The urogenital diaphragm has deep muscles.
The transverse deep perineal muscle is a flat muscle. The main action of the muscle is to strengthen the urogenital diaphragm and urethra. Forms the urinary sphincter (voluntary sphincter).
The muscular layer of the urogenital diaphragm in women is formed by m. transversus perinei profundus and circular bundles of muscle fibers similar to m. sphincter urethrae in men. These fibers encircle the urethra and vagina and, when contracted, compress them.
The superficial muscles of the urogenital diaphragm include:
1. M. bulbospongiosus, bulbospongiosus muscle, which differs depending on gender. In men, the muscle covers the inferolateral surface of the bulb and the nearest part of the cavernous body. By squeezing the urethra, it promotes the ejection of semen and urine. In women, the muscle is divided into two symmetrical halves surrounding the vaginal opening. When contracted, the muscle narrows the opening of the vagina.
2. M. ishiocaverndsus, ischiocavernosus muscle. The muscle promotes erection of the penis or clitoris by squeezing the venous vessels.
3. M. transversus perinei superficialis, superficial transverse muscle of the perineum. When contracting, it fixes the center of the perineum. In women it is poorly developed.
Fascia of the perineum.
1. Fascia pelvis, pelvic fascia. It has two parts - parietal and visceral. Between the pelvic fascia and the peritoneum there are spaces filled with loose connective tissue: the retropubic is located behind the pubic symphysis and in front of the bladder, spreading to its sides, the rectal is located in front of the sacrum and behind the rectum.
2. Fasciae diaphragmatis urogenitalis superior et inferior, the lower and upper fascia of the urogenital diaphragm, cover the front (lower fascia) and back (upper) transverse deep muscle of the perineum and the sphincter of the urethra and make up the urogenital diaphragm. Separates the deep muscles of the urogenital diaphragm from the superficial ones. In women, both fascia of the genitourinary diaphragm are connected to the vagina.
3) Fascia perinei superficialis, superficial fascia of the perineum. It covers the superficial muscles of the urogenital diaphragm and forms the vagina for the corpus spongiosum of the penis. In women, the fascia is divided into two halves by the vestibule of the vagina.
Vessels and nerves. The perineal area is fed from the internal pudendal artery. At the lower edge of the urogenital diaphragm a. The pudenda interna is divided into two terminal branches - the deep penile artery and the dorsal penile artery. Veins are companions of arteries.
The skin of the perineum is innervated by the pudendal nerve (n.Pudendus) and the coccygeal plexus.
The perineum, perineum, is a space corresponding to the outlet of the pelvis and made by voluntary muscles, which are covered with fascia and together with them form two diaphragms: the genitourinary, diaphragma urogenitale, and the pelvic, diaphragma pelvis. Both diaphragms allow the channels of the genitourinary and digestive systems to pass out, for which they form pulps that cover the external openings of these channels. The perineum can be compared to a diamond shape: in front - symphysis pubica, in back - the tip of the coccyx, on the right and left - the ischial tuberosities. The rhombus consists of two triangles: the anterior one, filled with the urogenital diaphragm, and the posterior one, filled with the pelvic diaphragm. The urethra passes through the urogenital diaphragm in men, and in women, in addition, the vagina. The rectum emerges through the pelvic diaphragm in both sexes. The space between the anus and the external genitalia is called the perineum in the narrow sense of the word.
Perineal muscles:
Diaphragma urogenitale has the following deep muscles: m. transversi perinei profundus is a flat muscle covering the paras membranace urethrae. It starts from the ischial tuberosities and ends in the tendon center - centrum perineale. Function – strengthening the genitourinary diaphragm and urethra. Circular fibers form a voluntary sphincter - m. sphincter urethrae. M. transversi perinei profundus in women, along with the urethra, also covers the vagina.
Superficial muscles include: m. bulbospongiosus, bulbospongiosus muscle. In men, it covers the inferolateral surface of the bulbus and the nearest part of the corpus spongiosum penis and is fused along the midline by a narrow tendon bridge. Function - takes part in the ejection of semen and urine from the urethrae (m.ejaculator seminis et accelerator urinae). In women, it surrounds the vagina. Function – narrows the vaginal opening (m.constrictor cunni). M. ischiocavernosus, the ischiocavernosus muscle, originates from the ischial tuberosities and is attached to the corpus cavernosum. Function – erection of the penis or clitoris, compresses the venous vessels. M. transversi perinei superfacialis. It runs transversely from the ischial tuberosity and ends in the centrum perineale. Function – fixes this center. In women it is poorly developed. Is the boundary between diaphragms.
