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Abdominal Wall. Akmal Abbasi. Abdominal Wall. The muscles of the abdomen may be divided into two groups: (1) the anterolateral muscles (2) the posterior muscles. Antero-lateral Muscles of the Abdomen —The muscles of this group are: *Obliquus externus. *Rectus.
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Abdominal Wall Akmal Abbasi
Abdominal Wall • The muscles of the abdomen may be divided into two groups: • (1) the anterolateral muscles • (2) the posterior muscles. • Antero-lateral Muscles of the Abdomen—The muscles of this group are: *Obliquus externus. *Rectus. *Transversus. *Obliquus internus. *Pyramidalis.
Abdominal Wall • The Superficial Fascia.—divisible into two layers. • The superficial layer (fascia of Camper). • The deep layer (fascia of Scarpa).
Abdominal Wall • The Posterior Muscles of the Abdominal wall are: • Psoas major. • Iliacus. • Psoas minor. • Quadratus lumborum.
Pelvis---Boundaries, Types & Contents Akmal Abbasi
Anatomy of the bony pelvis • It is composed of inlet, cavity and outlet. • (I) The Pelvic Inlet (Brim): • Boundaries: • Sacral promontory, alae of the sacrum, sacroiliac joints, iliopectineal lines. • iliopectineal eminencies, upper border of the superior pubic rami. • pubic tubercles, pubic crests and upper border of symphysis pubis.
Anatomy of the bony pelvis • (II) The Pelvic Cavity: • It is a segment , the boundaries of which are: • - the roof is the plane of pelvic brim, • - the floor is the plane of least pelvic dimension, • - anteriorly the shorter symphysis pubis, • - posteriorly the longer sacrum.
Anatomy of the bony pelvis • (III) The Pelvic Outlet: • (A) Anatomical outlet: • It is lozenge-shaped bounded by; • the lower border of symphysis pubis, • pubic arch, • ischial tuberosities, • sacrotuberous and sacrospinous ligaments and, • tip of the coccyx.
Anatomy of the bony pelvis • (B) Obstetric outlet: • It is a segment, the boundaries of which are: • - the roof is the plane of least pelvic dimension, • - the floor is the anatomical outlet, • - anteriorly the lower border of symphysis pubis, • - posteriorly the coccyx. • - laterally the ischial spines.
Types of True Pelvis • Four types of female pelvis were described. Actually, the majority of pelvis are of mixed types: • (I) Gynecoid pelvis(50%) : • It is the normal female type. • 1.Inlet is slightly transverse oval. • 2.Sacrum is wide with average concavity and inclination. • 3.Side walls are straight with blunt ischial spines. • 4.Sacro- sciatic notch is wide. • 5.Subpubic angle is 90-100o.
Types of True Pelvis • (II) Anthropoid pelvis (25%): • It is ape-like type. • 1.All anteroposterior diameters are long. • 2.All transverse diameters are short. • 3.Sacrum is long and narrow. • 4.Sacro-sciatic notch is wide. • 5.Subpubic angle is narrow.
Types of True Pelvis • (III) Android pelvis (20%): • It is a male type. • 1.Inlet is triangular or heart-shaped with anterior narrow apex. • 2.Side walls are converging (funnel pelvis) with projecting ischial spines. • 3.Sacro-sciatic notch is narrow. • 4.Subpubic angle is narrow <90o.
Types of True Pelvis • (IV) Platypelloid pelvis (5%): • It is a flat female type. • 1.All anteroposterior diameters are short. • 2.All transverse diameters are long. • 3.Sacro-sciatic notch is narrow. • 4.Subpubic angle is wide.
Contents of Pelvis Bones, Muscles, Urinary system, Reproductive system, GI tract.
Female Reproductive System Akmal Abbasi
External structures of the female reproductive anatomy include the labium minora and majora, the vagina and the clitoris. Internal structures include the uterus, ovaries and cervix.
