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the perineum is a diamond shaped area below the pelvic diaphragm, is bounded by : 1-the pubic symphysis anteriorly 2-tip of coccyx posteriorly 3-ischial tuberosities laterally on each side it include ;urogenital & anal triangles the urogenital triangle is bounded by the pubic arch & ischial tuberosities. it includes 2 spaces (pouches) , a superficial perineal pouch & urogenital diaphragm(deep perineal pouch) - the superficial perineal pouch is enclosed between the membranous layer of superficial fascia(below) & the perineal membrane(above) -contents in the male includes: 1-the root of the penis which include bulb of the penis & two crura of the penis 2-bulbospongiosus(applied to bulb) & ischiocavernousus muscles (applied to crura) 3-perineal branch of the pudendal nerve 4-superficial transverse perinei muscle -contents in the female 1-the root of clitoris which includes bulb of the vestibule & 2 crura of clitoris 2-bulbospongiosus & ischiocavernousus 3-superficial transversus perinei muscle 4-perineal branch of pudendal nerve the perineal body: a small mass of fibrous tissue gives attachment to 1- external anal sphincter 2-bulbospongiosus muscle 3- superficial transversus perinei muscle -the deep perineal pouch is the space enclosed between the perineal membrane below & the endopelvic fascia above , within the urogenital diaphragm -contents in the male includes: 1-membranous part of urethra 2-the sphincter urethrae muscle 3-bulbourethral glands 4-deep transversus perinei muscle 5-internal pudendal vessels & their branches 6-dorsal nerve of the penis -contents in the female include : 1-part of the urethra 2-part of the vagina 3-sphincter urethra surrounding 1 & 2 4-deep transverse perinei muscle 5-the internal pudendal vessels & their branches 6-the dorsal nerve of clitoris * the perineal body in the female is larger than in the male & more important , is wedge shaped between lower end of vagina & the anal canal - the penis has a fixed root & a body that hangs free the body of penis composed of 3 cylinders of erectile tissue enclosed in a tubular sheath of fascia called buck's fascia . the erectile tissue made up of 2 dorsally placed corpora cavernosa & a single corpus spongiosum which is traversed by the urethra. the distal part of spongiosum is called glans penis with slit like opening the external urethral meatus blood supply of the penis by: 1-dorsal artery of penis on the dorsum 2-deep arteries of penis to corpora cavernosa 3-artery of the bulb all these branches are infact coming from the internal pudendal artery -venous drainage to internal pudendal vein -the lymphatics of penis as: 1-skin of penis to superficial inguinal nodes 2-deep structure of penis to internal iliac nodes -the scrotum is an outpouching from lower part of the anterior abdominal wall it contains: 1-the testes 2-epididymus 3-lower end of spermatic cord the wall of the scrotum consist of the following layers: 1-skin 2-dartos muscle (smooth m) as a superficial fascia , this replaces the colle's fascia of the region 3-external spermatic fascia 4-cremaster fascia 5-internal spermatic fascia 6-tunica vaginalis of testes the scrotum is supplied by 1-external pudendal branches of femoral artery, 2- scrotal branches of internal pudendal arteries lymphatics: 1-skin ------- to superficial inguinal group 2-testes------along spermatic cord to para aortic lymph nodes group at the level of L1 vertebra nerve supply: 1-ilio inguinal n 2-genital branch of genitofemoral n 3-branches from perineal nerve 4-posterior cutaneous n of thigh the urethra in the male : 1-prostatic urethra ; 3-4 cm in length , is the widest & more distenable part of the entire urethra traverse the urethra from base to apex on its posterior surface is the urethral crest on each side of it the prostatic sinus (for opening of prostatic glands), on the summit of the crest is the prostatic utricle ,on the edge of the opening of this utricle is the opening of the ejaculatory duct 2-membranous urethra; about 1.25-1.5 cm , traverses the urogenital diaphragm & is surrounded by the sphincter urethra .it is the least dilatable part of the urethra 3-penile urethra; about 16 cm in length, it traverse the corpus spongiosum & terminal into the external urethral meatus(which is the narrowest part of the urethra) the female urethra: is about 4 cm in length , starts at the neck of bladder & ends as external meatus into the vestibule of vagina. it traverses sphincter urethrae, immediatly infront of the vagina.around the external meatus opens the duct of paraurethral gland (it corresponds to the prostate) the greater vestibular gland(mucous secreting) opens into the vestibule of vagina by opening between the hymen and posterior part of labia minora THE VULVA: Vulva means the external genitalia in the female includes: 1. Mons pubis 2. The clitoris 3. Labia majora 4. Labia minora 5. The vestibule of the vagina 6. The bulb of the vestibule 7. The