Unit 1 - Pelvis PDF

Diploma in Physiotherapy Please do not reproduce, redistribute or share without the prior express permission of the author. Lecture notes ANATOMY II PELVIS Please do not reproduce, redistribute or share without the prior express permission of the author. ...

Diploma in Physiotherapy Please do not reproduce, redistribute or share without the prior express permission of the author. Lecture notes ANATOMY II PELVIS Please do not reproduce, redistribute or share without the prior express permission of the author.  Learning Outcome At the end of the lesson, students will be able to: Understand the structure of the pelvic wall Understand the structure and functions of the pelvic floor musculature. List out the joints of the pelvic complex. Describe the structure of Uro-genital organs and its Clinical importance. Please do not reproduce, redistribute or share without the prior express permission of the author.  A basin-shaped bony structure that supports the internal organs of the lower abdomen, and serves as a point of attachment for muscles that move the lower limbs. The pelvis consists of the sacrum, coccyx, and two innominate or hip-bones. The joints of pelvis are the two sacroiliac joints, the pubis symphysis and the sacrococcygeal joint. Please do not reproduce, redistribute or share without the prior express permission of the author.  Subdivisions The pelvis is divided by the plane of the pelvic inlet (pelvic brim) into two parts. 1. The upper part is known as the greater pelvis – False pelvis. contains 2 iliac fossae and part of the posterior abdominal wall. 2. The lower part is known as the lesser pelvis – True pelvis. contains the pelvic viscera. Please do not reproduce, redistribute or share without the prior express permission of the author.  Boundaries of the pelvis The pelvic walls are made up of bones, ligaments and muscles. 1. Bony walls are formed - Anteriorly by pubic symphysis and pubic bones, Posteriorly by the sacrum and coccyx, - On each side by the two rami of the pubis, ischium and Ilium. 2. Ligaments and membranes - Obturator membrane / Sacrotuberous and sacrospinous ligaments. 3. Muscles - Obturator internus / Piriformis. Please do not reproduce, redistribute or share without the prior express permission of the author. Please do not reproduce, redistribute or share without the prior express permission of the author.  PELVIS Pelvic / hip girdle Function: Attaches the lower limbs to spine Supports the viscera of the pelvis Transmits the weight of the upper body Please do not reproduce, redistribute or share without the prior express permission of the author. Each pelvic / hip bone is formed by, Ilium Superior region Ischium Postero-inferior region Pubis Anterior region Please do not reproduce, redistribute or share without the prior express permission of the author. Please do not reproduce, redistribute or share without the prior express permission of the author.  Pelvic Girdle Please do not reproduce, redistribute or share without the prior express permission of the author.  iliac crest anterior superior greater sciatic notch iliac spine ischial tuberosity ischial spine lesser sciatic notch Please do not reproduce, redistribute or share without the prior express permission of the author.  ILIUM-LATERAL VIEW The ilium is a large flaring bone that forms the superior region of the coxal bone. It consists of a body and a superior wing like portion called the ala. The broad posterolateral surface is called the gluteal surface. Please do not reproduce, redistribute or share without the prior express permission of the author.  ILIUM-MEDIAL VIEW The auricular surface articulates with the sacrum (sacroiliac joint). Major markings include the iliac crests, four spines, greater sciatic notch, iliac fossa, arcuate line, and the pelvic brim. Please do not reproduce, redistribute or share without the prior express permission of the author.  ISCHIUM The ischium forms the posteroinferior part of the hip bone. The thick body articulates with the ilium, and the thinner ramus articulates with the pubis. Major markings include the ischial spine, lesser sciatic notch, and the ischial tuberosity. Please do not reproduce, redistribute or share without the prior express permission of the author.  PUBIS-MEDIAL VIEW  The pubic bone forms the anterior portion of the hip bone.  It articulates with the ischium and the ilium.  Major markings include superior and inferior rami, the pubic crest, pubic tubercle, pubic arch, pubic symphysis, and obturator foramen (along with ilium and ischium). Please do not reproduce, redistribute or share without the prior express permission of the author.  Comparison of Male and Female Pelvic Structure Female pelvis Male pelvis Tilted forward, adapted for Tilted less forward. childbearing. Adapted for support of heavier True pelvis defines birth canal. male build and stronger Cavity of the true pelvis is muscles broad, shallow, and has greater Cavity of true pelvis is narrow capacity. and deep. Please do not reproduce, redistribute or share without the prior express permission of the author. Please do not reproduce, redistribute or share without the prior express permission of the author. Female pelvis Male pelvis Please do not reproduce, redistribute or share without the prior express permission of the author. Please do not reproduce, redistribute or share without the prior express permission of the author.  