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Yeison pelvis Pelvis by Diana Zarate M.

pelvic muscles
posterolateral wall of the pelvis is partially closed by the piriformis and obturator internus belonging to the lower limb. The bottom wall is closed by a muscle-fascial whole perineum. Piriformis muscle


Originated in the pelvis out of it by the greater sciatic foramen and passes through the gluteal region, which is a key structure for addressing the neurovascular pedicles.
O: face pelvic sacral vertebrae II, III and IV, between the foramen pelvic and between the grooves that extend laterally.
-Top edge greater sciatic notch.
-sacrotuberal Anterior ligament.
I: superior border of greater trochanter.
N: sacral plexus (LV, SI and SII)
A: abductor and lateral rotator of the femur. Internal obturator muscle

:
has a broad origin on the pelvis and out the lower sciatic foramen and crosses horizontally coxal joint.
O: inside of the obturator membrane.
-contour of the obturator foramen to the line terminal.
-obturator fascia.
-range fibers converge to four or 5 tabs tendon reflected at right angles lesser sciatic notch, separated from it by the bag ischial internal shutter.
I: medial aspect of the greater trochanter forward and above the trochanteric fossa.
N: nerve to obturator internus and superior twin (LV, SI and SII)
A: abductor and lateral rotator of the femur. Set


PERINEUM soft tissue at the lower pelvic cavity closed.
Its Limits osteo-fibrous framework diamond shape formed earlier by the lower edge of the symphysis pubis and ischium-pubic branch, and subsequently by the apex of the coccyx and sacro-tuberous ligament.
A horizontal line that goes from one ischial tuberosity the other divides the perineum into two triangular segments, one rear and one earlier. The rear triangle is pierced by the anal canal, the anal region (triangle anal). The anterior triangle is traversed by the urethra in men and the urethra and vagina in women, is the urogenital region (urogenital triangle).
A different lines that cross through the perineum in the median plane are attached the muscles and fascia sphincter by promoting their role.
perineal muscles are arranged in different planes and each plane has its own fascia. The deep layer is the diaphragm of the pelvis formed by the levator ani muscles and coccyx, which are described in the sphincter external anal. In the front of the perineum, exclusively, there is a medium shot, the urogenital diaphragm is comprised of the external sphincter muscles of the urethra and deep transverse perineal. The flat surface composed of the muscles associated with the external genitalia: superficial transverse perineal, external anal sphincter, and bulb-hamstring-cavernous spongy. PLANO

DEEP PELVIC DIAPHRAGM OR
levator ani muscles and coccyx form a partition or septum superiorly concave and convex downward, like the hull of a ship, which extends between the walls of the pelvis. Presented in the line stretched half a hole from anterior to posterior, from pubis to the rectum to allow the passage of the urethra, blood vessels and nerves of the penis or clitoris and vagina in women. Therefore it is deficient in the anterior and median, then crossed the ano-rectal junction. Has the ability to increase abdominal pressure with the abdominal muscles.

levator ani muscle
Both levator ani muscles confined between them in the midline before the anus an opening called the urogenital hiatus.
We divided into two parts: a medial and sagittal pubic origin, and lateral iliac origin. Pubococcygeus muscle

:
O: inner side of the body and upper branch of the pubis, until the channel stopper.
I: lifting plate formed by the intersection of the fascicles of both sides (median raphe).
-apex of the coccyx bone.
A: Moves the upper anal canal and above, also tends to dilate the duct and participates in the voluntary control of urination.

Levator prostate or pubovaginal muscle in women: the pubococcygeus medial fascicles
O: inside of the body of the pubis. Limits
genital hiatus and the man crosses the gap of the prostate, in women, the union of the upper two-thirds to the lower third of the vagina, to which it adheres.
I: central tendon of the perineum
A: the pubovaginal involved in intercourse by intermittent contractions prelude to orgasm. Puborectalis

: includes medial and inferior fascicles, visible on the underside of the levator ani muscle.
O: inside of the body of the pubis. Mix
its fibers like the pubococcygeus muscle in the tunic of the rectum and descending tracts gives the longitudinal portion of the rectum.
I: it joins the muscle heterolateral forming a hammock behind the perineal flexure of rectum.
A: contingency anal.

iliococcygeus:
sometimes developed, sometimes fibrous, the fibers are more transverse the more later.
O: inside of the spine ischial.
-tendinous arch of levator ani muscle. Most fibers are mixed with the obturator fascia and ascend with it to the finish line.
I: lifting plate (median raphe) of the levator ani muscle.
-edges and apex of the coccyx bone.
N: sacral plexus, nerve branches to the levator ani (SIII and SIV).
A: compresses the straight lateral to medial rectus are as constrictors.

coccygeus or isquiococcígeo:
is a sheet muscle tendon, triangular, located posterior to the levator ani muscle.
O: medial aspect of the ischial spine
-edge of the greater sciatic notch.
-pelvic surface sacrospinous ligament.
I: lateral margin of the last sacral and first two coccygeal.
N: sacral plexus (SIII and SIV)
A: in addition to the levator ani muscle that are inserted into the coccyx to oppose further tilting movement of the bone and build support for pelvis organs.

external anal sphincter muscle
largely regarded as a branch of the levator ani. Divided into 3 parts: Part subcutaneous

: Located near the anal opening, consists of concentric fibers decussate anteriorly and posteriorly the anal canal, separated from this channel only for terminal disintegration of the fibers of the stratum longitudinal rectum.

The superficial part: It surrounds the upper end of the subcutaneous muscle fibers consisting of elliptical, extended horizontally from the apex of the coccyx bone and ligament anococcygeal, the central tendon of the perineum, where it continues to bulboesponjoso muscle.

The deep end: Form a muscular tube that surrounds the top of the anal canal, then merges with the puborectalis muscle to form the anorectal ring, formerly fibers terminate in the central tendon and others are mixed with the superficial transverse muscle.

UROGENITAL DIAPHRAGM PLANE MEDIUM OR
Ranges between 2 branches ischio, is located in the urogenital region and muscles of the perineum are between the two fascial sheets of the pelvic diaphragm.


deep transverse perineal muscle
O: ischium and ischial pubic ramus.
I: central tendon of the perineum
-side wall of the vagina in women.
N: perineal branches of the pudendal nerve (SII AND SIV).
A: fixes the central tendon and supported by the bodies. Compress the veins of the two erectile bodies that cross so involved in erection.

