HUMAN ANATOMY regional anatomy regional anatomy of pelvic changsha medical university lecture csmu lecture by an chen uploaded by Prabesh raj jamkatel pelvics

1. Pelvic
Yu Qing-ping

2. Bony pelvis
Composition: formed by paired hip
bones, sacrum, coccyx, and their
articulations
Two portions
 Greater pelvis
 Lesser pelvis
 Terminal line ( pelvic inlet): formed
by promontory of sacrum, arcuate
line, pecten pubis, pubic tubercle,
pubic crest, upper border of pubic
symphysis
 Pelvic outlet: formed by tip of
coccyx, sacrotuberous ligament,
ischial tuberosity, ramus of ischium,
inferior ramus of pubic symphysis

10. Muscles of pelvic wall
 Piriformis m.
 Obturator internus m.

11. Muscles of floor of pelvis
 Levator ani
 Levator prostate
(pubovaginalis)
 Puborectalis
 Pubococcygeus
 Iliococcygeus
 Coccygeus

12. Levator prostate
Puborectalis
Pubococcygeus
Iliococcygeus
Coccygeus
Obturator internus

14. Pelivic diaphragm
 Formed by
 Superior fascia of pelvic diaphragm
 Levator ani and coccygeus
 Inferior fascia of pelvic diaphragm
 Hiatus of pelvic diaphragm

15. pelvic diaphragm
Superior fascia
Inferior fascia

16. pelvic diaphragm

17. Pelvic fascia
Parietal pelvic fascia Lines the
pelvic walls and is regionally named
according to the muscle it overlies.
 Above the pelvic inlet, it is
continuous with the fascia lining the
abdominal walls.
 Superior fascia of pelvic diaphragm
Inferior fascia of pelvic diaphragm

18. Pelvic fascia
Visceral pelvic fascia
 A layer of loose connective tissue that
covers and supports all the pelvic viscera.
 Ensheathes retroperitoneal viscera and
forms septa between retroperitoneal
organs
 Rectovesical septum
 Rectovaginal septum
 Vesicovaginal septum

20. Spaces of pelvic fascia
 Retropubic space
 Lies between pubic symphysis
and urinary bladder
 Pararectal space
Lies around the rectum
 Retrorectal space

21. Retropubic space
Retrorectal space

22. Common iliac artery
 Continuation of abdominal
aorta at level of L4 vertebra
 Run downward and
laterally to end opposite the
sacroiliac joint by dividing
into internal and external
iliac arteries.

23. Internal iliac artery
Parietal branches
 Obturator a.
 Iliolumber a.
 Lateral sacral a.
 Superior gluteal a.
 Inferior gluteal a.
 Internal pudendal a.

25. Internal iliac artery
Visceral branches
 Umbilical a. → superior vesical
a.
 Inferior vesical a.
 Uterine a.
 Internal pudendal a.
 Inferior rectal a.

28. Internal iliac artery
 Uterine a.
－about 2cm from neck of uterus it
crosses above and in front of ureter
Water below bridge

29. Uterine a.
ureter

31. Internal iliac artery
Internal pudendal artery
 Course: leaves the pelvis through the
infrapiriform foramen and enters the
gluteal region. It enters the perineum
through the lesser sciatic foramen and
then passes forward in the pudendal
canal with the pudendal nerve.
 Branches
 Anal artery
 Perineal artery
 Dorsal artery of penis (clitoris)

32. Anal n./A
Perineal n./A.
Dorsal
n./A of
penis or
clitoris
pudendal n/A.

33. Veins of pelvis
 Internal iliac vein
 Parietal tributaries: accompany
with arteries
 Visceral tributaries
 External iliac vein–
accompany the artery
 Common iliac vein
 Formed by union of internal and
external iliac veins in front of
sacroiliac joint
 End upon L4~L5 by uniting each
other to form inferior vena cava

34. Veins of pelvis
Internal iliac vein
Parietal tributaries: accompany with arteries
 Visceral tributaries
① Rectal venous plexus →superior rectal vein→inferior mesenteric v.
→inferior rectal vein→internal iliac v.
→anal vein→internal pudendal v.
② Vesical venous plexus →vesical v.
③ Uterine venous plexus →uterine v.

35. Venogram showing the veins
of the pelvis and groin.
Contrast medium has been
injected into the bodies of
the pubic bones.

