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Pelvic organs Sigmoid colon
y It is continuation of descending colon y Its length is 25 cm y It has (S) shape y It is attached to posterior pelvic wall y Relation Anterior : Uterus & Vagina Posterior:Sacrum & Rectum y Blood supply : Inferior mesenteric artery (Branch of abdominal aorta)

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Rectum
y Its length is 13 cm y It is continuation of sigmoid colon y It starts in front of 3rd sacral vertebra y It ends in front of tip of coccyx y It pierces pelvic diaphragm y Lower part of rectum has dilatation called ampulla y Rectum forms an angle with anal called anorectal angle y Peritoneum covers the anterior & lateral surfaces of upper third of rectum y Peritoneum covers the anterior surface of middle third of rectum y Lower third does not cover by peritoneum

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y Relation :
Anterior : Upper 2/3 :Peritoneum Sigmoid colon Coil of ileum

Lower 1/3 : Posterior surface of vagina no peritoneum Posterior : Sacrum Coccyx piriformis levator ani sacral plexus sympathetic plexus

y Blood supply (Superior Middle Inferior) rectal arteries Superior rectal A. (branch of inferior mesenteric A.) Middle&Inferior rectal A.(branches of internal iliac A.)

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Anal canal
y Its length is 4 cm y It extends from ampulla of rectum to anus y Relation Anterior : Perineal body Urogenital diaphragm Vagina Posterior : Anococcygeal body Lateral : Ischiorectal fossa External&Internal anal sphincter

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Involuntary anal sphincter(Internal) (thickening of smooth muscle)

y Anal sphincter
Voluntary anal sphincter (External) (Subcutananous Superficial Deep) y Puborectalis : Which is part of levator ani muscle,slings around anorectal angle & attached to pubic bone

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y Mucous membrane of anal canal forms longitudinal folds called anal columns which are joined together at lower end by semilunar folds called anal valves

Blood supply : 1- Upper half------- Superior rectal artery (branch of
Inferior mesenteric A.) 2- Lower half--------Inferior rectal artery (branch of Internal iliac A.)

Lymphatic drainage :
1- Upper half : Pararectal L.nodes ----------- Inferior mesenteric L.N. 2-Lower half : Superficial inguinal L.N.

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y Anorectal ring : It is formed by Internal sphincter + Deep part of external anal sphincter + Puborectalis It surrounds the junction of rectum & anal canal,pulling the two forward at an acute angle

Ureter
It is muscular tube extends from kidney to posterior surface of bladder.Its length is 25 cm y Its course in the pelvis is as follow
Crosses over pelvic inlet Infront of internal ilac art. Behind ovary Beneath broad ligament Crossed by uterine tube infront of bifurcation of common iliac artery Runs downward&backward region of iscial spine turns forward &medially runs forward lateral to lateral f ornix of vagina Enters bladder

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Urinary bladder

y It is hollow organ, lies in the pelvis y Its capacity is 500 ml y Its shape depend on the amount of urine

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Empty bladder is pyramidal in shape Full bladder is ovoid in shape

y It has apex base(posterior surface) superior surface y (2) inferolateral surfaces neck

y Apex lies behind the symphysis pubis, it is connected to umbilicus by median umbilical ligament y Base (posterior surface) is separated from rectum by vagina y Superior surface is related to uterovesical pouch of peritoneum

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y Inferolateral surfac es Ant.-----------Retropubic pad of fat+pubic bone Related Above---------Obturator internus M. Post. Below---------Levator ani M. y Neck-----Sits or rests on upper surface of urogenital diaphragm y It is held in its position by pubovesical ligament(thickening of pelvic fascia) y Mucous membrane of lining of bladder forms folds except in the region of trigone(which is triangular area lies on internal surface of base of bladder) y Mucous membrane folds of bladder are called rugea y Mucous membrane of trigone is smooth because it is adherent to underlying muscle y The two superior angles of trigone are related to openings of ureters

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y Inferior angle is related to urethral orific e y Trigone is limited above by muscular ridge called ( interuretric ridge) y Uvula vesicae, it is small elevation lies behind urethral orifice y Muscular coat of bladder is composed of interlacing muscle fibers called detrusor muscle y At the neck,circular muscle fibers form sphincter vesicae

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Blood supply : Superior & Inferior vesical arteries (branches of internal iliac artery) Nerve supply : inferior hypogastric plexus 1-Sympathetic nervous system from L1-L2--------hypogasric plexus 2-Parasympathetic nervous system from S1-S2-S3----Hypogastric plexus Micturation : It is performed through micturation reflex Reflex is started when the volume of urine is 300 ml 1-Impulse from bladder wall-----S2-S3-S4 ---Spinal cord Central nervous system L1-L2 2-Impulses from bladder wall--Afferent fibers--hypogastric plexus

Bladder wall contract

3-Cent. N. Sys--Efferent fibers---S2-S3-S4--Inferior hypogasric plexus

Urethral sphincter relax

Sphincter vesicae relax

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Male urthra : y It is 20 cm long y Extends from neck of bladder to external urethral meatus y It consists of 3 parts : 1-Prostatic part : 3 cm long-- lies within prostate-widest part 2-membranous part : 1.5 cm long--lies within urogenital diaphragm 3-Penile part : 15.5 cm long- lies within penis-part of urethra that lies within glans of penis is dilated &called (fossa terminalis) Female urethra : y It is 4 cm long y Extends from neck of bladder to external urethral meatus

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y It lies in front of vagina y It can be dilated easily

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