UROGENITAL ANATOMY: STRUCTURE LIST Labs 1, 2, and 3

Total Page:16

File Type:pdf, Size:1020Kb

UROGENITAL ANATOMY: STRUCTURE LIST Labs 1, 2, and 3 UROGENITAL ANATOMY: STRUCTURE LIST Labs 1, 2, and 3 NOTE: * Indicates a structure can be identified on a cadaver in addition to a model. Red Highlighting = Lab 1 Structures Hip bones (os coxae pelvic bones) • Ilium • Ischium • Pubis Osseous Landmarks on hip bones • Pubic symphysis • Sacral promontory • Sacrum • Ischial spine • Coccyx • Ischial tuberosity • Iliac crest • Ischiopubic ramus • Anterior superior iliac spine • Pubic arch • Anterior inferior iliac spine • Pubic tubercle • Arcuate line • Acetabulum • Pectineal line • Obturator foramen • Sacral ala • Pubic symphysis Ligamentous Structures on Pelvis • Obturator membrane • Anterior & posterior sacroiliac • Sacrotuberous ligament* ligaments • Sacrospinous ligament* Pelvic foramina/spaces • Greater sciatic foramen* • Lesser sciatic foramen* • Obturator canal • Pelvic brim (pelvic inlet or superior pelvic aperture) • Pelvic outlet (inferior pelvic aperture) • Greater pelvis (false pelvis) • Lesser pelvis (true pelvis, pelvic cavity) Differentiate a male pelvis from a female pelvis Obstetrical pelvic measurements • Interspinous • Obstetrical conjugate • Transverse • Diagonal conjugate • True (anatomical) conjugate Pelvis muscles • Obturator internus • Piriformis muscle • Pelvic diaphragm (floor) • Levator ani muscles o Puborectalis o Pubococcygeus o Iliococcygeus ▪ Coccygeus muscle ▪ Tendinous arch 1 Perineum Male & Female • Urogenital triangle o Urogenital hiatus • Anal triangle o Rectal hiatus (anal aperture) • Perineal membrane • Deep perineal pouch (space) o “Fibromuscular” region (former urogenital diaphragm) o Anterior recesses of ischioanal fossa • Superficial perineal pouch (space) Posterior Abdominal Wall Muscle • Diaphragm* • Psoas major* • Quadratus lumborum* • Iliacus* Removed Kidney • Renal artery* • Renal hilum* • Renal vein* • Renal sinus* • Renal capsule* • Minor calyx* • Renal cortex* • Major calyx* • Renal medulla* • Renal pelvis* • Renal columns* • Ureter* • Renal papilla* Kidney in Situ • Right and left renal veins* • Renal fascia • Right and left renal arteries* • Perinephric space • Renal pelvis* • Perinephric fat* • Ureter (path into pelvis)* Bladder • Opening of ureter • Internal urethral orifice* • Trigone • Apex* • Base (Fundus)* • Body* • Urachus (median umbilical fold) * • Detrusor muscle * o Contraction (emptying): parasympathetic via pelvic splanchnic nerves (S2-S4) o Relaxation (filling): sympathetic (T11-L2) • Internal urethral sphincter (Male) o Contraction: (filling): sympathetic (T11-L2) o Relaxation (emptying): parasympathetic via pelvic splanchnic nerves (S2-S4) Peritoneal Cavity Spaces • Rectouterine pouch* (female only) • Vesicouterine pouch* (female only) • Pararectal fossae* • Paravesical fossa* • Rectovesical 2 Lumbar Plexus Nerves: • Iliohypogastric*: o Sensory to posterolateral gluteal region and pubic region o Motor to transversus abdominis and internal abdominal oblique muscles • Ilioinguinal* o Motor to transversus abdominis and internal abdominal oblique muscles o Sensory • Men: sensory to the upper medial thigh, the root of the penis, the anterior scrotum • Women: sensory to the upper medial thigh, the mons pubis, and labia majora. • Genitofemoral nerve o Femoral branch*: sensory to skin in the upper anterior thigh o Genital branch* • Men: innervates the cremaster muscle and terminates in the skin of the upper anterior scrotum • Women: accompanies the round ligament of the uterus and terminates/innervates skin of the mons pubis and labia majora • Obturator nerve* o Motor innervation to muscles of the medial compartment of the thigh and sensory innervation to a small area of the medial thigh. • Lateral femoral cutaneous nerve of the thigh*: sensory innervation to the skin across the anterior and lateral region of the thigh • Lumbosacral trunk: L4 and L5 contribution to lumbosacral plexus • Pudendal nerve*: o Inferior rectal nerve*: skin in the perianal area, mucosa of the lower half of the anal canal, and the external anal sphincter o Dorsal nerve of the penis (males) or clitoris (females). • Perineal nerve*: innervates the muscles of the superficial perineal pouch (bulbospongiosus, ischiocavernosus, superficial transverse perineal, and external urethral sphincter) and the skin of the posterior scrotum in males and the labia majora in females. CT Abdomen/Pelvis • Kidney • Aorta • Psoas major m. • Common iliac arteries • Iliacus m. • Inferior vena cava • Quadratus lumborum m. • Common iliac veins • Ureter • Renal arteries • Bladder • Renal veins • Iliac Arteries • Common iliac artery* • External iliac artery* • Internal iliac artery* • Superior gluteal a.