True and False Pelvis  Separated by the pelvic brim  False Pelvis Superior to the pelvic brim contains abdominal organs attachment for muscles and ligaments to body wall  True Pelvis Inferior to the pelvic brim Space contains - part of colon / rectum / bladder / uterus / ovaries (females) Please do not reproduce, redistribute or share without the prior express permission of the author. Please do not reproduce, redistribute or share without the prior express permission of the author.  Pelvic cavity The pelvic cavity is continuous above with the abdominal cavity at the pelvic brim, and it is limited below by the pelvic diaphragm. It is J shaped, and has unequal walls, measuring about 2” anteriorly and 6” posteriorly. In females, this region is longer/wider than in males. Contents of pelvic cavity: 1. Sigmoid colon and rectum 2. Urinary bladder 3. In females – uterus, uterine tubes, round ligament of uterus and ovaries. Please do not reproduce, redistribute or share without the prior express permission of the author.  Pelvic floor  The canal of the bony and ligamentous pelvis is closed by a diaphragm of muscles and fasciae which the rectum, urethra and, in the female, the vagina, must pierce to reach the exterior.  The muscles of the pelvic floor are divided into: (1) the pelvic diaphragm, formed by the levator ani and the coccygeus; and (2) The superficial muscles (a) anterior (urogenital) perineum and (b) posterior (anal) perineum. Please do not reproduce, redistribute or share without the prior express permission of the author. Pelvic floor Please do not reproduce, redistribute or share without the prior express permission of the author.  Levator ani It is the largest and most important muscle of the pelvic floor. It arises from the posterior aspect of the body of the pubic bone, the fascia of the side wall of the pelvis (covering obturator internus) and the spine of the ischium. From this wide origin it sweeps down in a series of loops. Please do not reproduce, redistribute or share without the prior express permission of the author. 1. to form a sling around the prostate (levator prostatae) or vagina (sphincter vaginae), inserting into the perineal body; 2. to form a sling around the rectum and also insert into, and reinforce the deep part of, the anal sphincter at the anorectal ring (puborectalis); Please do not reproduce, redistribute or share without the prior express permission of the author. PELVIC FLOOR MUSCLES Please do not reproduce, redistribute or share without the prior express permission of the author. The Levator ani and Coccygeus form the pelvic diaphragm and called as pelvic floor muscles and together regarded as one morphological entity, and divisible into 1.Pubococcygeus, 2.Iliococcygeus, 3.Ischiococcygeus. The muscle fibers slope downwards and backwards to the midline, making a gutter shaped pelvic floor. Please do not reproduce, redistribute or share without the prior express permission of the author.  Muscle attachments The Levator Ani This muscle is divisible into a pubococcygeus and iliococcygeus part. 1.Pubococcygeus - arises from the body of pubis and inserted into the perinial body. The middle fibers constitute the puborectalis. 2. Iliococcygeus - arises from obturator fascia and ischial spine and inserted into the tip of the coccyx. Nerve supply The Lavator Ani is supplied by a branch from fourth sacral nerve and also from pudendal nerve. Please do not reproduce, redistribute or share without the prior express permission of the author.  The Coccygeus This muscle represents the posterior part of the pelvic diaphragm – Ischiococcygeus. It is triangular in shape and partly muscular/tendinous. It arises from ischial spine and sacrospinous ligament and inserted into the fifth sacral vertebra. Nerve supply It is supplied by a branch from fourth and fifth sacral nerve. Please do not reproduce, redistribute or share without the prior express permission of the author.  Actions of pelvic floor muscles 1. Close the posterior part of the pelvic outlet. 2. Support the pelvic viscera. 3. During coughing, sneezing, lifting and other muscular efforts, the levator ani and coccygei counteract and increase the intra abdominal pressure to maintain the continence of the bladder and the rectum. 4. Prevents any form of pelvic prolapse. 5. Support the coccyx bone during defecation/parturition/child birth. Please do not reproduce, redistribute or share without the prior express permission of the author.  Perineum Area between the anus and external genitalia Diamond shaped Pubic symphysis anteriorly Ischial tuberosities laterally Coccyx posteriorly Females: External genitalia Anus Males: Scrotum Root of penis Anus Please do not reproduce, redistribute or share without the prior express permission of the author.  