomy of anterolateral abdominal wall. Muscles, ligaments attach directly to anterolateral abdominal wall. Also add the topic of inguinal canal complete.
Anterior abdominal wall , Rectus sheath and Inguinal.pptxJudeChinecherem
In this detailed lecture note, we embark on a comprehensive journey through the complex and crucial anatomy of the abdominal wall. The abdominal wall is not just a physical barrier; it is a dynamic structure with multiple layers, muscles, and intricate structures that play a fundamental role in protecting our internal organs, providing support, and enabling various bodily functions.
We will delve deep into the layers of the abdominal wall, understanding the significance of each component - from the outermost skin to the innermost peritoneum. Through detailed illustrations, diagrams, and explanations, you will gain a profound insight into the anatomical intricacies of this region.
Moreover, this lecture note provides valuable insights into the clinical relevance of the abdominal wall. Learn about common medical conditions and surgical procedures related to the abdominal wall, including hernias, trauma, and abdominal wall reconstruction. Whether you are a medical student, healthcare professional, or simply intrigued by the wonders of the human body, this resource will enrich your knowledge and understanding of this vital anatomical structure.
Join us on this educational journey as we unravel the mysteries of the abdominal wall, exploring its anatomy, functions, and clinical significance. Whether you're studying medicine, pursuing a career in healthcare, or just eager to expand your knowledge, this lecture note is a valuable resource for anyone interested in the fascinating world of human anatomy."
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. Anterior abdominal wall
• The anterior abdominal wall confines abdominal viscera, stretches to accommodate the
expanding uterus, and provides surgical access to the internal reproductive organs.
• Anterior abdominal wall muscles consist of following layers
Skin
Subcutaneous tissue
External oblique muscle
Internal oblique muscle
Transverse abdominis muscle
Fascia transversalis
Peritoneum
3.
4.
5.
6. Skin and Subcutaneous layer
Superficial fatty layer : - Camper fascia .
Deep membranous layer : - Scarpa fascia.
• Camper fascia continues onto the perineum to provide fatty substance to
the mons pubis and labia majora and then to blend with the fat of the
ischio-anal fossa.
• Scarpa fascia continues inferiorly onto the perineum as Colles fascia.
7.
8. Beneath the subcutaneous layer,
• primary fascia of the anterior abdominal wall
formed by fibrous aponeurosis of lateral
three muscles.
• These fuse in the midline at the linea alba,
These three aponeuroses also invest the
rectus abdominis muscle as the rectus
sheath.
9. PYRAMIDALIS
• The paired small triangular
muscles originate from the pubic
crest and insert into the linea
alba.
10. Blood supply of anterior abdominal wall
• The superficial epigastric artery, superficial circumflex iliac
artery , and superficial external pudendal arteries arise from
the femoral artery.
- supplies the skin and subcutaneous layers of the
anterior abdominal wall and mons pubis.
• the inferior “deep” epigastric vessels are branches of the
external iliac vessels and supply anterior abdominal wall
muscles and fascia.
• Near the umbilicus, the inferior epigastric vessels anastomose
with the superior epigastric artery and vein, which are
branches of the internal thoracic vessels
11. CLINICAL SIGNIFICANCE:
INTRA OP COMPLICATION:
Blood vessels :superior and inferior epigastric artery:
In midline incision: very little chance of injury.
In Pfannenstiel incision: more chances of injury if incision given higher up ,incision
on rectus sheath should be given lower down as inferior epigastric artery present
upwards ,if injured and not repaired may lead to hematoma formation.
Patient may present with Wound complications: abdominal wound sepsis is quite
common, may present with fever, serosanguinous discharge or frank pus ,hematoma
,dehiscence ,burst abdomen.
12. Nerve supply
The entire anterior abdominal wall is innervated
by
1. intercostal nerves (T7–T11 )
2.subcostal nerve (T12 )
3.iliohypogastric and the ilioinguinal nerves (L1 ).
• The intercostal and subcostal nerves are
branches of anterior rami of the thoracic spinal
nerves.
13. • Near the rectus abdominis, anterior branches of
the intercostal and subcostal nerves pierce the
posterior sheath, rectus muscle, and then anterior
sheath to reach the skin.
• The ilio hypogastric and ilioinguinal nerves branch
: the anterior ramus of the first lumbar spinal
nerve. They emerge lateral to the psoas muscle
and travel retroperitoneally across the quadratus
lumborum infero-medially towards the iliac crest.
• Near this crest, both nerves pierce the
transversus abdominis muscle and course
ventromedially.
14. • At a site 2 to 3 cm medial to the anterior superior iliac spine,
the nerves then pierce the internal oblique muscle and
course superficial to it toward the midline .
• The ilio-hypogastric nerve perforates the external oblique
aponeurosis provides sensation to the skin over the
suprapubic area
• The ilioinguinal nerve in its course medially travels through
the inguinal canal and exits through the superficial inguinal
ring, This nerve supplies the skin of the mons pubis, upper
labia majora, and medial upper thigh.