greater vestibular glands Nerve supply by : Ilio-inguinal Genital branch of the genitofemoral Branches of perineal nerves Posterior cutaneous nerve of the thigh THE VAGINA Muscular tube extends upward and backward between the vulva and the uterus Of about 8-10 cm in length The cervix of uterus pierces its anterior wall, and there are 4 fornices around the entrance of the cervix. The upper ½ of the vagina lies above the pelvic floor, While the lower ½ below the pelvic floor. The vagina is supported by: a- Perineal body to lower 1/3 b- Urogenital diaphragm middle 1/3 c- The upper 1/3 is supported by the transverse cervical pubocervical and sacrocervical ligaments BLOOD SUPPLY BY: 1- The vaginal artery from the anterior division of the internal iliac artery 2- Vaginal branch from the uterine artery VENOUS DRAINAGE: to the internal iliac veins LYMPHATIC DRAINAGE: 1- upper1/3 1- internal and external iliac 2-middle 1/3 internal iliac nodes 3-Lower 1/3 superficial inguinal nodes NERVE SUPPLY: 1- Upper part by branches from inferior hypo gastric plexus 2- Lower part around vaginal opening ilioinguinal and dorsal nerve of clitoris MONS PUBIS : Hair bearing elevation of skin anterior to the pubis CLOTORIS: at anterior aspect of the vestibule ,the glans of clitoris is hidden by the prepuce (skin). LABIA MAJORA: a prominent hair bearing folds of skin extends from mons pubis to unite posteriorly in the mid line. LABIA MINORA: hairless folds of skin lying between the labia majora ,anteriorly they split to enclose the clitoris forming anterior prepuce and posterior frenulum . The posterior ends form fourchette . The vestibule: a triangular area bounded on each side by the labia minora. The clitoris is a tits apex , While the fourchette at its base. THE ANAL TRIANGLE Is the posterior part of the perineum , Is bounded behind by tip of coccyx and on each side by ischial tuberosity and the sacrotuberous ligaments. In its middle part is the anus (opening of anal canal) and on each sie of it is the ischiorectal fossa . THE ANAL CANAL: Is about 4 cm , passes downward and backward from rectal ampula opposite tip of coccyx to the anus below , related posteriorly to anococcygeal body, laterally to ischiorectal fossa , While anteriorly into perineal body, membranous urethra and bulb of penis , While female to urethra and lower part of vagina MUCOSA OF UPPER HALF 1-lines by columnar epithelium 2-show anal columns and valves MUCOSA OF LOWER HALF 1- lined by stratified squamous epithelium 2-no anal columns & valves 3-Innervated from autonomic via hypogastric plexus 4-Supplied by superior rectal artery ( from inferior mesenteric) 5-Venous drainage to portal vein 6-Lymphatics to pararectal nodes and then to inferior mesenteric nodes 7Embryologically derived from the hind gut endoderm 3- Innervated by inferior rectal(somatic). 4-supplied by inferior rectal of internal pudendal (internal iliac) 5-to systemic vein 6-drain to superficial inguinal nodes 7-derived from ectoderm and the proctoderm The pectineal line marks the junction between the upper and lower halves of the anal canal . Anal sphincters are : Internal anal sphincter (involuntary) External anal sphincter (voluntary) The internal sphincter is surrounding the upper part of the anal canal and is smooth in nature. The external includes 3 parts as: 1- Subcutaneous encloses lower end of the canal 2- Superficial extends between coccyx and perineal body 3- Deep part encircles the upper part of the canal and surrounding the internal sphincter Both 1 and 3 has no bony attachment. The puborectalis part of levatorani blends with the deep part of the external sphincter forming a slip as passing around junction of ……….? Rectum- anal canal & is attached to the pubic bones in front At junction of rectum- anal canal the internal sphincter ,puborectalis and deep part of the external sphincter form anorectal ring ISCHIO-RECTAL FOSSA: A wedge-shaped space on each side of the anal canal 1- Base by skin 2- Medial wall by the sloping evator ani 3- lateral wall lower part of obturator interna It contains: 1- Dense fatty tissue to support the anal canal during defecation 2- The pudendal canal near the lateral wall of the canal 3- The inferior rectal nerve and artery cross the fossa from lateral to medial to reach the anal canal THE PUDENDAL NERVE: A branch from sacral plexus , passes through both greater and lesser sciatic foramina ,then run in the pudendal canal ,here it give rectal branch (to supply external sphincter ) and skin of perineum , then divides into: Dorsal nerve of penis or clitoris Perineal branch to supply muscles of the 2 perineal paces then continue as posterior scrotal or (labial)) to skin of scrotum or of labia majora. INTERNAL PUDENDAL ARTERY: A branch of internal iliac, has the same course as pudendal nerve it gives: 1- Inferior rectal artery 2- Artery of the bulb of penis or of bulb of vestibule in female 3- Deep artery of penis into the corpus cavernosum 4- Dorsal artery of the penis.