2005-05-19T17:54:00.000Z

Peritoneum and Peritoneal Cavity

• Peritoneum – thin, translucent, serous mambrane. Lines the walls of ab cavity and is there known as parietal peritoneum. Peritoneum in contact with peritoneum everywhere in cavity
• Walls – side of abdominal cavity
• Parietal Peritoneum – peritoneum on sides of abdominal cavity
• Peritoneal Cavity – formed by peritoneum
• Visceral Peritoneum – outer serous coat of an organ that invaginates the peritoneal sac. Mainly GI system
• Retroperitoneal Organs – remains behind sac. Mainly urinary system
• Lesser Omentum – attached to lesser curvature of stomach
• Hepatogastric Ligament – from liver to stomach
• Hepatoduodenal Ligament – from liver to duodenum
• Hepatic Artery
• Portal Vein
• Bile Passages
• Omental Foramen – passage behind hepatoduodenal ligament
• Omental Bursa (or Lesser Sac) – behind omental foramen
• Greater Omentum – attached to greater curvature of stomach. Covers anteriorly the transverse colon and extends inferiorly to portions of small intestine.
• Mesenteries – two layers of peritoneum that sling intestine from post abdominal wall. Vessels and nerves travel in it.
• Root of the Mesentery – stretches diagonally across posterior wall from duodenojejunal ligament to ileocecal junction
• Intestinal Border of Mesentery
• Peritoneal Ligaments – all other double layers and folds of peritoneum
• Folds (or Plicaes) – produced by blood vessels & ducts, lift peritoneum off body wall
• Diaphragam – roof of abdomen
• Liver (or Hepar)
• Right Lobe – 6x’s as large as left
• Left Lobe
• Falciform Ligament – connects liver to diaphragm & anterior abdominal wall
• Diaphragmatic Surface – extensive, convex, smooth
• Visceral Surface – concave, irregular
• Portic Hepatis – doorway to liver
• Gallbladder – attached to visceral surface of liver. Also duodenum, colon, and anterior abdominal wall.
• Stomach (or Gaster)
• Greater Curvature
• Lesser Curvature
• Spleen (or Lien)
• Small Intestine
• Duodenum
• Pylorus
• Hepatoduodenal Ligament
o
• Duodenojejunal Junction – where immobile duodenum ends and mobile jejunum begins
• Suspensory Ligament of the Duodenum – suspends ascending part of duodenum
• Jejunum – proximal 2/5
• Ileum – distal 3/5
• Ileocecal Orifice (or Junction)
• Large Intestine
• Cecum – extends into right iliac fossa
• Vermiform Appendix
• Colon
• Ascending Colon – no mesentery, attached to posterior ab wall
o Right Colicflexure (or Hepatic Flexure) – right angle bend
• Transverse Colon
o Left Colicflexure (or Splenic Flexure)
• Phrenicocolic Ligament
o Transverse Mesocolon – mesentery of transverse colon
o Greater Omentum
• Descending Colon
• Sigmoid Colon
o Sigmoid Mesocolon – mesentery of sigmoid colon
• Rectum
• Anal Canal
• Teniae Coli – outer longitudinal muscular coat of large intestine. Three narrow bands.
• Anterior Tenia – easily visible
• Haustra – sacculations of colon
• Appendices Epiploicae – small bags of fat hanging from colon
• Alimentary Canal (or GI Tract)

Omental Bursa and Peritoneal Reflections

• Omental Bursa
• Inferior Recess – between two double layers of gastrocolic ligament
• Superior Recess
• Splenorenal Ligament
• Gastrosplenic Ligament
• Peritoneal Attachments of the Liver
• Falciform Ligament of the Liver
• Subphrenic Recesses – right and left anterior. Divided by falciform ligament
• Bare Area of liver
• Coronary Ligament – peritoneal reflections around bare area
• Hepatorenal Ligament – inferior portion of coronary ligament
• Left Triangular Ligament – peritoneal fold attaching left tip of left hepatic lobe to diaphragm
• Hepatorenal Pouch (or Recess) – bound by liver, right kidney, colon and duodenum
• Four Peritoneal Gutters
• Right Lateral (Paracolic) Gutter
• Left Lateral (Paracolic) Gutter
• Gutter to Right of Mesentery
• Gutter to Left of Mesentery