*: muscle and skin of the gluteal region and muscles and bones of the pelvic wall • Umbilical a.*: patent and fibrous portions • Superior vesical a. *: supplies the superior bladder and the distal ureter. • Obturator a. *: supplies the medial compartment of the thigh 3 • Uterine a.*: supplies the uterus • Inferior vesical a.* (male): supplies the bladder, ureter, seminal vesical, and prostate • Vaginal a.* (female): vagina and parts of the bladder • Middle rectal a.: supplies the rectum • Inferior gluteal a.*: contributes blood supply to the gluteal region • Internal pudendal a.*: primary blood supply of the perineum, which includes the erectile tissue of the penis and clitoris FEMALE REPRODUCTIVE STRUCTURES Structures of superficial perineal pouch (space) • Muscles: innervated by (deep) perineal branch of pudendal nerve o Bulbospongiosus o Ischiocavernosus o superficial transverse perineal muscle o Perineal body • Clitoris o Crura of clitoris (surrounded by ischiocavernosus m.) o Root (bisected pelvis model) o Body (bisected pelvis model) o Glans* o Prepuce* o Frenulum* • Bulb of vestibule (surrounded by bulbospongiosus) • Greater vestibular gland Vulva • Mons pubis* • Labia majora* • Labia minora* • Vestibule* o Vaginal orifice o Urethral orifice and urethra* Reproductive Tract/Organs • Vagina* o Posterior, Anterior, and lateral fornices • Uterus* o Body* o Fundus* o Isthmus o Cervix* o Cervical canal • Internal os • External os o Normal uterine position • Anterverted • Anteflexed 4 • Uterine (Fallopian) tube o Infundibulum* o Fimbriae* o Ampulla* o Isthmus* o Uterine portion Ligaments • Round ligament of uterus* • Ligament of ovary* • Broad ligament o Mesosalpinx* o Mosovarium* o Mesometrium* • Suspensory ligament of ovary (infundibulopelvic ligament) * o Ovarian artery* o Ovarian vein (termination point of right versus left)* MALE REPRODUCTIVE STRUCTURES Penis regions • Root • Glans* • Body* • Corona (of glans) * Penis erectile tissue • Corpora cavernosa* • Corpus spongiosum* Penis connective tissue layers • Superficial (dartos) fascia • Tunica Albuginea surrounding corpus • Deep (Buck's) fascia* cavernosum* Penis vessels and nerves • Deep dorsal vein* • Dorsal arteries * • Dorsal nerve (branch of pudendal nerve) * • Deep arteries (of penis) • Root of penis o Bulb of penis (surrounded by bulbospongiosus m.) o Bulbospongiosus muscle: innervated by (deep) perineal branch pudendal nerve o Crura of penis (surrounded by ischiocavernosus m. o Ischiocavernosus muscle: innervated by (deep) perineal branch pudendal nerve. Male Urethra • Intramural (preprostatic) urethra • Membranous urethra • Prostatic urethra* • Spongy urethra* • External urethral sphincter • External urethral orifice* o Innervation: pudendal nerve S2- S4 5 Glands • Prostate gland* o Ejaculatory duct o Prostatic urethra* • Seminal gland* • Bulbourethral (Cowper's) gland Testicular Blood Supply/Ductus Deferens • Testicular artery in abdomen/pelvis • Testicular vein (termination point of right versus left) * • Ductus (vas) deferens * ▪ Ampulla* Inguinal canal* • Deep inguinal ring* • Superficial inguinal ring* Spermatic cord • Cremaster muscle: innervated by genital branch genitofemoral (genital branch courses through deep ring, inguinal canal, and superficial ring. o Cremaster reflex • Afferent: ilioinguinal/femoral of genitofemoral • Efferent: genital of genitofemoral • Layers of abdominal wall from which spermatic cord layers are derived o External oblique aponeurosis* = external spermatic fascia o Internal abdominal oblique muscle and fascia* = cremaster muscle and fascia o Transversalis fascia = internal spermatic fascia • Testicular artery* • Pampiniform venous plexus* Scrotum • Testis* • Tunica vaginalis* o Visceral layer* o Parietal layer* • Epididymis* o Tail* o Body* o Head* 6 .
