pelvis 1 (complete)

8/8/2019 Pelvis 1 (Complete)

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PELVIS

Slide 1-2

Special thanks to:

Adalia ain

Aina syahirah

Faten nur ezzati

Aisyah KZ

Kauthar

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Pelvis consists of bones, muscles, fascia, ligaments and joints. Its also

contents the nerves, blood vessels, lymphatic vessels and the pelvic

organs.

Pelvis bones consist of 2 hip bones, sacrum and coccyx. Ill talk about

the bone. After that I will show you the diagram. Each hip boneconsists of 3 bones. These 3 bones unite together at the acetabulum.

And there are ileum, ischium and pubis. Between the pubis anteriorly

and ischium posteriorly there is the gap and this gap is called obturator

foramen(open). As I told you the hip bone consist of 3 bones. Ileum lies


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above and two bones lies inferiorly. One of them lies anterior and the

other posterior. And there is a gap between these two inferior bones.

This gap is called obturator foramen. Do you know what the means of

foramen? Its an opening.

Feature Of Each Bone.

Features of ileum. The ileum has the apparent criteria.

The first one, iliac forming crest. What the meaning of crest? What

are the differences between crest and tubercle? (Refer the picture)

#crest = margin #tubercle = end of the margin(lies atthe end of crest)

Then the iliac crest to the anterior iliac spine. What is the meaning of

spine? It is the spinous process.

Have anterior superior iliac spine, anterior inferior iliac spine,

posterior superior iliac spine, posterior inferior iliac spine and greater

sciatic notch.

There are 2 surfaces: medial surface and lateral surface.

Medial surface within the ileum. There are iliac fossa (fossa means

shallow depression while the notch is deep depression) lies on the

medial surface of ileum. Then you have iliac tuberosity, auricular

surface, and arcuate line. Arcuate means arch.

Lateral surface of the ileum are the 3 lines. These lines are called the

posterior, anterior & inferior. (gluteal line). These line lies at the

lateral surface of the ileum.


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Features of ischium. Ischium has body, the main part of the bone.

Then we have inferior ramus (branch the limb???Sorry. Im not sure),

ischial spine, lesser sciatic notch and ischial tuberosity.

Features of pubic bone or pubis. Consist of body, superior ramus,

inferior ramus, pubic crest (margin), pubic

tubercle (end of margin), and we have

ileopectineal line.

Dr is referring to the pelvic girdle picture. This

is the pelvic bone of the pelvis. Consist of 2 hip

bone unite anteriorly together but posteriorly they unite to thesacrum. So consist of 2 hip bone, sacrum and coccyx.

Now the dr is explaining the picture of

medial surface of the ileum. Please refer to

the picture. This is the iliac crest (at the

top). Then all the 4 types of spine. Anterior

superior iliac spine and anterior inferior

iliac spine is at the left side of the picture

which is at the anterior view. While the

posterior superior iliac spine and posterior

inferior iliac spine is at the right side of

the figure which is at the posterior view.

Then this is the greater sciatic notch. This is arcuate line (the medial

surface of the ilium is divided into two parts by arcuate line) and theileopectineal line (runs downward and forward around the inner surface

of the ilium).

And the pubis we have the body of pubis, pubic tubercle, superior

ramus of pubis, inferior ramus of pubis, and then we have ischial


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tuberosity. And we have (lesser sac foramen??? Not sure about this)

and the ischial spine. This is the inferior ramus of ischium. There is a

gap in between of pubis anteriorly, and the ischium posteriorly, and this

gap is called obturator foramen.

On the lateral surface we can see the 3 gluteal line. The anterior,

posterior and inferior gluteal line.

[p/s: the iliopectineal line and the arcuate line you can see it clearly on

ur textbook page 175 or 311. And about the gluteal line... I also dont

know the exact location for it. Sorry.]

How can we differentiate between the medial surface and the lateral

surface of the hip bone? Acetabulum is the side for the head of femur.

The side of articulation will be the femur. So this head of femur shows

it is the lateral surface of the hip bone.

SACRUM

Now we are going to talk about the other bone of pelvis, the sacrum,

which is triangular bone. And it has base which lies superiorly & apex

lies inferiorly. It consists of five sacral vertebrae fuse together.

Vertebral foramina together form a sacral canal.(cant hear what the

doctor said). Do you know what is mean by vertebral foramen? What is

the foramina? What is inside of the vertebral foramen? Vertebral

foramen is the vertebral canal consists of many vertebral foramen lietogether. Vertebral foramen lie between pedicle and lamina of pelvis.

So these vertebral foramen unite together to form a sacral canal.


