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3) Pelvic walls, joints, vessels _ nerves.ppt
- 1. ANATOMY OF THEPELVIS
- 2. OBJECTIVES • By theend of the lecture, you should be able to: By the end of the lecture, you should be able to: • Describe the anatomy of the pelvic wall, bones, joints & muscles. • Describe the boundaries and subdivisions of the pelvis. • Differentiate the different types of the female pelvis. • Describe the pelvic floor. • Describe the components & function of the pelvic diaphragm. • List the arterial & nerve supply of the pelvis. • List the lymph & venous drainage of the pelvis.
- 3. 3 The bony pelvisis composed of four bones: • Two hip bones, which form the anterior and lateral walls. • Sacrum and coccyx, which form the posterior wall. • These 4 bones are connected by 4 joints and lined by 4 muscles. • The bony pelvis with its joints and muscles form a strong basin-shaped structure (with multiple foramina), • The pelvis contains and protects the lower parts of the alimentary & urinary tracts and the internal organs of reproduction.
- 4. 4 FOUR JOINTS 1- Anteriorly: Symphysis pubis(cartilaginous joint). 2- Posterolateral: Two Sacroiliac joints. (Synovial joint, plain variety). 3- Posteriorly: Sacrococcygeal (cartilaginous joint).
- 5. 5 The pelvis isdivided into two parts by the pelvic brim. 1. Above the brim is the False or greater pelvis, which is the lower part of abdominal cavity. 2. Below the brim is the True or lesser pelvis. The False pelvis is bounded by: Posteriorly: Lumbar vertebrae. Laterally: Iliac fossae and iliacus muscle. Anteriorly: Lower part of the anterior abdominal wall. It supports the lower abdominal contents. Pelvic brim
- 6. 6 The True pelvis has: An Inlet. An Outlet. A Cavity: The cavity is a short, curved canal, with a shallow anterior wall and a deeper posterior wall. It lies between the inlet & the outlet.
- 7. 7 Anteriorly: Symphysis pubis. Posteriorly:Promontory of sacrum, & ala of sacrum. Laterally: Ileopectineal (arcuate) lines. Anteriorly: Symphysis pubis. Posteriorly: Coccyx, Coccyx, Anterolaterally: Ischiopubic ramus. Posterolaterally: Sacrotuberous ligament., PELVIC OUTLET PELVIC INLET
- 8. 8 In female theSacrum is usually shorter and wider. Also, the Angle of the pubic arch is wider. The promontory and the ischial spines are less projecting. MALE FEMALE
- 9. Types of FemaleBony Pelvis 9 Information of the shape and dimensions of the female pelvis is of great importance for obstetrics, because it is the bony canal through which the child passes during birth especially its head.
- 10. 10 • The pelvishas 4 walls: • Anterior. • Posterior. • Lateral. • Inferior or floor. • The walls are formed by bones and ligaments that are lined with muscles covered with fascia and parietal peritoneum. ANTERIOR PELVIC WALL It is the shallowest wall and is formed by the posterior surfaces of the bodies of the pubic bones, the pubic rami, and the symphysis pubis. Pelvic walls
- 11. 11 It is largeand formed by sacrum, coccyx , piriformis muscles and their covering of parietal pelvic fascia. POSTERIOR PELVIC WALL
- 12. 12 • Origin: Pelvicsurface of the middle 3 sacral vertebrae. • It leaves the pelvis through the greater sciatic foramen. • Insertion: Greater trochanter of the femur. • Action: Lateral rotator of the femur at the hip joint. • Nerve supply: Sacral plexus. Piriformis
- 13. 13 It is formedby: 1- Part of the hip bone below the pelvic inlet, 2- Obturator internus and its covering fascia & the obturator fascia. 3- Sacrotuberous ligament. 4- Sacrospinous ligament. LATERAL PELVIC WALL
- 14. 14 • Origin: Innersurface of the obturator membrane and the hip bone. • Insertion: It leaves the pelvis through the lesser sciatic foramen to be inserted into the greater trochanter of the femur. • Action: Lateral rotator of the femur at the hip joint. • Nerve supply: Nerve to obturator internus. Obturator Internus
- 15. 15 • Basin-like structurewhich supports the pelvic viscera and is formed by the pelvic diaphragm. • It stretches across the true pelvis and divides it into: • Main (true) pelvic cavity above, which contains the pelvic viscera, & • Perineum below which carries the external genital organs. INFERIOR PELVIC WALL, OR PELVIC FLOOR
- 16. 16 It is incomplete anteriorlyto allow passage of the urethra in males and urethra and vagina in females. It is formed by the levator ani and the coccygeus muscles and their covering fasciae. PELVIC DIAPHRAGM
- 17. LEVATORES ANI ORIGIN:Linear origin; From 1. Back of body of the pubis. 2. Tendinous arch of obturator fascia. 3. Spine of the ischium. It is a wide thin sheet-like muscle . Its fibers are divided into 3 parts: 1- Anterior: Pubococcygeus. (Levator prostate or sphincter vaginae). 2- Intermediate part: Puborectalis. 3- Posterior part: 2- Iliococcygeus OR Ischiococcygeus.