Diaphragma pelvis forms the floor of the pelvic cavity. Deep muscles:
m.levator ani, muscle that lifts the ani. It originates on the wall of the pelvis in front of the descending branch of the ischium, lateral to the pubic symphysis, then from the fascia m.obturatorius internus, and behind the pelvic surface of the ischium, part of the fibers are directed back and to the middle, clasping the rectum, merging with its muscular layer. The other part passes, bypassing the rectum, from the lateral side of the prostate gland, bladder, and in women the vagina, closely adjacent to them and intertwined with the muscles of the vesica urinaria et vagina. It ends at the coccyx through the lig.anococcygeum. function – raises the anus, strengthens the pelvic floor, and in women it also compresses the vagina.
m. coccygeus, coccygeus muscle. It starts from the spina ischiadica and from the pelvic surface of the lig.sacrospinale, attaches to the lateral edge of the coccyx and the apex of the sacrum.
The superficial muscles of the pelvic diaphragm include one muscle: m. sphincter ani externus – external sphincter of the anus.
Fascia of the perineum.
1) Fascia pelvis, pelvic fascia - continuation of f.iliaca in the small pelvis. Fascia pelvis parietalis lines the walls of the small pelvis (m.obturatorius internus, m. piriformis) and passes to the upper surface of the pelvic diaphragm, covering the m.levator ani on top. The other is called fascia diaphragmatis pelvis superior. It wraps around the internal organs and is called fascia pelvis visceralis. The lower surface of the pelvic diaphragm is covered with fascia diaphragmati pelvis inferior. Diaphragma pelvis consists of muscles lying between two fasciae: fascia diaphragmatis pelvis superior et inferior.
2) Fascia diaphragmatis urogenitalis superior et inferior cover the front (lower fascia) and back (upper fascia) m. transversi perinei profundus and m. sphincter urethrae and together with them make up the diaphragma urogenitale. In front, where m. transversi perinei profundus does not reach the symphysis pubica, both fascia fuse with each other, forming the fibrous part of the urogenital diaphragm, called lig.transversum perinei. Between it and the lig.arcuatum pubis there is the v.dorsalis penis s.clitorius. At the back, the fascia is also connected to each other. On the sides, the upper fascia of the genitourinary diaphragm, covering the prostate gland, passes into the fascia pelvis, and the lower one fuses along the midline with the bulbus penis, covering the glandulae bulbourethrales. In women, both fascia of the genitourinary diaphragm are connected to the vagina and adhere to its bulbus vestibuli.
3) Fascia perinei superfacialis, superficial fascia of the perineum - continuation of the common subcutaneous fascia to the perineum. It covers the superficial muscles of the urogenital diaphragm (mm.bulbospongiosus, ischiocavernosus, transversi perinei superfacialis) and, together with the fascia diaphragmatis urogenitalis inferior, forms the vagina for the spongy bodies of the penis. In women, the fascia is divided into two halves by the vestibule of the vagina.
Fascial - cellular space.
Between the pelvic fascia and the peritoneum there are spaces filled with loose connective tissue: one of them - spatium retropubicum, is located behind the pubic symphysis and in front of the bladder, the other is located in front of the sacrum and behind the rectum - spatium retrorectale. On the sides of the pelvic diaphragm, between it and the ischial tuberosities, there are pits - fossa ischiorectalis, filled with fatty tissue, paraproctus.
Blood supply and innervation.
Arterial blood enters through the a.pudenda interna (in the fossa ischiorectalis it gives 1-3 branches - aa.rectalis inferior, which go to the muscles and skin of the anus). At the lower edge of the urogenital diaphragm, it is divided into a.profunda penis and a.dorsalis penis. Veins are companions of arteries. Outflow of lymph to the nodi lymphatici inguinales superfaciales. Innervation: n.pudendus, which gives off nn.rectales inferior, n.perinei and nn.scrotales (in women - nn.labiales) posterior, as well as the coccygeal plexus.
2.1. General patterns of development, structure, classification, blood supply and innervation of internal organs.
Viscera, viscera, s.splanchna are organs located mainly in body cavities. These include the digestive, respiratory, and genitourinary systems. Parts of the body of the embryo are laid in the vectral. There is ectodermal here. primary like, rounded laterally by mesoderm in the form of paired bags containing coelom. The walls of the sacs adjacent to the ento- and ectoderm form the visceral and parietal layers of mesoderm, respectively. The digestive organs develop from the intestinal tube. and breathe. systems.
The formation of the genitourinary system occurs in the part of the mesoderm adjacent to both the visceral and parietal. her leaves.
