ANAT Exam 3 - Pelvis

Describe the coccyx.

- 3-5 small, fused vertebrae (4 is most common). - The coccygeal cornuae articulate with the sacral cornuae. - The coccyx is an origin for the levator ani and coccygeus muscles, and for part of gluteus maximus

Describe the triceps coxae

- It is formed by three muscles between the piriformis and the quadratus femoris muscles. - The common tendon of these muscles attaches to the greater trochanter of the femur.

Describe the quadratus femoris muscle

- It laterally rotates the thigh - Its origin is one the lateral border of the ischial tuberosity - It inserts on the femur at the quadrate tubercle on the intertrochanteric crest. - It is innervated by the nerve to the quadratus femoris - It may supplied with blood by several adjacent arteries, including the inferior gluteal

Describe the gluteus medius muscle.

- It lies deep and lateral to gluteus maimus. - It originates from the eternal surface of the ilium, and inserts on the lateral surface of the greater trochanter of the femur. - It abducts the thigh at the hip and rotates it medially, and plays an important role during locomotion. - It is responsible for preventing sagging of the unsupported side of the pelvis during walking. - It is supplied by the superior gluteal nerve (L5-S1). - Vascular supply is from the superior gluteal artery and vein

Describe the nerves of the sacral plexus - common peroneal nerve

- aka common fibular nerve - dorsal divisions of L4-L5, S1-2

Describe the nerve of the sacral plexus - sciatic nerve

- The broadest nerve of the body, supplying the lower limb. - Its branches are the tibial and common peroneal (common fibular) nerves

Describe the fat of the deep perineal space.

The ischioanal fat pads extend forward into the deep perineal space

mesovarium

part of the broad ligament that projects posteriorly to the ovary

Describe the venous drainage of the uterus

the uterine plexus -> internal iliac vein

Describe the nerves of the sacral plexus - tibial nerve

ventral divisions of L4-5,S1-3

Describe superior and inferior gemelli muscle

- It assists the obturator internus - The tendon of the obturator internus receives the distal attachments of the gemlli - The superior gemellus arises from the ischial spine - The inferior gemellus arises from the ischail tuberosity

Describe the pelvic ligament - sacrotuberous ligament

- paired - from the posterior ilium, lateral sacrum, and lateral coccyx to the ischial tuberosity. Counters rotation of the sacrum. Forms the medial borders of the greater and lesser sciatic foramina.

Describe the pelvic ligament - iliolumbar ligament

- paired - from the transverse processes of vertebra L5 to the ilia on either side. These help prevent the lumbar spine from sliding forward on the sacrum, as in spondylolisthesis, and also assist in stabilizing the sacroiliac joint.

Describe the pelvic ligament - ventral (or anterior) sacroiliac ligament

- paired - joins the ilium and sacrum on the anterior or pelvic surface, anterior to the synovial joint capsule of the sacroiliac joint. This is a very thin ligament.

Describe the pelvic ligament - dorsal (or posterior) sacroiliac ligament

- paired - joins the ilium and sacrum on the posterior surface; is visible posteriorly; not really separable from the interosseous sacroiliac ligament.

Describe the pelvic ligament - interosseous sacroiliac ligament

- paired - joins the ilium and the sacrum, deep to the dorsal sacroiliac ligament but posterior to the synovial joint capsule of the sacroiliac joint. This ligament is the strongest connection between the bones of the pelvis.

Describe the pelvic ligament - greater sciatic foramen

- paired - opening in the pelvis bounded by the ilium, ischium, sacrospinous ligament, and sacrotuberous ligament, superior to the ischial spine and sacrospinous ligament.

Describe the pelvic ligament - lesser sciatic foramen

- paired - opening in the pelvis bounded by the ischium, sacrospinous ligament, and sacrotuberous ligament, inferior to the ischial spine and sacrospinous ligament.

Describe the bony landmarks of the ischium - tuberosity

- part of the body of ischium - attachment point for the sacrotuberous ligament, hamstring muscles, and part of adductor magnus muscle. The inferomedial part is covered by fibrous adipose tissue and a bursa, which make it comfortable to sit on.

Describe the bony landmarks of the ischium - spine

- part of the body of ischium - attachment point of the sacrospinous ligament, which separates the greater and lesser sciatic foramina.

Describe the bony landmarks of the ischium - lesser sciatic notch

- part of the lesser sciatic foramen

Describe the bony landmarks of the pubis - sumphysis

- part of the pubic body - joint between the left and right pubes. Discussed further below.

Describe the bony landmarks of the pubis - pubic tubercle

- part of the pubic body - medial attachment of the inguinal ligament

Describe the bony landmarks of the pubis -

- part of the superior ramus - the pecten pubis - continuous with the arcuate line of the ilium, and part of the linea terminalis, which demarcates the "true pelvis" from the "false pelvis."

Describe the arterial supply of the ducutus deferens

- receives blood from the artery to ductus deferens - usually this is a tiny branch of one of the superior vesical arteries - it ma arise from the inferior vesical artery - artery to the ductus deferens anastomoses with the testicular artery

Describe the ischiofemoral ligament of the hip

- reinforces posterior aspect of capsule - prevents hyperextension

Describe the bony landmarks of the ischium - ramus

- upper border forms part of the obturator foramen - the adductor magnus muscle mostly originates from the ischial ramus.

Describe the bony landmarks of the pubis - superior ramus

- upward from the body of the pubis, forming the superolateral border of the obturator foramen and part of the acetabulum. - contains the pectineal line

Describe the joints of the pelvis - sacrococcygeal joint

- usually represented by an intervertebral disk (although sometimes a synovial joint occurs) reinforced by longitudinal ligaments.

Describe the arterial supply of the uterus

- uterine arteries branch from the internal iliac arteries. - uterine arteries also have branches which supply the vagina, uterine tubes, and ovaries. - they anastomose with the ovarian arteries

Describe the nerves of the lumbar plexus - accessory obturator nerve

- variable - from the ventral divisions of L2, L3

Describe the nerves of the sacral plexus - nerve to quadratus femoris

- ventral divisions of L4, L5, S1. - supplies quadratus femoris and gemellus inferior mm.

Describe the nerves of the sacral plexus - nerve to obturator internus

- ventral divisions of L5, S1, S2 - supplies the obturator internus and gemellus superior mm.

Describe the nerves of the sacral plexus - posterior femoral cutaneous nerve

- ventral divisions of S2 and S3, and dorsal divisions of S1 and S2. - Cutaneous innervation to the perineum, gluteal region, and back of the thigh and leg.

Describe the nerves of the sacral plexus - pudendal nerve

- ventral divisions of S2-4 - supplies both the muscles and skin of the perineum

Describe the afferent innervation of the urinary bladder

Afferent innervation depends on the area of the bladder. Superiorly, the bladder is in contact with the peritoneum, and afferent fibers follow sympathetic fibers to T 11 to L3. The inferior part of the bladder, which is the part that feels pain when it's to fall, is innervated by afferents following the course of the parasympathetic innovation.

Describe the arterial supply of the gluteal region.

Arteries of the gluteal region arise directly or indirectly from the internal iliac arteries. Patterns of origin are highly variable.

How will herniation affect the nerves of the plexuses of the pelvis?

