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Similar to anatomy of pelvis, perineum and pelvic diaphragm.pptx
anatomy of pelvis, perineum and pelvic diaphragm.pptx
- 1. PELVIS AND PERINEUMDr shabana ali
- 2. PELVIC GIRDLE The pelvicgirdle is a basin-shaped ring of bones that connects the vertebral column to the two femurs.
- 3. Bear the weightof the upper body when sitting and standing. Transfer that weight from the axial to the lower appendicular skeleton for standing and walking. Provide attachment for the powerful muscles of locomotion and posture and those of the abdominal wall, withstanding the forces generated by their actions. Contain and protect the pelvic viscera (inferior parts of the urinary tracts and the internal reproductive organs) an the inferior abdominal viscera (intestines), while permittin passage of their terminal parts (and, in females, a fullterfetus) via the perineum.
- 4. DIVISION OF PELVIS Thepelvis is divided into greater (false) and lesser (true) pelvis by the oblique plane of the pelvic inlet (superior pelvic aperture).
- 5. Pelvic brim Promontory andala of the sacrum (superior surface of its lateral part, adjacent to the body of the sacrum). A right and left linea terminalis (terminal line) together form a continuous oblique ridge consisting of the: Arcuate line on the inner surface of the ilium. Pecten pubis (pectineal line) and pubic crest, forming the superior border of the superior ramus and body of the pubis.
- 7. Pelvic outlet Pelvic outlet(inferior pelvic aperture) is bounded by the Pubic arch anteriorly. Ischial tuberosities laterally. Inferior margin of the sacrotuberous ligament (running between the coccyx and the ischial tuberosity) posterolaterally. Tip of the coccyx posteriorly.
- 10. Greater pelvis (falsepelvis) Superior to the pelvic inlet. Bounded by the iliac alae posterolaterally and the anterosuperior aspect of the S1 vertebra posteriorly. Occupied by abdominal viscera (e.g., the ileum and sigmoid colon).
- 11. Lesser pelvis Between thepelvic inlet and the pelvic outlet. Bounded by the pelvic surfaces of the hip bones, sacrum, and coccyx. That includes the true pelvic cavity and the deep parts of the perineum (perineal compartment), specifically the ischioanal fossae That is of major obstetrical and gynecological significance.
- 15. Pelvic Diameters (Conjugates) Todetermine the capacity of the female pelvis for childbearing, the diameters of the lesser pelvis are noted radiographically or manually during a pelvic examination. The minimum antero-posterior (AP) diameter of the lesser pelvis, the true (obstetrical) conjugate from the middle of the sacral promontory to the posterosuperior margin (closest point) of the pubic symphysis.
- 16. Pelvic cavity The abdominopelviccavity extends superiorly into the thoracic cage and inferiorly into the pelvis, so that its superior and inferior parts are relatively protected. The funnel-shaped pelvic cavity—the space bounded peripherally by the bony, ligamentous, muscular pelvic walls and floor—is the inferoposterior part of the abdominopelvic cavity.
- 17. Walls Of PelvicCavity Anterior Pelvic wall The bodies and rami of the pubic bones and the pubic symphysis It participates in bearing the weight of the urinary bladder.
- 18. LATERAL PELVIC WALLS. •Right and left hip bones, each of which includes an obturator foramen closed by an obturator membrane. • The fleshy attachments of the obturator internus muscles cover and thus pad most of the lateral pelvic walls.
- 19. Posterior pelvicwall consists of a bony wall and roof in the midline (formed by the sacrum and coccyx) and musculoligamentous posterolateral walls, formed by the ligaments associated with the sacroiliac joints and piriformis Muscles. The ligaments include the anterior sacroiliac, sacrospinous, and sacrotuberous ligaments.