The internal organs are divided into four tubes: digestive, respiratory, urinary, genital. The walls of the cavities (thoracic, abdominal, pelvic) are lined with serous tissues, which extend to most of the viscera. According to their structure, they are usually divided into parenchymal (liver, kidneys, lungs) and special cell elements consisting of parenchyma and connecting cells; and tubular (esophagus, stomach, ureter) - having the form of a tube, the walls of which limit the cavity.
The walls of tubular organs consist of an inner membrane - mucous, submucosal, muscle. and serous.
The surface of the tunica mucosa, facing the organ cavity, is lined with epithelium, which lies on the lamina propria mucosae, representing. loose fibrous compound tissue containing lymphoid nodules, glands, blood and lymph capillaries, and nerves. Below is the lamina muscularis mucosae. When it contracts, the mucous membrane gathers into folds. The glands of the mucosa are divided into unicellular (lie between epithelial cells) and multicellular (in the mucosa or submucosa or form separate organs). The shape of multicellular glands is: tubular, alveolar, alveolar-tubular. In structure - simple and complex, formed by a branched system of tubes or bubbles, breaking off in the ductus exterioris.
Glands that have ducts - g.external secretion, not having. – internal secret Large multi-cl. The glands consist of lobes separated by layers of connective tissue. The lobes consist of lobules, within which the secretor is located. conc. parts of the gland. From the conclusion. The ductus glandulae is formed from the ducts of the lobes and lobules.
Theta submucosa contains blood and lymphatic vessels, nerves, and glands penetrate there. In the presence of teta submucosa, the mucosa can shift and form folds. It may be absent, then the mucous membrane does not form folds.
Tunica muscularis. In the end. dept. consists of transverse stripes of mice. fabrics, most of the internal ones are smooth.
Consists of several layers (2 or 3). The layers are circular, longitudinal, and oblique.
Tunica adventicia – external Well, it contains blood vessels and nerves.
Art. veins are located along the nerves. tubes and nerves. Most of the visceral vessels are paired. They walk the shortest distance to the organ. The artery enters the organ on a concave medial or internal surface, so the hilum is on a concave surface facing the midline, where the aorta lies, sending branches to it. Movable insides (for example, the stomach, which changes shape) have many ring-shaped arcuate elastoids. The caliber of the arteries is determined not only by the size, but also by the function of the organ (renal art.). The endocrine glands receive multiple sources of nutrition. In organs of lobular structure (liver, kidneys, lungs) art. enters the center and diverges (three-dimensionally) to the periphery of the corresponding. lobes and segments. In tubular organs: 1) vessels??? // branches extend from the long axis at right angles, covering. a tube in the form of a ring (uterus); 2) vessels // of the long axis on one side of the organ, the branches run longitudinally (ureter); 3) the vessels form a network on the surface of the tube, from which arteries extend towards the center in the thickness of the wall. On the inside, changing the volume, but located. located in cavities with rigid walls. venous plexuses (facilitates venous outflow when the organ is compressed) – bladder, uterus.
Nerves travel the shortest distance from y?? to the organ.
Innervation internal. Vegetation is carried out. nerve. system. Some organs are advantageous. innerv. one of its departments (sympathetic or parasympathetic). Spleen, adrenal gland - only symp., urine. bubble - parasympto. When an organ moves from its initial site to its final location, the nerve follows the organ (as do the vessels).
Afferent nerve fibers transmit impulses from the organ to the organ. Efferent - from the organ to the innervated organ.
1. Fascia pelvis, pelvic fascia, is a continuation fascia iliaca in the pelvic area. It has two parts - parietal and visceral. Fascia pelvis parietalis lines the walls of the small pelvis (m. obturatorius internus, m. piriformis) and passes to the upper surface of the pelvic diaphragm, covering the m. levator ani. This part of the fascia pelvis parietalis is also called the upper fascia of the pelvic diaphragm, fascia diaphragmatis pelvis superior. The latter, having covered the diaphragm, wraps around the pelvic organs passing through the bottom of the pelvis, where it is called the visceral part of the pelvic fascia, fascia pelvis visceralis. Between the pelvic fascia and the peritoneum, lining the pelvis from the inside, there are spaces filled with loose connective tissue: one of them (spatium retropubicum) is located behind the pubic symphysis and in front of the bladder, spreading to its sides, the other is located in front of the sacrum and behind the rectum (spatium retrorectale).
