pelvis last complete)

8/8/2019 Pelvis Last Complete)

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PELVIS

Slide 7-9

Special thanks to:

NUR SHARINA

SITI FATIMAH

NUR NUHA

WAN MUHAMMAD NAJIB

We have talked about the ovary. I told you no need to know therelation of uterus only the part u need to know.The main femalefunctions of uterus is for reception,implantation and nutrition of thefertilized hormone. The position of uterus like this (hand makingbend-like shape) is in 2 angles.anteversion and anteflexion.the first

angle lies between the uterus and vagina called anteversion.the otherone lies between body of uterus and cervix termed anteflexion. Butsometime,uterus bent backward on vagina and lies on pouch ofdoughlas. This position is called retroversion and retroflexion.retromeans back. This position lead to abortion. Usually in the third month


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of pregnancy . we have 3 layers. I thinked I have talked about thisone.(dr lupa daaa). The support of uterus are not so important. Theposition of uterus ya3ni anteflexion and anteversion is maintained byround ligament of uterus.

we stopped at sacral plexus right?.

No need to know the relation of sacral plexus.only we have to knowthe branches of sacral plexus. The root of the nerve is not importantfor you to know.

Q : What is the meaning of the root of the nerve? (sambil2 aim katbudak malaysia)

A: the origin of the nerve

The sciatic nerve comes from lumbar spinal nerve number 4 andnumber 5 plus the sacral spinal nerve number 1,number 2,number 3and number 4. The sciatic nerve is the largest nerve in the body. Itsupplies the muscle of the back of the thigh area. The condition fordisease causes by pressure is called sciatica. The pressure willcauses pain in the posterior of the thigh and the leg.


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O nce again no need to know the root of each nerve but we need toknow the function of each nerve. The superior gluteal nerve supplythe gluteus medius and minimus. The inferior gluteal nerve alsosupply the gluteus. The gluteus maximum in exact. Nerve toquadratus femoris supplies to inferior gemellus. Nerve to obturatorinternus supply to superior gemellus and the posterior cutaneous :means skin : nerve of thigh supplies skin of buttocks and thigh (allinformation available in slide for better understanding).

The sacral plexus branches to pelvic muscle and organ. We havepudendal nerve that leaves pelvis and enters gluteal region through

greater sciatic foramen then enters lesser sciatic foramen. Itsupplies to external genital organ.

Q : what pudendal means?

A : the hidden region ya3ni the genital organ

The other is nerve to piriformis.next is pelvic splanchic nerve andperforating cutaneous nerve of thigh which supplies skin of lowermedial part of buttocks .ok ?


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Lumbar plexus mainly supplies the lower limb and formed by ventralrami of L1,L2,L3 and L4. Branches of this plexus emerge from lateraland medial borders of psoas muscle and also anterior surface ofpsoas muscle. So these (the slides) are the branches either frommedium or lateral. We have one branch from the anterior of psoasmuscle,the red line (slides). We have 4 nerve branches arise fromlateral border of psoas muscle,2 from the medial border and onefrom the anterior surface of psoas muscle.

We have the important one,the obturator nerve. It supplies to the

medial compartment of the thigh called adductor muscle. Thefemoral nerve supplies the muscle of the front of thigh. We havelateral cutaneous nerve of thigh which supplies the skin of lateralpart of the thigh. Ilioinguinal supplies the inguinal region andiliohypogastric supply the skin of lower part of anterior abominalwall.


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MALE GE NITA L OR GAN

Here is the male genital organ, consists of the following organs:ScrotumTestisEpididymidesSpermatic cordVas DeferensSeminal vesiclesEjaculatory ductProstateProstatic urethraPenis

SCROTUM

Scrotum means pouch or sac of lower part of anterior abdominalwall,which contains the following organ: the testis,epididymis, lower

part of spermatic cord.

This is the layers of the is the scrotum,from outside to inside:

The first layer:skin which is wrinkled pigmented skin, in the midlinethere is line of fusion of 2 labioscrotal.

So we have two lateral scrotum swelling(labioscrotal), this twoswelling is corresponding to labia majora in female.

And we have the second layer which is superficial fascia underlyingthe skin.

The fatty superficial fascia in the abdomen is replaced in thescrotum by muscle and this muscle is called the dartos muscle.

The membranous layer is the second layer of the superficial fascia inthe scrotum and changes its name into colles fascia.(in scrotum,it is

called colles fascia instead of membranous layer of superficialfascia)

So,the fatty layer is replaced by dartos muscle and themembranous is replaced by colles fascia. ok?