The center of the perineum or perineal body is a fibromuscular mass located in the median plane between the diaphragm urogenital and anal canal. Fibers converge there 8 muscles: levator ani, and deep transverse surface of the anus and sphincter bulboesponjoso sternum.

urethral sphincter muscle:
surrounds the membranous urethra and the underside of the female urethra.
O: union of the lower branches of the pubis and ischium.
-walls adjacent deep perineal space.
I: crossing of fibers before and after the urethra in women is mixed behind the deep transverse muscle. The deep fibers in man ring, stretch up on the anterolateral part of the prostate.
N: perineal branches of the pudendal nerve (SII AND SIV).
A: role in the urinary sphincter. FLAT SURFACE OR

superficial perineal muscles

superficial transverse perineal muscle:
sometimes absent, muscle is a thin reed.
O: medial border of the ischial tuber
I: central tendon of the perineum
N: pudendal nerve (SII, SIII and SIV)
A: fixing the central tendon attachment. Muscle

ischiocavernosus:
form of semi-cone has applied to the free surface of the cross of the penis or clitoris.
O: medial border of the ischial tuberosity and ischial industry.
I: medial side and bottom of the cross of the penis or clitoris, near the junction of the corpora cavernosa.
N: pudendal nerve
A: it plays a role in the erection discussed. Muscle

bulboesponjoso:
form in man, with the opposite side, a semivaina covering the bulb and back of the body spongiosa penis. In women, the muscle is separated contralateralpor the lobby of the vagina.
O: central tendon of the perineum, continuous with the fibers of the external anal sphincter muscle.
I: inferior fascia of urogenital diaphragm (posterior fibers).
-Dorsal penile body spongiosa (middle fibers).
-deep fascia of the dorsum of the penis or clitoris, after circling the homolateral cavernous body (anterior fibers).
A: in the erection like ischiocavernosus by compressing the erectile bodies of blood to the front of them. The anterior fibers of this muscle closes the venous return by compressing the deep dorsal penile vein
-in women, and bulboesponjoso ischiocavernosus down the clitoris during intercourse and apply his penis against the penis, in addition to the vestibular gland compresses bulboesponjoso higher.

FASCIA OF THE PELVIS facial
There are 3 levels of the 3 perineal fascial planes of the 3 perineal muscle planes

FASCIA OF THE PELVIC DIAPHRAGM
The pelvic diaphragm is covered on both sides by a fascia. Fascia

top of the diaphragm of the pelvis:
covers the face top of the elevators and the coccyx, is continuous with the obturator fascia laterosuperiormente, reaching the line of the tendinous arch of levator ani muscle, which appears to be inserted into the muscle, limiting both fascias.

lower fascia of the pelvic diaphragm
is thin and covers the underside of the levator ani and coccygeal and corresponds to the ischiorectal fossa. FASCIA


UROGENITAL DIAPHRAGM As the former has two Fascias an upper and lower covering both sides of the muscles that make up and spread as they ischio between the two branches, the lower fascia is sometimes called perineal membrane is stronger and dense than the upper. Later the two fascias are lost in the central tendon of the perineum, and sides are joined at the back edge of the deep transverse. Previous to the urethral sphincter, the two fascias to merge to form the thick transverse ligament of perineum. The 2 fascias limit perineal deep space, filled with his muscles and traversed by the urethra. SUPERFICIAL FASCIA

Perineum

is thin and is of the underside of the superficial muscles. Laterally
is inserted in the fields below ischiatic ischiocavernosus. The Hormbre
:
Back: confused in the midline with the perineal body, while their sides, outline the posterior border of superficial transverse perineal and continue with the superficial penile fascia and tunica dartos of the scrotum.
In Women:
Continue ahead to the fascia of the clitoris and descends medially in the connective tissue at the base of the labia minora. Between the inferior fascia of urogenital diaphragm and superficial fascia of the perineum is located superficial perineal space.

BIBLIOGRAPHY Ø Chatain L. Ives, B. Jairo Bustamante, gross anatomy FUNCTIONAL CLINICA Y; Ed Addison-Wesley Iberoamericana, Paj. 169-174. Ø
Ruviere Henri, Andre Delmas, Skeleton Descripton, Y FUNCTIONAL TOPOGRAPHY; 11 Ediciones,; Paj. 666-679. Ø
Richard L. Drake, Wayne Vogl, Adam WM Mitchell, ESTUDIANTES ANATOMY TO GRAY; Ed ELSEVIER
Ø Frank H. Netter, ATLAS OF HUMAN ANATOMY; 2 Edición, Ed Masson SA; Blades 333-336.

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Pelvis osea

The skeleton of the pelvis is robust and its main functions are to transmit the weight of the upper body of the lower appendicular skeleton axial and resist compression forces and other support resulting from the body, along with the provision of inserts
powerful muscles girdle is a closed, formed behind by the sacrum and the coccyx bone, laterally and in front of the coxal bones. The bones are joined by hinges almost motionless, in the anterior portion of the pubic symphysis and sacroiliac joints later, lumbosacral and sacrococigea.

pelvic bone hip bone:
are two major bones of irregular shape and flattened, bone narrow in its central part and which carries a hemispherical cavity side down: The acetabular cup that is shaped and articulates with the femoral head. Have an oval opening, the foramen sealed.
Each hip bone is developed from the fusion of three bones:
· Ilion
· ischium Pubis

·

The bones of infants and children consist of three bones joined by cartilage in the acetabulum; at puberty the ilium, ischium and pubis are joined to form the innominate.
The ilium: Esla top, flattened, which opens like a fan of the hip bone. Consists of a body that is above two-fifths of the acetabulum (Figure 2) and a wing that is the whole upper segment of the innominate (range): both sides are demarcated on the inner side of the arcuate line. The iliac crest, the edge of the fan, has a curve that follows the contour of the wing between the anterior and posterior iliac spines. The concave portion of the ilium above a lower quadrant.
The ischium: The back and bottom of the hip bone. Has a body and a bouquet. The body of the ischium helps create the acetabulum (forming his two fifths posteroinferior Figure 2), and the branch that ascends medially toward the pubic bone and helps to form the lower boundary of the hole plug. The union of body and field widens and forms a huge bump after the ischium is the ischial tuberosity, the small rear projection sharp, near the junction between the branch and the body is the ischial spine. The concavity between the ischial spine and ischial tuberosity corresponds to the lesser sciatic notch. The greater sciatic notch, is above the ischial spine and is formed in part by the ilium.
The pubis: a bone is angular, with an upper branch that helps form the acetabulum (Figure 2), and lower, which contributes to the bolt hole. The thickening of the upper body of the pubis up to the pubic crest, which ends laterally in an eminence called the tubercle of the pubis. The lateral portion of upper branch has the crest dentate (dentate line pubic figure 3).
The outer side of the pelvic bone shows up side down buttock, the acetabulum and the framework of the obturator foramen (Fig. 3).

