Pelvis

Slide 5-7

Special thanks to:

Nabilah

Nur Atiqah

Nur Farahin

Amirah Labibah

‫بسم هللا الرحمن الرحيم‬

The anorectal ring is formed by the internal sphincter and deep part of
external anal sphincter and puborectalis. It surrounds the junction of
rectum and anal canal, pulling them forward at an acute angle,
anteriorly to the pubic bone.
URETER

It is a muscular tube extends from kidney to posterior surface

of bladder.Its length is 25 cm (very important).

Its course in the pelvis is as follow (very important)

Crosses over pelvic inlet infront of bifurcation of common iliac artery

Infront of internal iliac art Runs downward&backward

Behind ovary region of ischial spine

Beneath broad ligament turns forward &medially

Crossed by uterine tube runs forward lateral to lateral fornix of vagina

Enters the posterior surface of bladder

At the beginning, in front of pelvic brim, what is pelvic
brim/pelvic inlet?

What are the boundaries of pelvic inlet?

Promontory of sacrum posteriorly, the arcuate line and

iliopectineal line laterally and symphysis pubis anteriorly

(Dr repeats the course in the pelvis)

(While referring to the diagram above) The ureter. Internal iliac

artery turns downward and backward. Then, the broad ligament,
turns medially and forward and then lies lateral fornix of vagina
and enters the posterior surface of the bladder.

URINARY BLADDER

It is a hollow (empty) organ, lies in the pelvis. Its capacity is

500 ml. Its shape depend on the amount of urine. Empty
bladder is pyramidal in shape. Full bladder is ovoid in shape.
It has apex – base (posterior surface) –superior surface.(2)
inferolateral surfaces—neck. Apex lies behind the symphysis
pubis, it is connected to umbilicus by median umbilical ligament.
Base (posterior surface) is separated from rectum by vagina.
Superior surface is related to uterovesical pouch of
peritoneum. Part of the peritoneum lies to the vesical, what is the
meaning of vesical?

Vesical=bladder

This pouch (uterovesical pouch) separates between bladder and

the uterus.

(No need to know the relation of inferolateral surfaces)

Neck sits or rests on upper surface of urogenital diaphragm.

What is urogenital diaphragm?

Ok, as7al, what is pelvic diaphragm?

Floor of pelvic cavity formed by 2 muscles; levator ani muscle and
coccygeus muscle. This pelvic diaphragm divide the pelvic cavity
into superior compartment and the inferior compartment.

Superior compartment is perineum, inferior compartment is the

proper ventricle (?) or the main ventricle (?). So neck lies or sits
on the urogenital diaphragm is held in its position by pubovesical
ligament which is the thickening of the pelvic fascia. Mucous
membrane of the bladder, the lining interior of the bladder or
the mucous membrane of the linings of the bladder has a hilum(?)
and these fold of mucous membrane are called the rugea. The
fold of the mucous membrane of lining interior of the bladder is
called the rugea except one region and this region is called the
trigone.

Trigone is a triangular area (from its name), lies on the posterior

surface of the bladder. Posterior surface of bladder is bounded
by 2 urethral orifices above, the one urethral orifice below, this
is called the trigone. The mucous membrane of trigone is smooth
because it is attached to the underlying structure. While the
other part of the bladder has transverse fold and these folds are
called the rugea. Ok don’t forget rugea, if you would to remember
rugea, what’s name similar to rugea, who can tell me? Yes very
good, rugae of the stomach. We have another rugea, I will talk
about it.

Ok. Vagina, there are two. Er, the rugea of vagina, the rugea of
the stomach, the rugea of the bladder. And if you forget rugea,
how you can remember rugea? You can remember ruby, it’s similar
(Dr is just joking).

The mucous lining of trigone is smooth as I told you because

there is underlying structure. The two superior angle of the
trigone are the opening of urethral orifice, while the inferior
angle of this triangular is the urethral orifice. Trigone is limited
by above by muscular ridge called interuretic ridge. The ridge
which lies between two uretic openings. This ridge is called
interuretic ridge.

Uvula vesicae is a small elevation lies behind the urethral orifice.

The muscular cord of bladder composed of interlacing, what’s the
meaning of interlacing? Interlacing, a network of fiber. And these
interlacing muscle fiber are called the detrusor muscle, detrusor
muscle. OK? So, we have two muscles. I’ve talked about the
cutaneous muscle in the scrotum which is called the Dartos
muscle. Ok, and this one is called the detrusor muscle, the muscle
of the bladder wall.