Recommended publications
  • 1 Male Checklist Male Reproductive System Components of the Male
    Male Checklist Male Reproductive System Components of the male Testes; accessory glands and ducts; the penis; and reproductive system the scrotum. Functions of the male The male reproductive system produces sperm cells that reproductive system can be transferred to the female, resulting in fertilization and the formation of a new individual. It also produces sex hormones responsible for the normal development of the adult male body and sexual behavior. Penis The penis functions as the common outlet for semen (sperm cells and glandular secretions) and urine. The penis is also the male copulatory organ, containing tissue that can fill with blood resulting in erection of the penis. Prepuce A fold of skin over the distal end of the penis. Circumcision is the surgical removal of the prepuce. Corpus spongiosum A spongy body consisting of erectile tissue. It surrounds the urethra. Sexual excitement can cause erectile tissue to fill with blood. As a result, the penis becomes erect. Glans penis The expanded, distal end of the corpus spongiosum. It is also called the head of the penis. Bulb of the penis The proximal end of the corpus spongiosum. Bulbospongiosus muscle One of two skeletal muscles surrounding the bulb of the penis. At the end of urination, contraction of the bulbospongiosus muscles forces any remaining urine out of the urethra. During ejaculation, contractions of the bulbospongiosus muscles ejects semen from the penis. Contraction of the bulbospongiosus muscles compresses the corpus spongiosum, helping to maintain an erection. Corpus cavernosum One of two spongy bodies consisting of erectile tissue that (pl., corpora cavernosa) form the sides and front of the penis.
    [Show full text]
  • Anterior Abdominal Wall (Continue)
    Anterior rami (T7 – L1) . T7-T11 called intercostal nerves. T12 called subcostal nerve. L1 through lumber plexus i.e. ilio inguinal & ilio hypogastric nerves T7……. Epigastrum T10……Umblicus L1…Above inguinal ligament & symphysis pubis. Arterial: Upper mid line: superior epigastric artery (internal thoracic artery). Lower mid line: inferior epigastric artery (external iliac artery). Flanks: supplied by branches from intercostal artery, lumbar artery & deep circumflex iliac artery. Venous: all venous blood collected into a plexus of veins that radiate from umbilicus toward: : Above : to lateral thoracic vein then to axillary vein. Below : to superficial epigastric & greater saphenous veins then to femoral vein. Lymphatic Of Anterior abdominal Wall: Above umbilicus : drain into anterior axillary lymph nodes. Below umbilicus: drain in to superficial inguinal nodes 1)External oblique muscle. 2) Internal oblique muscle. 3) Transversus abdominis 4)Rectus abdominis. 5) Pyramidalis. Origin: The outer surface of lower 8 ribs then directed forward & downward to its insertion. Upper four slip interdigitate with seratus anterior muscle. Lower four slip interdigitate with latissimus dorsi muscle . Insertions: As a flat aponeurosis into: * Xiphoid process. * Linea alba * Pubic crest. * Pubic tubercle. * Anterior half of iliac crest . Internal Oblique Muscle: Origin : * Lumber fascia * Anterior 2/3 of iliac crest. * Lateral 2/3 of inguinal ligament. Insertion: The fibers passes upward & foreword & inserted to lower 3 ribs & their costal cartilages, xiphoid process, linea alba & symphysis pubis. Conjoint Tendon: Form from lower tendon of internal oblique joined to similar tendon from transversus abdominis . Its is attached medially to linea alba ,pubic crest & pectineal line but has a lateral free border. The spermatic cord, as it passes below this muscle, it gains a muscular cover called " Cremaster muscle " which composed of muscle & fascia.
