The pelvis
Bones of the pelvis are: The hip bone ( ilium, ischium and pubis) The sacrum The coccygxThe pelvic inlet
The line which extend from the symphysis pubis and pubic crest anteriorly to the pectineal line to the arcuate line and to the promontory of the sacrum is called the pelvic inletSacrospinous and sacrotuberous ligaments
Pelvis is divided into : False pelvis above the pelvic inlet related to the abdomen. True pelvis below the pelvic inlet contains the pelvic viscera.The cavity of the true pelvis lies between the pelvic inlet and pelvic outlet. Pelvic outlet closed anteriorly by the urogenital diaphragm and posteriorly by the levator ani muscle.
Differences between female and male pelvis
1-Female pelvis is broader the male pelvis. 2- pelvic inlet in female is oval while in male is heart shape. 3- pelvic cavity is short I in female long in male. 4- the pubic arch in female is wide while in male is sharp angled. 5- the pelvic cavity in female is cylinder while in male it become narrower as it descend downward.Pelvic outlet (perineum)
Boundaries Anteriorly pubic symphysis Posteriorly sacrum and coccygx Anterolaterally ischiopubic ramus and ischial tuberosity. Posterolaterally sacrotuberous ligament.Pelvic outlet (the perineum)
It divided into two triangle Anteriorly urogenital triangle closed by urogenital diaphragm. Posteriorly anal triangle closed by levator ani muscle.Urogenital triangle
Boundaries: Anteriorly inferior border of the pubic symphysis. Laterally ischiopubic rami. Posteriorly an imaginary line between the 2 ischial tuberosities.Urogenital diaphragm consist of: Superior fascia of the urogenital diaphragm. Inferior fascia of the urogenital diaphragm (perineal membrane)
The urogenital triangle composed of two spaces: Superficial perineal space between the skin and the superficial fascia and the inferior fascia of the urogenital diaphragm( perineal membrane). The deep perineal space between the superior and inferior fasciae of the urogenital diaphragm.
Superficial perineal space
Contents in male 1- The root of the penis include two crura of the penis (corpus cavernosus). 2- Bulb of the penis (corpus spongeosa). 3- Superficial transveres perineal muscle. 4- Perineal nerve and posterior scrotal vessels and nerve.Superficial perineal space
Contents in female 1- crura of the clitoris covered by ischiocanernosus muscle. 2- bulb of the vestibule covered by bulbospongiosus muscle. 3- the great vestibular gland. 4- superificial transverse perineal muscle 5- perineal nerve and posterior labial vessels and nerve. .Deep perineal space
Lies between superior fascia of the urogenital diaphragm and the perineal membrane (inferior fascia of the urogenital diaphragm)Deep perineal space
Contents: 1-membranous part of urethra. 2-Sphinctor urethrae muscle and deep perineal muscle. 3-Bulbourethral gland. 4-internal pudendal vessels and dorsal nerves of peins and clitoris. 5-Deep transverse perineal muscle. In female it traversed by both vagina and urethra.Pelvic diaphragm
It is the muscular part of the floor of pelvic cavity separates the pelvic cavity from the perineum. Consists of levator ani and coccygeus muscles.Anal triangle
Boundaries: Anteriorly the posterior border of the urogenital diaphragm. Posteriorly tip of the coccygx. Posterolateral sacrotuberous ligament.Contents of the anal triangle are; 1- Anal canal with the external sphinctor muscle. 2- Ischiorectal fossa (ischioanal fossa)
Anal canal
Blood and nerve supply of the anal canal Through inferior rectal artery from the internal iliac artery and partially by the middle rectal artery.Ischiorectal fossa
Boundaries: 1- base the skin and fascia. 2-lateral wall is the fascia of obturator internus muscle and tuberosity of ischium. 3- medial wall is the pelvic diaphragm.Contents of the ischiorectal fossa 1- inferior rectal nerve and vessels. 2- perineal branch of S4 nerve. 3- perineal and posterior scrotal branches of the pudendal nerve. 4- loose fatty areolar tissues.
Lesser pelvis (true pelvis)
Boundaries of the pelvic cavity: 1- superiorly pelvic inlet. 2- inferiorly pelvic outlet. 3- anteriorly posterior surface of the body of the pubis and symphysis pubis. 4- posteriorly sacrum and coccygx. 5- laterally inner surface of ischium and pubis, obturator internus and piriformis muscles.Contents of the true pelvis
1-Urinary bladder. 2-rectum. 3-male and female internal genital organs. 4-blood vessels and nerves.Peritoneum of the pelvis
The rectum
Blood and nerve supply of the rectumBlood supply through Superior, middle and inferior rectal rectal arteries. Superior rectal vein drains to the inferior mesenteric vein Middle and inferior rectal veins to the inferior vena cava. Nerve supply autonomic innervation.
Lymphatic drainage of the rectum and anal canal
1-Through the supserior rectal vessels to the inferior mesenteric nodes 2-Through the middle and inferior rectal vessels to the internal iliac nodes. 3-The terminal part of the anal canal to the superficial inguinal nodes. 4-Some channels pass to the sacral nodes.Urinary bladder
Relations: Posteriorly in male to the seminal vesicle and ductus deferens and to the rectum. In female to the uterus Inferiorly rest on the prostate gland in male and to the pelvic diaphragm in female. Superiorly it is covered by peritoneumParts of the urinary badder
The apex The fundus or the base The neckThe interior of the urinary bladder
Openings of the ureters The trigon Interureteric folds Urethral opening Uvula of the bladder
Blood supply of the urinary bladder Superior and inferior vesical arteries branches from the internal iliac artery. Venous plexuses of veins communicate with the prostatic venous plexus then end as vesical vein which end in the internal iliac vein.