Pelvis and Perineum: GIOBUNNNYY, super simple lang ng notes ko.

Hope it helps kahit di detailed and di siya complete :D A. Pelvis and Pelvic Cavity Pelvic Wall: Formed by Pelvic Girdle Pelvic/ Hip Bone: Ilium+Ischium+Pubis Sacroiliac joint: Syndesmosis; attached to iliac tuberosity Pubic Symphysis: Synovial; auricular surface Triradiate Cartilage: separates childs hip bone at acetabulum *Pelvic bone of children is separate until puberty Ilium: Arcuate Line: part of linea terminalis below auricular surface *Linea Terminalis: Arcuate line+pectineal line+pubic crest Ischium: Ischial tuberosity: rough surface behind inferior rami Greater sciatic notch: between PIIS+ ischial spine Pubis: Pectineal Line: continuation of arcuate line Subpubic line: assessment for vaginal delivery Sacrum: Sacral Promontory Coccyx: CLINICAL: Coccydenia: painful coccyx; fracture of coccyx Pelvic Fracture: 2 fractures for displacement/ instability Divisions of Pelvis Greater (False) Pelvis Superior to pelvic inlet Borders: Iliac alae; S1 y Pelvic Inlet/ brim Borders: Promontory+ ala of sacrum

Linea Terminalis Symphysis Pubis Lesser (true) Pelvis Between pelvic inlet and outlet Surfaces of hip bone and coccyx Divided by pelvic diaphragm into pelvic cavity proper and perineum y Pelvic Outlet/ Inferior pubic aperture Tip of coccyx Sacrotuberous Ligament Ischial Tuberosities Pubic Arch CLINICAL: Pelvic Diameters and Conjugates Pelvic Inlet Diameters: Anteroposterior: from pubic symphysis to sacral promontory True Conjugate Obstetric Conjugate: smallest Diagonal conjugate: External measurement Transverse: measurement of pelvic inlet using widest part of linea terminalis Oblique: left/ right; use sacroiliac joint Midpelvis: Plane of greatest dimension Diameters: Anteroposterior: IV disc bet S2-3 to the midpoint of pubic symphysis Transverse: midpoint between obturator foramen

Plane of least dimension

Diameters: Anteroposterior: Anatomical: tip of coccyx to tip of pubic symphysis Transverse/ Bispinous: smallest diameter, bet ischial spines Variations in Male/ Female Pelvis Gynecoid (for females): wide Anteroposterior and transverse diameters Android (for males): small diameters; <3 shaped Anthropoid: contracted transverse diameter Platypelliod: contracted anteroposterior diameter Subpubic angle: Female: > 85 Male: <70 Pelvic Axis: Central point of pelvic cavity Directed downward and posterior Directed downward and anterior Anatomical Position of Pelvis ASIS+ anterior aspect of pubic symphysis lie in the same angle. Symphysis pubis faces posteriorly and backward Pelvic Foramina Pudendal nerve supplies perineum by going through the Greater sciatic Foramen then reenters through the lesser sciatic foramen Obturator nerve exits pelvic cavity via obturator canal to supply mid thigh muscles

Sacroiliac: synovial (auricular)+syndesmosis (tuberosity) Ligaments: Anterior Sacroiliac Interosseous Posterior Sacroiliac Sacrotuberous Sacrospinous Sacrococcygeal Anterior Sacrococcygeal ligament Lateral Sacrococcygeal ligament Posterior Sacrococcygeal ligament Pubic Symphysis: fibrocartilage; interpubic disc Ligaments: Superior interpubic Inferior (arcuate) interpubic Pelvic Wall Muscles: Obturator Internus: exits via Lesser Sciatic Foramen Piriformis: exits via Greater Sciatic Foramen Pelvic Floor Muscles: incomplete anteriorly for urethra and vagina; below pelvic diaphragm= perineum Levator ani: originates from obturator fascia thickening (body of pubis-ischial spine) Anterior fibers: surrounds prostate and vaginal sphincter Intermediate fibers: Puborectalis: Surrounds rectum; holds feces in rectum Pubococcygeus Posterior fibers: Iliococcygeus Perineal Body: anterior connection between puborectalis muscles Posterior connection: anococcygeal ligament