External Structures • Following are the external female genitalia (vulva, pudenda). • Mons veneris (monspubis) • Labia majora and minora • Clitoris • Vestibule • ¨ Urinary meatus, or urethral orifice • ¨ Lesser vestibular, para urethral, or Skene’s glands
External Structures • ¨ Hymen and vaginal introitus ,orrifice • ¨ Greater vestibular, vulvovaginal, or Bartholin’s glands • Fourchet • Perineum
The mons veneris or mons pubis • Rounded, soft fullness of subcutaneous fatty tissue and loose connective tissue over the symphysis pubis. • It contains many sebaceous (oil) glands and develops coarse, dark, curly hair at pubarche, about 1 to 2 years before the onset of the menses. • The function of the mons are to play a role in sensuality and to protect the symphysis pubis during coitus.
Labia majora • Are two rounded length wise folds of skin-covered fat and connective tissue that merge with the mons. • Extend from the mons downward around the labia minora, ending in the perineum in the midline, and act as protection for the labia minora, urinary meatus, and vaginal introitus. • On their lateral surfaces, the labial skin is thick, usually pigmented darker than the surrounding tissue, and covered with coarse hair. • The medial (inner) surfaces of the labia majora are smooth, thick, and without hair.
clitoris • The clitoris is a short, cylindric, erectile organ liked just beneath the arch of the pubis; the visible portion is about 6 x 6 mm. • Its rich vascularity and innervation make the clitoris highly sensitive to temperature, touch, and pressure sensation.
The vestibule is an ovoid or boat-shaped area formed between the labia minora, clitoris, and fourchet. • The vestibule contains the openings to the urethra, paraurethral (lesser vestibule, Skene’s) glands, the vagina, (greater vestibular or Bartholin’s) glands. • The hymen is a partial, rarely complete, elastic but mucosa-covered fold around the vaginal introitus.
Greater vestibular (Bartholin’s) glands • The greater vestibular (Bartholin’s) glands are two compound glands at the base of the labia majora, one on either side of the vaginal orifice. • Each gland is drained by several ducts, about 1.5 cm long and opens into the groove between the hymen and the labia minora. • The glands secrete a small amount of clear, viscid mucus, especially during coitus. • The alkaline pH of the mucus is supportive of sperm. These glands are susceptible to gonorrheal infection and to abscess and cyst formation.
The fourchet is a thin, flat, transverse fold of tissue formed where the tapering labia majora and minora merge in the midline below the vaginal orifice. • The perineum is the skin-covered muscular area between the vaginal introitus and the anus. • The perineum forms the base of the perineal body.
Pelvic floor and perineum.The pelvic and perineum are composed of the pelvic diaphragm, the urogenital diaphragm or triangle, and the muscle of the external genitalia and anus. • The upper pelvic diaphragm, composed of muscles and their fascia and ligaments, extends across the lowest part of the pelvic cavity. • The largest and most significant portion of the diaphragm is formed by the pair of broad, thin levator ani muscles that extend sheet like between the ischial spines and coccyx, and the sacrum.
The levator ani group of muscle is made up of three muscle pairs: puborectalis, iliococcygeus, and pubococcygeus muscles. • The pubococcygeus muscle is particularly significant for women. • Its importance lies on bladder control and during labor for controlling perineal relaxation and explanation of the fetus during birth.
The urogenital (lowerpelvic) is located in the hollow of the pubic arch and consists of the transverse perineal muscles. • The transverse perineal muscles originate at the ischial tuberosities and insert into the perineal body. • The strong muscle fibers provide support to the anal canal during defecation and to the lower vagina during delivery.
The deep transverse perineal muscles join to form a central seamor raphe. • Some of their fibers encircle the urinary meatus and vaginal sphincters.
Perineum • The perineum is located below the upper and lower pelvic diaphragm. • Its muscles and fascia reinforce the strength of the pelvic diaphragm and aid in constricting the urinary, vaginal, and anal openings. • The bulbocavernosus muscle (sphincter vagina fig.) fibers originate in the perineal body and surround the vaginal openings as the muscle fibers pass forward to insert into the pubis.
The ischiocavernous muscle originate in the tuberosities of the ischium and continue at an angle to insert next to the bulbocavernosus muscle. • These muscle fibers contrac to cause erection of the clitoris.
Anal sphincter muscle fibers originate at the coccyx, separate to pass on either side of the anus, fuse, and then insert into the transverse perineal muscles. • The bulbocavernosus, transverse perineal, and anal sphincter muscle fibers can be strengthened through Kegel exercises.
