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 --- their connections (joints, ligaments and pubic symphysis)

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

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

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

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

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

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.

---The rectum: 1. Position and relations

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:

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

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

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

--- 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

ant.--- ant. Abdominal wall, 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

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

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

The uterine artery---from the internal iliac a. 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

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

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

--- 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

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

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

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