Uro – genital organs Genitalia (sex organs) Primary Gonads Ovaries and testes Produce the sex cells / gametes Eggs, sperm Secrete sex hormones Secondary Glands, ducts, external genitalia Nourish and transport of gametes Please do not reproduce, redistribute or share without the prior express permission of the author.  Male Reproductive System Primary sex organ Gonads = testes Lie in the scrotum Sperm-producing Secondary sex organs External Genitalia Penis Scrotum Please do not reproduce, redistribute or share without the prior express permission of the author.  Ducts Epididymis Efferent ductules Duct of epididymis Vas deferens Ejaculatory duct Urethra Glands Seminal vesicle Prostate Bulbourethral Please do not reproduce, redistribute or share without the prior express permission of the author. Please do not reproduce, redistribute or share without the prior express permission of the author.  Female Reproductive System Primary Sex Organs Ovaries = gonads Secondary Sex Organs External Genitalia = vulva Labia majora + minora Mons pubis Clitoris Please do not reproduce, redistribute or share without the prior express permission of the author. Please do not reproduce, redistribute or share without the prior express permission of the author. Please do not reproduce, redistribute or share without the prior express permission of the author.  Ducts Uterine tube = oviducts Vagina Glands Greater vestibular gland Please do not reproduce, redistribute or share without the prior express permission of the author. Uro-genital organs and its clinical importance Please do not reproduce, redistribute or share without the prior express permission of the author. Please do not reproduce, redistribute or share without the prior express permission of the author. Please do not reproduce, redistribute or share without the prior express permission of the author. Diseases of the female reproductive system Pelvic inflammatory disease(PID) Vulvar dystrophies Imperforate hymen Cervical carcinoma Disorder of the uterine body Endometritis Endometriosis Adenomyosis Endometrial hyperplasia Leiomyoma (fibroid, myoma) Endometrial carcinoma Please do not reproduce, redistribute or share without the prior express permission of the author.  Disorders of the uterine tubes and ovaries Acute salpingitis Ectopic pregnancy Ovarian tumours Please do not reproduce, redistribute or share without the prior express permission of the author.  Pelvic inflammatory disease (PID) Pelvic inflammatory disease (or disorder) (PID) is a term for inflammation of the uterus, fallopian tubes, and/or ovaries as it progresses to scar formation with adhesions to nearby tissues and organs. This can lead to infertility. Please do not reproduce, redistribute or share without the prior express permission of the author.  VULVAR DYSTROPHIES Vulvar dystrophy is a change in the skin of the vulva, the outer part of a female’s genitals. The area becomes dry, with white or grey patches, and the skin of the vulva becomes either too thick or too thin Symptoms include extreme burning and itching. This is a progressive condition which can lead to narrowing of the vaginal and rectal openings if left untreated. Please do not reproduce, redistribute or share without the prior express permission of the author.  Imperforate Hymen The hymen is the thin tissue around the entry of the vagina that usually has an opening for menstrual blood to pass through. Imperforate hymen means that the hymen does not have an opening, so the entry of the vagina is completely closed off by the hymen Imperforate hymen is often discovered when a girl starts her period. Because menstrual blood cannot get out of the vagina, the blood backs up. This causes pain and pressure in the pelvic area. Imperforate hymen is treated with surgery to create an opening in the hymen. Please do not reproduce, redistribute or share without the prior express permission of the author.  Cervical carcinoma Cervical cancer is a disease in which the cells of the cervix become abnormal and start to grow uncontrollably, forming tumors. Please do not reproduce, redistribute or share without the prior express permission of the author.  Disorder of the uterine body Endometritis Endometritis is an inflammation or irritation of the lining of the uterus (the endometrium). Endometriosis Endometriosis is a very common condition where cells of the lining of the womb (the endometrium) are found elsewhere, usually in the pelvis and around the womb, ovaries and fallopian tubes. It mainly affects women during their reproductive years. Please do not reproduce, redistribute or share without the prior express permission of the author. Please do not reproduce, redistribute or share without the prior express permission of the author. Adenomyosis Adenomyosis is uterine thickening that occurs when endometrial tissue, which normally lines the uterus, moves into the outer muscular walls of the uterus. Endometrial hyperplasia Endometrial hyperplasia is a condition of excessive proliferation of the cells of the endometrium, or inner lining of the uterus. Please do not reproduce, redistribute or share without the prior express permission of the author. Leiomyoma (Fibroid, Myoma) Uterine fibroids (also referred to as myoma, leiomyoma, leiomyomata, and fibromyoma) are benign (non-cancerous) tumors that grow within the muscle tissue of the uterus. Between 20-50% of women of childbearing age have uterine fibroids. Endometrial carcinoma Endometrial cancer refers to several types of malignancies that arise from the endometrium, or lining, of the uterus. Please do not reproduce, redistribute or share without the prior express permission of the author.  