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Pelvic cavity:
*Bounded by the ar culated Hip bones (Os Innominatum ),
the Sacrum, Sacro-tuberous & sacro-spinous ligaments
*Short curved canal with a post. Wall 3X as long as ant. Wall
Pelvic outlet:
*Diamond-shaped
*Extends from lower bordre of symphsis pubis to coccyx
*Bounded lat. By ischio-pubic rami & sacro-tuberous ligaments
4/29/2012 Prof. Dr. F. AL-Khafaji 2
Horizontal plane: passes thru. Upper border of symphysis
pubis, spine of ischium, p of coccyx, head and apex of
greater trochanter of femur.
Pos on of Pelvis:
In erect person, it is lted. The ant. Sup. Iliac spine & the
upper margin of symphysis pubis lie in same ver cal plane
viscera
The Perineum
Anal Canal
*About 3 cm long muscular tube
*Its muscle fibers are all arranged in a circular fashion
*Consis ng of an internal (smooth) and an external (striated)
sphincters
*The junc on of rectum and anal canal is at the pelvic floor
*From this junc on the anal canal passes downwards and
backwards to the skin of perineum
Thru.
Muscle wall of ampulla
- (6-10 in No.)
- In upper 2/3 of mucouss membrane
- Longitudinal ridges in mucous membrane produced by ver cal blood
channels
- Each column contains a terminal radical of the superior rectal art. & vein
- Three of these anal columns ( their veins , being largest at 4, 7, 11) are
prone to become varicose as the three primary hemorrhoids
- Vary in prominence according to amount of blood it contains (anal valves
remain constant irrespec ve of blood it contains)
- United to each other inferiorly by cross channels of anastomosing veins
which raise small mucosal folds known as the anal valves (near
muco-cutaneous junc on). These cross channels form a venous ring
called the Annulus hemorrhoidalis .
- Anal valves form a series of small pockets (Anal sinuses) each at the
Inf. End of a groove between two columns
4/29/2012 Prof. Dr. F. AL-Khafaji 16
Ischio-rectal fossa
*Wedge shaped space
*Fills lateral Part of anal triangle & extends forwards into
urogenital triangle
*Filled with so fat which forms dead spaces into which the
anal canal can expand during defeca on
** Lateral Wall : Formed by Obturator internis fascia,
Falciform margins of sacro-tuberous ligament & Ischial
tuberosity
** Medially: The 2 fossae are separated by the anal canal,
perineal body, & ano-coccygeal body
** Roof : By levator ani muscle
Contents:
1- Loose fa y ssue. 2- Internal pudendal vessels &
Pudendal nerves (in Pudendal canal). 3- Inf. Rectal vessels &
nerves. 4- Scrotal vessels & nerves. 5-Perineal branch of S4
4/29/2012 Prof. Dr. F. AL-Khafaji 17
Urogenital Diaphragm
*Musclo-fascial
*Triangular double layer of fascia (Sup. & Inf. layers)
* Inf. Layer is the perineal membrane
*Situated in ant. Perineum (filling in the gap of pubic arch)
*Ant. : The two layers fuse, leaving a small gap beneath
symphsis pubis
Post. : The two layers fuse with 1. each other
2. membranous layer of
superficial fascia
3. perineal body
Lat. : The layers are a ached to pubic arch
Formed by 1. Sphincter Urethrae muscle
2. Deep transverse prineal muscles
* The closed space between layers is called the deep perineal
pouch
4/29/2012 Prof. Dr. F. AL-Khafaji 18
Uro-genital triangle
Perineal body
APEX
NECK
4/29/2012 Prof. Dr. F. AL-Khafaji
BASE 31
Trigone
- Triangular area lying between the internal urethral orifices & the
orifices of the ureters
- Rela vely indistensible & immobile
-Held in pos on by: 1.Lat. Lig. Of bladder
In male
2. Fixed to prostate
1. Cervix uteri
In female
2.Ant. Vaginal fornix
-Smooth walled & mucous membrane is firmly adherent to underlying
muscle
* Veins
-From vesicle plexus at base of bladder
# In male: it communicates with prosta c plexus & middle rectal veins
which in turn drain across pelvic floor into internal iliac veins
# In female: it communicates with uterine plexus at base of broad
ligament
Which in turn drains across pelvic floor into internal iliac veins
*Lymph
- Follow arteries to nodes on side wall of pelvis alongside
1. Internal iliac art.
2. External iliac art. (from funds
4/29/2012 along pubic art.)
