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Pelvis is the region enclosed by the sacrum coccyx and coxal hip Rectal Examination

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Pelvis is the region enclosed by the sacrum coccyx and coxal hip  Rectal Examination Powered By Docstoc
					pelvis
         region enclosed by
                  sacrum
                  coccyx
                  coxal (hip) bones.
         linea terminalis
                  oblique line divides pelvis into
                           major pelvis
                           minor pelvis
                  part anterosuperior to the line
                           greater pelvis.
                  part posteroinferior to the line
                           lesser (minor or true)pelvis
                           most inferior and posterior portion of the general abdominopelvic cavity.
inferior pelvic aperture
                  diamond-shaped area
                  arbitrarily subdivided into 2 triangular regions by an imaginary transverse line
                           running between the anterior portions of the 2 ischial tuberosities
                  an anterior urogenital triangle
                  posterior anal triangle
                  corresponds to the perineum
                  In the middle of the perineum, just in front of the anus, is the central body of the perineum.
                  is bounded by
                           pubic symphysis
                                    anteriorly
                           ischio-pubic rami
                                    anterolaterally
                           ischial tuberosities
                                    on each side,
                           sacrotuberous ligament
                                    posterio-laterally
                           coccyx
                                    posteriorly.
pelvic cavity
         separated from the perineum by the pelvic diaphragm
                  composed of 2 muscles
                           levator ani
                           coccygeus.
pelvic diaphragm
         divides the cavity of the lesser pelvis into
                  upper part
                           containing the pelvic viscera
                  lower part
                           consisting of the ischiorectal fossa

         Muscles of the pelvis
         piriformis
                 takes origin from
                          sacrum
                 travels through
                          greater sciatic foramen
                 insert into


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                         tip of the greater trochanter of the femur
                lines posterior wall of lesser pelvis
       coccygeus
                is the muscular anterior part of the sacrospinous ligament
       obturator internus.
                covers most of the anterolateral (side) wall of the pelvis
                arises from almost the entire internal surface of the anterolateral wall of the minor pelvis
                travels through the lesser sciatic foramen
                to the medial aspect of the greater trochanter.
pelvic diaphragm
    Formed by 2 levator ani muscles
                descend from the anterolateral wall of the pelvis downward and medially
                arises from a tendinous arch,
                         thickening of the fascia covering obturator internus.
    Formed by 2 coccygeal muscles
                separate the pelvis from the perineum.
Each muscle has a long linear origin from the pelvic ( inner) surface of the body of the pubis.
The 2 muscles
    converge
    insert together into
       central perineal tendon
       anal canal
       anococcygeal ligament
       coccyx
anococcygeal ligament extends
    from the anus
    to the tip of the coccyx

 Anteriorly the 2 muscles are separated by a narrow interval
       in the male occupied by the lower part of prostate
       in female occupied by the urethra and vagina
 posteriorly by the anal canal.
      Descriptions of the pelvic fascia vary.
It is divided into parietal and visceral.
  parietal fascia is
        an extension into the pelvis of the abdominal fascial layer
        regionally designated as
          transversalis
          iliacus
          psoas fascia
 In the pelvis, the obturator fascia covering the internal surfaces of the obturator internus muscle is part of
 the parietal pelvic fascia.
 Likewise the superior and inferior surfaces of the pelvic diaphragm are covered by a layer of parietal pelvic
 fascia.
  visceral pelvic fascia
        on the same plane with the extraperitoneal fascia.
        fatty, areolar connective tissue
        varies in thickness
        forms fascial sheaths
          in which the pelvic viscera is completely enclosed.
        Blood vessels and nerves course through this layer to the viscera.
        In some cases, thickened portions of the visceral pelvic fascia are called ligaments.


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pelvic peritoneum
     passes over the superior surfaces of the pelvic viscera
     dips between them to form pouches.
        In males
                 rectovesical pouch,
        in females
                 vesicouterine pouch
                 rectouterine (or Douglas) pouch
urinary bladde r
        hollow muscular organ
        stores urine
When empty, the bladder
     lies in the true pelvis,
        posterior to the symphysis pubis
     from which it is separated by the connective tissue space
        the retropubic space.
     Superiorly the space is continuous with loose extraperitoneal tissue,
        which extends up the anterior abdominal wall.
     This arrangement permits the bladder to expand superiorly in the extraperitoneal tissue,
        stripping the peritoneum from the anterior abdominal wall.
can enter the distended bladder through the anterior abdominal wall without the involvement of peritoneum.

Calculi
foreign bodies or
small tumors
      may be removed from the bladder by this suprapubic route.

bladder
     has superior
     2 inferolateral
     posterior (or base) surfaces
     apex
        anterior extremity of the bladder
                 where superior and the 2 inferolateral surfaces meet
     neck
        where comes together
                 2 inferolateral surfaces
                 base
     floor of the retropubic space
                 formed by the puboprostatic (pubovesical) ligaments.
                          Puboprostatic ligaments
                                   in the male
                          pubovesical
                                   in female
                          thickenings of the visceral pelvic fascia with smooth muscle fibers.
                 pass from the back of the bodies of the pubic bones
                                   close to the median plane
                          to
                                   anterior surface of the sheath of the prostate
                                   neck of the bladder
                                            in male


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                                 neck of the bladder
                                 urethra
                                         in female.
      urinary bladder
                lined with transitional epithelium.
                muscles form the involuntary internal urethral sphincter
                        where the urethra leaves the urinary bladder.
                mucous lining of the bladder
                        forms irregular folds only over a small triangular area,
                                 trigone
                                 mucous membrane
                                          is firmly bound to the muscle layer
                                          is always smooth.