- 20. PELVIC FLOOR The pelvicfloor is formed by the bowl- or funnel-shaped pelvic diaphragm, which consists of the coccygeus and levator ani muscles and the fascias. The pelvic diaphragm lies within the lesser pelvis, separating the pelvic cavity from the perineum, for which it forms the roof. The attachment of the diaphragm to the obturator fascia divides the obturator internus into a superior pelvic portion and an inferior perineal portion.
- 22. COCCYGEUS Lateral aspects of theinferior sacrum and coccyx. Their fleshy fibers lying on and attaching to the deep surface of the sacrospinous ligament.
- 23. LEVATOR ANI A broadmuscular sheet is the larger and more important part of the pelvic floor . It is attached to the bodies of the pubic bones anteriorly, to the ischial spines posteriorly, and to a thickening in the obturator fascia (the tendinous arch of the levator ani) between the two bony sites on each side.
- 24. • Puborectalis • Thicker,narrower, medial part of the levator ani, consisting of muscle fibers that are continuous between the posterior aspects of the bodies of the right and left pubic bones. • It forms a U-shaped muscular sling (puborectal sling) that passes posterior to the anorectal junction. • Pubococcygeus: • Wider but thinner intermediate part of the levator ani, which arises lateral to the puborectalis from the posterior aspect of the body of the pubis and anterior tendinous arch. • Lateral fibers attach to the coccyx. • Medial fibers merge with those of the contralateral muscle to form a fibrous raphe or tendinous plate, part of the anococcygeal body.
- 26. Contents of pelviccavity The pelvic cavity contains the Terminal parts of the ureters, Urinary bladder, Rectum, Pelvic genital organs, Blood vessels, Lymphatics, and nerves
- 29. Injury to PelvicFloor The perineum, levator ani, and ligaments of the pelvic fascia may be injured during childbirth. pubococcygeus and puborectalis. they encircle and support the urethra, vagina, and anal canal.
- 30. Perineum The perineum refersto a shallow compartment of the body (perineal compartment) bounded by the pelvic outlet and separated from the pelvic cavity by the fascia covering the inferior aspect of the pelvic diaphragm. It is a diamond shaped area. Extending from the mons pubis anteriorly in females, The medial surfaces (insides) of the thighs laterally, The gluteal folds and superior end of the intergluteal (natal) cleft posteriorly.
- 32. Boundaries of Perineum Pubicsymphysis, anteriorly. Ischiopubic rami (combined inferior pubic rami and ischial rami), anterolaterally. Ischial tuberosities, laterally. Sacrotuberous ligaments, posterolaterally. Inferiormost sacrum and coccyx, posteriorly.
- 35. Perineal body The midpointof the line joining the ischial tuberosities is the central point of the perineum. This is the location of the perineal body, which is an irregular mass, containing collagenous and elastic fibers, and both skeletal and smooth muscle. The perineal body lies deep to the skin, with relatively little overlying subcutaneous tissue, posterior to the vestibule or bulb of the penis and anterior to the anus and anal canal.
- 36. Bulbospongiosus. External anal sphincter. Superficialand deep transverse perineal muscles. Smooth and voluntary slips of muscle from the external urethral sphincter, levator ani, and muscular coats of the rectum.
- 38.
- 39. UROGENITAL DIAPHGRAM Triangular muscularseptum. Sphnicter urethae muscles Deep tranverse perineal muscles Inferior layer of fascia is referred as Perineal membrane.
- 42. SUPERFICIAL PERINEAL POUCH Thesuperficial perineal pouch (compartment) is a potential space between the perineal fascia and the perineal membrane, bounded laterally by the ischiopubic rami.
- 43. Males • Root (bulband crura) of the penis and associated muscles • (ischiocavernosus and bulbospongiosus). • Proximal (bulbous) part of the spongy urethra. • Superficial transverse perineal muscles. • Deep perineal branches of the internal pudendal vessels and pudendal nerves. Females • Clitoris and associated muscles (ischiocavernosus). • Bulbs of the vestibule and surrounding muscle (bulbospongiosus). • Greater vestibular glands. • Superficial transverse perineal muscles. • Deep perineal branches of the internal pudendal vessels and pudendal nerves.