Prof. Dr. F. AL-Khafaji 34
*Nerves
- From both sympathe c (hypogastric plexus L1,2) &
parasympathe c (pelvic splanchnic nerves S,2,3,4 via inf.
Hypogastric plexus)
- Sympathe c is: 1. Inhibitory to detrusor muscle
2. S mulatory (motor) to internal vesicle sphincter
* Reach inf. Hypogastric plexus via the hypogastric nerves (
Lumbar splanchnics or presacral nerves, these are divided in
presacral neurectomy)
- Parasympathe c is: 1. S mulatory (motor) to detrusor muscle
2. Inhibitory to internal vesicle sphincter
* Afferent fibers of normal disten on & pain : -majority pass in
pelvic splanchnic nerves (parasympathe c) --some pass with
sympathe c via hypogastric plexus to L1,2 segments of spinal cord
II SECONDARY SUPPORTERS
are formed by peritoneal ligaments.
* Broad ligament
* Uterovesical
4/29/2012
fold of peritoneum Prof. Dr. F. AL-Khafaji 42
* Rectouterine fold of peritoneum.
Blood supply of uterus
Arteries
* Uterine artery: - of internal iliac artery, pass over pelvic floor in base
of broad lig., above ureter, reach level of supra-vaginal part of cervix
where it gives a branch to cervix & upper vagina.
- It then turns upwards, between leaves of broad lig. To run alongside
of uterus as far as entrance of tube, where it anastomoses, end on,
with tubal branch of Ovarian artery.
-During its course it gives off branches which penetrate walls of uterus.
Veins
* Pass below artery at lower edge of broad lig. Where they form the
Uterine plexus of veins across pelvic floor.
-This plexus communicates with vesicle & rectal plexuses & drain into
internal iliac vein.
4/29/2012 Prof. Dr. F. AL-Khafaji 43
Lympha cs
*Pass along arteries into internal iliac group of nodes which drains
upwards into common iliac nodes.
- Some pass along round lig. To superficial inguinal nodes. Others with
ovarian artery to Para-aor c nodes at origin of artery.
Nerves
* Branches from inf. Hypogastric plexus
-Sympathe c:- Efferent preganglionic sympathe c fibers are from
T12,L1 segments of spinal cord.
- Parasympathe c:- Efferent preganglionic parasympathe c fibers are
from S2,3,4 (pelvic splanchnics) segments of spinal cord.
- Sympathe c ac vity produce uterine contrac on & vasoconstric on
- Parasympathe c ac vity produce uterine inhibi on & vasodilata on
- The results of the ac vi es of these two systems are complicated by
the hormonal control of uterine func ons)
- Pain from cervix via pelvic splanchnic nerves, while pain from funds
(labour pain)via hypogastric
4/29/2012 Prof.nerves to T12,L1 segments.
Dr. F. AL-Khafaji 44
Uterine tubes (Fallopian tubes)
*10 cm long
*Lies in upper boarder of broad lig.
*Connects peritoneal cavity with
that of uterus.
*Four parts (Infundibulum,
Ampulla, Isthmus, Intramural part).
*Nerves: Inf. Hypogastric plexus
(Sympathe c & parasympathe c)
*Blood: Ovarian & Uterine arts. &
veins.
*Lymph: Corresponds to arts. (ie:
internal iliac & aor c nodes).
Rela ons:
Sup.: neck of bladder & seminal vesicles
Inf.: Sphincter urethra
Antro-lat.: Levator ani
Post.: Rectum
4/29/2012 Prof. Dr. F. AL-Khafaji 49
*The prostate Possesses a base (sup.) & an apex (inf.) & ant.,
post. & 2 inferiolat. Surfaces.
*Traversed by urethra & in post. Upper ½ by ejaculatory ducts
which divide gland into a median & 2 lat. Lobes .
Median lobe: between urethra & ejaculatory ducts.
Lateral lobes: below & lat. To median lobe & are con nuous
ant. But separated post. By a midline groove.