gluteal face of the hip bone (Figure 3) is traversed by three curved lines:
• The posterior gluteal line.
• The anterior gluteal line.
• The inferior gluteal line (Fickle).
obturator foramen, is bounded by the pubis and ischium (Fig. 4). Body of pubis
articulates with the opposite side by an oval articular surface, face symphysis, the binding site of both bones is called the pubic symphysis (Figure 4).
The ischial tuberosity (Figure 3) has a smooth top and bottom rough.
The inner side of the hip bone is divided into two parts by the arcuate line (Fig. 3), which continues ahead with the dentate line. Above the arcuate line are three-fifths above the iliac fossa. Posterior two-fifths are sacropelvic face, busy getting ahead in the face headset.
The upper edge of the innominate presents the iliac crest (Figure 3), which measures approximately 25 cm in length. Begins at the anterior superior iliac spine, she has a middle line which separates the outer and inner lips. Shopping iliac ends in the posterior superior iliac spine.
The anterior border of the innominate describes a concave curve superomedial; presented from top to bottom: anterior superior iliac spine (Figure 3), a notch, the anterior iliac spine and a wide groove.
The lower edge of the face begins below symphysis and forms with the bottom edge of the bone opposite the arch of pubis (Figures 3 and 4).

The trailing edge shows from top to bottom: the posterior superior iliac spine (Figure 3), a small notch, posterior inferior iliac spine, the deep and wide greater sciatic notch, ischial spine, lesser sciatic notch and ends the ischial tuberosity (Figure 5).

Sacrum:

The Sacred, which looks like an inverted triangle is formed by the fusion of five sacral vertebrae. The base of the sacrum articulates with the L5 vertebra and its apex with the coccyx does. Each of the side surfaces of the bone has a facet which articulates with the hip bone. Subsequent to that facet rough is a large area for insertion of the ligaments that hold the sacroiliac joint. The upper surface of the sacrum is formed by the upper surface of the body of the vertebra S1y is flanked on each side by a transverse expanded as a wing called Wing. The anterior edge of vertebral body is projected forward and represents the promontory. The anterior surface of sacrum is concave and convex posterior. The posterior and anterior branches of spinal nerves S1-S4 sacral arise through separate holes. There are four pairs of anterior sacral foramina on the anterior surface of the sacrum to the anterior branches and four pairs of posterior sacral foramina on the posterior surface for subsequent classes. The sacral canal is a continuation of the spinal canal, which ends at the sacral hiatus. Coccyx

The small terminal portion of the spine is the coccyx. Containing four fused coccygeal vertebrae. The base of the coccyx is oriented superiorly. The top side contains a facet for articulation with the sacrum, and two horns on each side that are projected upward to articulate or merge two similar poles that project down from the sacrum. These structures are modifications of the upper and lower articular processes such as those found in other vertebrae. Each side surface of coccyx is a small rudimentary transverse process extending from the first coccygeal vertebra. Coccygeal vertebrae vertebral arches are not, therefore, no spinal canal in the coccyx bone.
pelvic cavity:
The bony pelvis is divided into major pelvis minor pelvis or false or true (figura1y 6), by an oblique plane passing through the sacral promontory and the lines behind terminals (Fig. 7). The brim of the pelvis is defined by the level of the terminal lines (Fig. 6 and 7). The pubic arch is formed by the joint branch of the ischium and pubis on either side. These classes meet at the symphysis pubis to form the angle subpúbico, which can be measured by inserting fingers into the vagina during the examination.

The major pelvis:
· Now above the brim of the pelvis.
· Contains some abdominal viscera.
· It borders the front abdominal wall, iliac fossae in the posterolateral and L5 and S1 vertebrae at the back.
• The greater pelvic cavity is the lower portion of the abdominal cavity.
The pelvis:
· It is located between the narrow upper and lower pelvis.
· Contains the pelvic viscera, urinary bladder and reproductive organs such as uterus and ovaries.
• Limit the faces iliac pelvic bones, sacrum and coccyx.
· Bordered by the pelvic diaphragm musculofacial the underside.
• You have a huge significance obstetrics and gynecology.
The cavity of the pelvis is the true pelvic cavity that forms the lower portion of the abdominopelvic cavity.
The brim of the pelvis separating most of the lower pelvis. The brim of the pelvis is bounded by a border. The plan coincides with the line joining the sacral promontory to the upper edge of the symphysis pubis. This line is the anteroposterior or conjugate diameter of the brim of the pelvis, which borders:
· With the top edge of the symphysis pubis at the top.
• With the back edge of the pubic crest.
• With the dentate crest.
• With the arcuate line of ilium.
° with the edge of the wing of the sacrum.
• With the sacral promontory.
The lower pelvis narrow limits:
• With the lower edge of the symphysis pubis at the top.
· With the lower branches of the pubis and the ischial tuberosities of the anterolateral. • With
ligaments of the posterolateral sacrotuberous.
• With the apex of the coccyx in the back.
On top opening (Fig. 8), heart-shaped card, surrounded by the terminal lines, the lower pelvic cavity is continuous with the abdominal cavity. The lower opening of the pelvis (Figure 9) in a diamond shape, is limited behind by the apex of the coccyx bone, laterally by the ischial tuberosities and ligaments sacrotuberales, ahead of the pubic arch.

PELVIC ORIENTATION
In anatomical position, the pelvis is oriented so that the leading edge of the top of the symphysis pubis and anterior superior iliac spines are in the same vertical plane. Consequently, the top opening that marks the entrance to the pelvic cavity is inclined to head anteriorly, while the bodies of the pubic bone and the arch stands isquiopubian in a plane oriented nearly horizontal to the ground (Figure 10) .