As a result, herniation of the intervertebral disc between the centra of L4 and L5 vertebrae may impinge on the L5 spinal nerve, while herniation of the disc between vertebrae L5 and S1 may impinge on the S1 spinal nerve.

Describe the bony landmark of the ischium - body

Body - The thick part of the bone, making up part of the acetabulum and also including the following structures: - Tuberosity - Spine - Lesser sciatic nerve

Describe flexion of the hip joint.

Degrees of at the hip is determined, in part, b the position of the knee; when the knee is fleed, this relaes the hamstring muscles on the posterior of the thing, allowing greater fleion of the hip joint. Muscles fleing the hip include: iliopsoas, sartorius, tensor fasciae latae, rectus femoris, pectineus, adductor longus, adductor brevis, the anterior part of adductor magnus, and gracilis.

What is the clinical importance of pelvic ligaments?

During pregnancy the hormone relaxin increases the flexibility of the pelvic ligaments. This results in significant mobility of the pelvis and increase in diameter of the birth canal during childbirth. However, it also makes the pelvis unstable - the swayback and waddle of pregnant women are the result of relaxed ligaments - and may contribute to pelvic pain. Relaxin affects ligaments throughout the body, causing temporary laxity which may lead to injury. This has been particularly well- studied in the knee.

Describe the venous drainage of the ureter.

Finish drainage of the ureters corresponds to the arterial supply. Veins form along the ureter and drain into the internal iliacs. Superiorly, they drain into the testicular or ovarian plexuses in the abdominal portion into the inferior hypogastric plexus in the pelvic portion.

Describe the innervation of the urinary bladder

Innervation of the bladder is from the vesicle plexus, which is an anterior extension of the inferior hypogastric plexus. The vesicle plexus contains both sympathetic and parasympathetic fibers.

Describe the innervation of the ductus deferens

Innervation of the ductus deferens is autonomic (both smpathetic and parasmpathetic) from the inferior hypogastric plexus

Describe the lymphatic drainage fo the pelvis

Lmphatic drainage of the pelvis tends to follow vessels, which themselves are variable. In the case of an accessor obturator arter, for instance, the vein ma follow the regular obturator course, the accessor obturator course, or there ma be two veins following each. The lmphatic vessels tend to follow the veins in an case. All lmphatic drainage does, however, return through the thoracic duct. The most important groups of nodes to be aware of are the preaortic nodes, lateral aortic nodes, common iliac nodes, external iliac nodes, and internal iliac nodes.

Describe the parasympathetic innervation of the urinary bladder

Parasympathetic to rise from pelvic splanchnic nerves which also carry afferent fibers from the same sacral second men's segments S2 to S4. These components are involved in reflex emptying of the bladder, being motor to the detrusor muscle, and inhibiting the male internal urethral sphincter.

Describe the autonomics of ejaculation.

Point and Shoot for the parasmpathetic and smpathetic contributions is somewhat too simplistic. - Erection is effected by the parasmpathetic system, from S2-S4 through the prostatic nerve plexus and then into the cavernous nerves. - Emission of semen into the urethra is controlled by the smpathetic sstem, originating from L1-L2. - Ejaculation, however, is more complicated: 1. the internal urethral sphincter is closed - sympathetic 2. the urethral muscle contracts - parasmpathetic 3. m. bulbospongiosus contracts - somatic, through the pudendal nerves. 4. Remission is not passive, but is achieved by smpathetic stimuli to the smooth arterial muscle.

Describe the bony landmark of the ilium - posterior inferior iliac spine

Posterior inferior iliac spine - attachment point of the piriformis muscle.

Describe the blood supply to the rectum and anal canal.

Superior rectal artery - the terminal branch of the inferior mesenteric artery. - branches until left and right arteries and give off branches into the walls of the rectum, continuing into the anal canal. Middle rectal arteries - branches from the internal iliac arteries which supply the lower rectum. - anastomoses with branches of the superior rectal artery. Inferior rectal arteries - branch from the internal pudendal artery - supply the anal canal, not the rectum

Describe the sympathetic innervation of the urinary bladder

Sympathetic innervation reaches the trigonal muscle and the blood vessels. This component has a little to do with emptying the bladder. It causes contraction of the male internal urethral sphincter during ejaculation to prevent reflex of semen.

Describe the venous drainage of the urinary bladder.

Venous drainage of the bladder is downwards along the walls towards its base, which forms a vesicle plexus. Tributaries from this plexus drain into the internal iliac vein. In males these tributaries of the vesicle plexus communicate with the prosthetic plexus, and females they communicate with the veins of the vaginal plexus.

Describe the venous drainage of the rectum.

Venous drainage of the rectum, in general, follows the arterial supply. - The inferior rectal vein drains to the internal pudendal vein. - The middle rectal vein drains to the internal iliac and superior rectal veins. - The superior rectal vein drains to the inferior mesenteric vein.

What is the pectinate line?

a demarcaion in several respects: 1. epithelium changes from simple colmnar to stratified squamous 2. Sensory innervation is through branches of the pudendal nerve below the line, but follow parasympathetic nerves about it. 3. Venous drainage below the line is to the IVC via the middle and inferior rectal veins, but above the pecinae line it is to the portal vein via the surperior rectal vein. Hemorrhoids are internal above, and external below. 4. Lymphatic drainage below he line is to the superficial inguinal node, but above the pectinate line it is to the internal iliac node. 5. Cancer above the line tend to be adenocarcinoma, but below the line they tend to be sqamous cell.

lateral cervical ligament

also known as the transverse ligament, the cardinal ligament, or Mallenkrodts ligament. At the base of the broad ligament. Extends from the cervix to the lateral pelvic wall, stabiliing the uterus and transmitting uterine vein, arter, and lmphatics.

preaortic nodes

anterior to the abdominal aorta. These collect lmphatic drainage mostl from the gut, but with reference to the pelvis lmphatic drainage from the uterine fundus, ovar or testis ma be to these nodes in the lumbar region

external iliac nodes

around the external iliac vessels, these collect from the inguinal nodes, the abdominal wall below the umbilicus, the adductor region of the thigh, as well as from pelvic structures such as the bladder, glans penis or clitoridis, prostate, cervix, and upper vagina.

internall iliac nodes

around the internal iliac vessels, these collect from the gluteal and posterior femoral area, as well as from the deep perineum and various pelvic viscera.

ovarian ligament

attaches the ovary to the lateral, superior corner of the uterus, posterior to the uterine tube

Describe the arterial supply of the seminal vesicle

branches from the inferior vesicle and middle rectal arteries branches from the artery to ductus deferens - Veins accompany the arteries.

suspensory ligament

contains ovarian vessels and nerves

Describe the zones of the anal canal mucosa.

cutaneous zone: - The most external (inferior). It is deeply pigmented, and contains hair follicles and glands. intermediate zone: - About 1 cm wide and hairless, representing a transitional area between the cutaneous stone and the true mucous membrane. - It is sometimes called the white line of Hilton. true mucous membrane: -begins about 2 cm from the anal aperature, at the anal valves. - Anal columns extend vertically from the valves. - The pectinate line is just below the anal valves, at the beginning of the mucous membrane.

