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Transcript of Ole Petter Ottersen Anatomy of the genital organs Jon Storm-Mathisen Department of Anatomy,...
Ole Petter Ottersen
Anatomy of the genital organsAnatomy of the genital organsJon Storm-Mathisen
Department of Anatomy,
Institute of Basic Medical Sciences &
Centre for Molecular Biology and Neuroscience,
University of Oslo, Norway
http://www.cmbn.no/group-storm-mathisen.html
Per BrodalUndervisningsleder i anatomi
The Pelvic Region: The Pelvic Region: IntroductionIntroduction to its Functional Anatomyto its Functional Anatomy
Per BrodalPer BrodalInstitutt for medisinske basalfagInstitutt for medisinske basalfag
Universitetet i OsloUniversitetet i Oslo
9th Semester 20089th Semester 2008
Anatomy 9th Semester
Lectures• gross anatomy, histology (microscopic anatomy),
embryology• Intention: overviews, help to self-study
Practicals Histology• assumes a certain level of theoretical knowledge
(lecture given a few days in advance of the practical classes)
Gross Anatomy Demos• three PBL-groups (20-25 students)
Demos, cont’d
Keep the group-size optimal: Meet at your scheduled time!
You are not allowed to switch to another group for convinience
Study the booklet for the Demos in advance (”Kompendium”, sold at the Akademika)
Assessment
Practical anatomy test (see page 41 in the Semester Booklet)
Modified OSCE - four anatomy stations• Photomicrographs of histological sections • Theoretical questions – functional anatomy:
emphasis on clinically relevant topics
Some Advice About Learning Anatomy..
Always try to find the link between structure and function
You must know a fair number of names to able to communicate..
..but don’t get lost in details The real challenge is to establish ones own
internal three-dimensional pictures Therefore: spend ample time with prosected
specimens, models and microscopic slides
Anatomic nomenclature used in this semester
Latin/greek – classical anatomical nomenclature English based on latin/greek but modified
grammatically Norwegian terms A mess??
Tasks of the Human Pelvis
Transition between the back and the lower extremities
Special requirements due to our upright, two-legged walking
Container of viscera – carrying some of the weight of the abdominal content
Birth channel
The Pelvic Girdle (bekkenet)
Pelvis major (store bekken)
Pelvis minor (lille bekken)
Linea terminalis
Iliosacral joint
Symphysis
Sacrum
L5
Rauber/Kopsch: Anatomie des Menschen 1987
Os coxae (innominate bone, hip bone)
Os ilium
Lateral view Medial viewOs ischii Os pubis
Foramen obturatum
Facies auricularis (Iliosacral joint)
Spina ischiadica
Tuber ischiadicum (Ischial tuberosity)
Incisura ischiadica major (greater ischiadic notch)
Incisura ischiadica minor
Spina ilaca posterior superior
Spina iliaca anterior superior
10 year
Ossification of Os Coxae
Wolf-Heidegger’s Atlas of Anatomy, Vol 1.
Os ilium
Os ischii
Os pubis
GROWTH ZONES CLOSE AT 16-18 YEARS
Infant, 3 months
Ligaments and openings of the pelvis
Ligamentum sacrotuberale
Ligamentum sacrospinale
Sacroiliac ligaments
Foramen ischiadicum majus
Foramen ischiadicum minus
Promontorium
Thieme, Atlas of Anatomy 2006
Landmarks – The Michaelis’ Rhomboid
Spina iliaca posterior superior
Spinous process of L4
Anal cleft (rima ani)
Michaelis’ rhomboid
Iliac crest
Thieme, Atlas of Anatomy 2006
Characteristics of the female pelvis
The female pelvis is ”designed” to give room for the exit of the ”passenger”
Normal birth depends on:
a) The expulsive forces
b) The passages
c) The passenger
Characteristics of the female pelvis, cont’d
Factors contributing to wider passages in the female :• Larger diameters of pelvic inlet• Less protruding promontory• Wider subpubic angle• Wider distance between the
ischial tuberosities and the ischial spines
• Wider and lower symphysis • The sacrum curves less than in
the male
The Diameters of the Birth Canal
Transverse diameter = 11 cm (intertubarvidden)
Transverse diameter = 13 cm (Tverrvidden)
Antero-posterior diameter = 12 cm (conjugata vera, likevidden)
Antero-posterior diameter =12,5 cm (diameter recta, likevidden)
Bispinous diameter = 10,5 cm (Interspinalvidden)
The Bony Passages
Antero-posterior diameter = 12 cm (conjugata vera, likevidden)
Antero-posterior diameter =12 cm (diameter recta, likevidden)
Pelvic Fracture?
18Per Brodal 2008Hamilton Bailey’s Physical Signs in Clinical Surgery
The fetal skull
Anterior fontanelle (Bregma)
Suboccipito-bregmatic diameter = 9,5 cm
Biparietal diameter = 9,5 Moulding during labor
Llewellyn-Jones 1999
Soft Parts of the Passages
Sheets of muscles and connective tissue Several overlapping layers Funnel-shaped Stretched and pushed aside during
childbirth Subcutaneous and subperitoneal spaces
with loose connective tissue, vessels, nerves and lymph nodes
Pelvic floor muscles (levator ani)
Peritoneum
Muscles of the pelvic floor
Thieme, Atlas of Anatomy 2006
Levator ani muscle
Urogenital diaphragm with sphincter muscles
Formation of the Birth Canal and Moulding of the Fetus During Labour
Amniotic fluid
Soft tissues
Skeleton