PELVIS AND ITS VISCERA

 The pelvis is the region of the trunk that lies below the abdomen.
 The bony pelvis is formed by four bones united at four joints.
 Two hip bones in front and on the sides,
 Sacrum and
 Coccyx behind.
The joints are the
 Two Sacroiliac joints,
 Pubic symphysis and
 Sacrococcygeal joint

The pelvis is divided by the plane of the pelvic inlet or pelvic brim, or superior aperture of the
pelvis into two parts:
 The upper part is known as the greater or false pelvis; and
 The lower part is known as the lesser or true pelvis.
The plane of the pelvic inlet passes from the sacral promontory to the upper margin of the pubic
symphysis.

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  The greater or false pelvis includes the two iliac fossae, and forms a part of the posterior
abdominal wall.
 The lesser or true pelvis contains the pelvic viscera.
Pelvic Floor
The pelvic floor is formed by the pelvic diaphragm which consists of the levator ani and the
coccygeus

Pelvic Cavity
The pelvic cavity is continuous above with the abdominal cavity at the pelvic brim, and is
limited below by the pelvic diaphragm
The cavity is more roomy or larger in the female than in the male.
Contents
 The sigmoid colon and rectum occupy the posterior part of the pelvis.
 The urinary bladder lies anteriorly.
 The prostate lies below the neck of the urinary bladder.
 In between the bladder and the rectum, there is a transverse septum or genital septum, In
the male, the septum is small.
 It contains the ductus deferens, the seminal vesicle and the ureter on each
side.
 In the female, the septum is large, and contains the uterus, the uterine tubes,

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 the round ligament of the uterus, the ligaments of the ovary, ovaries, the vagina and the
ureters.

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 Urinary bladder
 Is the temporary sac for urine which gets emptied through the urethra.
 The external urethral sphincter is the sphincter urethral which is placed proximally in the
deep perineal space, and not at the terminal part of the urethra.
 Location and Description
 The urinary bladder is situated immediately behind the pubic bones within the
pelvis with maximum capacity of about 500 ml.
 The empty bladder is pyramidal having an apex, a base, and a superior, two
infero-lateral surfaces and neck.

 The apex of the bladder points anteriorly and lies behind the upper margin of the
symphysis pubis.
 It is connected to the umbilicus by the median umbilical ligament (remains of urachus).
 The base, or posterior surface of the bladder, faces posteriorly and is triangular.
 The supero-lateral angles are joined by the ureters, and the inferior angle gives rise to the
urethra.
 The two vasa deferentia lie side by side on the posterior surface of the bladder and
separate the seminal vesicles from each other

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RELATIONS
 The apex
-Connect to the umbilicus by the median umbilical ligament which represents the
obliterated embryonic urachus
 Base
In the female it is related to
- Uterine cervix and to the vagina
In the male the upper part of the base is separated
-From the rectum by the retrovesical pouch and
-Contained coils of intestine; and
-Lower part is separated from the rectum by the seminal vesicles and the
terminations of the vas deferens.
-Triangular area between the two deferent ducts is separated from the
rectum by the rectovesical fascia of Denonvilliers

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The neck
-It is the lowest and most fixed part of the bladder.
-It lies 3 to 4 cm behind the lower part of the pubic symphysis.
-It is pierced by the internal urethral orifice,
 In males it rests on the base of the prostate.
 In females it is related to the pelvic fascia which surrounds the upper part of the urethra.
 In infants, the bladder lies at a higher level.
 The internal urethral orifice lies at the level of the superior border of the pubic
symphysis.
Superior surface:
In males, it is completely covered by peritoneum, and is in contact with the
-Sigmoid colon and
-Coils of the terminal ileum.
In females, peritoneum covers the greater part of the superior surface, except for a small area
near the posterior border, which is related to the supravaginal part of the uterine cervix.
 The peritoneum from the superior surface is reflected to the isthmus of the uterus to form
the vesico-uterine pouch