At the neck, circular smooth muscle fiber called the sphincter

vesicae, vesicae bladder, sphincter vesicae.
Blood supply of the bladder by superior and inferior vesical
artery which are branches from the internal iliac artery. Nerve
supply by the inferior hypogastric plexus.

Sympathetic nervous system from the L1 and L2 to the

hypogastric plexus. Parasympathetic nervous system from the
S1,S2, S3 to the hypogastric plexus.

Micturation reflex is performed through the micturation reflex.

You take this in the physiology. Reflexes start when the volume
of urine is 300 ml. Impulses from the bladder wall through the S,
sacrospinal nerve no.2 , no.3, no.4, to the spinal cord to the
central nervous system and also at the same time, the impulses
from bladder wall through the afferent fibers pass to the
hypogastric plexus then to the L1, L2 to the central nervous
system. Then the orders come from the bladder wall,from the
central nervous system to the bladder wall to the afferent
fibers, from the central nervous system to the efferent fibers
through S2,S3,S4 to the inferior hypogastric plexus to the
bladder wall contract and to the sphincter vesicae and to the
urethral. sphincter vesicae to relax, these two sphincter to
relax, sphincter vesicae and urethral sphincter to relax. (this
sentence is hard to be understood, refer to the slide or the
book). Ok and at the same time send impulse to the bladder wall
to contract.

So I’m going to talk about the male urethra. It’s length is 20cm,
extends from the neck of bladder to the external urethral
meatus. It consists of three parts, first parts which lies within
the prostate. It’s length is 3cm, lies within the prostate, the
widest part of the urethra. Second part or the membranous part,
one and a half cm long lies within the urogenital diaphragm. And
penile part, it’s length is 15.5cm long, lies within the penis.

Part of urethra that lies within glans penis, dilated in the

internal part of the penile part of the penile urethral. And this
has a tissue, the widest part and this part is called fossa
terminalis. What’s the meaning of fossa? Shallow depression. And
the terminalis from end, terminal place(?). Fossa terminalis lies
within the glans of the penis, internal part at the end of penis.

Female urethra, it’s 4cm, extend from the neck of bladder to the
external meatus. It lies in front of the vagina, it can be dilated
easily. Ok? This short urethra in female leads to the urethral
infection in the female. From the 4 to 5(?) to the 7kilo(?).. so the
female is very easy to get infection from the exterior. While the
male is away from the infection but has another problem which is,
who can tell me the problem of male? Prostate.
Female, problem of female, the common problem in female is uteri. It is
very prone (x clear, tp ayt lbh krg mcm ni la) to infection, while the
common problem of male is the problem of prostate either the
infection or the prostatic swelling.
Female genital organ, ovaries, each ovary is oval in shape, attach to
broad ligament by the mesovarium. What is broad ligament? Fold of
peritoneum extend between uterus and the lateral pelvic wall. Folds of
peritoneum, this is the uterus. Ok this suppose, imagine this is the
uterus and this is folds theof peritoneum extends between the uterus
medially and the lateral pelvic wall laterally. Ok, this is called the broad
ligament.

The ovary attaches to the broad ligament by the mesovarium,

mesovarium is a fold of peritoneum, connect the ovary to the broad
ligament. This is called the mesovarium. The part of broad ligament
which extend in the mesovarium and the lateral pelvic wall is called the
suspensory ligament of ovary. So this suspensory ligament of the ovary,
part of the broad ligament which extend or lies between the ovary and
the lateral pelvic wall and this called the suspensory, what’s the
meaning of suspensory?

Suspensory ligament of the ovary is part of broad ligament which lies

or extend between the ovary and the lateral pelvic wall. The round
ligament of ovary which connects the lateral margin of the uterus and
the ovary. The round ligament of ovary is a round ligament which
connect between the lateral margin of the uterus and the ovary.

The ovary lies in a depression called the ovarian fossa..( fossa means
depression/hollow). This fossa is called the ovarian fossa, is bounded
by two vessels,internal iliac vessel and external iliac vessel. (Someone
interrupt DR,,asking him to magnify the slide..) SO the ovary lies within
the ovarian fossa and this fossa is bounded by 2 vessels; internal iliac
vessel and external iliac vessel.
However,the position of ovaries are variable. Sometimes,it goes down in
the pouch of douglas and in pregnancy it goes up in the abdominal
cavity.

DR asked,, what is pouch of douglas?

*Pouch of douglas is a form of peritoneum, lies in the rectum and the

uterus. Other name for this pouch is called rectouterine pouch. So the
ovary (section ? <xjelas>) lies in the pouch of douglas, so this push down
the ovary. So, the position of ovary is variable.

Vessels from the ovary by the ovarian artery branch from the
abdominal aorta.