Pelvic joints

Pelvic Cavity: contains distal ureter and urinary bladder, rectum and pelvic genital organs Borders: Superiorly: Pelvic Inlet Inferiorly: Pelvic Floor Posteriorly: Sacrum, coccyx, piriformis Anteriorly: Pubic bone, symphysis Laterally: Hip bone, obturator membrane, internus muscle Pelvic Fascia: Membranous: continuous with transversallis fascia Parietal: covers the wall Visceral: covers the organs inside the pelvis cavity Endopelvic: between parietal and visceral membranous fascia; fatty Pelvic Peritoneum: continuation of parietal peritoneum into the pelvic cavity but doesnt reach the pelvic floor Peritoneal Recess: Depressions of the pelvic peritoneum Peritoneal Reflections: Fascia goes back/ folds on itself Supervesical Fossa: above urinary bladder and connected to abdominal wall Pararectal Fossa: Surrounds rectum Pouches: Male: Rectovesical Female: Uterovesical pouch: uterus/bladder Rectouterine pouch (Douglas Pouch): rectum/ uterus; blood accumulation= sign for ectopic pregnancy Rectovesical: rectum/bladder; only possible after hysterodectomy( removal of uterus)

Pelvic Viscera Urinary Bladder: Posterior to pubic bones separated by potential space ( retropubic space of Retzius) Detrussor Muscle Urethral Orifice/ Surface Uretral Orifice Bladder Trigone: triangular smooth surface of bladder Internal urethral sphincter: involuntary; thickening of muscle in the bladder neck External urethral sphincter: motor Sympathetic: T10-12; Pelvic and Hypogastric Plexus Motor to external sphincter Inhibitory to detrussor and internal Sphincter Parasympathetic: Responsible for micturation S2-S4; Pelvic Splanchnic nerves and Inferior Hypogastric Plexus CLINICAL Catheter: > Rectum: Superior 3rd covered by peritoneum Innervated by S3 Spread tenia coli Abscence of fatty appendices Flexures: Anterior Sacral Anarectel: 800 angulation to hold poop Lateral (valve of Houston) Superior Left Inferior Intermediate: Right Rectal Ampulla: stores feces CLINICAL: Digital Rectal Exam: for prostatic enlargement

Arteries: Internal Iliac: main blood supply of pelvic cavity Anterior Division: (IIOUVM) Umbilical: distal portion medial umbilical ligament proximal portion superior vesical artery Obturator: passes obturator canal Inferior Vesical (males) Uterine/ Ductus Deferens Vaginal (female) Middle Rectal Inferior Pudendal Inferior Rectal: supplies perineum Inferior Gluteal Posterior Division: Iliolumbar Lateral Sacral Superior Gluteal: direct continuation Ovarian Median Sacral: from Aorta Superior Sacral: from Inferior Mesenteric Blood supply of Rectum: Inferior Mesenteric Artery Superior Rectal Internal Iliac Artery Middle Rectal Inferior Pudendal Inferior Rectal; middle sacral Blood Supply of Bladder: Umbilical: Superior vesical Internal Iliac: Inferior Vesical: also supplies prostate Venous Plexus Caval Circulation: directly to IVC via Internal Iliac Vein Portal Circulation: passes thru liver via Superior Rectal Vein inferior Mesenteric Vein Internal vertebral: drains vertebrae via Lateral Sacral vein

Venous drainage of Rectum Superior Rectal IMV (PORTAL) Middle Rectal Internal Iliac CAVAL Inferior Rectal Inferior Pudendal Venous Drainage of Bladder Vesical Venous Plexus Internal Iliac (Caval) Pelvic Nerves: Lumbosacral and Coccygeal Spinal Nerves: Somatosensory; supplies skin Sacral Sympathetic Periarterial Hypogastric

B. Perineum Standing position:Narrow region between the thighs Abducted Legs: *center of diamond= perineal body Urogential Triangle Anal Triangle

Anal Triangle: Contents: Ischioanal fossa: wedged space beside anal Canal Alcocks Canal: Contains Internal Pudendal Nerve Anal canal: Rectal Ampulla Anus External Sphincter: Deep Superficial: Nerve to Levator Ani Subcutaneous: Nerve to Levator Ani + Inferior Rectal Nerve

Columns of Morgagni: Proximal: Anorectal Line

Distal: Pectinate and Dentate line Transitional Zone Anoderm: Below dentate line Pecten: From dentate line to anocutaneous line Anocutaneous line: non keratinizing to keartinizing Corrugator cutis ani muscle: Surgical canal: anorectal line to anal opening Anatomical canal: dentate line to anal opening