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The sacrum has two surfaces, anterior surfaces and posterior

sufaces. Anterior surface of sacrum has foramina and these are called

anterior sacral foramina and posterior sacral foramina. The upper

anterior part of sacrum is called promontory of sacrum. This isposterior surface of sacrum we can see the sacral foramina. There are

four posterior sacral foramina in the posterior surface. Posterior

surface of sacrum is rough and the anterior surface of sacrum is

smooth. Also in the anterior part consists of four anterior sacral

foramina. The promontory of sacrum is the upper anterior part of the

sacrum, projecting forward. The sacrum articulate superiorly with

lumbar vertebrae to form lumbosacral joint while articulate with thecoccyx they form sacrococcygeal joint. The coccyx consists of 4

vertebrae fused together to form triangular bone which articulates

with the lower end of sacrum. The coccygeal vertebrae does not have

articular process or the spinous process consists of bodies only except

the 1st vertebra that has transverse process and cornua. What is mean

by cornua? (cant hear clearly what the doctor said but he refer to the

diagram of coccyx). Only the first vertebra of coccyx has 2 cornua and

two transverse process.

Pelvis is divided into 2 parts: greater and lesser by pelvic brim.

Above pelvic brim is greater pelvis that is FALSE pelvis and below

pelvic brim we have TRUE pelvis form lesser brim. Pelvic brim which is

from behind forward is the promontory of sacrum posteriorly we have

the arcuate line on middle of sacrum we have ileopectineal line and wehave symphysis pubis. So all this region form the pelvic brim. So the

pelvic brim separate between true pelvis below and the false pelvis

above. The other name of true pelvis is the lesser pelvis and the false

pelvis is the greater pelvis. This is the sagittal view that show pelvic


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brim. This area represent beyond this line is true pelvis, above this line

is false pelvis. This is form the pelvic outlet this axis. The other is

pelvic inlet.

p/s: The lesser pelvis (or true pelvis) is that part of the pelvic cavity

which is situated below and behind the pelvic brim.

The greater pelvis (or false pelvis) is the expanded portion of

the cavity situated above and in front of the pelvic brim

1-Pelvic inlet

2-Pelvic outlet

Between the area of pelvic inlet and outlet is the pelvic cavity. Pelvic

cavity which lie in the pelvic brim. Boundaries of false pelvis are

important. Posteriorly, we have the lumbar vertebrae. Laterally we have

iliac fossa and iliacus muscle. Iliacus muscle which lie forward the iliac


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fossa.(not sure about this). Anteriorly, we have lower part of anterior

abdominal wall. True pelvis is very important in obstetric (delivery).

(cant hear what the dr. said). The boundaries of pelvic outlet,

posteriorly we have the coccyx, anteriorly we have pubic arch andlaterally we have ischial tuberosity. (the dr. asked about the meaning

of tuberosity). Why the ischial tuberosity is rough in this area?

Because we are sitting down on ischial tuberosity.

Ligament of the pelvis.We have 4 bounded ligament:

1. Sacrotuberous lig(extend between sacrum,coccyx & ischial

tuberosity)2. Sacrospinous lig(extend between sacrum,coccyx & ischial spinous)

Do you remember ischial spine? Spine which lie between greater ischial

foramen and lesser xxxxx (sorry cant hear his word clearly)


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3. sacroiliac lig(extend between ilium & sacrum in the middle

4. Sacrococcygeal lig(extend between the sacrum above & coccyx

below)

Those are 4 important ligaments.

Obturator membrane: Fibrous sheet closes the obturator

foramen.This obturator foramen is close by obturator membrane.Thismembrane enclosing leaving a small gap called obturator canal.So this is

incomplete membrane.The gap is for the nerve.

recall what is the obturator foramen?the gap lies between tuberosity

anteriorly &ischium.


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Diameters of pelvic brim (pelvic inlet)

1. Anteroposterior diameter-Extends from promontory of

sacrum(this is an inlet for pelvic foramen)to theupper border of

symphysis pubis2. Oblique diameter (12cm)-Extend from sacroiliac joint to

iliopectineal eminence

3. Transverse diameter (13cm)- Extends between furthest points

on opposite ileopectneal lines

Im talking about pelvic inlet.Now we will talk about pelvic outlet.We

have 2 type,first is anatomical outlet which line the lower border of

each bone,and second is obstetric outlet which is diamond in shape.Thistable may ease you to remember

Ant.post oblique transverse

Circular Brim 11 cm 12 cm 13 cm

Circular Cavity 12 cm 12 cm 12 cm

Diamond Outlet 13 cm 12 cm 11 cm

Anterior-posterior is increasing,oblique is just the same 12 cm,and the

tranverse is decreasing.