Describe the arteries of the gluteal region - inferior gluteal artery

exits the pelvis from the greater sciatic foramen, inferior to the piriformis - supplies the gluteus maimus, obturator internus, quadratus femoris, and superior portions of the hamstrings - participates in the cruciate anastomosis of the thigh (1st perforating arter of the deep arter of the thigh and medial and lateral circumfle femoral arteries) - may give off inferior rectal branches. - In some variations, the internal pudendal artery may arise from this artery.

parametrium

fibrous tissue between the laers of the broad ligament

rectouterine fold

folds of peritoneum extending from the cervix of the uterus on each side of the rectum to the posterior pelvic wall & sacrum

Describe the bony landmark of the ilium - greater sciatic notch

forms part of the greater sciatic foramen Gluteal surface - lateral surface of the ala, with origins of the gluteal muscles.

Describe the arterial supply of the vagina.

from vaginal branches of the uterine, vaginal, and internal pudendal arteries.

common iliac nodes

inferior to the aortic bifurcation and anterior to the 5th lumbar vertebra. Drain the external and internal iliac nodes and have efferent to the lateral aortic nodes.

Describe the bony landmark of the pubis - inferior ramus

joins the ischial ramus (the two together are sometimes called the ischiopubic ramus), forming the lower border of the obturator foramen. Origins for many of the adductor muscles of the leg: adductor longus, adductor brevis, gracilis, and a small part of adductor magnus.

mesometrium

largest part of the broad ligament, from the pelvic floor to the uterine bod and the uterine tube

Describe the bony landmark of the ilium - posterior superior iliac spine

posterior end of the iliac tuberosity and iliac crest, often indicated externally by a dimple.

Describe the testes.

the testes are the male gonads, which lie in the scrotum, where the are surrounded b tunica vaginalis and are separated b a septum. Testicular arteries and veins run back to the abdomen through the spermatic cord.

Describe the bony landmark of the ilium - tuberosity

thick, rough part of the iliac crest that is the lower attachment of the erector spinae muscle. The sacropelvic (anterior) surface is an attachment for the posterior sacroiliac ligaments, and anteriorly to that the interosseus sacroiliac ligament and the iliolumbar ligament.

round ligament

thicker at the uterus than at its distal, fibrous end at the labia majora; attaches superiorl to the uterine wall, then laterall passes through the deep inguinal ring

Describe the bony landmark of the ilium - anterior inferior iliac spine (AIIS)

this is one origin for the rectus femoris muscle.

lateral aortic nodes

to either side of the abdominal aorta, anterior to the medial margins of psoas major. These receive lmph from the testis, ovar, upper part of the uterus, and uterine tube directl. The also receive lmph from all the iliac nodes, and therefore from the lower limbs.

Describe the venous drainage of the ductus deferens

venous drainage is mostly to the testicular vein and pampiniform plexus, but its proximal part has venous drainage into the prostatic venous plexus.

Describe the innervation of the ureter

- Afferent fibers that conduct pain sensations follow sympathetic fibers to the spinal ganglia and segments T 11 to L2. - Pain in the ureter is often referred to the lower abdomen and groin on the same side. - Autonomic innervation is from the renal, aortic, superior hypogastric, and the inferior hypogastric autonomic nerve plexuses.

Describe the innervation of the rectum.

- Autonomic innervation of the rectum is via the middle rectal plexus, a branch of the inferior hypogastric plexus. Sympathetic innervation goes to the blood vessels and originates from T 10-L2. Parasympathetic innervation is the primary motor invasion and pain reception. It is derived from the splanchnic nerves from S2-S4.

What is the clinical implication of female pelvic shape?

- Beyond allowing childbirth, the wider female pelvis has functional and clinical implications, particularly regarding locomotion. - Because the proximal femora are farther apart in women, but the distal femora are not farther apart at the knee, the femur rests on the tibia at a greater angle in women. This tends to make running more inefficient (many great female runners are narrow-hipped) and knee injuries more common among women. Knee injuries are estimated to be 4-6 times more common in women (not counting pregnant women and the effects of relaxin described above) than in men.

What are the bony landmarks of the pubis?

- Body - pubic tubercle and symphysis - Superior ramus - pectineal line - Inferior ramus

What are the bony landmarks of the ischium?

- Body - tuberosity, spine, and lesser sciatic notch - Ramus

Describe the position of the ureters

- Descending from the kidneys to the urinary bladder along the posterior wall of the abdominal cavity, the ureters are retroperitoneal. - They cross the pelvic and look at the level of the bifurcation of the common iliac artery anterior to the sacroiliac joint the course inferolateral to the pelvic parietal peritoneum and curve towards the base of the bladder, passing posterolateral to the ductus deference and anterior to the seminal vesicles in the male - They enter the posterolateral aspect of the bladder and course obliquely through the walls. This means that when the water is full and the walls are stretched, ureters are passively blocked.

Lymphatics

- Drainage from the deep tissues of the buttocks follows the gluteal vessels to the superior and inferior gluteal lymph nodes, then to the internal, external, and common iliac nodes, and to the lateral lumbar (aortic/caval) lymph nodes. - Lymph from superficial tissues of the gluteal region enters the superficial inguinal lymph nodes, which also receive lmph from the thigh. - All superficial inguinal lymph nodes send efferent lmphatic vessels to the eternal iliac lymph nodes.

Describe spinal nerves of the lumbar, sacral, and coccygeal plexuses.

- Each spinal nerve has a dorsal ramus and a ventral ramus (posterior and anterior rami). - The dorsal rami go to the posterior body walls and epaxial muscles. - The ventral rami supply structures of the anterior body wall, pelvis, and lower limb. - Many of the ventral rami in the lumbar and sacral regions split into dorsal and ventral divisions. - The lumbar, sacral, and coccygeal plexes are composed of the ventral rami.

Describe gluteal intramuscular injections

- Gluteal intramuscular injections must be made safely to avoid injury to the sciatic nerve. - Injecting into the superolateral quadrant of the buttock or into the tensor fasciae latae reduces risk of injuring non-muscular structures, thus minimiing the risk of complications such as nerve injur, hematoma, and abscess formation.

Describe the pelvic outlet.

- Inferior pelvic aperture - diamond-shaped and is bounded by the pubic symphysis, ischiopubic rami, ischial tuberosities, sacrotuberous ligaments, and the tip of the coccyx. Measurements of the pelvic outlet include: anteroposterior diameter between the tip of the coccyx and inferior edge of the pubic symphysis; transverse diameter between ischial tuberosities; oblique diameter between midpoint of the sacrotuberous ligament to the junction of the ischium and pubis on the other side. Average female measures are greater than average male measures.

Describe the piriformis muscle.

- It almost fills the greater sciatic foramen - It arises from the anterior surface of the sacrum and sacrotuberous ligament - It attaches to the greater trochanter of the femur. - It is a key landmark in the gluteal region because it adis in the identification of the gluteal vessels and nerves (superior and inferior gluteal vessels and nerves).

Describe the nerves of the sacral plexus - inferior gluteal nerve

- dorsal division of L5, S1, S2 - supplies gluteus maximus

Describe the obturator internus muscle

- It exits the pelvis by the lesser sciatic foramen. - It laterally rotates and extends the thigh. - It is innervated by the nerve to the obturator internus (L5-S2). - It has a proximal attachment at the pelvis surface of the obturator membrane and surrounding bones - It attaches distally to the trochanter fossa (medial surface of greater trochanter of the femur) of the femur. - This muscles laterally rotates an extended thigh, abducts a flexed thigh, and helps hold the femoral head within the acetabulum.