Lab 8

Bile Passages, Celiac Trunk and Portal Vein

• Lesser Omentum
• Hepatoduodenal Ligament
• Bile Passages
• Hepatic Artery
• Portal Vein
• Autonomic Nerves – originate from celiac ganglia
• Hepatic Lymph Nodes – around bile duct & portal vein
• Bile Passages
• Bile Duct – caliber of pencil, connected to gallbladder via cystic duct
• Cystic Duct – connects gallbladder and bile duct
• Common Hepatic Duct – superior to junction of cystic duct and bile duct. Branches to kidneys:
• Right Hepatic Duct
• Left Hepatic Duct
• Celiac Trunk – branches into:
• Common Hepatic Artery – branches into:
• Gastroduodenal Artery – inferior passing branch of common hepatic. Branches into:
o Right Gastroepiploic Artery
• Hepatic Artery Proper – left of bile duct. Branches from it include:
o Right Gastric Artery – to lesser curvature of stomach
o Left Hepatic Artery – to left lobe of liver
o Right Hepatic Artery – to right lobe of liver. Branches into:
• Cystic Artery
• Splenic Artery – runs along pancreas border
• Left Gastroepiploic Artery – anastamoses with right gastroepiploic
• Left Gastric Artery – to lesser curvature of stomach. Anastamoses with right gastric to form arterial arch along lesser curvature
• Cystic Triangle – defined by cystic duct, hepatic duct, and liver
• Portal Vein – carries venous blood from abdominal portion of GI tract, spleen and pancreas to liver. Branches that empty into it:
• Splenic Vein
• Superior Mesenteric Vein—largest tributary to portal vein
• Inferior Mesenteric Vein – may empty from splenic or superior mesenteric, or may empty into portal at junction of the two
• Right Gastric Vein – superior to left gastric vein
• Left Gastric Vein – direct to stomach. Along with right gastric, branches that empty into it:
• Esophageal Veins
• Esophageogastric Varices – esophageal and gastric veins become engorged, dilated, and varicose d/t portal venous hypertension.

Superior and Inferior Mesenteric Vessels

• Superior Mesenteric Artery – 1 cm caudal to celiac trunk. Arises from abdominal trunk. Dorsal of pancreas. Crosses inferior part of duodenum. Branches into:
• Intestinal Arteries – feed jejunum and ileum. Arteries unite to form loops or arches, which then branch into:
• Vasa Recta – pass alternately to opposite sides of jejunum and ileum
• Ileocolic Artery – passes to right iliac fossa, supplies cecum and appendix
• Right Colic Artery – from superior mesenteric or ileocolic. Supplies ascending colon.
• Middlie Colic Artery – supplies right half of transverse.
• Superior Mesenteric Vein – right of artery. Empties into portal vein
• Lymph Nodes
• Superior Mesenteric Nodes – located near point of origin of superior mesenteric artery from abdominal aorta.
• Superior Mesenteric Plexus of Nerves – surround superior mesenteric artery
• Inferior Mesenteric Artery – about 3 cm superior of aortic bifurcation. Branches into:
• Left Colic Artery – supplies descending colon and left half of transverse colon. Divides into ascending and descending branches.
• Sigmoid Arteries – four branches that form arches
• Superior Rectal Artery – supplies proximal part of rectum. Divides into left and right branches
• Marginal Artery – arterial border of colon formed from anastamosing loops of superior and inferior mesenteric arteries
• Inferior Mesenteric Vein – empties into portal vein
• Left Colic Vein
• Sigmoid Vein
• Superior Rectal Vein
• Lymph Nodes
• Inferior Mesenteric Nodes – around root of the inferior mesenteric artery

