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The pelvis and perineum

The pelvis and perineum. Introduction pelvis — bony pelvis pelvic walls pelvic diaphragm pelvic organs blood vessels and nerves. The bony pelvis: --- hip bones, --- sacrum --- coccyx

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The pelvis and perineum

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  1. The pelvis and perineum

  2. Introduction • pelvis — bony pelvis • pelvic walls • pelvic diaphragm • pelvic organs • blood vessels and nerves

  3. The bony pelvis: • --- hip bones, • --- sacrum • --- coccyx • --- their connections • (joints, ligaments • and pubic symphysis)

  4. divisions: • --- greater pelvis • --- lesser pelvis • oblique plane: Promontory of sacrum Arcuate line Pecten pubis Pubic tubercle Pubic crest Superior border of pubic symphysis

  5. The pelvic walls: • Post.--- sacrum, coccyx • piriformis • Ant.--- pubes, pubic symphysis • Lat.--- ilium, • body of the pubis, ischium • ligaments • obturator internus

  6. The floor of pelvis: • --- pelvic diaphragm • levator ani • coccygenus • deep fasciae --- urogenital diaphragm • muscles • deep fasciae

  7. The pelvic organs • ---The urinary bladder • ---The rectum • ---The pelvic part of ureter • ---The prostate • ---The pelvic part of ductus deferens • ---The seminal vesicle • ---The ejaculatory duct • ---The uterus • ---The ovaries • ---The uterine tubes • --- The vagina

  8. Ⅱ.The urinary bladder 1. Position, shape and relatons It rests against pubis. When it empty, is pyramid has a apex, body and fundus.

  9. 2. The interior of the bladder • urinary trigone— • ureteric orifices and • internal urethral • orifice position boundaries clinical notes to be susceptical to tuberlosis and tumor.

  10. ---The rectum: 1. Position and relations

  11. 2. The shape of the rectum --- 12~16cm in length --- 2 parts: pelvic part (ampulla of rectum) anal canal --- 2 curves in sagittal plane: sacral flexure perineal flexure --- 3 curves in coronal plane:

  12. 3. The internal features of the rectum • --- 3 transverse folds • --- 6~10 anal columns • --- anal valves • --- anal sinuses • --- dentate line • ectoderm and entoderm • there are differents in • epithelial lining, blood and • nerve supply and • lymphatic drainage • --- anal pecten

  13. 4.The blood vessels , lymphatic drainage and nerves --- Arteries: superior rectal a. inferior rectal a. anal a. --- veins: internal rectal venous plexus external rectal venous plexus

  14. --- lymphatic drainage: • inferior mesenteric lymph nodes • internal iliac lymph nodes • superficial inguinal lymph nodes

  15. --- The uterus: • Position : • between the urinary bladder and rectum • Anteflection: • bent forward between the body • and neck • Anteversion: • bent forward between the uterus • and vagina

  16. 2. relations: ant.--- ant. Abdominal wall, urinary bladder, intestine post.--- rectouterine pouch, rectum inf.--- vagina lat.--- uterine tube, ovary, broad lig., blood vessels sup.--- intestine

  17. 3. The shape: • pear-shaped • anterior and posterior surfaces • lateral borders • fundus, • body • neck: supravaginal part • vaginal part • isthmus

  18. 4. The ligaments: • broad lig. of uterus: • mesometrium • mesosalpinx • mesovarium suspensory lig. of ovary • cardinal lig. of uterus • round ligament of uterus • uterosacral lig.

  19. 5. Blood vessels: • The uterine artery---from the internal iliac a. • crosses above (or in front of) the ureter lateral to the • neck of uterus about 2cm

  20. 6. The lymphatic drainage: • Fundus and upper part --- lumbar lymph nodes • along the round lig. --- • superficial inguinal lymph • nodes • lower part and neck--- • internal and external iliac • lymph nodes • 7. The nerves

  21. Introduction • The Perineum — • boundaries • divisions • anal region • urogenital regions in male and female

  22. boundaries: • --- same boundaries as the outlet of pelvis: • inferior border of the pubic symphysis, • inferior rami of the pubes, • the rami of ischia • ischial tuberosities • sacrotuberous ligaments

  23. 2. divisions: --- anal region: anal canal --- urogenital region: urethra (male) urethra, vagina (female)

  24. 3. Pelvic diaphragm: --- levator ani --- coccygeus --- superior fascia of pelvic diaphragm --- inferior fascia of pelvic diaphragm

  25. The ischioanal fossa (ischiorectal fossa): • med.--- levator ani, sphincter ani externus, inferior fascia of pelvic • diaphragm • lat.--- ischial tuberosity, sacrotuberous lig., and the fascia of • obturator internus

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