trigone is marked by 3 openings:
      2 ureteral
      1 urethral
ureters
      run obliquely within the wall of the bladder
      become compressed when the bladder is distended
                 prevents regurgitation of urine from the bladder into the ureter.
      are crossed
                 in the abdomen by the gonadal vessels
                 in the pelvis
                          by ductus deferens
                                  in the male
                          by the uterine artery
                                  in the female.
In males, the posterior aspect of the bladder or the base of the bladder
      is in contact with
        seminal vesicles
        ampullae of the ductus deferens.

seminal vesicles
      are coiled membranous pouches
      secrete a fluid
        adds to the bulk of the semen
The ampulla of the ductus deferens
      terminates by joining the excretory duct of the seminal vesicle to
      form the ejaculatory duct.
2 ejaculatory ducts
      pass through the substance of the prostate
      join the prostatic urethra.

prostate
    Located below the bladder.
    Traversed by prostatic portion of the urethra
    Composed of glandular tissue
       produces a thin milky fluid
               adds to the bulk of the semen.
    Rests on the urogenital diaphragm.
    Surrounded by


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        portion of the levator ani muscle
                 called levator prostatae .
        then by a thickening of the visceral pelvic fascia called the prostatic sheath.
        thin fibromuscular capsule.

Between the last 2 layers
         is a venous plexus
                 which drains
                          prostate
                          bladder
                          deep dorsal vein of penis.
In all operations on the prostate
         surgeons regard the prostatic plexus with respect,
         because veins are
                 thin
                 valveless
         damage to these veins may result in severe hemorrhage

Enlargement (hypertrophy) of the prostate is common in older men.
Compression of the urethra may cause difficulty in urinating.
Bacterial inflammation of the prostate produces a condition called prostatitis.

A periodic rectal examination of the prostate is essential in preventive and diagnostic medical care.

Female pelvis.

 broad ligament
        portion of the peritoneum which covers
                 uterus
                 ovaries
                 uterine tubes
        portion that supports the ovary
                 mesovarium.
        portion that lies above the mesovarium and contains the uterine tube
                 mesosalpinx;
        portion below
                 mesometrium.
        lateral portion
                 suspensory ligament of the ovary
                 contains ovarian vessels and nerves
    ligament of the ovary
        lies within the broad ligament
        band of connective tissue
        smooth muscle
        extends
                 from the medial end of the ovary
                 to the superior surface of the junction between the uterine tube and uterus.
uterine (Fallopian) tubes
    are paired
    about 10 cm long
    extend
        from the vicinity of the ovary


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        to the superior lateral angle of the uterus.
    distal end of the each tube opens into peritoneal cavity, very close to an ovary.

Infundibulum.
        Distal end of each uterine tube
        Opens into the peritoneal cavity, very close to an ovary
        has finger like projections called fimbriae.
                 One of the fimbriae is attached to the ovary.
                          discharged ovum is
                                   picked up by the fimbriae
                                   carried into the uterine tube
    Each tube is composed of a uterine part
        in the wall of the uterus
        continuous with the narrow isthmus.
             isthmus is continuous laterally with the expanded and slightly convoluted ampulla,
                 expands into the funnel-shaped infundibulum
uterus consists of
    fundus
    Body
    Cervix
        Communicates with
                 cavity of the body
                          through the internal os,
                 vaginal cavity
                          through the external os.
        upper third is called the isthmus.

uterus forms an angle
     between its body and cervix (anteflexion)
     with the vagina (anteversion).

    round ligaments
       fibrous bands
       Run
               from the lateral margins of the uterus
               through the inguinal canal
               to the labia majora.
       Play a very minor role in supporting uterus
       Help to keep the uterus anteverted and anteflexed

ligaments of the cervix
     Play an important part in keeping the uterus in its correct position.
     Are condensations of visceral pelvic fascia.
     transverse cervical (or cardinal or Mackenrodt) ligaments
             pass
                 from the lateral wall of the pelvis
                 to
                         cervix
                         upper end of the vagina
     pubocervical ligaments
             pass
                 from the posterior surface of the pubis


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                to the cervix

    sacrocervical ligaments
           pass
              from the lower end of the sacrum
              to the cervix and upper end of the vagina.

    chief support of the uterus and vagina is provided by
       pelvic diaphragm
       urogenital diaphragm

    uterus
       receives its arterial supply from
                uterine artery
                         branch of the internal iliac
                ovarian artery
                         branch of the aorta
    wall of the uterus consists of 3 layers:
       serous –perimetrium
       muscular layer – myometrium
       mucosal lining-endometrium.
             endometrium has 2 layers
                superficial or functional,
                         which undergoes changes during the menstrual cycle
                deep basal,
                         which does not change.
    vagina
       passes between the medial borders of the 2 levator ani muscles
       opens into the vestibule of the vagina between the labia minora.
       canal of the cervix is continuous with the cavity of the vagina.

cervix of the uterus
    projects into the slightly enlarged superior part of the vagina
    forms clefts called vaginal fornices
        anterior
        posterior
        2 lateral

Culdoscopy is an examination of the pelvic viscera with a culdoscope through the posterior vaginal wall.

    blood supply of the pelvic viscera
       is provided by branches of the internal iliac artery.

    Veins of the pelvis
       accompany the pelvic arteries
       empty into the internal iliac veins

    pelvic viscera are supplied by the autonomic nervous system.




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Description: Pelvis is the region enclosed by the sacrum coccyx and coxal hip Rectal Examination