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

jon.storm-mathisen@medisin.uio.no

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