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The third layer is spermatic fascia.

So this is the arrangement from superficial to deep: skin superficialfascia spermatic fascia

We have external spermatic fascia.This fascia is derived(comes)from the external obligue muscle .The second layer of the spermaticfascia which is cremastric fascia is derived from internal obliquemuscle of the abdomen.The internal spermatic fascia is derivedfrom fascia transversalis muscle.

(not clear)......of the scrotum into the superficial inguinal l igamentwhich you can palpate easily. What is superficial inguinal ligament?


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Abu answered:the ligaments that separate external and internalobligue muscle..

Dr:Internal or external?what do you mean?

Abu said:external..

Dr:yes..very good, the superficial inguinal ligaments is the lowestpart of the external obligue muscle which extend btw theanterior superior iliac spine and the pubic tubercle *** veryimportant.

So these are the layers of scrotum:skin,superficial fascia,ductus

muscle. You can see the skin of scrotum is wrinkle.

TESTIS

The second organ,called the testis is the mobile organ lies within thescrotum.The left testis lies at lower level than the right one.(opposite to the position of kidney which the right side lies at lower

level than the left kidney.)

Each testis is surrounded by a fibrous capsule and this fibrouscapsule is called tunica albuginea . The tunica albuginea sends septumwhich divide the testis into lobules;each lobule contains 1 to 3 coiledseminiferous tubule. Each tubule opens to network of channel andthis network of channel called the rete testis;rete means network.

The efferent ductule that merge from this reti testis connect retitestis to the upper end of epididymis. This efferent ductile is theductile that leaves the reti testis. (Afferent:comes which is opposite


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to efferent:leaving)

EPIDIDYMIS

The epididymis is the third organ lies posterior to the testis and vasdeferens lies on its medial site. It consists of folded tube 20ft inlength. The epididymis consists of 3 region:head,body and tail. Itslength is 20 ft. Sinus of epididymis lies on the lateral side.

So the vas deferens is the tube which emerge from the tail ofepididymis,or its called also ductus deferens (the same).

BLOOD SUPPLY

The blood supply by testicular artery which is from aorta.And itdrains into the testicular vein which emerge from epididymis andtestis to form venous network.This is called pampiniform plexus ofthe testis and its formed by testicular vein. The right testicularvein drain into inferior vena cava directly while the lefttesticular vein drains into left renal vein and the the left renalvein drains into inferior vena cava. So you have to know thisdifferent.


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LYMPH DRAINAGE

The lymph from testis ascends in spermatic cord and ends in para -aortic lymph nodes.

The spermatic cord is a collection of structure which passthrough the inguinal canal. What is inguinal canal? It lies in theobligue passage,it lies or extend btw the superficial inguinalring/opening and deep ingunal ring/opening***very important.

The superficial ingunal ring is the opening lies through the externalobligue muscles. While the deep ingunal ring is the opening lies in thefascial transversalis.

SPER MATIC COR D

It begins at the deep inguinal ring and ends at the testes, consist of:

Testicular artery

3 vessels Testicular veinTesticular lymph vessel

Genital branch of genitofemoral nerve2 nerves

Autonomic nerve

Vas deferens(ductus deferens)2 other things

Processes vaginalis(peritonealdiverticulum)

What is the meaning of diverticulum?


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Extension, protrusion from peritoneum. This is called peritonealdiverticulum.

These are the contents of the spermatic cord. The covering of

spermatic cord similar to the scrotum; external spermatic fascia,cremastric fascia and internal spermatic fascia. All these arecovering layer of spermatic cord. External spermatic fascia isderived from external oblique muscle. Cremastric fascia is der ivedfrom internal oblique muscle while internal spermatic fascia isderived from fascia transversalis.

Vas Deferens

y Thick walled tube (45cm).y It conveys sperm from epididymis to ejaculatory duct &

urethray It arises from tail of epididymis & passes through inguinal

canaly It emerges from deep inguinal ring & enters the pelvic cavityy It crosses the ureterthen runs medially & downward on

posterior surface of bladdery Terminal part of vas deferens is dilated to form Ampulla of

vas deferensy Inferior end of ampulla joins duct of seminal vesicle to form

ejaculatory duct

E jaculatory duct opens to posterior surface of prostatic urethra.

Seminal vesicle

y Two lobulated organs about (5cm long) lie on posterior surfaceof bladder


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y Each seminal vesicle consists of coiled tube embedded inconnective tissue (coiled tube+ connective tissue will formseminal vesicle)

y Blood supply :

1-ArteryInferior vesicleMiddle rectal

2-Veindrains into internal iliac veiny L ymphatic drainage : into internal iliac lymph nodesy Function : it produces secretion to nourish the sperms

This is seminal vesicle, lies on the posterior surface of thebladder.

