Introduction to the pelvis, perineum and gluteal region Pelivs The region located below the abdomen; lower

boundary of abdomen: pelvic brim; contains pelvic viscera (bladder, uterus, neurovascular structures etc.); provides attachments for trunk and lower limb muscles, transmits weight of body from vertebral column to femur. Surface landmarks Iliac crest highest point of the iliac crest at L4 ASIS iliac crest anteriorly PSIS has the tubercle of the iliac crest located about 5 cm posterior to the ASIS and is a projection of the outer part of the iliac crest, usually at the level of L5. Pubic tubercle important surface landmark, small protuberance at the ., it is the medial attachment of the inguinal ligament Symphysis Pubis cartilaginous joint lying in the midline between the bodies of the pubic bone Pubic crest bridge or small elevation on the suprerioor surface of the pubic bone just medial to the pubic tubercle PoupartsSuperficial inguinal ring not a surface landmark but can be palpated, put little finger in the scrotum then palpate inquinal area to feel the aperture Scrotum contains the testicles, epididymis and distal part of the seminal cordf Linea alba fibrous band that extends from symphu=ysis to xiphoid

Umbilicus Rectus abdominis attached above underneath the lower part of the sternum going towards the syumphysis pubis inferiorly Linea semilunaris Posterior landmarks Spinous processes of sacrum -Fused at the midline: median sacral crest Sacral hiatus- situated at posterior aspect of lower end of sacrum,. Lies beneath the skin of the cleft between the buttocks Coccyx about 1 inch or 2.5 cm above and behind the anus Pelvic Viscera contents: Urinary bladder behind the pubic bone in the retropubic space, but when distended or filled with urine it becomes abdominal in location *cystocatherization- distend the urinary bladder first (for evactuation of urine_ Uterus- behind the symphysis pubis but during pregnancy (2nd month) starts to elevate, by 5th month it is at the level of the umbilicus, eventually occupies a large part of abdominal cavity and pushes abdominal organs upward Bony pelvis has 4 bones: 2 innonimate/hip bones Sacrum Coccyx Divided into two parts by the pelvic brim Above : false pelvis

Below true pelvis False Pelvis- of very little clinical importance bounded by abdominal wall anteriorly, laterally by iliac fossae (contains iliacus muscle), posteriorly by lumbar vertebra. Fxn: supports abdominal contents and at 3rd month pregnancy supports the gravid uterus; in early stages of labor it acts as a guide for the fetus in passing to the true pelvis True Pelvis bony canal through which the child passes during birth Has an inlet outlet and a cavity Inlet or pelvic brim bounded by sacral promontory posteriorly, laterally by iliopectineal line and anteriorly by symphysis pubis Outlet posteriorl coccyx, anteriorly by pubic arch, laterally by ischial tuberosities Cavity- area between pelvic inlet and pelvic outlet PerineumAbove pelvic diaphragm : main pelvic cavity Below: perineum Perinuem is usually seen with the dorsal lithotomy position Diamond shaped structure bounded anteriorly by symp pubis, posterior by tip of coccyx, lat by ischial tuberosities Divided into two triangles: A line drawn between the two ischial tuberosities, below is anal triangle and above is urogenital triangle

Glueal region or buttocks; quadrilateral in shape; inferiorly by fold of buttocks Made of gluteal muscles (g. maximus), with a thick layer of superficial fascia and deep fascia, bones: hip bones Urogenital diaphragm at the level of sphincter urethrae