The perineal body, the wedge-shaped mass between the vaginal and anal openings, serves as an anchor point for the muscle, fascia, and ligaments of the upper and lower pelvic diaphragm. • The skin-covered base of the body is known as the perineum. • The perineal body, about cm wide by cm deep, is continuous with the septum between the rectum and vagina.
Gross appearance of a normal uterus with fundus, cervix, vaginal cuff, right fallopian tube, left fallopian tube, right ovary, and left ovary.
Normal cervix with a smooth, glistening mucosal surface. There is a small rim of vaginal cuff from this hysterectomy specimen. The cervical os is small and round, typical for a nulliparous woman. The os will have a fish-mouth shape after one or more pregnancies.
Internal Genitalia-Vagina • Location and support. • The vagina is a tubular structure located in front of the rectum and behind the bladder and urethra. • The vagina extends from the interoitus, the external opening in the vestibule between the labia minora of the vulva, to the cervix. • It is supported mainly by its attachment to the pelvic floor musculature and fascia.
Structure. • The vagina is a thin-walled, collapsible tube that is capable of great distention. Because of the way the cervix protrudes into the upper most portion of the vagina, the length of the anterior wall of the vagina is only about 7 to 8 cm while that of the posterior wall is about 10 cm. • The recesses for med all around the protruding cervix are called fornices: right, left, anterior, and posterior. • The posterior fornix is deeper than the other three.
The smooth muscle walls are lined with glandular mucosa is arranged in transverse folds called rugae. • Innervation. The vagina is relatively insensitive. There is some innervation from the pudendal and hemorrhoidal nerves to the lowest one third. The nerve supply is mainly autonomic. Sensations arising in the vagina terminate at the level of S2, S3, and S4.
Blood supply. descending branches of the uterine artery, the middle hemorrhoidal artery, and the internal pudendal arteries. The venous return of the vaginal blood is through the pudendal, external hemorrhoidal, and uterine veins. • Lymphatics.The lymphatics of the upper vagina drain to the recto vaginal septal, presacral, externaliliac, and hypogastric nods. • The lower vaginal lymphatic are directed to the superficial inguinal nodes.
Internal Genitalia-Uterus • The uterus is a hollow viscus composed of plain muscle whose sole function is gestation. It lies between the rectum and the bladder and is continuous with the vagina. • Structure • Shape, size, and divisions. The uterus is a fattened, hollow, muscular, thick-walled organ that looks some what like an upside-down pear. • Its length,width, and thickness vary, averaging about. 7.5 cm 3.5 cm x 2 cm.
Internal Genitalia-Uterus • In adult woman who has never been pregnant, the uterus weighs 60 g(2 oz). • The uterus has three parts : the fundus, the upper, rounded prominence above the insertion of the fallopian tubes; the corpus, or main portion, encircling the intra-uterine cavity; and the isthmus, the slightly constricted portion that joins the corpus to the cervix and is known as the lower uterine segment during pregnancy.
Internal Genitalia-Uterus • Uterine wall. The wall of the uterus is made up of three layers: the endometrium, the myometrium, and a partial outer layer of parietal peritoneum. • Cervix The lower most portion of the uterus is the cervix, or neck. • The attachment site of the uterine cervix to the vaginal vault divides the cervix into the longer supera vaginal (above the vagina) portion and the shorter vaginal portion. The length of the cervix is about 2.5 to 3 cm, of which about 1cm protrudes into the vagina in the non gravid woman.
Internal Genitalia-Uterus • The external os is small before parturition. • After the birth of a child it becomes a transverse slit ‘the parous os’
Uterine position • For the majority of normal women, with the urinary bladder empty, the uterus is anteverted and slightly anteflexed. The cervix is directed downward and backward the tip of the sacrum so that it is usually at approximately a right angle to the plane of the vagina. • For other women the uterus may be in the middle position or tipped backward (retroverted).
Uterine position • A full bladder pushes the uterus back toward the rectum, while a full rectum moves the uterus forward against the bladder. • Uterine position also changes depending on the woman’s position (e.g., lying supine, prone, on her side, or standing), her age, and pregnancy.