Disorders of the uterine tubes and ovaries Acute salpingitis Acute salpingitis is infection of the fallopian tubes. These two tubes carry the ovum from the ovary to the uterus. Pelvic pain is the main symptom of acute salpingitis. Ectopic pregnancy An ectopic pregnancy is a pregnancy that occurs outside the womb (uterus). It is a life- threatening condition to the mother. The baby (fetus) cannot survive. Ovarian tumours The majority of ovarian tumours are benign, usually occuring between 20 and 45 years of age. Please do not reproduce, redistribute or share without the prior express permission of the author.  Acute Salpingitis Ectopic Pregnancy Please do not reproduce, redistribute or share without the prior express permission of the author. Diseases Of The Male Reproductive System Infections of the Penis Infections of the Urethra Epididymitis Orchitis Cryptorchidism Hydrocele Testicular Tumours Prostatitis Benign Prostatic Enlargement Malignant Prostatic Tumours Please do not reproduce, redistribute or share without the prior express permission of the author.  Infections of the penis Inflammation of the glans and prepuce may be caused by a specific or non specific infection. In non-specific infections, or balanitis, lack of personal hygiene is an important predisposing factor, especially if phimosis (prepuce) is present i.e. the orifice in the foreskin (prepuce) is too small to allow for its normal retraction. If the infection becomes chronic there may be fibrosis of the foreskin, which increases the phimosis. Please do not reproduce, redistribute or share without the prior express permission of the author.  Infections of the urethra Gonococcal urethritis is the most common specific infection. Non-specific infection may be spread from the bladder (cystitis) or be introduced during catheterisation, cystoscopy or surgery. Both types may spread throughout the system to the prostate, seminal vesicles, epididymis and testes. Please do not reproduce, redistribute or share without the prior express permission of the author.  Epididymitis Epididymitis (inflammation or infection of the epididymis) is generally caused by a bacterial infection. Epididymitis is swelling (inflammation) of the epididymis, the tube that connects the testicle with the vas deferens. Please do not reproduce, redistribute or share without the prior express permission of the author.  Orchitis (inflammation of the testes) Orchitis is swelling (inflammation) of one or both of the testicles. Please do not reproduce, redistribute or share without the prior express permission of the author.  Cryptorchidism (undescended testicle) Undescended testicle occurs when one or both testicles fail to move into the scrotum before birth. During embryonic life the testes develop within the abdominal cavity, but descend into the scrotum prior to birth. If they fail to do this and the condition is not corrected, infertility is likely to follow and the risk of testicular cancer is increased. Please do not reproduce, redistribute or share without the prior express permission of the author.  Hydrocele A hydrocele testis is an accumulation of clear fluid in the tunica vaginalis, the most internal of membranes containing a testicle. Please do not reproduce, redistribute or share without the prior express permission of the author.  Testicular tumours Testicular tumours are the most common tumours in males between the ages of 20 and 40. Please do not reproduce, redistribute or share without the prior express permission of the author.  Prostatitis Prostatitis is an infection or inflammation of the prostate gland. Please do not reproduce, redistribute or share without the prior express permission of the author.  Benign prostatic enlargement Benign prostatic hyperplasia (BPH), benign enlargement of the prostate (BEP), adenofibromyomatous hyperplasia and incorrectly referred to benign prostatic hypertrophy, is an increase in size of the prostate. It is a common condition that affects older men. Please do not reproduce, redistribute or share without the prior express permission of the author.  Malignant prostatic tumours Prostate cancer is a malignant (cancerous) tumor (growth) that consists of cells from the prostate gland. These are a relatively common cause of death in men over 50. Please do not reproduce, redistribute or share without the prior express permission of the author. Q&A Session Please do not reproduce, redistribute or share without the prior express permission of the author.  Thank you Address Telephone Website Lot 33-40, Blok C, Plaza Juta, +6088 431 025/35 kk.cyberjaya.edu.my KM 7.2 Off Jalan Tuaran, 88400 Likas, Kota Kinabalu, Email Sabah, Malaysia [email protected]