MODULE 1:

OBJECTIVES:

1.1 Identify the bony walls, the joints and the ligaments of the pelvis. Identify the bony and ligamentous boundaries of the perineum. Identify the pelvic viscera, their normal positions and anatomical relationships.

1.2 Identify the extent of the peritoneal cavity, its folds, its reflections, and its pouches and spaces in the female pelvis and their relationship to the pelvic contents. Distinguish between the ligaments which are formed by folds of peritoneum, ligaments formed by the gubernaculums, and ligaments which are formed by condensations of visceral pelvic fascia in terms of their function and location.

1.3 Identify the muscular and ligamentous components of the inguinal ligament and inguinal canal in the female. Demonstrate the surface projections of the inguinal rings and inguinal canal.

1.4 Trace the course of the round ligament of the ovary as it passes through the inguinal canal to the labia majora.

READINGS:

SECTRA TABLE WORK:

1. Select Female Pelvis



Indentify the Pubic crest

Identify the Pubic symphysis

Identify the Pubic tubercle

Identify the Anterior superior iliac spine

Identify the Ischial spine

Identify the Coccygeus

Rotate and itdentify the boundaries of the Pelvic Inlet.

2. Now add the muscles and ligaments that define the lateral borders of the pelvis.

3. Add Piriformis

4. Add Obturator internus

5. Add Sacrotuberous ligament

6. Add Sacrospinous ligament



Rotate and identify the aperatures of the pelvic wall. These include the Greater sciatic foramen, the lesser sciatic foramen and the Obturator canal

7. Select Right hemipelvis

Note the listed structures that penatrate the pelvic wall through these aperatures.

The lesser foramen is the only entry for vessels and nerves to the perineum. All the other apertures allow entry from the abdomen to the leg and gluteal areas.

8. Formation of the inguinal canal:

9. Add Inguinal ligament

Remember that aponeurosis of the transversalis, internal oblique and the external oblique muscles form the inguinal ligament and the separation of these three aponeuroses forms the liguinal canal.



The deep inguinal ring is where the round ligaments exit the abdomen through the transversalis fascia and follows the aponeuroses of the internal and external oblique muscles to the superfical inguinal ring, where the round ligaments exit near the pubic tubercle and enters the labia majora.

The lacunar ligament runs backward from the inguinal ligament near the pubic ligament and helps to form the pectineal ligament which is also known as Cooper's ligament.

Find the lacunar ligament which has already highlighted on this cadaver.

10. Below the inguinal ligament is the femoral canal.

Rotate the image in order to see this relationship.

11. Let us now add the components of the female pelvis in order to see how these are suspended in the pelvis.

12. Add Rectum and sigmoid colon.

13. Add Ureters

14. Add Vagina

15. Add Uterus

The embryologic GUBERNACULUM becomes the round ligament in females. What does the Gubernaculum become in males?

16. Add Round ligament of the uterus

17. Highlight the ureters to see the relationship to the round ligament.

Notice how the ureters go under the round ligament. This is an important surgical landmark.

18. Add Uterine tubes

19. Add Ovarian fimbriae

20. Add Ovaries

21. Add Ligaments of the Ovaries

22. Add Suspensory (infundibulopelvic) ligament of the ovary

These ligaments are peritoneal folds that contain the ovarian arteries, veins and lymphatics.

23. The following structures form the Broad ligament which is also a peritoneal fold:



24. Add Mesovarium of the broad ligament

25. Add Mesosalpinx of the broad ligament

26. Add Mesometrium of the broad ligament

27. Add Urinary bladder

28. The peritoneal folds are not visable but, using the following illustration, find the listed pouches:



29. Vesico-uterine pouch

30. Recto-uterine pouch

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