Describe the gluteus maximus muscle.

- It is the most superficial and largest. - When the hip is straight it covers the ischial tuberosit, but when the hip is fleed it slides superior to the ischial tuberosity. - The ischial tuberosit is palpable along the inferior portion of this muscle and superior to the gluteal fold. - It originates from ilium, dorsal surface of the sacrum and cocc, and the sacrotuberous ligament. Inserts on the (IT band or IT tract) and of the femur. - It extends the thigh and assists in lateral rotation. It functions primaril between the fleed and standing positions of the thigh (e.g., raising from a chair, walking up stairs, running, stabiliing the knee through the iliotibial band). It is used little for casual walking. - It is supplied by the inferior gluteal nerve (L5-S2), which enters its deep surface near its center. - Vascular supply is from communicating branches between the superior and inferior gluteal vessels - Important anatomical relationships: The sciatic and posterior femoral cutaneous nerves pass deep to the gluteus maimus and enter the posterior aspect of the thigh deep to the gluteal fold. They do not supply gluteus maimus.

Describe the gluteus minimis muscle.

- It lies deep to gluteus medius. - It originates from the eternal surface of ilium, and inserts on the anterior surface of the greater trochanter of the femur. - It abducts the thigh at the hip, and rotates it medially and also acts to keep the pelvis level when the opposite side leg is swinging forward in locomotion. - It is supplied by the superior gluteal nerve (L5-S1). - Vascular supply is from the superior gluteal artery and vein.

Describe the obturator externus muscle.

- It occurs deep in the thigh, and thus is often considered a muscle of the medial compartment of the thigh. - It arises from the margins of the obturator foramen and obturator membrane and passes deep to the quadratus femoris before attaching to the trochanteric fossa (medial surface of greater trochanter of the femur) of the femur. - It serves as a lateral rotator of the thigh and stabilizes the hip joint. - It is NOT a part of the triceps coxae.

Describe the tensor fasciae latae muscle

- It originates proimally on the ASIS and the anterior part fo the iliac crest - It inserts distally on the iliotibial band and joins with fibers of the superior part fo the gluteus maximus. - It acts in concert with the iliiopsoas msucle to flex the hip and aids gluteus medius and gluteus minimus in medial rotation of the thigh at the hip. - Its nerve supply is the superior gluteal nerve - The arterial supply is via the deep branch of the superior gluteal artery. - This muscle is enclosed between two layers of fascia lata, the investing fascia of the thigh.

Describe the nerves of the lumbar plexus - ilioinguinal nerve

- L1 - to internal oblique, skin of the anterior 1/3 of the perineum, skin of the medial thigh

Describe the nerves of the lumbar plexus - iliohypogastric nerve

- L1 - to transversus abdominis, internal oblique, skin of the most inferior body wall

Describe the nerves of the lumbar plexus - genitofermoral nerve

- L1 and L2 - supplies perineum, cremaster muscle, femoral artery, skin over femoral triangle

Describe the differences between the male and female urethra.

- Male and female urethrae are different. - The male urethra is 18 to 22 cm long and divided into prostatic, membranous and spongy parts while the female urethra is only about 4 cm long. - In females, there is not an internal urethra sphincter, but the external sphincter muscles extend up to the urethra quite far. There are paraurethra glands, which are homologes of the prostate. - In male urethra, there is an internal urethral sphincter, which is involuntary, and an external urethral sphincter, which is voluntary. The proximal part of the urethra is supplied with blood by prostatic branches from the interferior vehicle in the middle rectal arteries, and blood drains into the prostatic venous plexus. The prostatic urethra of the male has several interesting internal features: - a median ridge called the urethral crest - prostatic sinuses to either side of the urethra crest - prosthetic ducts opening into the prostatic sinuses - the seminal colliculus - in the center of the colliculus the prostatic utricle which is the homolog of the vagina. - The ejaculatory ducts open into the urethra on either side of the prostatic utricle.

What are the joints of the pelvis?

- Sacroiliac joint - Pubic symphysis - Lumbosacral joint - Sacroccocygeal joint

Describe the acetabulum of the bony pelvis.

- The acetabulum consists of a semilunar articular portion and a deep, non- articular portion. - The articular surface is composed from the ilium (two-fifths); the pubis (one-fifth); and the ischium (two-fifths). - The acetabular fossa is the deep, non-articular part of the acetabulum. - This fossa opens inferiorly as the acetabular notch.

Describe the articulations of the bony pelvis.

- The articulations of the pelvis include the lumbosacral joint, sacrococcygeal joint, sacroiliac joint, and symphysis pubis. - These articulations are NOT freely moveable. Their rigidity provides stability in standing and locomotion. - In general, the morphology of the bony pelvis represents a functional compromise between locomotion and obstetrics. Changing the parameters of one function also changes the parameters of the other.

Describe the arterial supply of the urinary bladder

- The bladder is supplied by branches of the internal iliac artery. - superior vesicle artery, which is a branch of the umbilical artery - deferential artery in males, a branch of the umbilical artery - inferior vesicle arteries, which are usually branches from the middle rectal artery, but which may be replaced by vaginal arteries in the female. / - small branches from the obturator and inferior gluteal arteries may also contribute

Describe the position of the urinary bladder

- The bladder lies in the anterior portion of the true pelvis and is separated from the pubis by the rectal retropubic space. - The position in the shape of the butter very somewhat depending on how full and understanding it is. - The retropubic space is founded anteriorly by transversalis fascia and posteriorly by the endopelvoc fascia that closely invests the bladder. - Inferiorly, the space is bounded by the puboprostatic ligaments in the male. These ligaments attached the bladder via the prostate gland to the pubis. In female these ligaments are the pubovesical ligaments.

Describe the bony pelvis.

- The bony pelvis consists of the os coxae (hip bones, in English) and sacrum. - The os coxae are joined to each other anteriorly at the pubic symphysis. - Posteriorly they are joined to the sides of the sacrum. - Each ossa coxa is composed of three primary ossification centers, represented by the ilium, ischium, and pubis. All three contribute to and completely fuse in the acetabulum (hip socket, in English) some time in the second decade of life.

Describe the rectum and anal canal.

- The borders of the rectum are not sharply delineated. It begins at the third cycle vertebra, at the end of the sigmoid colon. It ends about 4 cm below and in front of the coccyx, which makes it about 12 cm long. - It is inferior and posterior to the prostate and males or the vagina and females. - The rectum is not suspended via mesentery, but is covered by peritoneum on its lateral and anterior sides for its superior third. - The rectum follows the curve of the sacrum, which reflects a sacral fracture. As it passes through the general hiatus of the pelvic diaphragm, the rectum bends posteroinferiorly, creating the perineal flexure. - The rectum does not have teniae coli, haustra, or sacculations. The teniae coli fused together and create a complete longitudinal layer of smooth muscle. - Viewed from the anterior, the rectum bins from side to side creating three transverse rectal folds. - Follow the peritoneum, the rectum is distensible, creating the rectal ampulla. - It is surrounded by loose connective tissue and is loosely attached to the sacrum. There is a rectovesical septum in males or a rectovaginal septum in females.