The lower (outer) surface of the pelvic diaphragm is covered lower fascia of the pelvic diaphragm, fascia diaphragmatis pelvis inferior. As a result, the muscles of the pelvic floor find themselves lying between two fasciae, fasciae diaphragmatis pelvis superior et inferior together with which they make up diaphragma pelvis.
Since the pelvic diaphragm protrudes somewhat downwards in the form of a dome, below its level, between it and the ischial tuberosities, on the sides of the anus a paired fossa, fossa ischiorectalis, made by fatty tissue, paraprbctus (hence the name of its inflammation - paraproctitis).
2. Fasciae diaphragmatis urogenitalis superior et inferior cover the front (lower fascia) and back (superior) m. transversus perinei profundus and m. sphincter urethrae and together with them make up diaphragma urogenitale. In front, where m. The transversus perinei profundus does not reach the symphysis pubica; both fascia fuse with each other, forming the fibrous part of the urogenital diaphragm, called lig. transversum perinei. In front of this ligament, between it and lig. arcuatum pubis, passes v. dorsalis penis s. clitoridis.
At the back, along the posterior edge of the same muscle, the fascia is also connected to each other. On the sides, the upper fascia of the urogenital diaphragm, covering the prostate gland, passes into the fascia pelvis, and the lower fascia fuses along the midline with the bulbus penis, covers the glandulae bulbourethrales and separates the deep muscles of the urogenital diaphragm from the superficial ones.
In women, both fascia of the genitourinary diaphragm are connected to the vagina and adhere to its bulbus vestibuli.
3. Fascia perinei superficialis, The superficial fascia of the perineum is a continuation of the general subcutaneous fascia of the body to the perineum. It covers the superficial muscles of the urogenital diaphragm (mm. bulbospongiosus, ischiocavernosus et transversus perinei superficialis) and, together with the fascia diaphragmatis urogenitalis inferior, forms the vagina for the spongy bodies of the penis. In women, the fascia is divided into two halves by the vestibule of the vagina.
Crotch, perineum , - a complex of soft tissues (skin, muscles, fascia) covering the exit from the pelvic cavity.
The perineum occupies the area bounded in front by the lower edge of the pubic symphysis, in the back by the apex of the coccyx, and on the sides by the lower branches of the pubic and ischial bones and the ischial tuberosities. If we take the ischial tuberosities as the outermost lateral points of the perineum, the lower point of the pubic symphysis in front, and the apex of the coccyx in the back, then the outline of the perineum can be compared to a rhombus.
The transverse line connecting the ischial tuberosities divides this area into two parts shaped like triangles: the anterosuperior part is called genitourinary area,regio urogenitalis, and the infero-posterior - anal area,regio analis. Within the genitourinary region there is the so-called urogenital diaphragm, and in the anal region there is the pelvic diaphragm. Both diaphragms are adjacent to each other with their bases, and their apices are directed respectively to the pubic symphysis and coccyx.
In a narrow sense, the perineum is understood as the area located between the external genitalia in front and the anus in the back, which corresponds tendon center of the perineum,centrum tendineum perinei. In women, this area extends from the posterior edge of the genital fissure to the anterior edge of the anus (Fig. 15), and in men - from the posterior edge of the scrotum to the anterior edge of the anus (Fig. 16). In the anterior-posterior direction there is a dark stripe on the skin of the perineum - crotch seam(median), raphe perinealis, which in men continues into the suture of the scrotum.
The genitourinary diaphragm (genitourinary region) and the pelvic diaphragm (anal region) are a muscular-fascial plate formed by two layers of muscles (superficial and deep) and fascia. In the anal region, the muscles of the pelvic diaphragm lie between its upper and lower fascia. The muscles of the genitourinary diaphragm are located in such a way that their deep layer is enclosed between the upper and lower fascia of the urogenital diaphragm. This entire muscular fascial plate from the side of the pelvic cavity is covered by the parietal layer of the pelvic fascia, and on the outside (bottom) by the superficial fascia.
Urogenital diaphragm occupies the anterior part of the perineum and has the shape of a triangle, the apex of which faces the pubic symphysis. The sides are bounded by the lower rami of the pubis and ischium, the base corresponding to the line connecting the ischial tuberosities. The urethra passes through the urogenital diaphragm in men, and the urethra and vagina in women.