Axis of pelvis: curved, almost parallel to the face pelvic sacrum and the coccyx bone and describes a right angle, in women, is layered at the cervicovaginal junction to follow the axis of the vagina. The axis of the pelvis is the path followed by the fetal head at birth and the mainline of forceps (Fig. 11).

PELVIC SEXUAL DIFFERENCES
The male and female pelvis are different in several respects (Fig. 12). These sex differences appear mainly in puberty and are related to the function. The main function of the pelvis is locomotive in both sexes. Sex differences are mainly due to the heavier constitution and increased muscle mass most men and adaptation of the female pelvis, including the pelvis for delivery

The male pelvis is heavier and thicker than the female and usually has a more striking bony landmarks. By contrast the female pelvis is wider, thin and has a narrow top and bottom larger. The pubic arch is formed by the joint branch of the ischium and pubis on either side. These classes meet at the symphysis pubis to give women subpúbico angle (80-85 degrees) and males (50 - 60 °). When you miss three fingers vagina on one side l other subpúbico means that the angle is large enough to allow the fetal head passes once you leave the narrow lower pelvis.
Although anatomical differences between male and female pelvis are usually clear, the pelvis of a given person may show traits of the opposite sex. Pelvic types are illustrated in Figure 13 are: Gynecoid circular, elliptical anthropoid form anteroposterior axis, triangular-shaped android based platipeloide back and oval shaped. The android pelvis can present a risk for women during childbirth. The size and shape of the brim of the pelvis are important, because the baby's head moves to the pelvis, through this opening, during labor delivery.
ginecoide The pelvis has an oval-shaped feature with a maximum diameter cross while in men is heart shaped. Ischial spines usually do not do much protrusion medially into the pelvic cavity in women as they do in men. In women, is most often blocked foramen triangular oval.
The female pelvis, adapted to the dynamics of labor in the upper opening has a diameter anteroposterior or OB (true conjugate) of 11 cm that passes from the upper edge of the pubic symphysis to the center of the sacral promontory. The transverse diameter passing through the widest part opening, crossing the conjugate at the junction of the posterior third with their anterior thirds and measures 13.5 cm. The oblique diameter, sacroiliac joint path to eminence opposite iliopubic measured 12cm.

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muscles and fascia of the pelvis by Guillermo Buitrago

Muscles and fascias of the pelvic fascia pelvis
: connective tissue that occupies the space between the membranous peritoneum and pelvic muscle walls and the floor is not occupied by the pelvic viscera, is then Fascia of endoabdominal which is situated between the abdominal wall muscles and the peritoneum superiorly. Pelvic fascia has been described in parietal and visceral. Fascia
membranous pelvic
is divided into parietal and visceral.
- parietal pelvic fascia, membranous layer that lines the inside of the muscles that form the walls and pelvic floor. Covers the inner surfaces of the muscles, internal shutters, pear, coccygeal, levator ani, and part of the urethral sphincter muscles. Parties are called fascia overlying muscle, is continued upward with the transversalis fascia and iliopsoas.
- visceral pelvic fascia, which lines the way their bodies and adventitia. The parietal and visceral fascia become continuous where the bodies penetrate the soil pélvico. La Fascia parietal se espesa y forma el arco tendinoso de la Fascia pélvica, una banda bilateral que va desde el pubis hasta el sacro a lo largo del suelo pélvico, Anterior se conforma por el ligamento puboprostático en el hombre que une la próstata al pubis  o pubo vesical en la mujer donde une la vejiga al pubis, la parte más posterior de este arco tendinoso se extiende como ligamentos sacrogenitales, desde el sacro a los alrededores del recto hasta la próstata en el hombre o hasta la vagina en la mujer.
Fascia endopélvica:
Tejido conectivo entre las capas parietal y visceral, se considera como Fascia pélvica subperitoneal la cual se continua con ambas fascias: parietal y visceral. Es una Fascia fill, composed of areolar connective tissue or fat. Limit the retropubic space and retrorectal. There may be condensation of this fascia and the hypogastric sheath such that leads to the vessels and nerves that pass from the side wall of the pelvis to the pelvic viscera, along with the ureters and the man with the vas deferens. Hypogastric sheath is divided into three layers that pass between the pelvic organs and neurovascular structures are, for this function are called ligaments, most previous film called the lateral ligament of the bladder and bladder vessels are superior and the lamina carries more posterior superior rectal vessels. In man the middle lamella forms a fascial division, rectovesical septum between the posterior surface of the bladder and prostate in the front and the back straight. In women, the middle lamella forms the transverse cervical ligament in its upper portion at the base of the broad ligament peritoneum, the uterine artery.


To understand the muscles of the pelvis is necessary to understand the walls and floor of the pelvis, which is divided into a wall above a rear wall and two side ground, the front wall is formed by the bodies and branches of pubic bones and pubic symphysis, the side walls formed by the innominate bones and the shutter hole that is closed by the obturator membrane, the internal obturator muscles lining the side wall are located medially obturator vessels and nerves and other branches of internal iliac vessels, each internal obturator muscle is a journey back from the pelvis through lesser sciatic hole and rotates in the lateral plane to fit into the greater trochanter of the femur, the surface of these muscles is covered by obturator fascia thickened in the center and the tendinous arch which gives attachment to the pelvic diaphragm, the muscle insertion in a split upper pelvic portion and a lower portion of perineal pelvic portions of these muscles are obturator nerve. The back wall is formed by the sacrum and coccyx and posterolateral walls consist of muscle ligament ligaments associated with the sacroiliac joint and piriformis muscles, medial sacral plexus is located, form a bed "muscle" for this. The pelvic floor consists of the pelvic diaphragm, coccygeal muscle, levator ani, and fascias that cover the top and bottom. Separates the pelvic cavity of the perineum into the pelvis. The levator ani muscle has different portions depending on the direction and insertion of the fibers, up almost the entire floor of the pelvis and divides into three parts:
- Pubococcygeus, the main portion of the levator ani muscle, was born in the back of the pubic body and goes almost horizontal to the rear.
- puborectalis muscle: consists of the medial portion of the pubococcygeus muscle, binds to heterolateral to form a U-shaped loop that goes back to the anorectal junction.
- iliococcygeus: back of the levator ani muscle.
The levator ani muscle supports the pelvic viscera, resists the elevations of intraabdominal pressure, helps maintain the gut pelvic in position. When acting together the parts of this muscle helps to elevate the pelvic floor and helps anterolateral abdominal muscles to increase intra-abdominal pressure, action should be forced expiration, coughing, sneezing, depositions, urination, fecal continence. According

