Anatomy of pelvis and retropouch PDF

Preview

Summary

Aetiology, Signs ands Symptoms, Diagnosis, Management and Treatment...

Description

7. Anatomy of pelvis & / Recto-uterine pouch - Fallopian tube infection? Ectopic pregnancy? - Dermatomes & referred pain - Rovsing's point & McBurney’s point https://teachmeanatomy.info/pelvis/ The pelvic region of the trunk includes the bony pelvis, the pelvic cavity (the space enclosed by the bony pelvis), the pelvic floor, below the pelvic cavity, and the perineum, below the pelvic floor. The pelvic skeleton is formed in the area of the back, by the sacrum and the coccyx and anteriorly and to the left and right sides, by a pair of hip bones. The two hip bones connect the spine with the lower limbs. They are attached to the sacrum posteriorly, connected to each other anteriorly, and joined with the two femurs at the hip joints. The gap enclosed by the bony pelvis, called the pelvic cavity, is the section of the body underneath the abdomen and mainly consists of the reproductive organs and the rectum, while the pelvic floor at the base of the cavity assists in supporting the organs of the abdomen.

The bladder is an organ in the urinary system, it plays two main roles: - Temporary storage of urine: the bladder is a hollow organ with distensible walls, it has a folded internal lining known as rugae. - Assists in the expulsion of urine: the musculature of the bladder contracts during micturition with concomitant relaxation of the sphincters

Shape of the bladder: - Apex: located superiorly, pointing towards the pubic symphysis. It is connected to the umbilicus by the median umbilical ligament - Body: main part of the bladder located between the apex and the fundus - Fundus or base: located posteriorly, triangle shaped, with the tip of the triangle pointing backwards - Neck: formed by the convergence of the fundus and the two inferolateral surfaces. It is continuous with the urethra. Urine enters the bladder through the left and right ureters and exits via the urethra. In contrast with the rest of the internal bladder, the trigone has smooth walls. The musculature of the bladder plays a key role in the storage and emptying of urine. In order to contract during micturition, the bladder wall contains specialised smooth muscle known as the detrusor muscle. Its fibres are orientated in multiple directions in order to retain the structural integrity when stretched. It receives innervation from both the sympathetic and parasympathetic nervous system. The fibres of the detrusor muscle often become hypertrophic in order to compensate for increased workload of the bladder emptying, this is very common in conditions that obstruct the urine outflow such as benign prostatic hyperplasia. There are two muscular sphincters located in the urethra: - Internal urethral sphincter - Male: consists of circular smooth fibres which are under autonomic control. It is thought to prevent seminal regurgitation during ejaculation. - Females: thought to be a functional sphincter. It is formed by the anatomy of the bladder neck and proximal urethra. - External urethral sphincter: has the same structure in both sexes. It is skeletal muscle and under voluntary control. However in males the external sphincteric mechanism is more complex as it correlates with fibres of the rectourethralis muscle and levator ani muscle. Vasculature is primarily derived from the internal iliac vessels. Arterial supply is via the superior vesical branch of the internal iliac artery. Nervous supply: neurological control is complex with the bladder receiving input from both the autonomic and somatic arms of the nervous system. - Sympathetic: hypogastric nerve, causes relaxation of the detrusor muscle and promoting urine retention

-

Parasympathetic: pelvic nerve, increased signals from this nerve causes contraction of the detrusor muscle, stimulating micturition - Somatic: pudendal nerve, it innervates the external urethral sphincter, providing voluntary control over micturition In addition to the efferent nerves supplying the bladder, these are sensory (afferent) nerves that report to the brain, they are found in the bladder walls and signal the need to urinate when the bladder becomes full. The bladder stretch reflex: is a primitive spinal reflex, in which micturition is stimulated in response to stretch of the bladder wall. It is analogous to the muscle spinal reflex. The reflex arc is: - Bladder fills with urine and the bladder walls stretch, sensory nerves detect stretch and transmit this information to the spinal cord - Interneurons within the spinal cord relay the signal to the parasympathetic efferents - The pelvic nerve acts to contract the detrusor muscle and stimulate micturition It is non-functional post childhood, the bladder stretch reflex needs to be considered in spinal injuries (where the descending inhibition cannot reach the bladder), and in neurodegenerative diseases (where the brain is unable to generate inhibition). Recto-uterine pouch: is the extension of the peritoneal cavity between the rectum and the posterior walls of the uterus in the female human body. It is the deepest point of the peritoneal cavity. It is normal to have approximately 1 to 3ml of fluid in the recto-uterine pouch throughout the menstrual cycle. After ovulation there is between 4 and 5 ml of fluid in the recto-uterine pouch. The recto-uterine pouch, being the lowest part of the peritoneal cavity in a woman at supine position, is a common site for the spread of pathology such as ascites, tumour, endometriosis, pus. Pelvic inflammatory disease (PID) is an infection of the female upper genital tract, including the womb, fallopian tubes and ovaries. Symptoms: pain around the pelvis or lower tummy, discomfort or pain during sex, pain when peeing, bleeding between periods or after sex, heavy periods, painful peruods, unusual vagina discharge. Most cases of PID are caused by a bacterial infection that's spread from the vagina or the cervix to the reproductive organs higher up. Many different types of bacteria can cause PID. In many cases, it's caused by a sexually transmitted infection (STI), such as chlamydia or gonorrhoea. Another type of STI called mycoplasma genitalium is thought to be increasingly responsible for cases of PID. An ectopic pregnancy is when a fertilised egg implants itself outside of the womb, usually in one of the fallopian tubes. The fallopian tubes are the tubes connecting the ovaries to the womb. If an egg gets stuck in them, it won't develop into a baby and your health may be at risk if the pregnancy continues.

Rovsing sign refers to pain in the right lower quadrant with palpation of the left lower quadrant. If the patient is said to have a positive Rovsing's sign, they may have appendicitis. McBurney's point refers to the point on the lower right quadrant of the abdomen at which tenderness is maximal in cases of acute appendicitis. Acute appendicitis is characterized by the inflammation, infection, or swelling of the appendix....