    [Show full text]
  • Systematic Approach to the Interpretation of Pelvis and Hip
    Volume 37 • Number 26 December 31, 2014 Systematic Approach to the Interpretation of Pelvis and Hip Radiographs: How to Avoid Common Diagnostic Errors Through a Checklist Approach MAJ Matthew Minor, MD, and COL (Ret) Liem T. Bui-Mansfi eld, MD After participating in this activity, the diagnostic radiologist will be better able to identify the anatomical landmarks of the pelvis and hip on radiography, and become familiar with a systematic approach to the radiographic interpretation of the hip and pelvis using a checklist approach. initial imaging examination for the evaluation of hip or CME Category: General Radiology Subcategory: Musculoskeletal pelvic pain should be radiography. In addition to the com- Modality: Radiography plex anatomy of the pelvis and hip, subtle imaging fi ndings often indicating signifi cant pathology can be challenging to the veteran radiologist and even more perplexing to the Key Words: Pelvis and Hip Anatomy, Radiographic Checklist novice radiologist given the paradigm shift in radiology residency education. Radiography of the pelvis and hip is a commonly ordered examination in daily clinical practice. Therefore, it is impor- tant for diagnostic radiologists to be profi cient with its inter- The initial imaging examination for the evaluation pretation. The objective of this article is to present a simple of hip or pelvic pain should be radiography. but thorough method for accurate radiographic evaluation of the pelvis and hip. With the advent of cross-sectional imaging, a shift in residency training from radiography to CT and MR imag- Systematic Approach to the Interpretation of Pelvis ing has occurred; and as a result, the art of radiographic and Hip Radiographs interpretation has suffered dramatically.
    [Show full text]
  • Female Perineum Doctors Notes Notes/Extra Explanation Please View Our Editing File Before Studying This Lecture to Check for Any Changes
    Color Code Important Female Perineum Doctors Notes Notes/Extra explanation Please view our Editing File before studying this lecture to check for any changes. Objectives At the end of the lecture, the student should be able to describe the: ✓ Boundaries of the perineum. ✓ Division of perineum into two triangles. ✓ Boundaries & Contents of anal & urogenital triangles. ✓ Lower part of Anal canal. ✓ Boundaries & contents of Ischiorectal fossa. ✓ Innervation, Blood supply and lymphatic drainage of perineum. Lecture Outline ‰ Introduction: • The trunk is divided into 4 main cavities: thoracic, abdominal, pelvic, and perineal. (see image 1) • The pelvis has an inlet and an outlet. (see image 2) The lowest part of the pelvic outlet is the perineum. • The perineum is separated from the pelvic cavity superiorly by the pelvic floor. • The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus muscle, and associated connective tissue. (see image 3) We will talk about them more in the next lecture. Image (1) Image (2) Image (3) Note: this image is seen from ABOVE Perineum (In this lecture the boundaries and relations are important) o Perineum is the region of the body below the pelvic diaphragm (The outlet of the pelvis) o It is a diamond shaped area between the thighs. Boundaries: (these are the external or surface boundaries) Anteriorly Laterally Posteriorly Medial surfaces of Intergluteal folds Mons pubis the thighs or cleft Contents: 1. Lower ends of urethra, vagina & anal canal 2. External genitalia 3. Perineal body & Anococcygeal body Extra (we will now talk about these in the next slides) Perineum Extra explanation: The perineal body is an irregular Perineal body fibromuscular mass.