Latarjet Muscles of the pelvic girdle are divided into three groups:
1. Pelvitrocantéricos Muscles:, join the hip bone to the greater trochanter of the femur, are ten and are subdivided in:
gluteal muscles: the more medium and smaller tensor fascia lata. Muscles
pelvitrocantericos themselves: piriformis obturator internus, obturator externus, superior twin, twin lower femoral square.
2. Iliopsoas muscle group, joins the coxal femur through the iliac spine and through the psoas.
3. Adductor muscles of thigh muscle pectineus, adductor magnus, adductor longus, adductor brevis, adductor and gracilis minimum.

pelvic walls are made up (according to moore's anatomy):
lateral pelvic wall: obturator internus
:
Insertion proximal sides of the ilium and pelvic ischium, obturator membrane insertion
Distal femoral trochanter
Nerve: nerve to obturator internus (L5, S1 and S2)
Action: laterally rotates the thigh helps hold the femoral head within the acetabulum
Relationships: has two parts: one part where her face deep intrapelvic the obturator membrane lining the perimeter of the obturator foramen and the quadrilateral surface of the hip bone. His face is covered by fascia superficial obturator, thick, which gives insertion into the middle fibers of the levator ani muscle, the insertion divides the muscle in an upper part of the side wall of the pelvis and lower limiting ischioanal fossa laterally, from which the levator ani muscle forms the medial wall, the muscle leaves the pelvis through the lesser sciatic foramen. Extrapelvic portion: the internal obturator tendon lies between the two twins, upper and lower part of the deep level of the gluteal region, between the piriformis quadratus femoris superiorly and inferiorly, the hip joint above the posterior gluteus maximus, which is separated by the sciatic and posterior femoral cutaneous and inferior gluteal vessels.

rear wall: piriformis muscle

Insertion proximal pelvic side 2 to 4 sacral segments, the upper edge of the greater sciatic notch and ligament insertion sacrotuberous
Distal femoral trochanter
Nerve: ventral rami of S1 and S2
Action: laterally rotates the thigh, between the thigh, helps to hold the head of the femur to the acetabulum.
Relations: is a portion intrapelvic: where the muscle covers the anterior sacral back is covered by a fascia which separates it from the other front and side items, such as the rectum, ureter, internal iliac vessels and branches, is closely related with the sacral plexus. Extrapelvic portion, after passing through the greater sciatic notch, leaving the pelvis and reaches the gluteal region, this portion is covered later by the gluteus maximus, its anterior surface is applied to the hip joint. Is in contact with the gluteus minimus superiorly and inferiorly to the superior twin.

pelvic floor muscle levator ani (pubococcygeus, puborectalis, iliococcygeal)
proximal Insertion: body of pubis, tendinous arch of obturator fascia, ischial spine
Insertion of distal perineal body, rump anococcygeal ligament, walls of a prostate or vagina, rectum and anal canal.
Nerve: nerve to the levator ani muscle (branches of S4), inferior anal nerve, coccygeal plexus
Action: holding the pelvic viscera and resist increases in abdominal pressure
isquiococcígeo
muscle: proximal insertion
:
ischial spine insertion of distal lower end of the sacrum
Innervation: branches of S4 and S5
Action: form a small part of the diaphragm of the pelvis and supports the pelvic viscera and flexes the coccyx.

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urinary bladder ureter Anderson Anderson Arango

THE BLADDER The bladder is a hollow organ with thick muscular walls and distensible. Its main function is to re contain the urine and then eject. When empty is located in the pelvis beneath the peritoneum resting on the floor of the pelvis, posterior to the pubic bones which are separated by the space occupied by adipose tissue retropubic extraperitoneal bladder which moves freely, exception of the neck, which is strongly restrained by ligaments (puboprostatic pubovesical in men and in women). As
the bladder is filled ascends the extraperitoneal tissue in the pelvis minor, could even reach the navel.
When empty it is tetrahedral characterized by:
· Vertex: front end, pointing to the symphysis pubis
· Body: portion located between the top and bottom
· ; base or bottom: posterior wall, convex
· Neck: formed by the meeting of the fund and the inferolateral surfaces.
· Uvula: light projection of the bladder trigone.

The bladder bed is configured as follows:
· Laterally: pubic bone, internal obturator muscle and levator ani
· Back side: straight vajina the man or the woman.

bladder irrigation is mainly irrigated by the internal iliac artery.
· superior vesical artery, anterior portion of inferior vesical artery
·: Background and neck
· Vaginal arteries: posterior portion (the women)
· obturator artery inferior gluteal artery
·

VENOUS DRAINAGE

Levan veins the same names as the arteries and are tributaries of internal iliac veins, to bequeath to them through the veins of the lower bladder
vesical venous plexus which joins the venous plexus surrounding the prostate and bladder background, prostate, seminiferous vesicles, vas deferens, the lower portion the ureters, in addition to the women surrounding the pelvic portion of the urethra and the bladder neck and receives blood from the dorsal vein of clitoris. They reach
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external iliac lymph nodes draining the upper and bottom drainage reaches the internal iliac nodes. INNERVATION



parasympathetic fibers come through pelvic esplagnicos. Sympathetic fibers from T11 to L2. The union of these fibers form the vesical nerve plexus which continues as the inferior hypogastric plexus. Sensory fibers reach the parasympathetic fibers, which transmit the pain of the upper accompany sympathetic fibers.

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URETERS

muscular ducts are 20 to 25 cm long tubes that carry urine from the kidney to the bladder. Have abdominal still down from the renal pelvis from the pelvic brim to the bifurcation of the common iliac arteries and principle or external iliac artery. From here continue their ureters rump which runs along the side wall of the pelvis in convergence trend with the contra lateral and into the urinary bladder.