Function of the ovary is formation of hormones which are estrogen and

progesterone. The other function is for formation of ova.

Diameter of the is 2cm by 4cm..

(Refer to the diagram below)

This is the ovarian fossa where the ovary lies , bounded by the internal
iliac vessel and external iliac vessel, this is the broad ligament, this one
is the round ligament of the ovary which connects the ovary and the
uterus, this is the suspensory ligament of the ovary which connects the
ovarian lateral wall of lateral pelvic wall. This mesovarium is a part of
the broad ligament which connects the ovary and the broad ligament.

(Refer to the diagram from slide)

This is pouch of Douglas. This is called rectouterine pouch. And this

pouch is called the vesicouterine pouch. This is the superior view of the
pelvis.

So now I want to talk about the uterine tube. Each uterine tube is 10
cm in length. Uterine tube lies in the upper part of the broad ligament.
It is divided to 5 regions.First is fimbria, finger like projection or
processes which pick up the ova from ovary. The second part is
infundibulum,funnel shape part. The other part which is widest part is
the ampulla. Then we have the narrowest part which called isthmus and
we have intramural part, which lies within the muscular wall of uterus.
Blood supply of uterine tube is by uterine artery, which branched from
internal iliac artery.Function of uterine tube, first is the site of
fertilization of ovum.. Where is the site of fertilization? In the widest
part, the ampulla. The second function is provides nourishment for
fertilized ovum and transports it to the cavity of the uterus.

The other part of the female genital organ is the uterus, the hollow,
pear-shaped organ and it has thick muscular wall. The diameter, very
easy to remember, 3 by 2 by 1 (inches) [length x width x thickness].
(Refer the diagram above) These are the structures of uterus, consist
of fundus, and the body and the cervix. What is the meaning of fundus,
in Arabic?

DR said, every Friday you have to go to the mosque and you see the
fundus. What is fundus? Fundus means ‘Qubbah’ or dome.. (err,,tiap2
jumaat je ke???.. :P )

The other part is the body and the cervix. So,these are the parts of
uterus which consist of; fundus,body and cervix..So how you can
differentiate between the body and the fundus??

- Any part of the uterus which lies above the opening of uterine
tube..You put the pointer here(in the diagram), you search about
the opening of uterine tube. If it is above uterine tube, you have
to say this is fundus, and if it is below, you have to say this is
body. So,the line, demarcation between the fundus and body is
opening of uterine tube. Don’t forget this. This is very important
in the practical lab.
- The cervix lies in the lower part of uterus and the body lies
below the opening of uterine tube.

You have two cavities, first one is triangular in shape (uterus) the
body,cavity or uterine cavity. And we have cervical cavity, cylindrical in
shape called cervical canal (other name for cervical cavity). The
cervical canal has two parts; vaginal part, ends with external os. What
is the meaning of os?? – Os means the opening. The other part, super
vaginal part ends superiorly by the internal os. SO the cervical canal is
part of the cervix which lies between the internal os above and the
external os below.
*Relationship, NO need to know, Ok?

The function of uterus; reception, receiving of the fertilized ovum,

implantation, then nourishment of this ovum.

Position of uterus,, called anteversion, anteflexion; two angles within

the uterus and vagina. First angle lies within uterus with the vagina
(anteversion), and another angle lies between the body of uterus and
the cervix (anteflexion). So will be like this (DR buat gaye).

So this is cervix,(refer diagram),this is body of uterus, so the angle

here between body and cervix, is called anteflexion, and the other
angle lies between uterus and the vagina below(anteversion) , it should
will be like this (DR buat gaye jugak kot) ..

Abnormally, the uterus will turn backward. This is called retroversion

and retroflexion. This condition may leads to abortion.

(Doc explain about it again in Arabic. But i don’t understand. Sorry! =.=)

Structure of uterus consists of three parts. The myometrium, muscle

of uterus. The endometrium, lining epithelium and the outer, which is
called parametrium. Myo means muscle, endometrium and parametrium.
Para means external or around. From here from the outside. Endo
from the inside. And centre of the wall of uterus called myometrium.
Ok?
Blood supply, you can see. Uterine artery branch from internal iliac
artery. Uterine vein, drain into internal illiac vein. Lymphatic vein which
is very important. From the fundus, drain into paraaortic lymph node.
para means around. And from the body and cervix into external and
internal illiac lymph node. And from round ligament of the uterus drains
into superficial inguinal lymph node.

Nerve supply for uterus by inferior hypogastric plexus. (Dr repeats the
sentence above)

Support of uterus, do you like it? This is easy. (doc ask)

NO NO.

akid?