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Infero-lateral surfaces:
In the male, related to
 pubis,
 puboprostatic ligaments,
 retropubic fat,
 levatorani and
 obturatorinternus
In the female the puboprostatic ligaments are replaced by the pubovesical ligaments.
 As the bladder fills, the infero-lateral surfaces form the anterior surface of the distended
bladder, which is covered by peritoneum only in its upper part.
The lower part comes into direct contact with the anterior abdominal wall, with no intervening
peritoneum

 True Ligaments:
 Condensations of pelvic fascia around the neck and base of the bladder and continuous
with the fascia on the superior surface of the levator ani.
 The lateral true ligament of the bladder extends from the side of the bladder to the
tendinous arch of the pelvic fascia
 The lateral puboprostatic extends from the anterior end of the tendinous arch of the pelvic
fascia to the upper part of the prostatic sheath
 The medial puboprostatic ligament extends from the back of the pubic bone to the
prostatic sheath

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The ligaments of the two sides
 Puboprostatic ligaments are known as the pubo-vesical ligaments in female.
 The median umbilical ligamentis the remnant of the urachus
 The posterior ligament of the bladder extends on each side from the base of the bladder to
the wall of the pelvis
False Ligaments: Are peritoneal folds, which do not form any support to the bladder.
-Median umbilical fold;
-Medial umbilical fold;
-Lateral false ligament, formed by the peritoneum of the paravesical fossa; and
-Posterior false ligament formed by the peritoneum
After birth the proximal part of umbilical artery persists to form the first part of superior vesical
artery, and the rest of it degenerates into a fibrous cord, the medial umbilical ligament.

Interior of the Bladder

 Greater part of the mucosa shows irregular folds due to its loose attachment to the
muscular coat
 In a small triangular area over the lower part of the base of the bladder, the mucosa is
smooth due to its firm attachment to the muscular coat. This area is known as the trigone
of the bladder.

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  The apex of the trigone is directed downwards and forwards. The internal urethral orifice,
opening into the urethra is located here. The ureters open at the postero-lateral angles Of
the trigone.

 Their openings are 2.5 cm apart in the empty bladder

 5 cm apart in a distended bladder.
 A slight elevation on the trigone immediately posterior median lobe of the prostate is
called the uvula vesicae.
 The base of the trigone is formed by the inter-ureteric ridge or bar of Mercier produced
by the continuation of the inner longitudinal muscle coats of the two ureters.
 The ridge extends beyond the ureteric openings as the ureteric folds over the interstitial
part of the ureters.
Blood Supply
 The superior and inferior vesical arteries, branches of the anterior trunk of the internal
iliac artery.
 Additional supply is derived from the obturator, inferior gluteal arteries uterine and
vaginal arteries instead of inferior vesical in female
Venous Drainage
Drain by vesical venous plexus.
Veins from this plexus pass backwards in the posterior ligaments of the bladder, and drain into
the internal iliac veins.
Lymphatic Drainage
 Lymphatic's terminate in the external iliac nodes.
 few vessels pass to the internal iliac nodes or to the lateral aortic nodes
Nerve Supply
 Vesical plexus of nerves from the inferior hypogastric plexus.
 The vesical plexus contains both sympathetic and parasympathetic components.
 Parasympathetic efferent fibres or nervieri-gentes, S2, S3, S4 are motor to the detrusor
muscle and inhibitory to the sphincter vesicae.
If these are destroyed, normal micturition is not possible.

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Sympathetic efferent fibres (T11 to L2) are said to be inhibitory to the detrusor and motor to the
sphincter vesicae
 The somatic, pudendal nerve (S2, S3, S4) supplies the sphincter urethrae which is
voluntary.
 Sensory nerves:
Pain sensations carried mainly by parasympathetic nerves and partly by
sympathetic nerves.
In the spinal cord, pain arising in the bladder passes through the lateral spino-thalamic tract, and
awareness of bladder distension is mediated through the posterior columns

Uterus
Hollow pear shaped muscular organ in which the fertilized ovum is implanted until the
fetus is fully developed.
3 inches in length, 2 inches in width across its free end, gradually diminishing to an inch
inferiorly, with a thickness of 1 inch

• The uterus is piriform in shape. It is about 7.5 cm long, 5 cm broad, and 2.5 cm thick. It
weighs 30 to 40 grams.
Parts:
1. Fundus- the rounded free upper end above the attachment of the fallopian tubes.
2. Body- main part of the uterus.
3. Cervix- cylindrical shaped organ about one inch long that is connected to the vagina,
separated from the body above by a faint groove called the isthmus.

