ZOO 3733C Study Guide Clinical Points Important to know Golden Sentences will most likely be on exam Exam 5 Chapter 5 Pelvis and Perineum P 324 Figure 5 15 p 334 p 311 Homologous Structures Paraurethral glands Open into external urethral orifice Paraurethral glands of Skene female Prostate male Bulbourethral glands Cowper s male Bartholin s female Inferior Vesical A male Vaginal A female Uterine A female Artery of Ductus Deferens male Clitoris female Penis male Prepuce of clitoris female Glans Penis male Bulbs of vestibule female Bulbs of penis male Glans penis part that is circumcised Pelvis Anterior wall is muscular Contents Urinary bladder Ant Urinary tract Internal Male Female genital organs Distal parts of GI tract rectum rectovesical pouch and vesicouterine uterovesical pouch female only Superior part false pelvis Inferior part true pelvis Superior Pelvic Aperture pelvic brim or inlet Border between the true and false pelvis Between the promontory of the sacrum and the pubic tubercle Important for child bearing Anterior wall is boney Diameters Pelvic outlet Transverse Diameter 13 5 14cm Oblique Diameter I 12 12 5cm Oblique Diameter II 11 5 12cm Anatomical conjugate 12cm True Conjugate 11 5cm Diagonal conjugate minus 1 5 Diagonal conjugate 13cm between tip of the coccyx and lower border of pubic Symphysis Diameters Interspinous diameter 10cm Median Conjugate 11 5cm Straight Conjugate 9 5cm Peritoneum Covers major part of pelvic wall and parts of urinary bladder uterus and related structures and rectum Rectovesical pouch Pocket formed by peritoneum between Urinary bladder and Rectum 1 Produces various false ligs around bladder Median Umbilical fold In midline Remnant of embryonic allantois Medial Umbilical Ligs Obliterated umbilical arteries Found in body of urinary bladder extended to the umbilicus Lateral Umbilical Folds Over inf Epigastric vessels from ext iliac vessels Muscles of Pelvic Wall Iliopsoas Formed by Psoas major and Iliacus m after passing under Inguinal ligament through Lacuna Musculonervosum Covers the ala wing of ileum Fxn Innervation Chief flexor of hip Lat Flexion of Vertebral column Lumbar Plexus L1 L3 psoas Femoral n iliacus Obturator Internus Covers Lateral Wall of Pelvis Fxn Innervation Lat Rotation of thigh at hip joint Abductor when leg is flexed N to Obturator Internus L5 S2 Piriformis Covers Posterior wall of Pelvis Fxn Innervation N to piriformis S1 S2 Lat Rotation Abduction of thigh Pelvic Diaphragm Floor of Pelvis Separates Pelvis from Perineum Levator Ani SUPPORTS ALL PELVIC STRUCTURES Composed of 3 muscles Puborectalis Helps fecal continence small m Pubococcygeus Ileococcygeus Males attaches to wall of prostate levator prostatae Females attaches to urethra vagina pubovaginalis Innervation S4 n Inf Rectal n from pudendal Coccygeal Plexus Coccygeus ischiococcygeus Contraction flexes coccyx Post Part of pelvic floor NOT part of levator ani muscles Innervation S4 S5 2 SELF STUDY QUESTION Injuries to pelvic floor and perineum Injuries to the Pelvic floor and perineum Urinary stress incontinence Can be caused by childbirth Levator Ani m most often injured Can alter position of bladder and uterus Urinary Bladder Urinary Bladder Newborns above pubic bone Can hold 500 700mL of urine Urgency occurs around 280 350mL Detrusor M Internal urethral sphincter Transitional type of epithelium External urethral sphincter Can get infected cystitis Due to bad hygiene or water Symptoms Urgency to urinate Burning sensation Adults in lesser pelvis beneath peritoneum and behind pubic bone Internally covered by Transitional Epithelium Rough folds on mucosal surface become smooth when filled with urine At trigone formed by smooth m of bladder Controlled by ANS Don t wait for bacteria to culture start w wide spectrum antibiotics Covers bladder to Transverse Reserve Fold where ureters open into bladder Ex Augmentin Bactrim Loose connective tissue Contains Nerves Vessels Surrounds bladder ant lat Peritoneum Paracystium Bladder supported by Male Medial umbilical lig Pubovesical lig Innervation Female Pubourethral lig Sympathetic Inf Hypogastric plexus lesser least lumbar splanchnic n Motor efferent Contracts Int Urethral Sphincter Relaxation of Detrusor m Sensory afferent info from bladder Parasympathetic Pelvic Splanchnic n S2 S4 via Inf Hypogastric Plexus Motor efferent Relaxation of Int Urethral Sphincter Contracts Detrusor m Sensory afferent Pain Stretch info from bladder Referred pain dermatomes of perineum post Upper thigh Blood supply Branches of Int Iliac 3 Sup Vesical a Obturator gluteal a Inf Gluteal a Inf Vesical a MALE Vaginal a FEMALE Uterine A female Venous Drainage Vesical venous plexus connects to vertebral venous plexus both sexes Also connects to Prostatic venous plexus in males If cancer here bad b c cancer can travel to bones Lymphatics Lymph nodes along umbilical a SELF STUDY QUESTION Atonic v Hypertonic Bladder Atonic Enlarged bladder that doesn t empty normally Due to denervation or obstruction Incontinence due to overfilling Hypertonic Excess tension in Detrusor m Due to irritant or post surgery Female Urethra More prone to infection due to shortness Urethral glands open into it mostly upper part Greater Vestibular Bartholin s glands in lower parts At Urogenital diaphragm deep transverse perineal m Int urethral orifice Ext Urethral orifice in vestibule of Vagina Ant to Vaginal Opening Sup part in pelvis Inf Part in perineum Urethra Vagina surrounded by m fibers that produce Ext Urethral Sphincter voluntary m control Pudendal n in alcoxs canal Blood Supply Internal Pudendal a Starts from internal urethral orifice of the urinary bladder external urethral orifice at tip of glans penis Male Urethra Muscular tube about 20cm long 4 Parts PPMS Preprostatic In Pelvis Follows int urethral orifice Prostatic In Pelvis VERY IMPORTANT Most dilated part of urethra Semen is produced here Ends where urethra is covered by ext urethral sphincter Covered by Urothelium Urethral Crest Ridge on middle of post wall Seminal Colliculus expansion of crest Prostatic sinuses On both sides of seminal colliculus Openings of Prostatic ductules Secretes prostate gland Two openings of ejaculatory ducts Prostatic Utricle Blind opening in middle of seminal colliculus Remnant of Mullerian paramesonephric duct Female primitive genital tissue 4 Membranous In Perineum Narrowest eurogenitial diaphragm covers Most prone to injuries damage due being fixed less mobile Covered by