The muscles of the urogenital diaphragm are divided into superficial and deep. The superficial muscles include 3 muscles: the superficial transverse perineal muscle, the ischiocavernosus and bulbospongiosus. Superficial transverse perineal muscle,T.transversus perinei superficialis, - steam room, lies in a deep layer of subcutaneous fatty tissue, starts from the lower branch of the ischium near the ischial tuberosity, goes transversely towards the same muscle on the other side and ends in the tendon center of the perineum, formed by thin flat tendons of these muscles. Some of the fibers of this muscle are woven into the external sphincter of the anus and into the bulbospongiosus muscle of the opposite side. The superficial transverse muscles are involved in strengthening the tendon center of the perineum.
ischiocavernosus muscle,T.ischiocavernosus, - paired, starts from the lower branch of the ischium, is adjacent on the lateral side to the root of the penis (in men), its anterior end is woven into the tunica albuginea of the cavernous body of the penis or clitoris (in women). The superficial transverse perineal muscle and the ischiocavernosus muscle promote erection when contracted.
Bulbospongiosus muscle,T.bulbospongiosus, consists of two parts that originate from a suture on the lower surface of the bulb of the penis, cover the bulb and spongy body of the penis on the right and left and are attached to its tunica albuginea and to the superficial fascia on the back of the penis. When contracted, the muscle compresses the bulb, cavernous bodies and dorsal vein of the penis, as well as the bulbo-urethral glands, and participates in erection. In women, the bulbospongiosus muscle [T.sphincter urethrovagindlis] , steam room, covers the vagina in the area of its opening. This muscle starts from the tendinous center of the perineum and the external sphincter of the anus, attaches to the dorsal surface of the clitoris, weaving into its tunica albuginea. On its way, the muscle is adjacent to the glands of the vestibule from below. When contracted, the muscle narrows the entrance to the vagina, compresses the large gland of the vestibule, the bulb of the vestibule and the veins emerging from it. The deep muscles of the urogenital diaphragm include the deep transverse perineal muscle and the urethral sphincter muscle. Deep transverse perineal muscle,T.transversus perinei profundus, - steam room, looks like a thin plate, starts from the branches of the ischium and pubic bones. Along the midline of the perineum, this muscle, with its flat tendon, connects with the tendon of the same muscle on the other side and participates in the formation of the tendon center of the perineum. Both muscles strengthen the urogenital diaphragm. The unpaired muscle is also located here* - urethral sphincter,T.sphincter urethrae, bundles of fibers of which, starting partially from the lower branches of the pubic bones, have a predominantly circular direction, covering the membranous part of the urethra in men, and the urethra in women.
In men, bundles of fibers of this muscle are attached to the prostate gland, and in women they are woven into the vaginal wall. The muscle is a voluntary compressor of the urethra.
Diaphragm pelvis,diaphrdgma pelvis, occupies the back of the perineum and has the shape of a triangle, the apex of which faces the coccyx, and the angles are directed towards the ischial tuberosities. The final portion of the rectum passes through the pelvic diaphragm in both men and women.
The superficial layer of the muscles of the pelvic diaphragm is represented by the unpaired muscle - external anal sphincter,m. sphincter dni externus, surrounding the final section of the rectum. The muscle consists of several bundles, the most superficial of which end in the subcutaneous tissue. The bundles, starting from the top of the coccyx, cover the anus and end in the tendon center of the perineum. The deepest muscle bundles surround the lower rectum and are adjacent to the levator ani muscle. All bundles of the external anal sphincter, when contracting, compress (close) the opening of the anus.
The deep muscles of the pelvic diaphragm include two muscles that form the posterior part of the floor of the pelvic cavity: the levator ani muscle and the coccygeus muscle. The levator ani muscleT.levdtor dni, - steam room, has the shape of a thin triangular plate, forms a funnel with a similar muscle on the other side, the wide part facing upward. The lower parts of both muscles, tapering, cover the rectum in the form of a loop. The levator ani muscle originates from the lateral wall of the pelvis in several bundles. The anterior bundles begin from the inner surface of the lower branch of the pubic bone, the lateral bundles start from tendinous arch of the levator ani muscle,drcus tendineus muscles levatoris dni, representing an arcuate thickening of the fascia of the pelvis in the place where it forms the obturator fascia (fascia obturatoria). The bundles of the right and left muscles that lift the ani are directed downwards and backwards, connect to each other, and cover the rectum. Some of the fibers of the levator ani muscles are woven into the prostate gland (in men), the vaginal wall (in women), as well as into the wall of the bladder and rectum, and the muscles themselves end at the apex of the coccyx in the form anal-coccygeal ligament,lig. anococcygeum. When the levator ani muscle contracts, the pelvic floor is strengthened and raised, and the lower (terminal) section of the rectum is pulled forward and upward, which is then compressed. In women, this muscle also narrows the entrance to the vagina and brings the back wall of the vagina closer to the front. coccygeus muscle,t. suck-geu, - steam room, starts from the ischial spine and sacrospinous ligament, runs medially and posteriorly and attaches to the lateral edge of the coccyx and the apex of the sacrum. The bundles of this muscle are adjacent to the sacrospinous ligament on the medial side and are partly woven into it, strengthening the posterior part of the pelvic diaphragm.