The pelvic bone consist of the bone fascial,ligament,muscles &

peritoneum.This table shows you the wall of the pelvic.You have 4 walls:

1. Anterior wall

2. Posterior wall3. Lateral wall

4. Inferior wall/floor

The Pelvic wall consist of bones, fasciae, ligaments, muscles &

peritoneum. This table shows walls of pelvic cases(not sure and refer


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to drs slides) We have 4 walls. Anterior wall, posterior wall, lateral wall

and inferior wall or floor. Anterior wall is short, form by body of pubis

and rami of pubis. Rami means branches. Rami is plural while ramus is

singular. Anterior wall also consist of symphysis pubis. While theposterior wall is long, consist of sacrum and coccyx. Piriformis muscle

which cover this two bones and fasciae covering this muscle. Lateral

wall is formed by lower part of hip bone, obturator membrane which

cover by obturator internus muscle. Fasciae will cover the muscle. We

have 2 ligaments which is sacrotuberous ligament which run obliquely or

vertically and sacrospinous ligaments which lies transversly. All this will

form lateral wall compartment. Inferior wall form by levator animuscle, coccygeous muscle which lies posteriorly from the levator ani

muscle and fascia covering these 2 muscles (levator ani muscle and

coccygeous muscle).


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Anterior pelvic diaphragm has a gap. What is the meaning of the

gap??Gap is for the passage of urethra and vagina.

Levator ani muscle consist of 3 parts which are anterior fibers,

middle fibers and posterior fibers. Anterior fibers extend to sphincter

vaginae and extend to body of pubis and extend to perineal body.

Middle fibers is called puborectalis and pubococcygeus extend to body

of pubis into the anococcygeal body. Posterior fiber is called

illiococcygeus extend to pubis into coccyx and anococcygeal body.


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The action is very important. It act as a sling that support pelvic

organ. It also resists the rise in intrapelvic pressure during strain.

(Factor that can increase intrapelvic pressure : couphing, delivering,

vacation). Levator ani muscle also acts as a sphincter (anorectal

sphincter and vaginal sphincter).

Coccygeus muscle lies at posterior fiber extend to ischial spine to

lower end of sacrum an coccyx. The action is to support pelvic organs.

Vaginal Sphincter and Anorectal sphincter.

Coccygeal muscle extend between the Ischial spine and the lower endof Sacrum and Coccyx. So Coccygeal muscle action to support pelvic

organ.


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Anococcygeal body, the fibroid mass of fibroid tissue lie in the tip of

coccyx (posteriorly) and the anal canal(anteriorly) . Extend between

anal canal and tip of coccyx.

Perineal Body lies anteriorly in Anal Canal. It lies between vagina

anteriorly and anus posteriorly. It is very important in delivery which

you have to cut this Perineal Body in first delivery by disectomy.

Piriformis muscle which form posterior wall passes from sacrum,

enter through Greater Sciatic Foreman then into Greater Trochanter.

Do you know what is Greater Trochanter? It is a part of femur and

usually called as Greater Trochanter of Femur . The action of thismuscle is lateral rotation of femur.

What do we mean with Lateral Rotation, please boy? Amar! Could you

do it for me? Lateral Rotation. This is Lateral rotation.

Obturator Internus : Pelvic extend from pelvic surface of Obturator

membrane, and adjacent bone, passes through Greater Sciatic Foramen

and Greater Trochanter of Femur. It has the same action; Lateralmovement of Femur.

Pelvic Fascia formed by Connective Tissue. What do we mean by fascia?

-Line of Connective Tissue connecting muscle and bone and surrounding

organ. Above it lines abdominal wall and below with fascia of Perineum.

Pelvic Fascia is divided into Parietal Fascia and Visceral Fascia. What

do we mean with Parietal and Visceral?

Parietal : related to Wall

Viscera : related to Organ


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So this fascia to the organ and this fascia toward the wall of the

pelvic. So you can see the blue color represent parietal layer of Pelvic

fascia and this one represent Visceral layer of Pelvic Fascia.

Parietal Fascia lies the wall of pelvis and overlies muscle. Its name

refer to which part the fascia lies. For example, Obturator Internus

Fascia means fascia that cover Obturator Internus Muscle.

Pelvic fascia above the pelvic diaphragm(pelvic floor) is called Superior

Fascia layer. What are the 2 muscle covered by this fascia?

-Leverator Ani. Muscle and Piriformis muscle (?)

These 2 muscle are covered by superior layer of perietal pelvic fascia.

Continuous with internal layer is called Inferior Pelvic Fascia of

Parietal Fascia. These 2 layers are continuous to each other.

Parietal pelvic fascia cover the Sphincter Urethra and perineal

membrane forms the superior fascial layer of fascia of urogenital

diaphragm.

The visceral layer cover all the pelvic organ and some form ligament.

So, the ligament of Pelvic organ form part of Visceral Layer of Pelvic.

These ligament are Sacrocervical Lig. And Pubovesicle ligament.

Cervical mean urinary bladder.

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*No comment will be entertained*

SEKALUNG PENGHARGAAN BUAT SEMUA YG TERLIBAT DLM PEMBUATAN

LECTURE NOTE NI. MOGA ALLAH MEMBALAS JASA KALIAN DENGAN

GANJARAN YG LEBIH BESAR DI AKHIRAT KELAK

INSYAALLAH, ALLAH YUSAHHIL UMURUNA.AMIN

pelvis 1 (complete)

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