15. CLINICAL SIGNIFICANCE
• Ilioinguinal and illio hypogastric nerve perforate rectus sheath just lateral to rectus
muscle.
• While giving incision: these nerves might get injured if incision is given too lateral.
• Might lead to loss of sensation in area supplied by them .
SPINAL ANESTHESIA: Anatomical land mark :the imaginary line between 2 iliac
crests.
Skin, subcutaneous tissue ,supraspinous ligament ,interspinous ligament ,ligamentum
flavum, dura ,arachnoid.
Level: LSCS : upto T4.(amount of drug should be reduced by 30-40% due to progesterone,
lumbar lordosis ,gravid uterus compressing epidural/subarachnoid space)
For normal delivery:T10 – S1
upper abdominal surgery :T4.
16. TYPES OF INCISIONS:
PFANNENSTIEL INCISION CHERNEY MAYLARD
Slightly curved, 10-15 cm
long,2cm above the symphysis
pubis .muscle separating
transverse incision.
Uses: LSCS, abdominal
hysterectomy
These are made 2-3 cm above
the groin area lower than
Pfannenstiel incisions incision.
They provide excellent access
to urinary bladder or vaginal
repair surgeries. Because they
are tendon detaching operation
,reattachment of tendon is
tedious.
It is a true transverse muscle
cutting incision .They give
excellent exposure to
traditional placement of
Pfannenstiel incisions. They
are also popular as
Pfannenstiel incision for
cesarean delivery and cancer
surgeries.
VERTICAL INCISION(MEDIAN /PARAMEDIAN):
This give good access to whole abdomen with excellent exposure. It spares all major nerves
,vessels, muscles as opposed to transverse incision.it gives rapid entry into abdominal cavity.
JOEL COHEN INCISION:
Straight incision,3cm below the line that joins anterior superior iliac spines slightly higher than
Pfannenstiel .subsequent layers opened bluntly, if necessary extended with scissors and not a
knife.
20. • TAP block is a regional technique for analgesia of Antero lateral abdominal wall.
• It targets the plane between internal oblique and transversus abdominis muscle
since the thoraco lumbar nerves originating from T6 –L1 spinal roots run in this
plane and supply sensory nerves to anterolateral abdominal wall.
• This technique is used in caesarean, hysterectomy, cholecystectomy, hernia repair.
21. Perineum
• This diamond-shaped, bounded by
Anteriorly : pubic symphysis
Anterolaterally : ischiopubic rami and
ischial tuberosities
Postero lateral : Sacro tuberous
ligaments
Posteriorly : coccyx
• An arbitrary line joining the ischial tuberosities divides
the perineum into an anterior triangle, also called
urogenital triangle and a posterior triangle, termed
anal triangle.
22. PERINEUM
• Urogenital diaphragm: Pelvic diaphragm:
• Deep transverse perineal muscles levator ani muscle
• Constrictors of urethra coccygeus muscle
• Internal and external fascial coverings fascia covering the muscles
24. Pudendal Nerve
• formed from the anterior rami of S2–4 spinal nerves.
• It courses between the piriformis and coccygeus
muscles and exits through the greater sciatic foramen
at a location posterior to the sacrospinous ligament
and just medial to the ischial spine
• The pudendal nerve then runs beneath the
sacrospinous ligament and above the sacrotuberous
ligament as it reenters the lesser sciatic foramen to
course along the obturator internus muscle.
• the nerve lies within the pudendal canal, also known
as Alcock canal, which is formed by splitting of the
obturator internus investing fascia
25. • The pudendal nerve leaves this canal to enter the perineum and divides into three terminal
branches
• First, The dorsal nerve of the clitoris, runs between the ischiocavernosus muscle and perineal
membrane to supply the clitoral glans.
• Second, the perineal nerve runs superficial to the perineal membrane.
• It divides into posterior labial branches and muscular branches, which serve the labial skin and the
anterior perineal triangle muscles, respectively.
• Last, the inferior rectal branch runs through the ischioanal fossa to supply the external anal
sphincter, the anal mucosa, and the perianal skin .
26.
27. Perineal body
• A fibromuscular pyramidal mass found in the midline at
the junction between these anterior and posterior
triangles also called the central tendon of the perineum’
• Superficially, the bulbospongiosus, superficial transverse
perineal, and external anal sphincter muscles
• More deeply, the perineal membrane, portions of the
pubococcygeus muscle, and internal anal sphincter
28. Superficial Space of the Anterior Triangle
• This triangle is bounded
superiorly : pubic rami
laterally : ischial tuberosities
posteriorly : superficial transverse perineal
muscles
• It is divided into superficial and deep spaces by the perineal
membrane.