The ureters are relatively moving bodies, remain in place in the upper part by adherence to the medial border of the kidney and below for their adherence to the posterior parietal peritoneum. The renal FACA, formed by a sheet anterior and posterior kidney were consistently lower than locking, thus forming the sheath of the ureter strictures
Presents 3: 1) At the junction of ureter with binding to the inferior pole of the renal pelvis. 2) On the crossing of the ureter over the iliac wing to enter the pelvis 3) During their journey the bladder renal dare. SURFACE ANATOMY


The ureters are projected on the back along a vertical line marking a sagittal plane coursing height of the apex of transverse processes of lumbar vertebrae III, IV and V, this plane wound to the lumbosacral junction or to the upper posterior iliac spines

· Irrigation: ureteric artery superior branch of renal. They also provide gonadal artery branches, the abdominal aorta, common iliac artery. All these branches anastomose forming a network of irrigation ureteric
· venous drainage: drains into the gonadal veins and veins that correspond to the circle exorenal
· Lymphatic drainage: drains mainly lateral lymph infrarenal aortic and common iliac
· innervation: from the kidney and spermatic plexus which arrive through the vessels


ABDOMINAL PART RELATIONS
· Rear: for through the tissue that continues celuloadiposo pararenal fat, the psoas internal intersections that separate it from the transverse processes.
· Laterally: inner edge of the kidney infrahiliar
· Medially: Right-sided inferior vena cava, lymph nodes and chain nice; the left: the aorta.
· Next: the right side: 2 nd portion of duodenum, gonadal vessels (same height), ascending colon and right mesocolon (out), the left side: gonadal vessels (vein over the artery) colon Descending mesocolon and left (out). PART RELATIONS
Iliac
· Rear: iliac vessels, lumbosacral trunk, the ascending branch of the ilio-lumbar artery
· later: psoas, gonadal vessels
· ; Medially: remain sideways to 2 cm of the eminence of the promontory
· Next: the right side: lower end of mesenteric artery termination ileocolic, ileocecal angle and the appendix, the left side: mesosigmoid secondary root, then mesosigmoid own tour of the sigmoid artery. At this point the ureter attends the bottom of the pit intersigmoid.

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Joints Argoty Geovanny pelvis ureter and bladder

joints and ligaments OF THE PELVIS
We joints, which strengthen the pelvic bone such as the lumbosacral and pubic symphysis sacroccigeas strengthened and supported by several ligaments.
· Lumbosacral joint, held together by joints: Intervertebral
or above, consisting of the intervertebral disc. Interapoficiarias
or between the articular processes.
and iliolumbar ligaments, which join the ilia to the L5 vertebra. Sacroccigea
· joint is a secondary cartilaginous joint intervertebral disc, which connects the apex of the sacrum to the base of the coccyx; sacroccigeos reinforced by the anterior and posterior ligament.
· Joint sacroiliac are synovial joints strong weight bearing between the faces of the sacrum and headphones ilium. You
sacrum is attached between the innominate, by and sacroiliac interosseous ligaments. These have little mobility, because its function is to transmit the weight of the body most of the innominate bone.

It is also important to note sacrotuberous and sacrospinous ligaments, which allow only limited movement upward from the lower end of the sacrum, but gives more elasticity in this region increases sharply when the weight on the spine.
• The pubic symphysis is a secondary cartilaginous joint, created by the union of the pubic bodies in the median plane. The disto interpubico cartilage of the symphysis is usually thicker in women, reinforced by ligaments: superior pubic
or connecting the upper body of the pubis and extends laterally to the pubic tubercles. Pubic
or lower arch thickness of fibers connecting the edges of the joint subpubico rounded angle between the branches below the pubis, forming the upper edge of the pubic arch.

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Yeison

Yeison Alexander Arias Valencia
1094890782
Summary Anatomy, ureter and bladder.
The ureters are muscular from 25 to 30 centimeters in length, with a thickness of 8 to 10mm, can be considered the left a little longer in vivo can see white or gray, are attached to the parietal peritoneum later, being retroperitoneal. Continue after the renal pelvis, and ends at the bottom of the bladder, referred to two major parts of 12.5cm approx., Length each, and correspond to the abdominal and pelvic portion, other authors use three servings a lumbar and pelvic sacroilica (Testut, Latarjet)
The ureter has three normal constraints on their journey, the first is at the ureteropelvic junction, where the renal pelvis and ureter is continuous, the second is on the brim of the pelvis, the common iliac vessels pass on your fork, where they take an anterior, medial and convex, and the last is in contact with the bladder to join. The clinical significance of these constraints is that there may aground kidney stones, causing obstruction called urolithiasis.
The primary function of the ureter is driving the urine from the kidney to the bladder.
Relations (see fig.1)
relations are presented by portion of the ureter: lumbar
:
Post: it is in relation with celuloadiposo pararenal tissue, the phasic iliac psoas inserts, and the apex of the transverse processes of lumbar vertebrae. Laterally
: superolateral to the kidney, then the psoas muscle and femoral cutaneous nerve and the femoral genito. Medially
: they differ according to the ureter on each side:
the right side, the inferior vena cava, with the lymph nodes, and a little more distant with the right sympathetic chain.
On the left: the aorta at a distance.
Previous: also differ according on each side.
Right: from top to bottom, is in conjunction with the second portion of the duodenum, the gonadal vessels cross it obliquely, the ascending mesocolon, with the right colic vessels, and the root of the mesentery.
Left: relates to the descending mesocolon, the left colic vessels, with an oblique segment of the root of the mesentery, also with the gonadal vessels, and the sigmoid mesocolon. Pelvic Portion
: begins when the ureters cross the common iliac vessels at its bifurcation.
later: it is in relation to the common iliac vessels, the right ureter is in relation to the external iliac artery and the left common iliac. When you reach the ureters into the bladder, the man is posteromedially seminal gland, and the woman just before making contact with the bladder, is in relation to the front of the vagina. Laterally
: is present, the psoas major, and gonadal vessels some distance in parallel relationship to the ureter.
Medially, these distance more or less than two inches of the sacral promontory. And near the junction with the bladder in man is related to the vas deferens at its termination, the woman is on its way to the main uterine artery at the level of the uterine isthmus.
Previously: depending on their peritoneal relations is different on each side.
law: for the lower end of the mesentery, in conjunction with the appendix and the vessels that supply. Arriving near the bladder, it was found earlier on both sides.
Left: corresponds to the root of mesosigmoid with sigmoid vessels, and on their way, Breast intersigmoid. (See fig. 3.)
When you get in contact with the bladder, ureters have an oblique, opening the ureteral orifices found in the bladder trigone, a distance of 5 cm when the bladder is full and a 2 or 3 centimeters when that empty.
Irrigation:
arteries is given by that are related to its journey, including ureteral arteries, from the kidney, also have contribution of gonadal, and either common iliac or internal. In the final portion of women also contribute to the uterine artery, and the man of the lower bladder. The branches from anastomoses are frequent, where there are mainly two branches an ascending and descending.
venous drainage: drain mainly to the gonads, and the common iliac. Branched counterparts.
Nodes: lumbar lymph nodes, aortic, and both common and internal iliac, are responsible for lymphatic drainage.
Innervation: The plexus renal, aortic and superior hypogastric below, are responsible for providing innervation to the ureteral peristaltic function to send the urine in an inferior direction. Afferent fibers are by the nice going to the spinal segments T11 to L2.