Fascia of the perineum. The superficial fascia of the perineum, the upper and lower fascia of the pelvic diaphragm, as well as the upper and lower fascia of the genitourinary diaphragm are distinguished. Superficial(subcutaneous) perineal fascia,fascia perinei super- ficidlis, weakly expressed and is a continuation of the general subcutaneous fascia covering adjacent parts of the body. This fascia is adjacent below (outside) to the superficial muscles of the urogenital diaphragm (T.transversus perinei superficidlis, mm. ischio cavernosus et bulbospongiosus), fusing with their own fascia. Anteriorly in men, the superficial fascia of the perineum continues into the superficial fascia of the penis. On the sides it grows to the ischial tuberosities. Under the superficial fascia of the perineum in its posterior section is the lower fascia of the pelvic diaphragm, fascia diaphragmatis pelvis inferior. This fascia fuses with the fascia proper of the gluteus maximus muscle and lines the ischiorectal fossa. In it, the fascia covers the outer surface of the obturator muscle, reaches the top of the ischiorectal fossa, and then passes to the outer surface of the levator ani muscle. Moving to the outer surface of the external sphincter of the anus, the lower fascia of the pelvic diaphragm ends in the tissue surrounding the anus, and anteriorly it reaches the posterior edge of the urogenital diaphragm, where it connects with its lower and upper fascia. From above (from the side of the pelvic cavity) the levator ani muscle is covered with fascia, called the superior fascia of the diaphragm pelvis,fascia diaphragmatis pelvis superior.
Thus, the levator ani muscle, as well as the external sphincter of the anus, together with the lower and upper fascia of the pelvic diaphragm covering them, form the musculofascial plate - the pelvic diaphragm, diaphrdgma pelvis.
Lower fascia of the genitourinary diaphragm, fascia diaphragma tis urogentitalis inferior, located between the superficial and deep muscles, covering from below (outside) the deep transverse muscle of the perineum, as well as the sphincter of the urethra. On top of these muscles lies the upper facade urogenital diaphragm,fascia diaphragmatis urogenitalis superior. Between these fasciae are located the bulbo-urethral (Cooper's) glands in men and the large glands of the vestibule (Bartholin's) in women. The upper and lower fascia of the genitourinary diaphragm on the sides fuse with the periosteum of the lower branches of the ischial and pubic bones, and under the pubic symphysis both fascia fuse with each other, resulting in the formation transverse perineal ligament,lig. transver- sum perinei. This ligament is located in front of the membranous part of the urethra and does not reach the arcuate ligament of the pubis, due to which a narrow gap remains between these two ligaments through which the dorsal vein and arteries of the penis (clitoris) pass.
The superior fascia of the pelvic diaphragm is part of the parietal layer of the pelvic fascia (fascia pelvis). The part of the pelvic fascia that forms partitions between the internal organs located in the pelvic cavity is called the pelvic visceral fascia, fascia pelvis visceralis. Anteriorly, between the pubic symphysis and the lower part of the bladder, the visceral fascia of the pelvis forms paired pubovesical (puboprostatic) ligaments,ligamenta pubovesicales (puboprostatices). Between the bladder and rectum in men, the visceral fascia of the pelvis forms a frontally located plate - rectovesical septum,septum recto- vesicale. In women, between the rectum and vagina, the visceral fascia of the pelvis forms a transversely lying rectovaginal septum,septum rectovaginale.
The female perineum has some characteristic features (see Fig. 15). Thus, the urogenital diaphragm in women is wider; not only the urethra, but also the vagina passes through it. The muscles of this area are less pronounced than the muscles of the same name in men. The paired superficial transverse perineal muscle is often completely absent. The deep transverse perineal muscle is also poorly developed. Both fascia (upper and lower) of the urogenital diaphragm in women, on the contrary, are stronger. The muscle bundles of the sphincter of the female urethra also cover the vagina, weaving into its wall. The tendon center of the perineum is located between the vagina and the anus and consists of intertwining tendon and elastic fibers.