Describe the coccygeal plexus

- The coccygeal nerves emerge from the conus medullaris of the spinal cord. They all run inferiorly within the dural sac, exiting the spinal column through intervertebral foramina. Each exits an intervertebral foramen inferior to the pedicle of the vertebra from which it takes its name. - The coccygeal plexus is composed of branches from the ventral rami of S4 and S5, and the coccygeal ventral ramus.

Describe the urinary baldder

- The empty bladder is sort of tetrahedron shape. - The urachus is located at the Apex, while ureters enter at the posterolateral surface. The urethra begins at the neck of the bladder. The detrusor muscle of the bladder is the tunica muscularis. It consist of interlacing bundles of smooth muscle that course longitudinally, transversely, and obliquely. At the base of the bladder, and men, informs the internal urethral sphincter, which contracts involuntarily during ejaculation. - The trigone muscle is confined to the smooth trigone area on the inside of bladder. This muscle represents the continuation of longitudinal smooth muscles of the ureters. - The superior margin of the trigone is the interuteric fold. In the internal orifices of the ureters are superior and to either side. The internal urethral orifice is at the inferior aspect of the triangle. years are superior and to either side. Just superior to the urethral orifice is the uvula, a raised area which may become more prominent in men with the enlarged prostate.

How is sex determined from the pelvis?

- The female and male pelves differ in their gross morphology. - The female pelvis is on average wider in all populations of homo sapiens. - In the female pelvis the subpubic angle is wider, the ischial tuberosities point outward, the ischial spines are more everted, and the pubic symphysis is shallower. - To sex a pelvis at a glance, view the shape of the greater sciatic notch through the pelvic inlet. If the notch is rounded ("Mickey Mouse ears") it is female; if the notch is elongated ("Goofy ears") it is male.

Describe the surface anatomy of the gluteal region.

- The gluteal area is posterior to the pelvis and inferior to the level of the iliac crests and etending laterall to the posterior margin of the greater trochanter of the femur. Surface Anatomy: - The iliac crest is the curved superior borders of the ilia. The anterior one-third of each crest is subcutaneous, and thus is palpable. The posterior two-thirds of each crest is covered with fat, and so is difficult to palpate. - The hip region overlies the greater trochanter laterall, etending anteriorly to the anterior superior iliac spine (ASIS). Some anatomists consider the hip region as part of the gluteal region, but the two parts are usuall distinguished. - The intergluteal cleft is the groove that separates the left and right buttocks from each other. - The gluteal fold demarcates the inferior boundar of the buttocks and the superior boundar of the posterior thigh. - The posterior superior iliac spine (PSIS) occurs at the posterior end of the iliac crest and can be difficult to palpate. However, its position is eas to locate at the inferior border of a skin dimple. A transverse line joining each skin dimple occurs at the level of S2 and the sacroiliac joint.

Describe the oburator foramen.

- The obturator foramen is formed by the bodies and rami of the ischium and pubis. - It is round-ish in the male and triangular-ish in the female. In life it is mostly covered by the obturator membrane. - The membrane is incomplete only in its superior margin, just inferior to the obturator groove, allowing the obturator nerve and vessels to exit the pelvis and enter the thigh.

Describe the sacral plexus.

- The sacral nerves emerge from the conus medullaris of the spinal cord. They all run inferiorly within the dural sac, exiting the spinal column through intervertebral foramina. Each exits an intervertebral foramen inferior to the pedicle of the vertebra from which it takes its name. - The sacral plexus is composed of part of spinal nerve L4, L5-S5, and part of C1. Part of L4 and all of L5 combine to form the lumbosacral trunk, which descends into the false pelvis. Nerves of the sacral plexus are: - sciatic nerve - braches are tibial nerve and common peroneal (common fibular) nerve - pudendal nerve - nerve to quadratus femoris - nerve to obturator internus - superior gluteal nerve - inferior gluteal nerve - posterior femoral cutaneous nerve - muscular branches of levator ani, coccygeus, and sphincter ani externus - pelvic splanchnic nerves

Describe the course of the ductus deferens

- duct is continuous with the epididmis - sometimes called the vas deferens or deferent duct - has thick, muscular walls and a proportionall small lumen.

Describe the sacrum.

- The sacrum consists of five fused sacral vertebrae and is sort of triangular. It is concave anteriorly and convex posteriorly. It has a sacral canal continuous with the vertebral canal of the vertebrae superior to it. - Pelvic surface: sacral promontory, transverse ridges, and pelvic sacral foramina - Dorsal surface: median sacral crest, intermediate sacral crests, lateral sacral crests, and dorsal sacral foramina - Lateral surface: auricular surface and attachments of the dorsal sacraliliac ligaments - Superior surface

Describe the anatomy and process of ejaculation.

- The testes produce sperm, which passes through eferrent ductules to the epididmus, where the sperm mature. - On ejaculation, the sperm pass up through the ductus deferens. This is less than 10% of the total ejaculate by volume. - The seminal glands add a liquid that is by volume about 70% of the ejaculate, and contains fructose, a coagulant, and an immunosuppressant. - Where the duct of the seminal gland and the ductus deferens meet, the form the ejaculator duct. - Although the ejaculator duct runs through the prostate gland, prostatic fluid does not enter it. - Instead, the ejaculator duct opens into the prostatic urethra. - A large number of prostatic ducts also open into the prostatic urethra, and prostatic fluid makes up about 20% of ejaculate b volume. - It contains prostaglandin, citrate, and antigens. The ejaculate is prevented from going the wrong wa up the urethra b the internal urethral sphincter. - After it crosses the perineal membrane, it receives secretions from the bulbourethral glands, which contain acid, mucous, and antigens.

What are some measurements of the pelvic inlet?

- The true (obstetric) conjugate diameter of the pelvis is between the posterior superior pubic symphysis to the sacral promontory. - It is the narrowest inflexible dimension through which a baby's head must fit during parturition. - The transverse diameter is measured at 90 degrees to that, from the middle of the brim on one side to the other. - The oblique diameter is measured from the iliopubic eminence of one side to the sacroiliac articulation of the other side. - Average female measures are greater than average male measures.

Describe the innervation fo the uterus.

- The upper surface of the uterus is in contact with the peritoneum and therefore above the pelvic pain line, with afferents following smpathetic innervation. - The lower part is below the pelvic pain line with afferents following parasmpathetics.

Describe the superficial gluteal nerves.

- They supply the skin over the gluteal region, carring GSA fibers. superior cluneal nerves: - arise from the lateral cutaneous branches of the dorsal rami of L2-L3 - supply the skin of the gluteal region. middle cluneal nerves - arise from the lateral branches of the dorsal rami of S1-S3 - supply the skin and subcutaneous tissue over the sacrum and buttocks. inferior cluneal nerves - gluteal branches of posterior femoral cutaneous nerve (ventral rami of S2-S3). - supply the skin and subcutaneous tissue over the the gluteus maimus and buttocks. perforating cutaneous nerve: - arises from ventral rami of S2-S3 and passes through the sacrotuberous ligament and the inferior portion of the gluteus maimus - supplies the skin over the inferior half of the buttock and medial portion of the gluteal fold.

Describe veins of the gluteal region.