Histological structure (see fig.4.)
The ureter is composed of three layers, from outside to inside, adventitial, muscular with its different layers and the mucosa. The adventitia is the connective tissue that connects the posterior peritoneal lamina, and provides some mobility.
The muscular coat has different layers, are composed of smooth muscle, and is a longitudinal internal and external circular, the bottom layer is a third outer longitudinal and circular begins to disappear, to come into contact with the bladder.
The tunica mucosa is characteristic, as it is called transitional epithelium, which is one of these pathways, which are different cell layers with the ability to adapt to changes in mucosal surface of liquid volume in glorious ureter.
embryological development of the ureter.
The ureter is produced mainly in the fifth week of the ureteric bud of the mesonephric duct derivative,
The most common developmental anomalies of the ureters there occurs double ureter by duplication of the ureteric bud, and may give rise to two ureters pelvis. As for the bifurcation of the ureter may be complete or partial, with the difficulty that if full, one of the ureters can lead to a different place to the bladder, such as urethra, vagina, vestibule, or elsewhere, This is often called ectopic ureter.
Bladder:
The urinary bladder is the collector time between the urinary tract is a hollow organ with muscular characteristics important to be described later.
Status and Form:
to describe the bladder is necessary to know the names of their dimensions are when empty, by cadaver study. In addition to its location and shape is very variant depending on age, as infants in the bladder is abdominal, and will desentiendo until age 6 has a nearly pelvic position, which actually reaches the lower pelvis puberty. Also change, with sex as there are anatomical differences of the pelvis, its shape is modified by physiological conditions such as emptiness or fullness, although it should be noted that the bladder always has a normal and small volume of urine, in addition to other physiological condition that adjust is pregnancy.
Finally it is clear that when empty it is Semicon, is located mostly in the pelvis less, being the most anterior viscera, relating to the pubis.
of the bladder base or bottom recognize a post, a body with two faces a lower and an upper, an apex, its lateral edges, and the bladder neck. The apex is directed upward to the symphysis pubis, the body is the part between the top and bottom, and slightly convex posterior wall is the base or bottom. When the base and sides are united inferiorly, the neck is formed.
Regarding the situation of the pubic bone and levator ani muscle up the bladder bed being behind either the woman's vagina or rectum in man. The bladder is wrapped in a layer of connective tissue that is called fascia bladder. It should be noted peritoneal fornices, the vesicouterine in women between bladder and uterus, and rectovesical in man between bladder and rectum. (See Figs 5 and 6)
Relations:
Institutions: relates to the sigmoid colon in man and the woman's uterus. And through the peritoneum with thin handles.
Bottom: through the bladder fascia anterior to posterior communicating with the symphysis pubis, and the front of the levator ani and internal obturator muscle, covered by pelvic fascia, retropubic space there is filled with tissue loose cell, which allows expansion to her bladder.
Laterally: The man is with the vas deferens, with the arrival of the ureter, and seminal glands.
Previously, the vertex can be described in relation to the symphysis pubis. Later
: describes the relationship with the straight man, or the vagina in women.
As the bladder neck, the man that is attached to the prostate, and the woman is with pubococcygeal muscles. Fixing
bladder (see Fig 7)
The bladder is secured by the collateral ligaments, which are pods neurovascular vessels and nerves accompany bladder, both are set in front of the tendinous arch of the pelvis. Puboprostatic ligament in man and ensure women pubovesical in fixing the bladder neck to the upper face of the symphysis pubis.
Histological structure (see Fig 9)
is formed by layers, serosa, a thick muscle, the submucosa, and mucosa.
The serosa is formed by the peritoneum at the top, which gives its name to the bladder subperitoneal viscera, and around the bladder is the bladder fascia composed of loose connective tissue.
The muscle, which emphasizes the detrusor muscle, you have three layers, a circular half thickness that is between the two longitudinal than in the cervix form an arch above, which is lost with the opening of the urethra. Subsequently, it is called muscle trigonal to portions of longitudinal muscle from the ureters to make contact with the bladder.
The submucosa is strongly attached to the muscle, but there in the bladder trigone.
mucosa epithelium corresponds to the already known transitions, being smooth and trabeculated child in the adult, the only portion that remains smooth and uniform the trigone, which highlights the interureteral fold.
Irrigation:
is given by the internal iliac arteries, including the bladder over the lower bladder in men and vaginal uterine and women, besides the contribution of the middle rectal, bladder and from the pudenda previous internal.
The venous drainage through the bladder plexus anastomosing with prostate cancer in men and women, besides bladder vein that will drain into the internal iliac vein.
Nodes: Lymph nodes are responsible for the iliac, common, internal, external, and sacred.
Innervation: is given through the vesical plexus, which is composed as follows: (see Figure 8)
Friendly, through the contribution of the hypogastric plexus, with its spinal cord segments T11 to L2, this is action trigonal muscle. Parasympathetic
: by the sacral segments II, III, IV and pelvic splanchnic nerves, which have activity motor on the detrusor muscle.
afferent pathways follow the pelvic splanchnic, and nice to get the T11 to L2 segments.
The somatic innervation is given by the pudendal nerves from S2, S3, S4, supplying mainly the urethral sphincter.
eventually concluded that sacral segments are of great importance in the control of urination.
physiology: Urination, depending on the amount of urine in the bladder, you buy a muscle tone that causes a neural response. When the bladder volume is between 200 to 400 milliliters of urine, feels the desire to evacuate, then there, the abdominal muscles contract, and the pelvic floor as it descends down the neck of the bladder, detrusor contraction straightens the vesicourethral angle opens the internal opening urine comes after emptiness, generates a nervous hand control. If you do not want to urination, to sphincter education is achieved to suppress the desire to urinate by relaxing the muscle

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Pelvis bone Arias Giovanny A. New works