The ischiorectal [anal] fossa. In the perineal area, on the sides of the anus, there is a pair of depressions called the ischiorectal fossa. ischiorectal fossa,fossa ischiorectalis [ ischioanalisj, has a prismatic shape, filled with fatty tissue, wide open at the bottom and narrows at the top, contains blood vessels and nerves (see Fig. 16). On a section made in the frontal plane, it looks like a triangle, with its apex facing upward, towards the pelvic cavity. The apex of the ischiorectal fossa corresponds to the lower edge tendinous arch of the fascia of the pelvis,drcus tendineus fasciae pelvis. The lateral wall of the ischiorectal fossa is formed by the obturator internus muscle covered with fascia and the inner surface of the ischial tuberosity. The medial wall of the fossa is bounded by the outer surface of the levator ani muscle and the external anal sphincter, covered by the inferior fascia of the pelvic diaphragm. The posterior wall of the ischiorectal fossa is formed by the posterior bundles of the levator ani muscle and the coccygeus muscle. The anterior wall of the ischiorectal fossa is the transverse perineal muscles. Fatty tissue filling the cavity of the ischiorectal fossa acts as an elastic cushion.
Vessels and nerves of the perineum. The blood supply to the perineum is carried out by the branches of the internal (deep) pudendal artery, which leaves the pelvic cavity through the greater sciatic foramen, goes around the sciatic spine, and then through the lesser sciatic foramen enters the ischiorectal fossa, where it gives off several large branches: the inferior rectal artery, the perineal artery and the dorsal artery of the penis or clitoris. Venous blood flows through the veins of the same name into the internal iliac vein. Lymphatic vessels drain into the superficial inguinal lymph nodes. Innervation of the perineum is carried out along the branches of the pudendal nerve: along the nerve fibers of the lower rectal nerves, perineal nerves, as well as the anal-coccygeal nerves - branches of the coccygeal nerve.
84. General anatomy of blood vessels, patterns of their location and branching. Main, extraorgan and intraorgan vessels. Age-related changes in blood vessels. Characteristics of the microvasculature.
The cardiovascular system includes the heart and blood vessels. The cardiovascular system performs the functions of transporting blood, and with it nutrients and activating substances to organs and tissues (oxygen, glucose, proteins, hormones, vitamins, etc.), and metabolic products are transported from organs and tissues through blood vessels (veins) substances. Blood vessels are absent only in the epithelial cover of the skin and mucous membranes, in hair, nails, the cornea of the eyeball and in articular cartilage.
In the circulatory system, the heart is the main circulatory organ, the rhythmic contractions of which determine the movement of blood. The vessels through which blood is removed from the heart and supplied to the organs are called arteries, and the vessels that bring blood to the heart are called veins.
Heart- a four-chamber muscular organ located in the chest cavity. The right half of the heart (right atrium and right ventricle) is completely separate from the left half (left atrium and left ventricle). Venous blood enters the right atrium through the superior and inferior vena cava, as well as through the own veins of the heart. Having passed through the right atrioventricular orifice, along the edges of which the right atrioventricular (tricuspid) valve is strengthened, the blood enters the right ventricle, and from it into the pulmonary trunk, then through the pulmonary arteries into the lungs. In the capillaries of the lungs, closely adjacent to the walls of the alveoli, gas exchange occurs between the air entering the lungs and the blood. Oxygen-enriched arterial blood flows through the pulmonary veins into the left atrium. Having then passed the left atrioventricular orifice, along the edges of which the left atrioventricular mitral (bicuspid) valve is attached, it enters the left ventricle, and from it into the largest artery, the aorta (Fig. 25). Taking into account the peculiarities of the structure and function of the heart and blood vessels, there are two circles of blood circulation in the human body - large and small.
Systemic circulation begins in the left ventricle, from where the aorta emerges, and ends in the right atrium, into which the superior and inferior vena cava flow. Along the aorta and its branches, arterial blood containing oxygen and usually an arterial type vessel (arteriole) approaches the capillary network, and a venule leaves it. For some organs (kidney, liver) there is a deviation from this rule. So, an artery approaches the glomerulus of the renal corpuscle - the afferent vessel, vds dfferens. An artery, an efferent vessel, also emerges from the glomerulus. vas efferens. A capillary network inserted between two vessels of the same type (arteries) is called arterial miraculous network,rete mi- rablle arteriosum. The capillary network located between the interlobular and central veins in the liver lobule is built according to the type of miraculous network - venous miraculous network,rete mirdbile ve- nosum.
Pulmonary circulation begins in the right ventricle, from which the pulmonary trunk emerges, and ends in the left atrium, into which the pulmonary veins flow. Venous blood flows from the heart to the lungs (pulmonary trunk), and arterial blood flows to the heart (pulmonary veins). Therefore, the pulmonary circulation is also called pulmonary.
