1. Lesson 7A - Pelvis Male vs Female (2).pptx

Pelvis – Battle of the Sexes Instructor: Kara Rochette MRT(MR) [email protected]  Viscera of the Pelvis Organs Located Within the Pelvis False/Greater Pelvis Gastrointestinal Organs True/Lesser Pelvis Urinary Organs Reproductive Organs and Accessory Struct...

Pelvis – Battle of the Sexes Instructor: Kara Rochette MRT(MR) [email protected]  Viscera of the Pelvis Organs Located Within the Pelvis False/Greater Pelvis Gastrointestinal Organs True/Lesser Pelvis Urinary Organs Reproductive Organs and Accessory Structures (Sex dependant)  Gastrointestinal Viscera in the Pelvis Cecum & Ascending Colon: Found in greater pelvis on right side Descending Colon: becomes continuous with sigmoid colon at pelvic brim Sigmoid joins with rectum at level of mid sacrum – becomes fixed to posterior pelvic wall. Rectum follows the curvature of sacrum/coccyx onto the pelvic floor where it penetrates the levator ani muscle and becomes the anal canal  Female The peritoneum over the anterior surface of the rectum Male extends to the uterus and forms the rectouterine pouch then The peritoneum extends from the over the uterus anteriorly to the upper anterior portion of the rectum, to the bladder forming the bladder to form the rectovesical pouch. Inferior to this vesicouterine pouch. Inferior to level, the anterior portion of the this level, the rectum is posterior rectum is related to the posterior to the vagina and urethra. aspect of the bladder  Urinary Organs Upper half of ureters are in the abdomen but cross over pelvic brim anterior to the internal iliac artery origin. Follow course of internal iliac arteries then turn medially at level of ischial spine to enter urinary bladder on its posteroinferior surface Urinary bladder lies entirely within true pelvis Females: Bladder rests on pelvic floor, posterior to symphysis pubis Males: Prostate gland is between urinary bladder and pelvic floor Urethra projects inferiorly from bladder to exterior (through the prostate gland in males)  Female Urethra 4cm long muscular tube Extends from internal urethral orifice  external urethral orifice External urethral orifice opens into the vestibule just anterior to the vagina  Male Urethra Three Regions: Prostatic Urethra Passes through prostate gland Ejaculatory ducts from prostate gland open into this part Membranous Urethra Shortest/narrowest portion Passes through urogenital diaphragm to enter penis Penile (Spongy) Urethra Longest part, extending full length of the Approx. 5x length of female corpus spongiosum of the penis urethra. Ducts of the bulbourethral glands open Extends from internal into the proximal region of the spongy urethral orifice to external urethra urethral orifice at the tip of the glans penis Trigone Trigone: Area of bladder formed between the openings for 2 ureters and one opening for the internal urethral orifice. This area is the most sensitive to pain.  Quick Check In the male, the rectovesical pouch is a peritoneal cul-de- sac between which two organs? What organ is in between the bladder and the pelvic floor in the male? What three openings form the corners of the trigone in the urinary bladder? What is the most proximal portion of the male urethra?  Female Reproductive Organs Organs/ Structures: Ovaries Ovarian Tubes Aka: Fallopian Tubes Aka: Uterine Tubes Uterus Vagina  Ligaments Some ligaments are peritoneal (PL), while some are fibrous bands (FB) of tissue within the peritoneal ligaments Uterus Broad Ligament (x2) (holds uterus and ovaries) (PL) Round Ligament (x2) (FB) Uterosacral Ligament (x2) (FB) Lateral Cervical (Cardinal) Ligaments (x2) (FB) Anterior Ligament (x1) – anterior cul de sac (ACDS)/vesicouterine pouch (PL) Posterior Ligament (x1) –posterior cul de sac (PCDS)/pouch of douglas/rectouterine pouch (PL) Ovaries Mesovarium (x2) (PL) Ovarian Ligaments (x2) (FB) Suspensory Ligaments (x2) (FB)  Broad Ligament: Large fold of peritoneum that covers uterus, uterine tubes, and ovaries Broad Ligament Divides pelvic cavity into two compartments: of the Uterus Anterior compartment holds contains the bladder Posterior compartment holds the rectum  Round Ligaments (x2): Ligaments extend from the uterine horns to the anterior pelvic of the Uterus wall. They pass through the inguinal canal and attach to subcutaneous tissue of labia majora Uterosacral Ligaments (x2): connect uterus to sacrum Lateral Cervical (Cardinal) Ligaments (x2): extend from lateral walls of cervix to the pelvic floor and stabilize the