Topic: Pelvis Bone
Name: Giovanny Armando Chamorro Argoty
Code: 90022558080

The pelvis is defined as the inferoposterior part of the trunk of the abdomen, which is lined inside and out for muscular structures. The pelvis is closed below by a set musculofascial perineum and is open up toward the abdomen.
is how we define the pelvis bone marrow as a closed ring, made subsequently by the sacrum and coccyx (are part of the spine), laterally and in front of the coxal bones, which protect the distal portions of intestinal and urinary tracts as well as genital organs internal.

bones are closely united by joints almost motionless, above the pubic symphysis and posterior sacroiliac joint, lumbosacral (reinforced by the iliolumbar and sacroiliac ligaments) and the sacrococcygeal joint.
forming the pelvic cavity, shaped infundibulum, where the upper limit of the pelvic cavity is the superior strait of the pelvis and the lower limit is the narrow lower pelvis.
The main function of the bony pelvis:
· To transmit the weight of the upper body axial skeleton, the appendix below.
• Resists compression forces and other support resulting from the body.

innominate bone is a narrow flattened in its central part, which contains a hemispherical cavity called the acetabulum, located in the lateral and articulated with the femur. The top side and is oriented slightly backward and lateral and anterior is oriented above.
presents an oval-shaped opening, the obturator foramen.


is becoming an adult by the fusion of three bones (at the acetabulum), the ilium, pubis and ischium.
· The ilium is the top and concave (forming the lower quadrant), which opens like a fan, the cost of a body that helps to close the socket and a wing that represents the semicircle of the range, the iliac crest is her edge fan, which runs the coccyx between the anterior superior iliac spines and posterior superior.

• The ischium has an "L" is the innominate posteriorinferior, consisting of a body in the vertical (helps form the acetabulum) and a branch that rises to the pubis and forms the bottom the obturator foramen. Their union forms the ischial tuberosity.
• The pubis consists of a flattened body, forming the anterior part of the pelvis, formed by an upper branch that helps form the acetabulum, as well as the lateral portion of this branch, forming a sloping ridge: line dentate pubis. And a lower branch that contributes to form the plug. The thickening at the top of the pubis up to the pubic crest is located more laterally and the pubic tubercle. The body of the pubis is built on the opposite side, forming the pubic symphysis
The innominate presents an outer face, an inner face and four edges: top, inferior, anterior and posterior.
The outer side has a gluteal region, the acetabulum and obturator foramen.
• The gluteal region is undulating and crossed by three curved lines, anterior gluteal line, posterior end to the anterior superior iliac spine, posterior gluteal line, gluteal line almost vertical and lower variable almost horizontal.
·

The acetabulum is a hemispherical cavity facing side, bottom and above, which is surrounded by the limb of the acetabulum and on top form supraacetabulo groove. At the bottom, the limb is interrupted by the notch of the acetabulum. At the bottom of the cavity has a central part rough, acetabular fossa, surrounded by lunada face, this is where the femoral head articulates. The obturator foramen bounded by the pubis and ischium.

The inner surface of the bone is divided by the arcuate line, slanting downward and forward, above the pecten pubis. At the top line, above the iliac fossa is formed and later face sacropelvic headset and face. We also find that on the face headset is the iliac tuberosity. Lower


the arcuate line, the pelvic segment of the internal surface with a smooth surface.

· Edges:
or upper edge corresponds to the iliac crest, which has a middle line that separates outer and inner lips. O
edge shows the anterior superior iliac spine, a notch and anterior iliac spine.
or bottom edge forms a bottom edge to the bone opposite the pubic arch
or posterior edge shows the posterior iliac spines and lower sciatic notch higher and the ischial tuberosity.
The bony pelvis is divided into major pelvis minor pelvis or false or true, crossed by an oblique plane that elapses from the sacral promontory and terminal lines.
· top of the pelvis Strait separates the pelvis major pelvis minor, defined by a horizontal plane that courses from the sacral promontory to the upper edge of the pubic symphysis. That is bordering on the edge of the wing of the sacrum, the arcuate line of the ileum and the pecten.
· Lower pelvis narrow limits lower edge of the symphysis pubis, inferior pubic branches and apex of the coccyx in the back.
· Pelvis more: located on the brim of the pelvis, contains some abdominal organs such as the ilium, the sigmoid colon. Formed by the wings of the sacrum and the iliac arteries. Limited
above through the abdominal wall, posterolateral to the posterior iliac fossa and L5 and S1 vertebrae. Pelvis minor
· Strait lies between the upper and lower pelvis contains pelvic viscera, urinary bladder and reproductive organs.
· Subsequently formed by face pelvic sacrum and coccyx and above the inner surface of the pubic symphysis.

has a top opening surrounded by a lower line terminals and limited by the apex of the coccyx, the ischial tuberosity and ischiatic classes.
In upright position, where the ESIA and the front of the symphysis pubis are in the same vertical plane. Thus the pubic symphysis to the horizontal form an angle of 45 degrees and the pelvis at an angle to the plane of the top opening is 60 degrees and the bottom opening is 15 degrees.
Pelvic sex differences that appear after puberty, due to the conical shape of the pelvis that occurs in fetuses. The female pelvis is wider and less high than the male, which is heavier and thicker, and also the female pelvis are more triangular foramen oval subpubico an angle approximately 60 degrees. In addition to the adaptation of the female pelvis labor dynamics. Sacrum

Located in the back of the pelvis between the bones in the adult iliacos.Es fusion of 5 sacral vertebrae, forming a triangular-shaped bone below apex. The concave front has 4 transverse ridges of the sacrum, at its ends and located pelvic sacral foramina, which emerge the ventral rami of the first four sacral nerves.
The convex top with the 5 lumbar vertebrae at an angle known as the promontory


In the dorsal, median sacral crest find where is the fusion of the spinous processes, the dorsal sacral foramina are aligned with the pelvic.

emerge from its top two horns articulate with the sacrum, so that its upper surface articulates with the sacral apex medial to the sacral foramina are intermediate peaks by melting articular processes and lateral them lateral sacral crests by the merger of trasversos processes.
The sides have headphones faces for articulation with the posterior pelvic bone and it forms the sacral ala. Bone

coccyx results from the fusion of 4 or 5 vertebrae atrophied, odd and irregular triangular-shaped medium.
.
The tail bone is not inside the spinal canal.