Lab 9

Removal of the GI Tract

• Rectum
• Inferior Mesenteric Artery
• Mesentery of the Sigmoid Colon – V shaped, medial to inferior mesenteric vessels and left ureter
• Descending Colon
• Phrenicolic Ligament – at the left colic flexure
• Spleen
• Ascending Colon
• Origin of the Superior Mesenteric Artery
• Celiac Trunk
• Esophagus
• Stomach
• Duodenojejunal junction or flexure
• Suspensory muscle of duodenum – holds duodenojejunal junctionin place
• Duodenum
• Pancreas
• Inferior Vena Cava
• Liver
• Falciform Ligament
• Left Triangular Ligament
• Coronary Ligament

Detailed Examination of GI Tract and its Unpaired Organs

• Portal Vein – main tributaries:
• Splenic
• Superior Mesenteric
• Inferior Mesenteric
• Esophageal veins
• Gastric veins
• Celiac Trunk – branches into:
• Splenic Artery – sends branches to body and tail of pancreas
• Left Gastric Artery
• Common Hepatic Artery
• Hepatic Artery Proper
• Gastroduodenal Artery – contributes to:
o Pancreaticoduodenal arches (arcades) – in angle between duodenum and pancreas
o Superior Pancreatoduodenal arteries – supply proximal part of duodenum and pancreas with blood from celiac trunk
• Autonomic Nerve Fibers
• Lymph Nodes – specifically:
• Pancreaticosplenic Nodes -- along course of splenic artery, receive lymphatic drainage from tail of pancreas and from spleen
• Superior Mesenteric Artery – branches includes:
• Inferior Pancreatoduodenal Arteries – form part of two pancreaticoduodenal arches
• Gallbladder, etc.
• Common Bile Duct
• Major Duodenal Papilla – opening of common bile duct into duodenum
o Plica – hood like cover of duct
• Main Pancreatic Duct
• Sphincter of the Hepatopancreatic Ampulla (Sphincter Oddi) – common portion of bile and pancreatic ducts
• Cystic Duct
• Liver
• Bare Area – triangular, granulated, where liver is attached to diaphragm
• Coronary Ligament – around bare area
• Visceral Surface
• Four Lobes of the Liver – right, left, caudal and quadrate
• Right Saggital Fossa – posteriorly forming groove for IVC and inferiorly forming shallow bed for gallbladder
• Left Saggital Fissure – ligamentum venosum posteriorly and round ligament inferiorly
• Transverse Fissure (Porta Hepatis) – through which bile passages, hepatic artery and portal vein pass.
• Inferior Vena Cava
• Hepatic Veins – know difference b/w portal veins and hepatic veins
• Hepatic Lymph Nodes
• Celiac Nodes – lymph nodes around celiac trunk.
• Spleen
• Hilus – entrance and exit of splenic veins
• Borders – anterior, superior, posterior, inferior
• Visceral Surface – divided into: gastric, renal, pancreatic and colic
• Diaphragmatic Surface – convex and smooth
• Stomach
• Longitudinal Ridges
• Pyloric Antrum
• Pyloric Canal
• Pyloric Sphincter
• Pyloric Orifice
• Duodenum
• Major Duodenal Papilla
• Plica – hoodlike, covers papilla
• Plicae Circularis – pronounced folds of mucosa
• Jejunum
• Plicae Circularis
• Ileum
• Ileocecal Region
• Colon
• Haustra – sacculations
• Plicae Semilunares – crescentic mucosal folds