Yesss! Of course!!!

this is normal position of uterus anteflexion and anteversion. It lies

proper(?) on the superior surface of bladder. Ok? (i cant hear it also.
Please refer to the book to know the detail about the position. Sorry
100x!)

These are the support of the uterus transverse cervical, pubocervical

and sacrocervical. (these are ligaments that support uterus. but doc
doesn’t explain about it in detailed.)

The second organ which is vagina. Its is a muscluar tube extends

upward and backward . From vulva to uterus. Upper half of vagina lies
above floor of pelvic. Pelvic floor which is also called pelvic diaphragm.
The lower half lies below the, or lies within the perineum.
The upper part of vagina is pierced by the cervix. The upper part of
vagina surround by the cervix and this is called fornices. Fornices.
What’s the meaning of fornices? Fold like this. To form a fold. The
upper part of vagina surrounded by the cervix to form fornices.

So we have four fornices. Four folds. Two lateral (right and left) and
the third one is anterior and another one is posterior. Ok? Two lateral
fornices. Anterior fornix and posterior fornix. Ok?

Vagina orifice is closed by a thin membrane. Which is called hymen. (i

cant hear the description. but this is the meaning of hymen from wiki :
Hymen is a fold of mucous membrane that surrounds or partially covers
the external vaginal opening)

ok this is vagina. You can see the upper part lies above the pelvic floor.
Lower part lies below the pelvic diaphragm.

ok?
*Relationship is not important. Leave it.

Blood supply for the vagina is vaginal artery. Which branch from the
internal illiac artery and from uterine artery. Ok? So we have two
vagina arteries. First one from the internal illiac artery and another
from the uterine artery.

Lympathic drainage. The upper third drains into the external and
internal iliac lymph node. While the middle third drains into internal
iliac lymph node. While lower third drains into the superficial inguinal
lymph node.

Nerve supply. By the inferior hypogastric plexus.

Support for vagina. Leave it. Ok?

Contents of broad ligament. This is very important. I’ve given you the
definition. Now I gave you the contents of broad ligament. We have
two vessels, two ligaments and two other things. In order to remember
it.

The two vessels are the uterine artery and ovarian artery. Two
ligaments, we have the round ligament of uterus and round ligament of
ovary. And we have two other things, number one is uterine tube and
number two is the lymph vessels.

So remember it. We have two vessels, two ligaments and two other
things. Ok?
Nerve of the pelvis.

Sacral plexus. Very important. It lies on posterior pelvic wall in front

of piriformis. It is formed by anterior(ventral) rami of the L4 and 5
and S1, 2, 3 and 4.

During the later stages of pregnancy <-- this is not important for you.
leave it. ok. yeay! :)

The anterior rami of L4 and 5 come from lumbarsacral trunk and sacral
nerves. So these are the sacral plexus ok? What is the meaning of
rami? Branch. Ok. You can say rami or branch. Anterior branch of the
L4, 5 and S1, 2, 3, 4. L4 and 5 unite together to form lumbosacral
trunk. ok.

The main nerve of these sacral plexus is sciatic nerve. Have you heard
about this? Sciatic nerve? It is the largest nerve in the body. It
supplies the muscle of the back of the thigh and the leg. The other
important nerve is the posterior cutaneous nerve of thigh which
supplies the posterior part of the back of thigh, the skin of the back
of thigh.

The other one is called pudendal nerve. Pudendal from Latin word which
means secret region. It supplies the secrete region. What is the
secrete region in the human body? Syu hia? Close, cover any of the
body, anywhere. It is the genital organ. Pudendal is genital organ. So
pudendal nerve supplies the genital organ. Which means it supplies the
genital organ.
Relation is not important. Ignore it. (weeee~)

Branches, we have talk about it.

You just need to know the main nerves. Branches that supply the lower
limb called the sciatic nerve. (I can’t hear. but he did mention
something about gluteal region. please read it from the book ok. sorry!)

Other is branch to the pelvic muscle and organs. It is the pudendal

nerve.

Now the lumbar plexus. This plexus supplies mainly the lower limb. It is
formed by ventral rami of L1, 2, 3 and 4. Branches of this plexus
emerge from lateral and medial sides of psoas major muscle and the
anterior surface of psoas muscle. Either from medial side or lateral
side. Ok.

These are the roots of lumbar plexus. from L1, 2, 3, 4.

*No comment will be entertained*

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PEMBUATAN ‘LECTURE NOTE’ NI. MOGA ALLAH MEMBALAS JASA
KALIAN DENGAN GANJARAN YG LEBIH BESAR DI AKHIRAT KELAK”

INSYAALLAH, ALLAH YUSAHHIL UMURUNA. AMIN..