cervix  (Cornu Uterine a) horn  Ligaments Associated with the Ovaries Mesovarium: attaches ovary to posterior layer of broad ligament Ovarian Ligament: a cord-like thickening within the broad ligament, attaches ovary to lateral wall of uterus Suspensory Ligament: extension of broad ligament, carries ovarian vessels and attaches ovary to  Ovaries and Uterine Tubes Ovary: small, solid, oval Uterine tubes: slender tubes structure, 3cm long. Contains about 10cm long, located in upper 250,000 primary oocytes at birth border of broad ligament Ovarian Fossa: Shallow Extend from upper lateral angle of depression in lateral wall of the uterus to the ovarian region pelvis on either side of uterus Lumen is continuous with uterine cavity Infundibulum: funnel-shaped distal portion of uterine tube which is edged with fingers like extensions called fimbriae **Ovaries and Uterine tubes are NOT connected*** Basic Physiology Review Uterine lining thickens in preparation for embryo Ovary releases mature oocyte into peritoneal cavity Swept into uterine tube by fimbriae and propelled into the uterus by cilia in the uterine tubes Usually takes 3 days – fertilization usually occurs in this time period and location If fertilization occurs, the zygote (fertilized ovum) will go on to implant in the uterine wall for subsequent development If something blocks the way, the zygote will implant in the uterine tube and will result in an ectopic pregnancy. The uterine tube cannot accommodate the size and will  Uterus Hollow pear shaped muscular organ Functions to receive embryo and sustain its life during development Located in anterior portion of pelvic cavity, superior to vagina Usually tilted forward relative to the vagina and bends over superior surface of urinary bladder (anteverted & anteflexed) Can be retroverted as well Layers: Endometrium: inner layer Myometrium: middle muscular layer Perimetrium: serous peritoneum continuous with  Body: Upper 2/3rds (bulges superiorly – fundus) Horn Uterine tubes enter uterus at its broadest part, between the fundus and the body Horn: Area where uterine tube and uterus connect Cervix: Lower 1/3rd of uterus that extends inferiorly into the upper portion of the vagina External Os: opening of cervix into vagina Uterus  Vagina Plays a key role in both beginning and end of reproductive process Receives the male erect penis during intercourse and acts as the birth canal during childbirth 10-15cm long muscular tube that extends from the cervix to the vestibule on the exterior Located posterior to the urethra and anterior to the rectum  Fornices Because the cervix projects into the vagina on an angle, the anterior wall of the vagina is shorter than the posterior wall. Fornix (Fornices): the recesses of the vagina around the cervix. Posterior fornix is longer than anterior fornix due to cervical angle Posterior fornix is related to rectouterine pouch, therefore if penetrated by a surgical instrument, it could inadvertently perforate the peritoneum and possibly result in hemorrhage and peritonitis  External Female Genitalia Vulva (aka Pudendum): Clitoris: inferior to mons pubis collective term referring to all portions of the external female and between the anterior ends of genitalia labia minora Mons Pubis: subcutaneous fat Vestibule: narrow cleft between pad anterior to symphysis the two labia minora. Bordered by pubis. Area where pubic hair the clitoris at the anterior end grows during puberty Urethral Orifice: Opens into the Labia Majora: Two large folds anterior portion of the vestibule of skin filled with subcutaneous fat located at the lateral Vaginal Orifice: Opens within the margins of the vulva vestibule, posterior to the urethra Labia Minora: Two thin, Paraurethral and Greater delicate folds of skin located Vestibular Glands: secrete medial to the labia majora but mucous for lubrication, located on lateral to the urethral and vaginal openings. United either side of urethral and vaginal anteriorly to form the prepuce orifices External Female Genitalia  Vestibule  Quick Check What is the largest ligament that supports the uterus? When the uterus is in the normal position, in what direction is the fundus pointed? What portion of the uterus projects downward into the vagina? Which of the two fornices of the vagina is more closely related to the rectouterine pouch? What is another term for the vulva? What ligament extends laterally from the uterine body to attach it to the pelvic floor?  