Lab 10

Posterior Abdominal Surfaces

• Retroperitoneal Space – space between parietal peritoneum and muscles and bones of posterior abdominal wall. Includes kidneys, ureters, suprarenal glands, aorta, IVC, abdominal portion of bilateral sympathetic trunks.
• Right Kidny
• Left Kidney
• Vessels
• Male Cadaver
• Left Testicular Vein – Drains into:
o Left Renal Vein
• Right Testicular Vein – Drains into:
o Inferior Vena Cava
• Aorta
o Right Testicular Artery
o Left Testicular Artery
• Female Cadaver
• Ovarian Vessels – cross external iliac vessels close to ureter
• Kidneys and Suprarenal Glands
• Kidneys
• Perirenal Fat or Adipose Capsule – substantial mass of fat in which kidney is embedded
• Renal Fascia – encloses both the kidney and its fatty capsule
• Left Kidney:
• Left Renal Vein – from IVC to hilus. Tributaries
o Left Testicular Vein (male); Ovarian Vein (female)
o Venous Channels from the Left Suprarenal Gland
• Left Renal Artery
• Left Renal Pelvis and Ureter
• Renal Pelvis
• Ureter
o Abdominal Part of Ureter – crosses psoas major muscle. Runs obliquely posterior to testicular (ovarian) vessels
o Pelvic Part of Ureter
• Right Kidney
• Right Renal Artery
• Renal Pelvis
• Ureter
• Muscles
• Transversus Abdominis
• Quadratus Lumborum
• Psoas Major
• Diaphragm
• 12th Rib
• Kidney on Section
• Fibrous Capsule
• Renal Cortex – outer one-third
• Renal Medulla
• Renal Pyramids
• Renal Columns
• Renal Papillae – in groups of two or three, projecting into calyces minores
• Calyces Minores – small cups into which renal papillae project
• Calyces Majores – formed from two or three calyces minores
• Renal Pelvis – formed from uniting major calyces
• Ureter
• Suprarenal (Adrenal) Glands – close to superior poles of kidneys
• Right Adrenal Gland—triangular in shape, only loose attachment to superior pole of right kidney, posterior to IVC
• Left Adrenal Gland – semilunar in shape and closely adjacent to superior and medial border of left kidney
• Aorta – Branches into:
• Inferior Phrenic Arteris – Supply middle part of gland, from aorta superior of celiac trunk
• Renal Arteries – branches into inferior suprarenal branches
• Abdominal Aorta and its Branches:
• Branches to GI Tract and its Three Unpaired Organs
• Celiac
• Superior Mesenteric
• Inferior Mesenteric
• Branches to the Three Paired Organs
• Suprarenal
• Renal
• Testicular or Ovarian
• Branches to the Walls
• Phrenic
• Lumbar – there are four lumbar arteries
• Bifurcation of Abdominal Aorta
• Common Illiac Arteries
• Inferior Vena Cava – and its tributaries
• Portocaval System

Posterior Abdominal Wall

• Muscles
• Psoas Major – arise from lumbar vertabae
• Iliacus – fan shaped, occupies extensive iliac fossa
• Iliopsoas – function unit formed by iliacus and psoas
• Quadratus Lumborum – thick rhomboidal, runs from iliac crest to lumbar transverse processes and rib 12
• Transversus Abdominus – runs horizontally posterior to oblique borders of quadratus lumborum
• Nerves of Posterior Abdominal Wall
• Lumbar Nerve Plexus – eventually forms ventral rami of T12-L5
• Subcostal Nerve – T12, about 1 cm caudal to rib 12
• Iliohypogastric and Ilioinguinal Nerves – L1, Descending steeply in front of quadratus lumborum. Frequently nerves arise from common trunk and don’t separate until transverses abdominus
• Genitofemoral Nerve – pierces anterior surfaces of psoas
• Lateral Cutaneous Nerve of Thigh – passes deep to inguinal ligament near anterior superior iliac spine
• Femoral Nerve – L2, L3, L4. Large nerve lying in angle between psoas and iliacus, then deep to inguinal ligament
• Obturator Nerve – L2, L3, L4. Medial border of psoas
• Lumbosacral Trunk – consists of ventral rami of part of L4 and all of L5
• Sympathetic Trunk
• Review Autonomic Nerve Supply of Abdomen

Thoracic Diaphragm

• Diaphragm
• Sternal Part
• Costal Part – from inferior 6 ribs. Interdigitates with transversus abdominus
• Lumbar Part – consists of:
• Right Crus
• Left Crus
• Arcuate Ligaments – fleshy fibers
• Medial Arcuate Ligament – tendinous arch provides gap for psoas muscle
• Lateral Arcuate Ligament – across superior portion of quadratus lumborum
• Central Tendon
• Three Large Openings in Diaphragm
• Venal Caval Foramen
• Esophageal Hiatus
• Aortic Hiatus
• Greater Splanchnic Nerves – traverse crura of diaphragm