- Veins of the gluteal region join the internal iliac veins. - The superior and inferior gluteal veins the arteries through the greater sciatic foramen, and communicate with venous branches of the femoral vein. - The internal pudendal vein accompany internal pudendal arteries and join to form a single vein that drains into the internal iliac vein.

Describe the arteries of the gluteal region - internal pudendal artery

- accompanies the pudendal nerve - enters the gluteal region from the greater sciatic foramen inferior to the piriformis - re- enters the pelvis from the lesser sciatic foramen - supplies structures of the perineum, rectum, and eternal genitalia.

Describe the seminal vesicle

- also called seminal glands - do not store sperm, but the do secrete a fructose-rich compound to provide energ to sperm, and a coagulant. - lies between the fundus of the bladder and the rectum, superior to the prostate and posterior to the ureter. - The duct of the seminal vesicle joins that of the ductus deferens to form the ejaculator duct. - The ejaculatory ducts are less than 3 cm long and pass anteroinferiorl through the prostate without receiving an prostatic secretions.

Describe the nerves of the sacral plexus - nerve to piriformis

- always the dorsal division of S2 - sometimes part of the S1 dorsal division as well.

Describe the pubofemoral ligament of the hip.

- anterior and inferior articular capsule - prevents over-abduction

What are the ligaments of the pelvis?

- anterior longitudinal ligament - anterior sacrococcygeal ligament - superior pubic ligament - iliolumbar ligament - ventral (or anterior) sacroiliac ligament - sacrospinous ligament - sacrotuberous ligament - greater sciatic foramen - lesser sciatic foramen - dorsal (or posterior) sacroiliac ligament - interosseous sacroiliac ligament - posterior longitudinal ligament - dorsal sacrococcygeal ligaments - lateral sacrococcygeal ligament

Describe the joints of the pelvis - sacroiliac joint

- between the auricular surface of the ilium and sacrum. This is a synovial joint, but the rugosity of these surfaces permits only limited movement. The dorsal sacroiliac ligaments, ventral sacroiliac ligaments, and interosseous ligaments not only further limit movement on the joint, but are oriented so that weighting down the sacrum pulls the ilia tightly together against it.

Describe the joints of the pelvis - lumbosacral joint

- between the fifth lumbar and first sacral vertebrae. This is a typical vertebral joint with synovial joints and accessory ligaments. There is an iliolumbar ligament between the transverse process of the fifth lumbar vertebra to the iliac crest.

Describe the uterine tubes

- commonly referred to as oviducts or fallopian tubes. - conduct the ovum from the ovary to the uterus. - their openings are not fixed to the ovary, so for a short period after ovulation the ovum is within the peritoneal cavity. - ovum gets picked up in the fimbrae of the ends of the uterine tubes - fertiliation usuall occurs here four divisions: - infundibulum - ampulla - isthmus - uterine part - except for the ends of the infundibulum, the lie within the broad ligament.

Describe the nerves of the sacral plexus - superior gluteal nerve

- dorsal division of L4, L5, S1 - upplies gluteus medius, gluteus minimus, and tensor fasciae latae muscles.

Describe the lumbar plexus.

- emerge from the spinal cord at the lumbar enlargement. - composed of ventral rami. - composed of a branch of spinal nerve T12, nerves L1-L3, and part of L4. - emerges through the psoas major muscle Nerves of the lumbar plexus are - iliohypogastric - ilioinguinal - genitofemoral - lateral femoral cutaneous - femoral - obturator - accessory obturator - muscular branches to quadratus lumborum, psoas major, and psoas minor, and iliacus

Describe the arteries of the gluteal region - superior gluteal artery

- exits the pelvis from the greater sciatic foramen, superior to the piriformis - divides into superficial and deep branches - superficial branch supplies the gluteus maimus and little skin of the region - deep branch supplies the gluteus medius and minimus and tensor fasciae latae. - anastomoses with the inferior gluteal and circumflex femoral arteries.

Describe the lateral surface of the sacrum

- formed by fused transverse processes and costal elements Auricular surface - "ear shaped" articular surface of the sacroiliac joint. The three deep impressions just posterior to the auricular surface are for attachment of the dorsal sacroiliac ligaments.

Describe the arterial supply of the prostate gland

- from prostatic branches of the inferior vesical and middle rectal arteries. -nma also receive branches from the internal pudendal artery

Describe the nerves of the lumbar plexus - femoral nerve

- from the dorsal divisions of L2-4

Describe the nerves of the lumbar plexus - lateral femoral cutaneous nerve

- from the dorsal divisions of ventral rami of L2 and L3 - supplies parietal peritoneum in the iliac fossa, skin of the anterior and lateral thigh

Describe the nerves of the sacral plexus - muscular branches to levator ani, coccygeus, and sphincter ani externus

- from the ventral division of S4.

Describe the nerves of the lumbar plexus - obturator nerve

- from the ventral divisions of L2-4. - It runs posterior to antero-inferior across the inner surface of levator ani, exiting the pelvis through the obturator canal (the gap in the obturator membrane that otherwise closes off the obturator foramen), where it supplies the adductor muscles (except half of m. pectineus) and skin of the inner thigh. - It does not supply m. obturator internus, which is supplied by the nerve to obturator internus. - It does supply m. obturator externus.

Describe the pelvic ligament - superior pubic ligament

- one - joins the left and right pubic rami across the pubic symphysis. There is also an inferior (or arcuate) pubic ligament on the other side.

Describe the pelvic ligament - posterior longitudinal ligament

- one - runs on the posterior surfaces of the vertebral bodies, inside the vertebral canal, starting at the body of C2 and ending at the sacrum within the sacral canal.

Describe the pelvic ligament - anterior longitudinal ligament

- one ligament - the lower extent of the anterior longitudinal ligament (which starts up at C1) is on the anterior, superior aspect of the sacrum.

Describe the pelvic ligament - dorsal sacrococcygeal ligaments

- one of each - there are superficial and deep dorsal (posterior) sacrococcygeal ligaments. - The superficial one roofs the lower sacral canal, attaching the dorsal aspects of the sacrum and coccyx. - The deep ligament corresponds to the posterior longitudinal ligament, on the posterior surface of the vertebral bodies, within the sacral canal. - The filum terminale of the spinal cord runs between these two ligaments and blends with them on the body of the first coccygeal vertebra.

Describe the pelvic ligament - anterior sacrococcygeal ligament

- paired - a continuation of the anterior longitudinal ligament, although it may not be continuous with the anterior longitudinal ligament in the adult. Joins the sacrum and coccyx on their anterior aspects.

Describe the pelvic ligament - lateral sacrococcygeal ligament

- paired - completes the foramen for the 5th sacral nerve.

Describe the pelvic ligament - sacrospinous ligament

- paired - from the lateral sacrum and lateral coccyx to the ischial spine, the sacrospinous ligament divides the greater and lesser sciatic foramena. Resists rotation of the sacrum when heavily weighted (in weightlifting, for instance).

Describe the difference between "true" and "false" pelvis.

- sometimes the upper and lower parts of the pelvis are referred to as true and false pelvis true pelvis: - pelvis minor - lesser pelvis - has the pelvic brim or pelvic inlet as upper border and the pelvic outlet as a lower border. - it is curved, being longer posteriorly than it is anteriorly false pelvis: - pelvis major - greater pelvis - made of the alae of the ilium, protecting the lower abdomen, and open anteriorly - Its lower border is the pelvic brim.