    [Show full text]
  • Female Urethra
    OBJECTIVES: • By the end of this lecture, student should understand the anatomical structure of urinary system. General Information Waste products of metabolism are toxic (CO2, ammonia, etc.) Removal from tissues by blood and lymph Removal from blood by Respiratory system And Urinary system Functions of the Urinary System Elimination of waste products Nitrogenous wastes Toxins Drugs Functions of the Urinary System Regulate homeostasis Water balance Acid-base balance in the blood Electrolytes Blood pressure Organs of the Urinary system Kidneys Ureters Urinary bladder Urethra Kidneys Primary organs of the urinary system Located between the 12th thoracic and 3rd lumbar vertebrae. Right is usually lower due to liver. Held in place by connective tissue [renal fascia] and surrounded by thick layer of adipose [perirenal fat] Each kidney is approx. 3 cm thick, 6 cm wide and 12 cm long Regions of the Kidney Renal cortex: outer region Renal medulla: pyramids and columns Renal pelvis: collecting system Kidneys protected by three connective tissue layers Renal fascia -Attaches to abdominal wall Renal capsule: -Surrounds each kidney -Fibrous sac -Protects from trauma and infection Adipose capsule -Fat cushioning kidney Nephrons Each kidney contains over a million nephrons [functional structure] • Blood enters the nephron from a network that begins with the renal artery. • This artery branches into smaller and smaller vessels and enters each nephron as an afferent arteriole. • The afferent arteriole ends in a specialized capillary called the Glomerulus. • Each kidney has a glomerulus contained in Bowman’s Capsule. • Any cells that are too large to pass into the nephron are returned to the venous blood supply via the efferent arteriole.
    [Show full text]
  • Vocabulario De Morfoloxía, Anatomía E Citoloxía Veterinaria
    Vocabulario de Morfoloxía, anatomía e citoloxía veterinaria (galego-español-inglés) Servizo de Normalización Lingüística Universidade de Santiago de Compostela COLECCIÓN VOCABULARIOS TEMÁTICOS N.º 4 SERVIZO DE NORMALIZACIÓN LINGÜÍSTICA Vocabulario de Morfoloxía, anatomía e citoloxía veterinaria (galego-español-inglés) 2008 UNIVERSIDADE DE SANTIAGO DE COMPOSTELA VOCABULARIO de morfoloxía, anatomía e citoloxía veterinaria : (galego-español- inglés) / coordinador Xusto A. Rodríguez Río, Servizo de Normalización Lingüística ; autores Matilde Lombardero Fernández ... [et al.]. – Santiago de Compostela : Universidade de Santiago de Compostela, Servizo de Publicacións e Intercambio Científico, 2008. – 369 p. ; 21 cm. – (Vocabularios temáticos ; 4). - D.L. C 2458-2008. – ISBN 978-84-9887-018-3 1.Medicina �������������������������������������������������������������������������veterinaria-Diccionarios�������������������������������������������������. 2.Galego (Lingua)-Glosarios, vocabularios, etc. políglotas. I.Lombardero Fernández, Matilde. II.Rodríguez Rio, Xusto A. coord. III. Universidade de Santiago de Compostela. Servizo de Normalización Lingüística, coord. IV.Universidade de Santiago de Compostela. Servizo de Publicacións e Intercambio Científico, ed. V.Serie. 591.4(038)=699=60=20 Coordinador Xusto A. Rodríguez Río (Área de Terminoloxía. Servizo de Normalización Lingüística. Universidade de Santiago de Compostela) Autoras/res Matilde Lombardero Fernández (doutora en Veterinaria e profesora do Departamento de Anatomía e Produción Animal.
    [Show full text]
  • Penile Circular Fasciocutaneous Flaps for Complex Anterior Urethral Strictures K.J
    18 Penile Circular Fasciocutaneous Flaps for Complex Anterior Urethral Strictures K.J. Carney, J.W. McAninch 18.1 Penile Fascial Anatomy – 146 18.2 Flap Anatomy – 148 18.3 Patient Selection – 148 18.4 Preoperative Preparation – 148 18.5 Patient Positioning – 148 18.6 Flap Harvest – 149 18.7 Stricture Exposure – 150 18.8 Anastomosis – 151 18.9 Postoperative Care – 152 References – 152 146 Chapter 18 · Penile Circular Fasciocutaneous Flaps for Complex Anterior Urethral Strictures Surgical reconstruction of complex anterior urethral stric- Buck’s fascia is a well-defined fascial layer that is close- tures, 2.5–6 cm long, frequently requires tissue-transfer ly adherent to the tunica albuginea. Despite this intimate techniques [1–8]. The most successful are full-thickness association, a definite plane of cleavage exists between the free grafts (genital skin, bladder mucosa, or buccal muco- two, permitting separation and mobilization. Buck’s fascia sa) or pedicle-based flaps that carry a skin island. Of acts as the supporting layer, providing the foundation the latter, the penile circular fasciocutaneous flap, first for the circular fasciocutaneous penile flap. Dorsally, the described by McAninch in 1993 [9], produces excel- deep dorsal vein, dorsal arteries, and dorsal nerves lie in a lent cosmetic and functional results [10]. It is ideal for groove just deep to the superficial lamina of Buck’s fascia. reconstruction of the distal (pendulous) urethra, where The circumflex vessels branch from the dorsal vasculature the decreased substance of the corpus spongiosum may and lie just deep to Buck’s fascia over the lateral aspect jeopardize graft viability.