Lab 11

Pelvis

• Iliac Crest
• Anterior Superior Iliac Spine – anterior tip from iliac crest, most anterior point of pelvis when in erect posture
• Posterior Superior Iliac Spine
• Inferior Pubic Ramus
• Pelvic Brim – circumference of plane dividing pelvis into superior & inferior portion
• Promontory – part of sacrum, forms dorsal part of brim
• Pubic Arch – wider in females
• Symphysis Pubis – forms ventral part of brim
• Greater Pelvis – superior to pelvic brim. Sides bounded by ileum
• Muscles lining walls of greater pelvis
• Lesser Pelvis – inferior to pelvic brim.
• Superior Pelvic Aperture/Pelvic Inlet – inlet to lesser pelvis
• Inferior Pelvic Aperture/Pelvic Outlet – diamond shaped. Anterior is pubic symphysis, lateral is ischial tuberosities, and posterior is sacrum & coccyx
• Peritoneal Cavity – extends into lesser pelvis
• Floor of Pelvis – formed by muscles
• Perineum – diamond shaped. Covers pelvic outlet inferiorly. Includes:
• Anal Region/Anal Triangle – posterior, where GI tract passes through
• Urogenital Region/Urogenital Triangle – urinary system anterior and genital system in intermediate position
• Pelvic Fascia – two parts:
• Parietal Pelvic Fascia – lines intrapelvic surfaces of muscles lining walls of pelvic cavity. Firmly attached to pelvic brim
• Retropubic Space – space between parietal pelvic fascia and bladder. Contains fat, vessels, nerves.
• Visceral Pelvic Fascia – fascial covering for pelvic viscera e.g. bladder.
• Levator Ani – lateral to prostate, inferior to retropubic space
• Bony Pelvis – Formed by:
• Right Hip Bone, Left Hip Bone
• Ischial Tuberosity – lower
• Ischial Spine – higher. Attaches sacrospinous ligament
• Sacrospinous Ligament – short, medial plane. Coccyx to ischial spine.
• Sacrotuberous Ligament – longer, lateral, sacrum to ischial tuberosity.
• Sacrum
• Anterior Sacral Foramina – passage of ventral nerves S1-4, little holes in sacrum
• Promontory – where sacrum meets lumbar, below intervertebral disc.
• Sacral Canal – superior. Transmits S1-S5 on their way to sacral foramina.
• Sacroiliac Articulation – joint between auricular surfaces of sacrum and ilium
• Coccyx
• Obturator Foramen – hole to left and right of pubic symphysis
• Obturator Membrane – closes obturator foramen
• Lesser Sciatic Foramen – lower, smaller lateral foramen in pelvis
• Greater Sciatic Foramen – higher, bigger lateral foramen in pelvis
• Ischioanal (Ischiorectal) Fossa – large wedge shaped space on either side of anus
• Measurements –
• Transverse Diameter – across greatest width of superior aperture
• Anteroposterior/Conjugate Diameter – indicates pelvic outlet

Anal Region (Triangle)

• Gluteus Maximus – attached inferiorly to sacrotuberous ligament
• Posterior Cutaneous Nerve of Thigh
• Gluteal Branch of…
• Inferior Rectal (Hemorrhoidal) Nerve
• Inferior Rectal (Hemorrhoidal) Vessels
• Ischioanal Fossa
• Fatty Tissue of Ischioanal Fossa
• Pudendal Canal – includes in space:
• Pudendal Nerve
• Internal Pudendal Artery
• Obturator Internus muscle – along ischial tuberosity
• Fascia of Obturator Internus
• Levator Ani – runs medially towards rectum
• Rectum
• Sphincter Ani Externus
• Anus