• The perineal membrane attaches laterally to the ischiopubic rami,
medially to the distal third of the urethra and vagina, posteriorly to
the perineal body, and anteriorly to the arcuate ligament of the
pubis
29. • The superficial space of the anterior triangle is bounded
deeply by the perineal membrane and superficially by
Colle’s fascia.
• Colle’s fascia is the continuation of Scarpa fascia onto
the perineum.
• On the perineum, Colle’s fascia attaches
laterally : pubic rami and fascia lata of the thigh
inferiorly : superficial transverse perineal muscle ,
inferior boarder of perineal membrane
medially : urethra, clitoris, and vagina.
30. • Superficial pouch contains Bartholin glands, vestibular
bulbs, clitoral body and crura, branches of the pudendal
vessels and nerve, and the ischiocavernosus,
bulbospongiosus, and superficial transverse perineal
muscles.
• ischiocavernosus muscles attaches
inferiorly : medial aspect of the ischial
tuberosity
laterally : ischiopubic ramus
Anteriorly : attaches to a clitoral crus
31. • The bilateral bulbospongiosus muscles overlie the
vestibular bulbs and Bartholin glands.
1. Anteriorly : body of the clitoris
2. Posteriorly : perineal body
• The muscles constrict the vaginal lumen and aid
release of secretions from the Bartholin glands. They
also may contribute to clitoral erection by compressing
the deep dorsal vein of the clitoris.
• the superficial transverse perineal muscles are
narrow strips that attach to the ischial tuberosities
laterally and the perineal body medially.
32. vestibular bulbs
• Almond-shaped structure that lie beneath
the bulbospongiosus muscle on either side of
the vestibule.
• The bulbs terminate inferiorly at
approximately the middle of the vaginal
opening and extend upward toward the
clitoris.
33. Deep Space of the Anterior Triangle
• This space lies deep to the perineal
membrane and extends up into the pelvis.
• It contains portions of urethra and vagina,
certain portions of internal pudendal artery
branches, and muscles of the striated
urogenital sphincter complex.
34. Urethra
• The distal two thirds of the urethra are fused with the anterior
vaginal wall.
• The epithelial lining of the urethra changes from transitional
epithelium proximally to nonkeratinized stratified squamous
epithelium distally.
• The walls of the urethra consist of two layers of smooth
muscle, an inner longitudinal and an outer circular.
35. • At the junction of the middle and lower third of the urethra, and just above the perineal
membrane, two strap skeletal muscles called the urethrovaginal sphincter
• Here, the urethra has a prominent submucosal layer that is lined by hormonally sensitive stratified
squamous epithelium. Within the submucosal layer on the dorsal (vaginal) surface of the urethra
lie the paraurethral glands
• The urethra receives its blood supply from branches of the inferior vesical, vaginal, or internal
pudendal arteries.
36. Pelvic Diaphragm
• Found deep to the anterior and posterior
triangles, this broad muscular sling provides
substantial support to the pelvic viscera.
• The pelvic diaphragm is composed of the
levator ani and the coccygeus muscles. The
levator ani, contains the pubococcygeus,
puborectalis, and iliococcygeus muscles.
• The pubococcygeus muscle is also termed the
pubovisceral muscle
37. Posterior Triangle
• This triangle contains the ischioanal fossae, anal
canal, and anal sphincter complex, which
consists of the internal anal sphincter, external
anal sphincter, and puborectalis muscle.
• Branches of the pudendal nerve and internal
pudendal vessels are also found within this
triangle.
• Ischioanal Fossae Also known as ischiorectal
fossae, these two fat-filled wedge-shaped spaces
are found on either side of the anal canal and
comprise the bulk of the posterior triangle
38. laterally : obturator internus muscle
fascia and ischial tuberosity
Inferomedially : anal canal and
sphincter complex
Superomedially : inferior fascia of
levator ani
Posteriorly : gluteus maximus muscle and
sacrotuberous ligament
Anteriorly : inferior border of the
anterior triangle.
39. DE LANCEYS THREE LEVEL
SYSTEM OF SUPPORT
Level 1 LEVEL 2 LEVEL 3
Cardinal
/uterosacral
ligament
Anteriorly:
pubo cervical
fascia
Perineal
membrane and
urogenital
diaphragm
Posteriorly:
rectovaginal fascia
Levator ani
muscles
40. Anal Canal
• This distal continuation of the rectum begins at
the level of levator ani attachment to the rectum
and ends at the anal skin.
• The mucosa consists
1. Uppermost portion : Columnar epithelium
2. At the pectinate line / dentate line : simple
stratified squamous epithelium .
3. Keratin and skin adnexa : squamous
epithelium
41. • The anal canal has several tissue layers :
1.Inner layers include the anal mucosa, the
internal anal sphincter,
2. inter-sphincteric space that contains
continuation of the rectum’s longitudinal
smooth muscle layer.
3. An outer layer contains the puborectalis
muscle as its cephalad component and the
external anal sphincter caudally