Male Reproductive Organs Testes Scrotum Ductus Deferens Ejaculatory Duct Seminal Vesicles Prostate Bulbourethral Glands Penis **All of these organs are located in the pelvic cavity except the testes  Paired, primary male reproductive organs suspended in a sac of skin Testes called the scrotum Each teste is covered by a tough, fibrous connective tissue called the tunica albuginea Extensions of tunica albuginea project inwards dividing each teste into roughly 300 lobules Tunica Each lobule contains 1-3 tightly coiled albuginea Tunica vaginalis seminiferous tubules which is Visceral layer where spermatogenesis takes place Tunica vaginalis (Parietal layer) Each teste is also covered superficially to the the tunica **Because albuginea bytestes develop the tunica in abdomen, vaginalis – their blood supply and drainage is in the abdomen. derived An extension from peritoneum of peritoneum precedes the testes during – parietal layer lines descent the into scrotum,This scrotum. visceral layer portion becomes the tunica vaginalis. It is covers thefor important teste the testes to descend into the scrotum because  The spermatids produced in the seminiferous tubules pass through the Testes rete testis to the efferent ducts and into the epididymis for maturation and storage Epididymis: flattened, tightly coiled tubular structure on posterior surface of each teste Epididymis is continuous with the ductus deferens (aka vas Tunica deferens), which transports the albuginea sperm to the ejaculatory duct Tunica vaginalis Visceral layer The scrotum holds the testes and is divided by a median raphe (septum). Tunica vaginalis (Parietal layer)  Spermatic Cords Each teste is suspended by a spermatic cord. Originates at the inferior border of the teste at the tail of the epididymis and extends superiorly to the inguinal canal Holds/transports the following structures: Testicular artery Spermatic veins/venous plexus Cremasteric muscles Vas deferens/Ductus deferens Nerves and lymph vessels Connective tissue  Vas Deferens Thick-walled muscular tube that is continuous with the epididymis. Passes within the spermatic cord and cross through the inguinal canal, crosses over the external iliac vessels Ejaculatory and descends retroperitoneally along Duct the lateral wall of the pelvis and descends along posterior aspect of bladder to join with the duct from the seminal vesicles to form the ejaculatory duct, which opens into the prostatic Seminal urethra Vesicles: paired accessory glands that consist of coiled tubes. Located between the bladder and rectum. It’s duct joins with the duct from the vas deferens to form the ejaculatory duct. It’s secretion has a high fructose content to provide an energy source Prostate Gland Bulbourethral gland (AKA Cowper’s gland) Largest accessory Posterolateral to the gland of male each side of the membranous urethra reproductive system. Passes through the Inferior to bladder membranous urethra to Surrounds prostatic empty into the proximal portion of spongy urethra urethra In response to sexual Contains 20-30 stimulation, they secrete prostatic ducts that a small amount of an empty into the alkaline, mucoid urethra that aid in substance that the mobility and neutralizes the acidity of the spongy urethra and fertility of the sperm lubricates the tip of the If enlarged, can block penis urine passage  Penis Copulatory organ used to introduce sperm into the vagina of the female 3 cylindrical masses of erectile tissue 2 dorsal – corpora cavernosa (anterior when flacid) 1 midventral – corpus spongiosum (posterior when flacid) Encircles the spongy urethra Expands distally to form the glans penis Divided into a root and body Root of penis is the attached portion Bulb Proximal end of corpus spongiosum Anchored to urogenital diaphram Enclosed by bulbospongiosum muscle of perineum Crura Body of the Penis Free portion Composed of the three cylindrical columns of erectile tissue surrounded by connective tissue and skin Glans penis: distal end of body, has opening for urethra Prepuce: aka: foreskin – the skin that covers the body of the penis continues over the glans penis as the prepuce.  Quick Check What is the name of the connective tissue that surrounds the testes and extends inward to divide the testes in lobules What bundle of structures extend from the testes to the inguinal canal? What is the largest accessory gland of the male reproductive system? What erectile tissue forms the two dorsal cylinders in the body of the penis? What portion of the root of the penis is anchored to the urogenital diaphragm?