Diaphragma - PDF document

Diaphragma pelvis diaphragma urogenitale mm. Perinei Blood vessels , lymph nodes and innervation of urogenital organs Miloš Grim & Petr Valasek Anatom ický ús

tav 1. lékařské f a k ult y, Univer z it a Karlova v Pra z e přednáška pro posluchače vÅ¡eobecného a zubního lékařství Panevní dno Pelvic floor 1. Pel

vic diaphragm 2. Urogenital diaphragm 3. Perineal muscles Vagina (kolpos) fornix, ostium, hymen, rugae, columns, urethral carina, trigonal area of vagina, mucou

s membrane, muscular layer, spongy layer, parakolpium, urogenital hiatus, pubovaginal m., promontorium of vagina, urethrovaginal sphincter muscle, bulbospongios

us muscle, M agnetic re s onance image of female pelvis in sagittal plane 1. Diaphragma pelvis Pelvic diaphragm Pelvic diaphragm striated muscles from tail somite

s/spine thus innervated from sacral plexus lig. anococcygeum, arcus tendineus m. l.a., centrum tendineum perinei, hiatus urogenitalis, hiatus analis M. levator

ani pars pubica – m. pubococcygeus – m. pubovisceralis m. pubovaginalis m. puboprostaticus m. puboperinealis m. p uborectalis par

s iliaca – m. iliococcygeus M. coccygeus M. levator ani (1,2,3) a m. cocygeus (4) 1 – m. pubococygeus 2 – m. iliococcygeus 3 – m. puborectalis 4 â€

“ m. coccygeus 5 – m. obturatorius int. Levator ani Pelvic diaphragm Pelvic diaphragm Diaphragma pelvis, view from perineum Lacuna vasorum, lac. musculorum, ca

nalis obturatorius Suprapiriform foramen infrapiriform foramen Levator ani, tendinous arch of levator ani Sling of the pubovaginalis muscle Development of levator

ani et external anal sphincter 2. Diaphragma urogenitale Urogenital diaphragm Diaphragma urogenitale Closes hiatus urogenitalis – urethra (and vagina) pass th

rough it. It is connected with pelvic diaphragm in the centrum perinei. On its surface lie erectile organs and glands. muscles: M. t ransversus perinei profundus

( male only ) M. sphincter urethrovaginalis ( female only ) M. compressor urethrae ( female only ) M. transversus perinei superficialis ( variable ) Fibrous struc

tures: Membrana perinei Lig. transversum perinei ( male only ) Centrum perinei (corpus perineale/perineal body) Urogenital diapragm Deep transverse perineal musc

le ( in male only ) + variable superficial transversal perineal muscle, perineal membrane Fibrous structure - perineal body 3. Mm. perinei Perineal muscles Pe

rineum, hráz, in narrow (obstetric) understanding : transverse band of soft tissues between the anal orifice and posterior rim of (commissura labiorum posterio

r) Broader (anatomical) term perineum ( regio perinealis ) designates whole area of pelvic outlet and is divided into anterior regio urogenitalis , and poster

ior regio analis . Deep boundary of perineum is the inferior surface of diaphragma pelvis and thus fossa ischioanalis is part of it. Organa genitalia feminina

externa: mons pubis rima pudendi labia majora praeputium clitoridis glans clitoridis frenulum clitoridis labia minora vestibulum vaginae ostium urethrae externum

ostium vaginae carunculae hymenales commisura labiorum posterior perineum opening of glandula vestibularis major Perineal muscles of female, blood supply, inmner

vation Perineal region , regio perinealis - Urogenital triangle , regio urogenitalis - Anal triangle , regio analis, - Ischio - anal fossa , fossa ischioan

alis (ischiorectalis) Perineum Perineal region - blood supply, innervation M m. perinei , s valy hráze mm. regionis analis m. sphincter ani externus mm. regioni

s urogenitalis m. sphincter urethrae externus + urethrovaginal sphincter + compressor urethrae m. ischiocavernosus m. bulbospongiosus Fibrous structures: Perin

eal body, Anococcygeal lig. Fossa ischioanalis Corpus adiposum fossae ischioanalis Canalis pudendalis (Alcockův kanál) Perine al muscles Mm. of urogenital triang

le: Extern al urethra l sphincter ( + Urethrovaginal sphincter + Compressor urethrae ) I schiocavernosus , Bulbospongiosus , M. of anal triangle External anal

sphincter Fibrous structures: Perineal body, Anococcygeal lig. M. sphincter ani externus pars subcutanea – just under skin around anus, split by connective tiss

ue radiating into nearby skin pars superficialis – lies above the subcutaneous part, 0,5 - 1,5 cm thick and 1,5 cm high – strongest part of the sphincter p

ars profunda – forms a ring at the level of m. puborectalis and together they make m. compressor recti , the most important part of continen t ia alv i Func

tion: permanent contraction – relaxes only during defecation Innervation : n. pudendus M. sphincter ani externus (yellow) Muscles and cavernous tissues in regi

o urogenitalis: m.bulbospongiosus, m. ischocavernosus, m. compressor urethrae, m. sphincter urethrovaginalis, m. transverus perinei superficialis, m. levator an

i, m. sphincter ani externus, centrum perinei, crus, corpus, glans clitoridis, bulbus vestibuli Female external genitalia and perineal muscles - Bulbospongiosus