Describe the iliofemoral ligament of the hip

- strongest ligament in the body. - reinforces anterior aspect of articular capsule - prevents hyperextension

Describe the pelvic inlet.

- superior pelvic aperture - a plane demarcating the false pelvis above it from the true pelvis below it. This plane passes through the sacral promontory, the ala of the sacrum, the arcuate line of the ilium, the pectineal line of the pubis, and the crest of the pubic symphysis. It is also called the pelvic brim. The visible "line" on the ilia and pubes is called the linea terminalis.

Describe the dorsal surface of the sacrum.

- the "back," convex surface of the sacrum. Erector spinae and multifidus muscles attach here. Median sacral crest - formed by the fused spinous processes Intermediate sacral crests - formed by the fused articular processes Lateral sacral crests - represent the fused ends of the transverse processes Dorsal sacral foramina - transmit dorsal (posterior) rami of spinal nerves S1-S4 from the sacral canal.

Describe the bony landmarks of the pubis - body

- the anteromedial part, including the symphysis, pubic crest, and pubic tubercle. - contains the pubic tubercle and symphysis

Describe the ductus deferens

- the ductus deferens begins at the tail of the epididymis - ascends in the spermatic cord to inguinal canal - travels through the inguinal canal into the abdomen, entering at the deep inguinal ring. - the ductus deferens is directl external to the parietal peritoneum - courses inferiorly, crosses the external iliac vessels, and enters the true pelvis - turns medially toward the bladder, crossing superior to the ureter on the posterior surface of the bladder - at its end, it enlarges to form the ampulla of the ductus deferens, then narrows and joins the duct of the seminal vesicle to form the ejaculatory duct

Describe the ovaries.

- the female gonads - endocrine glands. - attached to the uterus by the ovarian ligament - ovarian vessels and nerves run within the suspensory ligament of the ovary, which makes up the lateral part of the mesovarium of the broad ligament. - the ovarian artery is a branch of the abdominal aorta. - innervation is from the ovarian and uterine plexuses. - visceral afferent pain fibers follow smpathetic fibers to T11-L1 spinal ganglia.

Describe the uterus

- the normal position of the uterus is anteflexed and anteverted, so that its upper portion partially overlies the bladder, and so that it forms an angle of 100 to 110 degrees with the vagina. - It is draped with peritoneum, which forms a vesicouterine pouch anterior to it and a rectouterine pouch posterior to it. - about 7.5 cm long, 5 cm wide, and 3 cm thick in a woman who is not pregnant. - The wall of the bod of the uterus has three layers: the perimetrium, myometrium, and endometrium parts of uterus: - fundus - the rounded upper segment above the uterine tubes - body - the part that the uterine tubes enter. The vesical surface of the body is flattened, while the intestinal surface is more rounded. - isthmus - narrow part between the bod and cervix - cecum the neck of the uterus, which is narrow and opens through an osteum into the vagina. The cervix is more fibrous and less muscular than the rest of the uterus.

Describe the innervation of the vagina.

- the pelvic (superior, deep) part of the vagina is innervated differentl than the perineal (inferior, superficial) part of the vagina. - the pelvic portion is innervated through uterovaginal plexus, which is a continuation of the inferior hypogastric plexus and thus includes both smpathetic and parasmpathetic innervation. - The perineal portion has somatic innervation, supplied by branches of the pudendal nerve.

Describe the venous drainage of the prostate gland

- the prostatic plexus lies between the capsule of the prostate and its sheath, and drains into the internal iliac vein. - superiorly, it is connected to the vesical venous plexus - posteriorly, it communicates with the internal vertebral venous plexus - deep dorsal vein of the penis drains into the prostatic plexus.

Describe the vagina

- the vagina connects the uterine cavit to the exterior. - It is muscular and capable of a great deal of distension. - most of the vagina is above the pelvic diaphragm - usually collapsed so that the anterior and posterior walls are in contact with each other. - oriented somewhat antero-posteriorly, and meets the cervix at an oblique angle. - The cervix protrudes slightly into the vagina, creating the fornices. At its superficial end, it opens into the vaginal vestibule posterior to the opening of the urethra. - The vagina lies posterior to the fundus of the bladder and the urethra, and is connected to the urethra b part of the external sphincter. - The vagina is anterior to the peritoneum of the rectouterine pouch, the ampulla of the rectum, and the perineal bod. The ureters pass laterall to either side of the vagina on their wa to the bladder.

Describe the venous drainage of the vagina.

- the vaginal venous plexus drains superiorly into the uterine plexus and the internal pudendal veins. - The deep dorsal vein of the clitoris drains into the vaginal plexus.

Describe the nerve of the sacral plexus - pelvic splanchnic nerves

- these are parasympathetic nerves, arising from S2- 4 and supplying the pelvic viscera.

Describe the bulbourethral glands of the male reproductive system.

- these lie in the deep perineal space, embedded in the external urethral sphincter. - sometimes called Cowpers glands. - lie lateral to the membranous urethra, the have 2-3 cm long ducts which open into the spong urethra. - their secretions, stimulated parasmpatheticall, make up a small fraction of seminal volume and contain acid, mucous, and antigens. - their homolog in the female are the greater vestibular glands.

Describe the pelvic surface of the sacrum.

- this is the "inside" surface, which is concave. - Sacral promontory - ridge on the anterior and superior edge of the body of the first sacral vertebra. - Transverse ridges - areas of fusion between the bodies of the vertebrae. - Pelvic sacral foramina - communicate with the sacral canal, through the intervertebral foramina. Ventral (anterior) rami of the spinal nerves S1-S4 exit through these.

Describe the joints of the pelvis - pubic symphysis

-The median articulation between the left and right pubic bones. The rugose articular surfaces are covered with hyaline cartilage, and there is an intervening interpubic disk of fibrocartilage. The superior pubic ligament crosses the symphysis, attaching to the pubic tubercles on either side. The arcuate pubic ligament crosses the joint inferiorly.

What are the bony landmarks of the ilium?

1. Ala and body 2. Anterior superior iliac spine 3. Anterior inferior iliac spine 4. Tuberosity 5. Posterior superior iliac spine 6. Auricular surface 7. Posterior inferior iliac spine 8. Greater sciatic notch 9. Arcuate line

Describe the musculature associated with the anal canal.

The anal canal is entirely below the pelvic diaphragm. It is only about 2 1/2 to 3 1/2 cm long. It has internal and external centers. - The internal sphincter ani muscle is a thickening of the inner circular layer of the muscle of the rectum. It is separated from the external sphincter ani muscle by the outer longitudinal layer of muscle. - The external sphincter ani muscle has subcutaneous, superficial, and deep parts. It is innervated by the inferior rectal nerves branching from the pudendal nerve.

Describe the bony landmark of the ilium - anterior superior iliac spine (ASIS)

The attachment point of the lateral end of the inguinal ligament. The sartorius muscle originates just inferior to it, on the anterior border of the ilium

Describe the bony landmark of the ilium - ala and body

The body of the ilium is the thick part close to the acetabulum. The ala, ("wing" in Latin) is the thin part curving up to the iliac crest. The internal surface of the ala forms the iliac fossa.

broad ligament of the uterus

The broad ligament is a laer of peritoneum draping over the uterus. It is in effect a mesenter of the uterus.