    [Show full text]
  • Outlet Contraction of the Pelvis *
    OUTLET CONTRACTION OF THE PELVIS * By W. I. C. MORRIS, M.B., F.R.C.S.E., M.R.C.O.G. There is no great unanimity in regard to the incidence or even the existence of outlet contraction. Stander (1946) states that contractions of the pelvic outlet occur in about 6 per cent, of all women. De Lee (1938) quoted figures as high as 26 per cent. (Stocker), but others, including Bourne and Williams (1939), are sceptical of the importance of outlet contraction, and emphasise that the head which passes the pelvic brim is unlikely to meet grave difficulty at the outlet. All of us, however, are familiar with the occasional unexpectedly stiff forceps operation, as a result of which we deliver with much soft tissue damage a still-born baby, or, perhaps worse, one which survives to develop signs of grave intra-cranial damage. A tentative diagnosis of outlet contraction in such a case may enable us to lay a flattering unction to our souls, but outlet contraction is a subtle condition which may result from a variety of deformities and abnormalities, and its detection before the occurrence of a disaster is often difficult. I propose to devote the major portion of this lecture to an examination of various diagnostic criteria which may give such forewarning, and to deal but briefly with other aspects of outlet contraction. The Shape and Dimensions of the Fcetal Head in Labour The first approach to this problem should be to obtain an accurate picture of the fcetal head in that stage of labour when it first meets the outlet resistance.
    [Show full text]
  • Trans-Obturator Cable Fixation of Open Book Pelvic Injuries
    www.nature.com/scientificreports OPEN Trans‑obturator cable fxation of open book pelvic injuries Martin C. Jordan 1*, Veronika Jäckle1, Sebastian Scheidt2, Fabian Gilbert3, Stefanie Hölscher‑Doht1, Süleyman Ergün4, Rainer H. Mefert1 & Timo M. Heintel1 Operative treatment of ruptured pubic symphysis by plating is often accompanied by complications. Trans‑obturator cable fxation might be a more reliable technique; however, have not yet been tested for stabilization of ruptured pubic symphysis. This study compares symphyseal trans‑obturator cable fxation versus plating through biomechanical testing and evaluates safety in a cadaver experiment. APC type II injuries were generated in synthetic pelvic models and subsequently separated into three diferent groups. The anterior pelvic ring was fxed using a four‑hole steel plate in Group A, a stainless steel cable in Group B, and a titan band in Group C. Biomechanical testing was conducted by a single‑ leg‑stance model using a material testing machine under physiological load levels. A cadaver study was carried out to analyze the trans‑obturator surgical approach. Peak‑to‑peak displacement, total displacement, plastic deformation and stifness revealed a tendency for higher stability for trans‑ obturator cable/band fxation but no statistical diference to plating was detected. The cadaver study revealed a safe zone for cable passage with sufcient distance to the obturator canal. Trans‑ obturator cable fxation has the potential to become an alternative for symphyseal fxation with less complications. Disruption of the pubic symphysis is commonly seen in pelvic ring injuries of trauma patients 1,2. Te disrup- tion of the anterior pelvic ring might occur in combination with a posterior pelvic ring impairment of variable severity.