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SUPPORTS OF THE UTERUS
The uterus supported and prevented from sagging down by muscular and fibro-muscular factors
Primary Supports
Muscular or active supports
 Pelvic diaphragm
 Perineal body
 Urogenital diaphragm
Fibromuscular or mechanical supports
 Uterine axis
 Pubocervical ligaments
 Transverse cervical ligaments of Mackenrodt
 Uterosacral ligaments
 Round ligaments of uterus.

Secondary Supports
 Broad ligaments
 Uterovesical fold of peritoneum
 Rectovaginal fold of peritoneum
Blood supply
 Supplied by the uterine arteries and partially ovarian arteries; drained by similar veins.
 Uterine vessels cross over the ureter adjacent to the cervix.
Ovary
 Almond shaped
 Has a smooth and pink surface in young women later becomes puckered due to repeated
discharge of ova.
 It is atrophied in elderly women.

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 Position and relation:
 Lies near the sidewall of the pelvis between the broad ligament and the ureter and is
attached to the upper layer of the broad ligament.
Extremities:
 Tubal end- immediately behind the external iliac vein; the terminal part of the uterine
tube curls around it.
 Uterine end- provides attachment to the ligament of the ovary.

Blood Supply of the ovary:

 Ovarian artery
 Ovarian veins
Lymph Supply
 Emerge through the hilum and, joined by the lymph vessels from the fundus of the uterus
and from the uterine tube.
Nerves
Derived from the aortic and renal plexuses
Ligaments of the Ovary:
 Ovarian ligament (round ligament of the ovary)
 Suspensory ligament of the ovary- also known as the infundibulo-pelvic ligament which
runs from the tubal end of the ovary to the lateral pelvic wall.
NOTES: Ligament contains ovarian blood vessels, lymphatic's, and nerves.

UTERINE TUBES (FALLOPIAN TUBE OR OVIDUCT)

Reproductive organs that convey discharged ovum from ovary to uterus.
Length- 4 inches
Width- ¼ inch but varies in width at different parts.
It pierces the wall of the uterus medially at the junction of fundus with the side of the body and
opens into the anterior angle of its cavity.
Divisions:
Intramural- part embedded in the wall of the uterus.
Isthmus- proximal to the uterus, about an inch long, almost straight, narrowest part

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  Ampulla- the longest and widest part of the tube comprising 2/3 of the length, slightly
sacculated and convulated, and it is bound loosely to the peritoneum, site of fertilization.
 Infundibulum- funnel-shaped lateral end of the tube. Broken up into a conical fringe of
finger-like processes called fimbrae. The longest fimbria is adherent to the ovary and is
called the ovarian fimbria.
Blood vessels- branches of the uterine and ovarian arteries.
Lymph vessels- drain to aortic nodes with the lymph vessels from the ovary and the fundus of
the uterus.
VAGINA
 Canal extending from the vulva to the cervix.
 Function as organ of copulation and birth canal.
Parts:
 Pelvic portion- upper half lying above urogenital diaphragm.
 Presents fornices which are found around the projection of the cervix into the vagina.
 Perineal portion- lower half lying below urogenital diaphragm.
Relationships:
 Anteriorly- superiorly- touches the fundus of the urinary bladder.
 Inferiorly- adheres to posterior wall of the urethra.
Posteriorly- superiorly- related to the recto- uterine pouch of douglas
 Inferiorly- perineal body.
 Laterally- adheres to fibers of urogenital diaphragm.

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  Blood vessels: blood supply through branches of the internal iliac artery- vaginal, uterine,
internal pudendal and middle rectal arteries.
Venous drainage- tributaries of the same name as the arteries draining iliac veins.

Lymphatic drainage:
 Upper vagina- to the external and internal iliac nodes.
 Middle vagina- into the internal iliac nodes.
 Lower vagina- to the superficial inguinal nodes.
Nerve supply: arises from the uterovaginal plexus.

The Vulva/ External Genitalian in Female

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