- 18. LEVATORES ANI MUSCLES- ANTERIOR FIBERS • 1- Pubococcygeus. • Originates from the posterior surface of the body of the pubis. • Inserted into the perineal body and coccyx. • Supports the prostate in male, (or constricts the vagina in female). • Stabilizes the perineal body. • Forms a sling around the prostate or the vagina. levator prostatae sphincter vaginae
- 19. 19 Intermediate Part: The puborectalis:forms a sling around the recto-anal Junction. It has a very important role in maintaining fecal continence.
- 20. LEVATORES ANI MUSCLES:Posterior Part Iliococcygeus, Or Ischiococcygeu s inserted into the anococcygeal body and the coccyx.
- 21. 21 Actions of levatorani: 1. The muscles of the two sides form an efficient muscular sling that supports and maintains the pelvic viscera in position. 2. They resist the rise in intra pelvic pressure during the straining and expulsive efforts of the abdominal muscles (as in coughing). 3. They have a very important role in maintaining fecal continence. 4. They serve as a vaginal sphincter in the female. Nerve supply to levator ani: 1. Perineal branch of the 4th sacral nerve. 2. perineal branch of the pudendal nerve.
- 22. COCCYGEUS MUSCLE Asmall triangular muscle. Origin: Ischial spine. Insertion: Lower end of sacrum and coccyx. Action: Assist the levator ani in supporting the pelvic viscera. Nerve supply: 4th and 5th sacral nerves.
- 23. Arteries of thePelvis (I) Internal iliac artery(IIA): • One of the 2 terminal branch of the Common iliac artery. • Arises in front of the sacroiliac joint. • It descends downward & backwards over the pelvic inlet. • It divides at the upper border of the greater sciatic foramen into: • Anterior & Posterior divisions Anterior & Posterior divisions. Posterior division Supplies: 1. Posterior abdominal wall. 2. Posterior pelvic wall. 3. Gluteal region. Anterior division supplies: 1. Gluteal region. 2. Perineum. 3. Pelvic viscera. 4. Medial (adductor) region of thigh. 5.The fetus (through the umbilical arteries). IIA
- 24. Parietal Branches • Fromposterior division: 1. Iliolumbar artery. 2. 2 Lateral sacral arteries. 3. Superior gluteal artery. • From anterior division: 1. Obturator artery. 2. Inferior Gluteal artery. Iliolumbar Lateral sacral Superior gluteal Obturator Inferior Gluteal
- 25. Visceral Branches (all fromanterior division) Umbilical artery: Gives the superior vesical artery: The distal part of this artery fibrosed and forms the Medial Umbilical Ligament. Inferior Vesical artery in male or vaginal in female: • In the male it supplies, the Prostate and the Seminal Vesicles. • It also gives the artery of the Vas Deferens within the spermatic cord.. • Middle rectal artery. • Internal pudendal artery. • It is the main arterial supply to the perineum. Umbilical superior vesical Internal pudendal
- 26. Visceral Branches (inFemale) Vaginal artery: Replaces the inferior vesical artery. Uterine artery: Crosses the Ureter superiorly and supplies the uterus & uterine tubes. (II) Ovarian artery: Arises from the abdominal aorta.
- 27.
- 28. INTERNAL ILIAC VEINS INTERNALILIAC VEINS • It collect tributaries corresponding to the branches of the internal iliac artery. • joins the external iliac vein in front of the sacroiliac joint to form the common iliac vein common iliac vein 28 Venous Drainage Ovarian vein: Right vein drains into IVC. Left vein drains into left renal Vein.
- 29. 29 LYMPHATICS OF THEPELVIS • The lymph nodes and vessels are arranged in a chain along the main blood vessels. • Thus, there are external iliac nodes, internal iliac nodes, and common iliac nodes. lymph from Common iliac nodes & the (Ovaries, uterine tubes & fundus of uterus) passes to Lateral aortic (paraortic) nodes.
- 30. Nerve Supply • Somatic: Somatic: •Sacral plexus. Sacral plexus. • Autonomic: Autonomic: • Sympathetic: • Pelvic part of sympathetic trunk: The 2 sympathetic trunks unite inferiorly in front of the coccyx and form a single ganglion (Ganglion Impar). • II- Superior & Inferior • Hypogastric plexuses • Parasympathetic: Pelvic splanchnic nerves: Pelvic splanchnic nerves: ( (From S 2 , 3 & 4)