    [Show full text]
  • UNJ Dec 2000
    C o n s e rvative Management of Female Patients With Pelvic Pain Hollis Herm a n he primary symptoms of Female patients with hy p e r t o nus of the pelvic musculature can ex p e- h y p e rtonus of the pelvic rience pain; burning in the cl i t o r i s , u r e t h r a , vag i n a , or anu s ; c o n s t i- m u s c u l a t u r e in female p a t i o n ; u r i n a ry frequency and urge n cy ; and dy s p a r e u n i a . P hy s i c a l patients include pain; t h e r a py techniques are effective in treating female patients with Tb u rning in the clitoris, ure t h r a , pelvic pain, and can successfully reduce the major symptoms asso- vagina or anus; constipation; uri- ciated with it. Using a treatment plan individualized for each patient’s n a ry frequency and urgency; and s y m p t o m s , these techniques can provide considerable relief to d y s p a reu nia (DeFranca, 1996). patients with debilitating pelvic pain. T h e re are many names for hyper- tonus diagnoses involving these symptoms including: levatore s ani syndrome (Nicosia, 1985; Salvanti, 1987; Sohn, 1982), ten- alignment and instability are pre- Olive, 1998), vaginal pH alter- sion myalgia (Sinaki, 1977), sent (Lee, 1999).
    [Show full text]
  • Clinical Pelvic Anatomy
    SECTION ONE • Fundamentals 1 Clinical pelvic anatomy Introduction 1 Anatomical points for obstetric analgesia 3 Obstetric anatomy 1 Gynaecological anatomy 5 The pelvic organs during pregnancy 1 Anatomy of the lower urinary tract 13 the necks of the femora tends to compress the pelvis Introduction from the sides, reducing the transverse diameters of this part of the pelvis (Fig. 1.1). At an intermediate level, opposite A thorough understanding of pelvic anatomy is essential for the third segment of the sacrum, the canal retains a circular clinical practice. Not only does it facilitate an understanding cross-section. With this picture in mind, the ‘average’ of the process of labour, it also allows an appreciation of diameters of the pelvis at brim, cavity, and outlet levels can the mechanisms of sexual function and reproduction, and be readily understood (Table 1.1). establishes a background to the understanding of gynae- The distortions from a circular cross-section, however, cological pathology. Congenital abnormalities are discussed are very modest. If, in circumstances of malnutrition or in Chapter 3. metabolic bone disease, the consolidation of bone is impaired, more gross distortion of the pelvic shape is liable to occur, and labour is likely to involve mechanical difficulty. Obstetric anatomy This is termed cephalopelvic disproportion. The changing cross-sectional shape of the true pelvis at different levels The bony pelvis – transverse oval at the brim and anteroposterior oval at the outlet – usually determines a fundamental feature of The girdle of bones formed by the sacrum and the two labour, i.e. that the ovoid fetal head enters the brim with its innominate bones has several important functions (Fig.
    [Show full text]
  • The Kidneys (Nephros)
    THE KIDNEYS (NEPHROS) Functions 1. Removal of excess water, salts and products of protein metabolism 2. Maintenance of PH 3. Production and release of erythopoietin, which controls blood cell production 4. Synthesis and release of renin to influence blood pressure 5. Production of 1, 25-hydroxycholecalciferol (activated form of vitamin D) for control of calcium metabolism. There are 2 kidneys in the body, one on either side of the median plane. The kidneys are bean-shaped about 10cm long, 5cm wide and weigh about 150g. The kidneys are intra-abdominal extending from T12-L3. The left kidney is about 1cm higher than the right one, owing to the large right lobe of the liver. The kidneys lay retroperitoneally on the posterior abdominal wall against Psoas major muscle. Each kidney is covered by a tough fibrous renal capsule. This is surrounded by fat known as perirenal /perinephric fat. The latter is enclosed in a renal fascia which attaches it firmly to the posterior abdominal wall. However, the renal fascia is flexible enough to allow kidneys shift slightly as the diaphragm moves during respiration. The kidney has • Anterior and posterior surfaces • Medial and lateral borders • Superior and inferior poles The lateral border is convex and lies against psoas major muscle. The medial border is concave. The hilus/hilum is a prominent medial indentation on this border. It’s a point of entry for the renal artery, renal nerves and exit for the renal vein and renal pelvis. From anterior to posterior are the; renal vein, renal artery and renal pelvis. The posterior surface of the superior pole is related to the diaphragm while the anteromedial surface to the suprarenal gland.
    [Show full text]