- 45. DEEP PERINEAL POUCH Itis bounded Inferiorly by the perineal membrane, superiorly by the inferior fascia of the pelvic diaphragm, laterally by the inferior portion of the obturator fascia (covering the obturator internus muscle). In both sexes, the deep perineal pouch contains: 1. Part of the urethra, centrally. 2. The inferior part of the external urethral sphincter muscle, surrounding the urethra. 3. Anterior extensions of the ischioanal fat pads.
- 47. Males • Intermediate partof the urethra, the narrowest part of male urethra. • Deep transverse perineal muscles, immediately superior to the perineal membrane. • Bulbourethral glands, embedded within the deep perinea musculature. • Dorsal neurovascular structures of the penis. Females • Proximal part of the urethra. • A mass of smooth muscle in the place of deep transvers perineal muscles on the posterior edge of the perinea membrane, associated with the perineal body. • Dorsal neurovasculature of the clitoris.
- 48. ISCHIOANAL FOSSAE The ischioanalfossae on each side of the anal canal are large fascia-lined, wedge shaped spaces between the skin of the anal region and the pelvic diaphragm. The apex of each fossa lies superiorly where the levator ani muscle arises from the obturator fascia. The ischioanal fossae, wide inferiorly and narrow superiorly, are filled with fat and loose connective tissue. The two ischioanal fossae communicate by means of the deep postanal space over the anococcygeal ligament.
- 50. BOUNDRIES OF ISCHIOANAL FOSSAE Laterally by the ischium and overlapping inferior part of the obturator internus, covered with obturator fascia. Medially by the external anal sphincter, Posteriorly by the sacrotuberous ligament and gluteus maximus. Anteriorly by the bodies of the pubic bones, inferior to the origin of the puborectalis. These parts of the fossae, extending into the UG triangle superior to the perineal membrane are known as the anterior recesses of the ischioanal fossae.
- 51. ANAL CANAL It extendsfrom the superior aspect of the pelvic diaphragm to the anus. 2.5–3.5 cm long Begins where the rectal ampulla narrows at the level of the U-shaped sling formed by the puborectalis muscle.
- 58. INTERNAL ANAL SPHINCTER Involuntarysphincter surrounding the superior two thirds of the anal canal. Its contraction (tonus) is stimulated and maintained by sympathetic fibers from the superior rectal (periarterial) and hypogastric plexuses. This sphincter is tonically contracted most of the time to prevent leakage of fluid or flatus.
- 59. EXTERNAL ANAL SPHINCTER Largevoluntary sphincter that forms a broad band on each side of the inferior two thirds of the anal canal. This sphincter is attached anteriorly to the perineal body and posteriorly to the coccyx via the anococcygeal ligament. It blends superiorly with the puborectalis muscle.
- 60.
- 62. Internal Hemorrhoids (Piles) Internalhemorrhoids are varicosities of the tributaries of the superior rectal (hemorrhoidal) vein and are covered by mucous membrane. a hemorrhoid is therefore a fold of mucous membrane and submucosa containing a varicosed vein.
- 64. CAUSES Family history The superiorrectal vein is the most dependent part of the portal circulation and is valveless. Chronic constipation Pregnancy hemorrhoids Portal hypertension as a result of cirrhosis of the liver
- 65. External Hemorrhoids varicosities ofthe tributaries of the inferior rectal (hemorrhoidal) vein as they run laterally from the anal margin. They are covered by skin. They are sensitive to pain, temperature, touch, and pressure.
- 67. Anal Fissure In peoplesuffering from chronic constipation, the anal valves may be torn down to the anus as the result of the edge of the fecal mass catching on the fold of mucous membrane. The elongated ulcer so formed, known as an anal fissure, is extremely painful. The fissure occurs most commonly in the midline posteriorly.