36. The lymphatic drainage of pelvis
 Internal iliac lymph node
 Surround internal iliac vessels
 Receive afferents from pelvic viscera,
perineum, buttock and back of thigh
 External iliac lymph nodes
 Lie along external iliac artery
 Receive afferents from lower limb and
some parts of pelvic viscera
 Sacral lymph node
 Common iliac lymph node
 Lie along common iliac artery
 Receive afferents from all the above
nodes
 Efferent pass to lumbar lymph node

37. Sacral plexus
 Formation:
formed by anterior rami of L4 and L5
spinal nerves (the lumbrosacral trunk)
and anterior rami of sacral and
coccygeal nerves
 Position:
lies in pelvic cavity, anterior to
sacrum and piriformis
L5
L4
S1
S2
S3
S4
S5
Co

38. It is located in the
pelvis, where it is
closely related to the
anterior surface of
the piriformis.
The position of Sacral plexus

39. It is formed by
lumbosacral trunk and
anterior branches of
sacral and coccygeal
nerves.
Ⅴ The sacral plexus

41. Sacral plexus
Branches
 Superior gluteal n.
 Inferior gluteal n.
 Posterior femoral cutaneous n.
 Pudendal n.
 Sciatic n.

42. Autonomic plexuses of plevic
 Hypogastric plexus
 Superior hypogastric plexus :
lies in front of L5 between common iliac
ateries
 Inferior hypogastric plexus (pelvic
plexus): lie on each side of rectum
 Sacral sympathetic trunk
 Is continuous above with the abdominal
part
 Has 4 or 5 ganglion

44. Superior hypogastric plexus
Inferior hypogastric plexus

46. Relations of rectum
Anteriorly in male
 Fundus of bladder
 Seminal vesicle
 Prostate
 Ampulla ductus deferentis
 Pelvic part of ureter
Anteriorly in female
 Neck of uterus
 Vagina

47. Relations of rectum
Posteriorly
 Sacrum and coccyx
 Piriformis
 Median and lateral sacral vessels
 Anterior branches of sacral and
coccygeal nerves
 Sacral sympathetic trunk and ganglion
impar
Laterally
 Pelvic plexus
 Superior and inferior rectal vessels
 Levator ani

48. Vessels and lymphatics of rectum
 Arteries
 Superior rectal a.
 Inferior rectal a.
 Median sacral a.
 Lymphatic drainge
 Pararectal ln.
 Superior → superior rectal ln.
 Inferior → internal iliac ln.
 Posterior → sacral ln.

49. Relations of urinary bladder
 Superior surface (covered by
peritoneum)
 Small intestine
 Sigmoid colon
 Body of uterus, when bladder if empty
 Posterior surface
 In males
 Seminal vesicle
 Ampulla of ductus deferens
 Rectum
 In females
 Vagina
 Neck of uterus

50. Relations of urinary bladder
 Inferolateral surfaces (devoid of
peritoneum)
 Anteriorly－retropubic pad of fat
and pubic bone
 Posteriorly －fascia overlying
obturator internus and levator ani
muscles
 Apex －pubic symphysis
 Neck (below and least mobile)
 In the male, rests of prostate and
urogenital diaphragm
 In the female,rests directly on
pelvic fascia surrounding the short
urethra

51. Relations of uterus
 Anteriorly
－ separated by vesicouterine
pouch from superior surface of
urinary bladder
 Posteriorly
－ separated by rectouterine pouch
and rectovaginal septum from
rectum

52. ★You must identify follow structures！
Male Genital Organs
 Testis
 Epididymis
 Head, body and tail of epididymis
 Ductus deferens
 Spermatic cord
 Seminal vesicle
 Prostate
 Male urethra
 Prostatic part
 Membranous part
 Cavernous part
 Subpubic curvature
 Prepubic curvature
Female Genital Organs
 Ovary
 Suspensory ligament of ovary
 Proper ligament of ovary
 Uterine tubes
 Infundibulum of uterine tube
 Ampulla of uterine tube
 Isthmus of uterine tube
 Uterus
 Fundus of uterus
 Body of uterus
 Neck of uterus
 Broad ligament of uterus
 Round ligament of uterus
 Fornix of vagina

53. ★You must identify follow structures！
 Common iliac artery
 Internal iliac artery
 Umbilical a.
 Superior vesical a.
 Inferior vesical a.
 Uterine a.
 External iliac artery
 Sacral plexus
 Obturator n.
 Obturator a.