Abdomen, Pelvis and Perineum Anatomy - www.jinekolojivegebelik.com

1. Abdomen, Pelvis and Perineum Dmitry Goldin [email_address]

4. Ventral mesogastrium Dorsal mesogastrium Dorsal Common Mesentery In post-partum age, the ligaments that are the remnants of these membranes still retain their general attachment points (use for IDing in lab). NOTE – The intestines take a 270deg turn counterclockwise and the stomach takes a 90deg turn clockwise

23. Referred pain overview Table 4-5. Referred pain pathways (visceral afferents) Left and right flanks and groins, lateral and anterior thighs L1,L2 Lumbar splanchnic nerves Hindgut (organs supplied by inferior mesenteric artery) Flanks (lateral regions) and pubic region T12 Least splanchnic nerve Kidneys and upper ureter Umbilical region T9,T10 (or T10,T11) Lesser splanchnic nerve Midgut (organs supplied by superior mesenteric artery) Lower thorax and epigastric region T5 to T9 (or T10) Greater splanchnic nerve Foregut (organs supplied by celiac trunk) Upper thorax and medial arm T1 to T4 Thoracic splanchnic nerves Heart Referral area Spinal cord level Afferent pathway Organ

30. Lymph - lateral aortic or lumbar lymph nodes receive lymphatics from the body wall, the kidneys, the suprarenal glands, and the testes or ovaries. - Pre-aortic nodes receive from GI tract (rectum too), as well as the spleen, pancreas, gallbladder, and liver -Finally, the lateral aortic or lumbar nodes form the right and left lumbar trunks , while the pre-aortic nodes form the intestinal trunk . These trunks come together and form a confluence that, at times, appears as a saccular dilation (the cisterna chyli ). This confluence of lymph trunks is posterior to the right side of the abdominal aorta and anterior to the bodies of vertebrae LI and LII . It marks the beginning of the thoracic duct .

46. ANTERIOR POSTERIOR Renal pelvis Vein then artery

47. * Clinical * -Abscess internal to renal fascia in one kidney CAN NOT spread to other kidney b/c although renal fascia is continuous across midline, it wraps around central vessels very tightly

50. Ureter clinicals -Ureteric caliculi – obstruction of flow most often occurs at 2 nd and 3 rd constrictions causing unilateral hydronephrosis -Passing of kidney stones is an excruciating pain -ectopic openings (urine leakage)

59. Lumbar plexus (somatic, ventral primary rami) Table 4-6. Branches of the lumbar plexus Skin on anterior thigh and medial surface of leg Iliacus, pectineus, and muscles in anterior compartment of thigh L2 to L4 Femoral Skin on medial aspect of the thigh Obturator externus, pectineus, and muscles in medial compartment of thigh L2 to L4 Obturator Skin on anterior and lateral thigh to the knee L2,L3 Lateral cutaneous nerve of thigh Genital branch-skin of anterior scrotum or skin of mons pubis and labium majus; femoral branch-skin of upper anterior thigh Genital branch-male cremasteric muscle L1,L2 Genitofemoral Skin in the upper medial thigh , and either the skin over the root of the penis and anterior scrotum or the mons pubis and labium majus Internal oblique and transversus abdominis L1 Ilio-inguinal Posterolateral gluteal skin and skin in pubic region Internal oblique and transversus abdominis L1 Iliohypogastric Function: sensory Function: motor Spinal segments Branch

62. Pelvic musc. Lateral rotation of the extended hip joint; abduction of flexed hip Branches from L5, S1, and S2 Medial side of superior border of greater trochanter of femur Anterior surface of sacrum between anterior sacral foramina Piriformis Lateral rotation of the extended hip joint; abduction of flexed hip Nerve to obturator internus L5, S1 Medial surface of greater trochanter of femur Anterolateral wall of true pelvis (deep surface of obturator membrane and surrounding bone) Obturator internus Function Innervation Insertion Origin Muscles of pelvic wall

63. Pelvic Diaphragm ***Childbirth can injure perineum, levator ani, & pelvic fascia. Usually pubococcygeus is torn. -Get urinary stress incontinence - sacrospinous lig . Is immediately external (posterolateral) of coccygeus m.

65. Pelvic nerves From sacral plexus: -sciatic n. (infrapiriform) -pudendal n. (infrapiriform) -obturator n. -pelvic splanchnic ns. -Sup. & inf. Gluteal ns. (supra & infrapiriform) -lumbosacral trunk (part L4 and all L5) -Hypogastric N . (connects sup. & inf. Hypogastric plexuses) -Sympathetic trunk (grey rami here only) *** Caudal Epidural block : anesthesia given in sacral canal (S2-S4) [entire birth canal, pelvic floor, & perineum is anesthetized]

66. Posterior trunk of Int. Iliac A. -iliolumbar A. -Lateral sacral As. (anastomose with median sacral a.) -sup. Gluteal A. (suprapiriform)

67. Anterior trunk of Int. Iliac a. -umbilical A.  sup. Vesical A. -obturator A. -Inf. Vesical A. -middle rectal A. -Int. Pudendal A. (infrapiriform) -Inf. Gluteal A. (infrapiriform)

69. Lymph from perineum -Lymphatic vessels from deep parts of the perineum accompany the internal pudendal blood vessels and drain mainly into internal iliac nodes in the pelvis. -Lymphatic channels from superficial tissues of the penis or the clitoris accompany the superficial external pudendal blood vessels and drain mainly into superficial inguinal nodes , as do lymphatic channels from the scrotum or labia majora. -The glans penis, the glans clitoris, labia minora, and the terminal inferior end of the vagina drain into deep inguinal nodes and external iliac nodes .

71. *** Pelvic relaxation is the weakening or loss of support of pelvic organs; caused by damage to: -perineal body (vaginal prolapse) -pelvic/ UG diaphragm -Transverse cervical, uterosacral, & pubocervical lig. -CAUSES: cystocele, rectocele, uterine/vaginal prolapse

73. Nerves in perineum -out of Alcock’s canal w/ Int. pudendal A. &V. *** Pudendal block (forceps delivery in childbirth) – landmark is ischial spine, needle through sacrospinous lig. (for complete perineal block need to get ilioinguinal and genitofemoral ns.) ***

75. Deep pouch musc. Man Woman

77. Supf. Perineal space musc.s

86. Male reproductive system -Epididymis (head, body, tail) sperm maturation and storage in head and body -Ductus deferens – begins at inf. Pole of testes, eventually joined by seminal vesicles to form 2 ejaculatory ducts, which open into prostate on urethral crest *** Vasectomy – cuts layers: 1)skin, 2)colles fascia, 3)dartos m., 4)ext. spermatic fascia, 5)cremasteric fascia & m., 6)int. spermatic fascia, 7)extraperitoneal fat (tunica vaginalis is NOT cut)