Describe the male reproductive system.

The male reproductive sstem includes not onl the pelvic viscera, but the testes and epididmis, which begin development in the abdominal cavit and descend through the inguinal canal into the scrotum before birth.

Describe the superior surface of the sacrum.

The sacral vertebrae have large, oval bodies (centra) and the first is separated from the fifth lumbar vertebra by a thick intervertebral disk. Extending from either side of the first sacral vertebra are the alae, which are formed from the fused costal and transverse processes of the first sacral vertebra.

Describe the ureter

The ureters are muscular, and peristalsis moves urine into the bladder. They are 25 to 30 cm long.

Describe the arterial supply of the ureter

The ureters receive their blood supply from small branches of the common iliacs - The deferential and the inferior vesicle arteries. In the female, the ureters are supplied by a ureteric branch from the uterine artery. The arteries anastomosis along the length of each ureter

Describe the muscles of the gluteal region.

There are superficial and deep muscle groups in the gluteal region. Superficial muscles - All have proximal attachments to the posterolateral surface and margins of the ala of the ilium. - gluteus maximus, gluteus medius, gluteus minimis, and tensor fasciae latae muscles Deep muscles - All are short rotators of the hip attaching to the trochanteric fossa. They all rotate the femur laterally - priformis, triceps coxae (tricipital), obturator internus, obturator externus, superior gemellus, and inferior gemellus muscle Quadratus femoris muscle

Describe the venous drainage of the pelvis.

They surrounding the public viscera form venous plexuses, which are principally drained through the internal iliac veins, which are posteroinferior to the internal iliac arteries. - In general, the tributary veins follow the arteries and are named like them, except when there's no umbilical vein. - Other routes of venous drainage are the median sacral vein, the superior rectal vein, the vertebral venous plexus, and the ovarian veins. - Anastomosis between the superior rectal vein ans the inferior rectal vein allows drainage of portal blood to the heart if the liver is blocked. - The pelvic surface of the greater pelvis is drained by the iliolumbar veins, which usually unite with the common iliac veins.

Describe the lymphatic drainage of different pelvic structures.

lower ureter -> common iliac, external iliac, or internal iliac bladder -> all or mostl to external iliac urethra in female, prostatic and membranous urethra in male -> internal iliac nodes rectum -> internal iliac nodes ovar or testis -> lateral aortic and preaortic prostate gland -> internal iliac, sacral, and external iliac nodes glans penis or clitoridis, spong urethra in the male -> deep inguinal nodes upper bod of the uterus -> lateral aortic and preaortic, some external iliac isthmus of the uterus -> superficial inguinal nodes, following round ligament lower bod and cervix of uterus -> external iliac, internal iliac, rectal and sacral upper part of vagina -> internal and external iliac lower part of vagina -> internal iliac vestibule of the vagina -> superficial inguinal (not including clitoris, which drains to deep inguinal nodes)

mesosalpinx

part of the broad ligament attached to the uterine tube, the mesovarium, the suspensor ligament of the ovar, and the ovarian ligament

Describe the prostate gland.

produces prostatic fluid, which contains compounds that activate sperm and composes about 20% of the volume of semen. - inferior to the bladder and rests on the perineal membrane. - ampulla of rectum is immediately posterior to the prostate gland. - about two-thirds of the prostate is glandular tissue, which produces prostatic fluid. - the rest is fibromuscular - part of the prostate related to the bladder is the base - also has an apex. - prostatic fluid leaves the prostate through man (20-30) small prostatic ducts, which open into the prostatic sinuses in the prostatic urethra. The prostate gland is described as having 5 lobes - Two lateral lobes - lateral to the ejaculator ducts and the urethra. - Anterior lobe - located anterior to the urethra, primaril muscular, and also termed the isthmus. This is fibromuscular, rather than glandular. - Middle lobe - superior to the ejaculator ducts and posterior to the urethra. This may become enlarged, resulting in a prominent uvula in the bladder. - Posterior lobe posterior to the urethra and posterior to the ejaculator ducts, the primar site of prostatic carcinoma. This lobe is palpable in a digital rectal exam.

Describe the bony landmark of the ilium - arcuate line

runs from the articulation with the sacrum (auricular surface) to the pecten pubis or pectinate line, on the medial surface of os coxa.

Describe the deep nerves of the gluteal region.

sciatic nerve: - largest nerve of the body - arises from the ventral rami of L4-S3 and runs through the greater sciatic foramen. - runs along the deep surface of the piriformis muscle near its inferior edge, inferolaterally and deep to the gluteus muscle, between the greater trochanter and ischial tuberosity, and superficial to the obturator internus and quadratus femoris muscles. - it is so large that it has its own arterial supply, a branch of the (inferior gluteal artery ). - It does not suppl muscles in the gluteal region. posterior femoral cutaneous nerve: - arises from S1-S3. - exits the pelvis with the inferior gluteal and sciatic nerves. - passes through the greater sciatic foramen inferior to the piriformis muscle and deep to the gluteus maimus. - carries GSA fibers to skin of the perineum and of the posterior thigh. superior gluteal nerve: - arises from the posterior divisions of the ventral rami of L4-S1. divides into a superior branch that supplies the gluteus medius and an inferior branch that supplies the gluteus medius, gluteus minimus, and tensor of the fasciae latae. - exits the pelvis from the greater sciatic foramen. inferior gluteal nerve: - arises from the posterior divisions of the ventral rami of L5-S2. - exits the pelvis from the greater sciatic foramen, inferior to the piriformis and superficial to the sciatic nerve, then divides into numerous branches that suppl the overling gluteus maimus muscle. nerve to the quadratus femoris: - arises from the anterior divisions of the ventral rami of L4-S1 - exits the pelvis through the greater sciatic foramen anterior to the sciatic nerve and obturator internus, passing over the posterior surface of the hip. - innervates the inferior gemellus and quadratus femoris. ** An articular branch supplies the hip joint.* pudendal nerve: - arises from the anterior divisions of the ventral rami of S2- S4 - passes through the greater sciatic foramen, but re-enters the pelvis from the lesser sciatic foramen. - the most medial structure to eit the foramen. - descends inferior to the piriformis, posterolateral to the sacrospinous ligament, and enters the perineum through the lesser sciatic foramen. - carries GSA and GSE to structures of the perineum, rectum, and eternal genitalia. nerve to the obturator internus: - arises from the anterior divisions of the ventral rami of L5-S2 - exits the pelvis from the greater sciatic foramen, paralleling the course of the pudendal nerve. - winds around the base of the ischial spine and supplies the superior gemellus - re-enters the pelvis from the lesser sciatic foramen (posterior to the ischial spine) - supplies the obturator internus muscle.

Describe the innervation of the seminal vesical

smpathetic and parasmpathetic from the inferior hpogastric plexus.

Describe the innervation of the prostate glands

smpathetic and parasmpathetic from the inferior hypogastric plexus

Describe the bony landmark of the ilium - auricular surface

the articular surface with the sacrum. Although the joint between the sacrum and the ilium is synovial, the roughness of this surface is one indication that there isn't movement on it.

Describe the epydidymis

the epididmis is connected to the testis b efferent ductules, through which sperm pass. Cellular maturation of sperm occurs within the epididmis. The epididmis is also connected to the ductus deferens.