, Ischocavernosus , Compressor of urethra , U rethrovaginal sphincter , Superficial transvers e perine al muscle Ischioanal fossa, middle part Ischioanal fos

sa M. sphincter urethrae externus lies in and above the level of diaphragma urogenitale, around the urethra, it contains slow muscle fibres for long - term contr

action – tone caudal fibres pass onto sides of vagina, cranial to the apex of prostate I nnerv ation via plex . hypogastricus inferior from motoneurons of On

uf nucleus in S2 a S3 M . sphincter urethrovaginalis , M. compressor urethrae Zijta M et al. Clin Anat 26:110 – 114 (2013) Axial T2 - weighted image of a 26 -

year - old nullipara. C demonstrates the multidirectional organization of the complex pelvic floor anatomy. The per - voxel vector values are color coded as fol

lows: green (anteroposterior direction), blue (craniocaudaldirection), and red (mediolateral direction). 3. Mm. perinei Perineal muscles DEVELOPMENT DSCN3423.JP

G kuře Gallus gallus domesticus křepelka Coturnix coturnix japonica Segmental origin of muscles quail chick ED3 ED10 Svaly DK Příklad: somit 32 Mole cular anal

ysis of chick cloacal musculature development Phase 1 – migration do leg - „In“ Pax3 MyoD ED3.5 ED 5 ED 5 ED 6 ED 7 E D 8 E D 9 Phase 2 – extension fro

m leg - „Out“ MyoD 26 32 The base of a leg gives off muscle cells for cloaca GFP chick kuře ED 4 ED10 wing Mouse cloacal - perineal muscles 1. Also murine c

loacal muscles develop from flexors 11.5 13.0 12.5 14.5 13.5 LA SAE Valasek et al., Development 2005 MyoD wt cMet - / - in cMet - / - 2. cMet - / - confirms m

igratory mechanism MyHC P elvic floor & BIRTH Female pelvic types: A. Gynecoid (40%) typical, smooth anterior and posterior segment. B. Android (30%) narrow ant

erior segment - wedged aditus pelvis. C. Anthropoid (20%) aditus pelvis anteroposterior oval. D. Platypeloid (výskyt 3%) aditus pelvis transverse oval. The le

vator hiatus in axial plane with minimally distensible (left) and highly distensible puborectalis muscle (middle) compared to the dimensions of fetal head at th

e term (right). The ultrasound data sets of 227 nulliparous women examined at 36 – 38 week’s gestation were investigated. Minimal hiatal diameters were measur

ed at rest, on Valsalva and pelvic floor muscle contraction. Results: some women will have to distend only 25%, others by 245%. Since childbirth - related trau

ma to the levator ani is common and clinically important, one should consider potential preventative measures . One approach would be to avoid vaginal delivery

by performing elective Caesarean Section . (Å vabik et al. 2009) Normal condition Avulsion after childbirth MRI picture of levator ani musc

le Perineal region - blood supply , innervation n. pudendus a a. pudenda interna n. genitofemoralis ( lateral ) n. cutaneus femoris posterior n.

ilioinguinalis n. pudendus https://www.sciencedirect.com/science/article/pii/S22 56208717300317 M agnetic re s onance image of female pelvis in plane of urogeni

tal hiatus (level 2 according to DeLancey) Symphysis Tendinous arch of levator ani Tendinous arch of pelvic fascia Urethra Vagina Anal canal Puborectal sling

(levator ani) Anatomy of the pelvic outlet (scheme based on MRI) Urogenital hiatus Plexus hypogastricus Inferior, parasympathetic fibres from sacral nerves Zd

roje ilustrací: Gray ´ s Anatomy, Sobottův atlas anatomie člověka, Grada, 2007 Grim, Druga: Základy anatomie, 5. díl Benninghoff, Drenckhahn: Anatomie I., II.

Carlson,B.M.: Human Embryology and Developmental Anatomy, archiv autora Doporučená literatura: Čihák R: Anatomie 2, Grada 2002, (3. vydání březen 2013) Gri

m, M., Druga, R.et al: 5. Anatomie krajin těla. Praha, Karolinum, Galén, 2010; 3. Trávicí, dýchací, močopohlavní a endokrinní systém , Praha, Karolinum

, Galén, 2005, Lüllmann - Rauch R.: Histologie, překlad 3. vydání , Grada 2012 Sadler T. W: Langmanova lékařská embryologie, překlad 10. vydání , Grada 201