Lab 12

Female Pelvis and Perineum

• General Arrangement
• Perineum – area between thighs. Divided into:
o Anal Region
o Anal Canal – pierces levator ani muscle
o Urogenital Region
o Urethra – pierces the anterior portion of the urogenital diaphragm
o Vagina – posterior wall in contact with rectum
• Fornix of Vagina – surrounds intravaginal part of cervix uteri
• Urinary Bladder – supported by muscular pelvic floor
• Uterus
• Colon
• Rectum
• Anal Canal
• Pubovesical Ligament

Female Urogenital Region (Triangle)

• External Genitalia
• Vulva
o Mons Pubis
o Labia Majora
o Labia Minora
o Vestibule of the Vagina
o Clitoris
o Prepuce of Clitoris
o Vaginal Orifice
o External Urethral Orifice
o Openings of Paraurethral Glands or Skene’s Glands
• Skin Incisions
• Ischial Tuberosities
• Ischioanal Fossa
• Perineal Body
• Round Ligament of the Uterus – distal part closely related to fat of labium majoris
• Posterior Labial Nerves
• Posterior Labial Vessels
• Suspensory Ligament of the Clitoris – attaches it to symphysis
• Superficial Perineal Space
• Superficial Perineal Fascia
o Superficial Perineal Space or Pouch – includes:
o Greater Vestibular Glands – attached to posterior end of bulbs
o Three Paired Muscle
• Superficial Transverse Perineal Muscle – ischial tuberosity to perineal body
• Ischiocavernosus – extend laterally posterior to symphysis, covers crus
• Bulbocavernosus – surround vaginal & urethral orifice. Covers vestibular bulb and vestibular gland
o Bulbs of the Vestibule – two elongated masses of erectile tissue on each side of vaginal orifice
o Clitoris
o Glans
o Prepuce – hood over glans
o Body
o Crura – attached to ischiopubic ramus
• Left Crus
• Right Crus
o Perineal Membrane – deeper membrane forming superficial perineal space
• Deep Perineal Space
• Inferior Fascia of Urogenital Diaphragm (Perineal Membrane)
• Deep Perineal Space or Pouch
o Deep Transverse Perineal Muscle – originates at pubic arch and meets opposite muscle in tendinous raphe posterior to vaginal wall
o External Sphincter Urethra – surrounds female urethra
o Sphincter Urethrovaginalis – surrounds sphincter urethra and vaginal orifice
• Superior Fascia – superiorly related to levator ani, particulary to anterior portion pubococcygeus
• Urogenital Diaphragm – striated muscles between two sides of pubic arch within deep perineal space

Peritoneum in the Female Pelvis

• Peritoneum
• Vesicouterine Pouch – between bladder and uterus
• Rectouterine Pouch – between uterus and rectum
• Retrorectal (Presacral Space) – between rectum and sacrum
• Paravesical Fossa – each side of bladder
• Pararectal Fossa – each side of rectum
• Adnexa or Uterine Appendages – ovaries, uterine tubes, ligaments of uterus
• Ligaments
• Round Ligament of Uterus – visible through anterior layer of broad ligament
• Broad Ligament of the Uterus – sides of uterus, fusion of two layers of peritoneum
o Uterine Tube – in free margin
o Mesoalpinx – surrounds uterine tube
o Mesovarium – contains ovary
o Parametrium – loose fatty and areolar tissues between 2 layers of broad ligament
o Uterine Artery – passes through, near ureter
o Ligament of the Ovary – cord within broad ligament connecting ovary with uterus at point below uterine tube
o Suspensory Ligament of Ovary – contains ovarian vessels; continuous with ligament of ovary
• Sacrouterine Ligaments – anchor uterus to sacrum; true musculofascial ligaments
• Transverse Cervical Ligament – anchors uterus to lateral wall of pelvis
• Ovary – attached to posterior aspect of broad ligament
• Structures Adhering to Peritoneum –
• Rectum
• Bladder
• Ureter
• Ovarian Vessels
• Round Ligament of Uterus
• Uterus

