learning objectives pelvic walls and floor
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Learning Objectives Pelvic Walls and Floor a.Understand the position, attachments and major divisions of the pelvic diaphragm. b.Define the difference between levator ani muscle and pelvic diaphragm. c.Understand how the pelvic and urogenital diaphragms close the pelvic outlet. - PowerPoint PPT PresentationTRANSCRIPT
Learning Objectives
Pelvic Walls and Floor
a. Understand the position, attachments and major divisions of the pelvic diaphragm.
b. Define the difference between levator ani muscle and pelvic diaphragm.
c. Understand how the pelvic and urogenital diaphragms close the pelvic outlet.
d. Describe the relationship of pelvic organs to the pelvic and urogenital diaphragms.
e. Describe the distribution of the branches of the internal iliac artery.
f. Describe the arrangement and distribution of pelvic autonomic nerves.
g. Describe the pelvic position of the sacral plexus and understand how the major nerves from this plexus exit the pelvic cavity.
Anorectal hiatus
Urethral hiatus
Tendinous arch
Piriformis m.
(Ischio)coccygeus m.
Iliococcygeus m.
Puborectalis m.
Pubococcygeus m.
Obturator internus m.
Plate 340
Superior fasca UG diaphragm
Plate 338
Urethra
Vagina
Rectum
Piriformis m.
Tendinous arch
Pubococcygeus m.
Iliococcygeus m.
(Ischio)coccygeus m.
Plate 338
Rectum
VaginaUrethra
Piriformis m.
Obturator internus m.
Tendinous arch
(Ischio)coccygues m.
Iliococcygues m.
Pubococcygeus m.
Puborectalis muscle
Moore et al; Fig. 3.12
Plate 372
Fat in ischioanal fossa
Obturator internus m.
Levator ani m. (iliococcyxageus)
Pudenal canal with pudendal n, internal pudendal a. and v.
Rectum
Anal canal
Plate 363
Superficial transverse perineal m.
Urethra
Deep artery of penisDorsal artery of penis
Deep dorsal vein of penis
Dorsal nerve of penis
Duct of bulbourethral gland
Artery of bulb of penis
Ischial tuberosity
Netter,Plate 487Levator ani m.
(Ischio)coccygeus m.
Pelvic splanchnic nn.
Gray rami communicantes
Sympathetic trunk
Sacralsplanchnic nn.
S4 nerve supply to muscles of pelvic diaphragm
Plate 382
L. Common iliac a.
L. Internal iliac a.
Uterine a.
Obturator a.
Umbilical a.
Sup. vesical aa.
Inf vesical aa.
Middle rectal a.
Internal pudendal a.
Inf. Gluteal a.
Sup. gluteal a.
Lateralsacral aa.
Iliolumbar a.
Plate 382
Rt. Internal iliac a.
Sup. gluteal a.
Piriformis m.
Inf. Gluteal a.
Internal pudendal a.
Middle rectal a.
Uterine a.
Umbilical a.
Obturator a.
Ureter
Plate 344
Supravaginal part of cervix
Ureter
URINARYBLADDER
Uterine artery in transversecervical ligament
Plate 383
Obturator a.
Umbilical a.
Prostatic venous plexus
Inf. vesical a.
IInternalpudendal a.
Inf. gluteal a.
Sup. gluteal a.
Plate 390
Pelvic splanchnic nn.
Ventral ramus, S1
Gray rami communicantesSuperior hypograstic plexus
Lumbar splanchnic nn.
Inferior hypogastric plexus
Prostatic plexus
Vesical plexus Pudendal n.
Prevertebral ganglia(sympathetic)
Left hypogastric n.
Plate 392
Rt. and left hypogastric nn. Superior hypogstric plexus
Inferior hypogastric plexusSacral splanchnic nn.
Pelvic splanchnic n
Lumbar splanchnic nn.
Gray ramus communicantes
Plate 388
Superficial inguinal nodes
Deep ingiunal nodes
External iliac nodes
Plate 386
MALE SEX RESPONSE
1. Erection (Parasympathetic)
a. Engorgement of erectile tissues b. Contraction of perineal muscles
2. Emission (Sympathetic)
a. Contraction of smooth muscle in ductus deferens, prostate gland, seminal vesicles
b. Contraction of internal urethral sphincter c. Release of secretions of testes, prostate gland,
seminal vesicles and bulbourethral glands
3. Ejaculation (Somatic) a. Rhythmic, spasmodic contraction of perineal
muscles, levator ani, external anal sphincter, gluteal muscles
b. Propulsion of semen along penile urethra c. Initiated by secretions entering penile urethra
4. Detumescence/Resolution (Sympathetic)
a. Return of erectile tissues to flaccid state b. Involves a refractory period
FEMALE SEX RESPONSE
1. Arousal/Excitement (Parasympathetic) a. Increased secretions; vestibular and vaginal b. Erection of clitoris
2. Plateau --minutes to hours (Sympathetic)
a. General vascular engorgement (clitoris, labia, breast, lower vagina)
b. Erection of nipples c. “Sex flush”; reddish vascular flushing of skin
over breasts, chest d. Dilation of upper vagina e. Uterine “tenting”
3. Orgasm (Somatic)
a. Rhythmic contractions of perineal muscles (~1 second intervals)
b. Number of and intensity of rhythmic contractions highly variable
c. Dilation of cervix d. Uterine contractions (due to release of oxytocin) e. Uterine “dipping”
4. Resolution (Sympathetic)
a. Return to pre-excitement stage b. No refractory period