The duct of vas deferens unites with the duct of seminalvesicles to form ejaculatory duct. The duct ejaculates seminal


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fluid. This is the posterior surface of bladder where theseminal vesicle lies. The ejaculatory duct will open to posteriorsurface of prostatic urethra.

E jaculatory ducty It is 2.5 cm longy It pierces posterior surface of prostate & opens into prostatic

urethra

You can see the 2 ducts merge

together to form the ejaculatory duct & open to prostaticurethra.


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This is the posterior surface of prostatic urethra.

Prostate

y It is fibromuscular glandular organy It surrounds prostatic urethray Is length is 3 cm longy It lies between neck of bladder & urogenital diaphragm

What is the meaning of urogenital diaphragm? (very important!!)It is a musculofascial diaphragm formed by 2 muscles and 2 fascia. 2muscles:

1) sphincter urethri2) deep perineal muscle

2 fascia:1) superficial fascia of urogenital diaphragm2) inferior fascia of urogenital diaphragm

y It is conical in shapey Its base lies nearer to bladder necky Its apex lies nearer to urogenital diaphragm


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y It c ts s(Ant. P st.Median (centre) Right Left ateral)

(Relation of ladder is not important)

y Fu nction : It prod uces milk y alkaline secretion to neu trali ze acidit y of agina

his alkaline medium ill assist/fa cilitate the movement of the sperm in the vagina ecau se pH of vagina is toward the acidit y.

his is another diagram. he apex of the prostate lies on the u rogenital diaphragm while the ase of the prostate is related to the neck of ladder.

These are the lobes of theprostate : (Ant-Post-Median)


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Body part is free part of penis which consists of 3 masses; 2 dorsalmasses (corpora cavernosa) and 1 ventral mass ( corpus spongiosum)*Spongiosum means spongy. Cavernous means contains venousnetwork (not sure about this)

Glans part is the distal expanded part of corpus spongiosum. Base ofglans is called the corona. Prepuce(foreskin) is fold of skin coversthe glans. And it is similar to the clitoris in vagina.

Lymphatic drainage of pelvis

Generally, the lymph nodes are arranged around the main bloodvessels. There are 3 main groups of lymph nodes related to pelvis.

1. Para-aortic lymphatic group of lymph nodes ( Lumbar)Group of lymph nodes arranged on the right and left sides ofaorta. They receive lymph from kidney, supernal glands, teste sand ovaries, uterine tubes, fundus of uterus, abdominal wall andcommon iliac lymph nodes.E fferent lymph vessels from right & left lumbar trunks givesbranch to cisterna chyli (sac of lymph-lies at the 1 st and 2 nd level of lumbar vertabtrae. Then, cisterna chyli will drain intothoracic duct which finally connects with brachiocephalic vein.

2. Inguinal lymph nodes: There are 2 groups (superficial & deep)

I. Superficial inguinal lymph nodes.- Lie in the superficial fascia below inguinal ligament- divided into 2 groups ( horizontal and vertical)

A. Horizontal group : lies just below & parallel to inguinalligament ( consists of 2 parts):-


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(i) Medial part: receives lymph from:-

a. Anterior abdominal wallb. Perineumc. Urethrad. External genetalia ( excepts testes in male)e. Lower half of anal canal

(ii) Lateral Part: receives lymph from:-a. Back below iliac crest (gluteal region)

B. Vertical droup: Lies along great saphenous vein (largestvein in lower limb) receives lymph from lower limbs.E fferent lymph vessels from superficial L ymph nodeswill pass through saphenous opening into join deepinguinal lymph nodes.

II. Deep Inguinal L ymph Nodes- Lies in the deep fascia of thigh-along medial side of

femoral vein

3. Common, Internal & external iliac lymph nodes:


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-these groups of lymph nodes arranged around common,internal, and external iliac arteries-they drain into para-aortic lymph nodes.

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* No comment will be entertained *

SEKALUNG PENGHARGAAN BUAT SEMUA YG TERLIBAT DLM

PEMBUATAN LECTURE NOTE NI. MOGA ALLAH MEMBALASJASA KALIAN DENGAN GANJARAN YG LEBIH BESAR DIAKHIRAT KELAK

INSYAALLAH, ALLAH YUSAHHIL UMURUNA

AMIN..

BY JJ

pelvis last complete)

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