Retropubic Space, Retrorectal Space, Nerves and Vessels

• Retropubic Space – between symphysis and bladder; U shaped, extends on both sides of bladder
• Pubovesical Ligament – anchors neck of bladder to pubis
• Retrorectal Space or Presacral Space – between rectum and coccyx
• Pelvic Sphlanchnic Nerves – sacral parasympathetic from ventral rami S2-S4
• Pelvic Plexus/Inferior Hypogastric Plexus – pelvic sphlanchnic nerves enter it. Also includes sympathetic.
o Rectal Pelxus
o Utero Vaginal Plexus
o Vesical Plexus
• Internal Iliac Artery
o Obturator Artery – in 75% of cases. Other 25% off inferior epigastric
• Obturator Canal – traverses superior aspect of obturator membrane
• Common Iliac Vein
o Internal Iliac Vein – left CIV posterior to aorta bifurcation
o External Iliac Vein
• Ureter (L & R) – crosses external iliac vessels medially

Pelvic Diaphragm

• Lateral Wall of Pelvic Cavity
• Obturator Foramen
• Obturator Nerve
• Obturator Vessels
• Obturator Canal
• Obturator Internus Muscle – internally closes obturator foramen
• Obturator Fascia
• Tendinous Arch – thickened superior part of obturator fascia, ischial spine to pubic bone
• Pelvic Diaphragm – fibromuscular floor of inferior pelvic aperture
o Levator Ani – arises in part from tendinous arch. Consists of:
o Puborectalis Muscle – medial portion of pubococcygeus
o Pubococcygeus – main part, arises from pubic bone. Forms puborectal sling
• Medial Puborectalis
• Pubovaginalis
o Iliococcygeus – arises from tendinous arch
• Ischiococcygeus
• Urogenital Hiatus – between vagina and anal canal
• External Anal Sphincter
• Anococcygeal Ligament
• Sacrotuberous Ligament
• Sacrospinous Ligament
• Greater Sciatic Foramen
• Lesser Sciatic Foramen
• Piriformis Muscle
• Sciatic Nerve
• Ischioanal Fossa
• Urethra
• External Urethral Orifice
o Deep Perineal Space or Pouch
o Sphincter Urethrae Muscle
• Ureter
• Uterine Artery – crosses superior to ureter
• Ureterovesical Junction – where ureter passes obliquely along bladder wall
• Urinary Bladder
• Muscular Coat/Detrusor Urinae – smooth muscle bundles
• Interior of Bladder
o Trigone
o Two Orifices of Ureters
o Internal Urethral Orifice
• Bladder Neck –
o Internal Sphincter Urethrae
• (Recall External Sphincter was in deep perineal space)
• Vagina
• Uterus
• Cervix
o Cervical Canal
• Body of Uterus
o Vesical Surface – facing vesicouterine pouch
o Superior Surface – facing rectouterine pouch
o Lateral Surfaces – attached to broad ligament
o Uterine Cavity
o Endometrium – uterine mucosa
o Myometrium – smooth muscle uterine wall
• Fundus
• Again, Broad Ligament
• Parametrium
• Uterine Tube
• Fallopian Tube
• Oviduct
• Infundibulum
o Fimbriae
o Isthmus – narrow medial 1/3
• Ovary
• Common Iliac Artery
• External Iliac Artery
• Internal Iliac Artery – branches into:
o Umbilical Artery
o Superior Vesical Arteries – 3 or 4 of them
o Superior Gluteal Artery
o Inferior Gluteal Artery
o Internal Pudendal Artery
o Middle Rectal Artery
o Uterine Artery
o Vaginal Artery
o Obturator Artery
• Pelvic Venous Plexuses
• Anal Canal
• Anal Columns
• Anal Valves
• External Anal Sphincter
o Deep
o Superficial
o Subcutaneous
• Internal Anal Sphincter
• Levator Ani and Fascia
o Puborectalis Muscle
o Pubococcygeus
o Illiococcygeus
o Tendinous Arch
• Coccygeus Muscle
• Longitudinal Muscle Coat
• Circular Muscle Coat
• Puborectalis Sling
• Piriformis Muscle
• Sacral Plexus
• Lumbosaccral Trunk
• Sciatic Nerve
• Gluteal Arteries
• Pudendal Nerve
• Sympathetis Chain and its Ganglia

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