All arteries of the systemic circulation begin from the aorta (or from its branches). Depending on the thickness (diameter), arteries are conventionally divided into large, medium and small. Each artery has a main trunk and its branches.
Arteries, blood supplying the walls of the body are called parietal (parietal), arteries of internal organs are called visceral (visceral). Among the arteries, there are also extraorgan arteries, which carry blood to the organ, and intraorgan arteries, which branch within the organ and supply its individual parts (lobes, segments, lobules). Many arteries get their name from the organ they supply (renal artery, splenic artery). Some arteries got their name due to the level of their origin (beginning) from a larger vessel (superior mesenteric artery, inferior mesenteric artery), by the name of the bone to which the vessel is adjacent (radial artery), in the direction of the vessel (medial artery surrounding the thigh ), as well as by depth of location: superficial or deep artery. Small vessels that do not have special names are designated as branches, rdmi.
On the way to the organ or in the organ itself, the arteries branch into smaller vessels. There are main types of branching of arteries and scattered ones. At trunk type There is a main trunk - the main artery and lateral branches gradually extending from it. As the lateral branches depart from the main artery, its diameter gradually decreases. Loose type artery branching is characterized by the fact that the main trunk (artery) is immediately divided into two or more terminal branches, the general branching plan of which resembles the crown of a deciduous tree.
There are also arteries that provide a roundabout flow of blood, bypassing the main path - collateral vessels. If movement along the main (main) artery is difficult, blood can flow through collateral bypass vessels, which (one or more) begin either from a common source with the main vessel, or from different sources and end in a common vascular network.
Collateral vessels connecting (anastomosing) with branches of other arteries serve as arterial anastomoses. Distinguish intersystem arterial anastomoses- connections (ostia) between different branches of different arteries and intrasystemic anastomoses- connections between branches of one artery.
The wall of each artery consists of membranes. inner shell,tunica intimate, educated? dothelium, basement membrane and subendothelial layer. It is separated from the middle shell by an internal elastic membrane. Middle shell,tunica media, formed mainly by smooth muscle cells of a circular (spiral) direction, as well as elastic and collagen fibers. It is separated from the outer shell by an outer elastic membrane. Outer shell (adventitia),tunica externa (adventitia), formed by loose connective tissue. It contains vessels that supply the wall of the artery - the vascular vessels, vasa vasorum, and you are nervous, pp.vasorum.
Large arteries, in the middle shell of which elastic fibers predominate over muscle cells, are called elastic arteries(aorta, pulmonary trunk). The presence of a large number of elastic fibers counteracts excessive stretching of the vessel by blood during contraction (systole) of the ventricles of the heart. The elastic forces of the walls of the arteries, filled with blood under pressure, also promote the movement of blood through the vessels during relaxation (diastole) of the ventricles, i.e., they ensure continuous movement - blood circulation through the vessels of the large and small (pulmonary) circulation. Some of the arteries of medium and all arteries of small caliber are arteries of the muscular type. In their middle shell, muscle cells predominate over elastic fibers. The third type of arteries is mixed arteries(muscular-elastic), which include most of the middle arteries (carotid, subclavian, femoral, etc.). The topography of the arteries is not random, but regular (P.F. Lesgaft). Arteries are directed to organs along the shortest path. So, on the limbs they run along their shorter flexion surface, and not along their longer extensor surface; The first branches of the aorta are the coronary arteries, which supply blood to the nearby heart. The main importance is not the final position of the organ, but the place where it is formed in the embryo. So, for example, to the testicle, which is laid in the lumbar region, a branch of the abdominal aorta - the testicular artery - is directed along the shortest path. As the testicle descends into the scrotum, the artery that feeds it descends along with it, the beginning of which in an adult is located at a great distance from the testicle. At the same time, the scrotum, which is formed and develops in the caudal parts of the body of the embryo, is supplied with blood from branches of nearby arteries.
The artery organs are approached from their inner side, facing the source of blood supply - the aorta or other large vessel, and the artery or its branches in most cases enter the organ through its gate, hilum.
There are certain correspondences between the skeletal plan and the number of main arteries. The spinal column is accompanied by the aorta, the clavicle is accompanied by one subclavian artery. On the shoulder (one bone) there is one brachial artery, on the forearm (two bones - radius and ulna) - two arteries of the same name.
On the way to the joints, collateral arteries depart from the main arteries, and opposite them - from the underlying sections of the main arteries - the recurrent arteries. By anastomosing with each other around the circumference of the joints, they form articular arterial networks that provide continuous blood supply to the joint during movements.
The number of arteries entering an organ and their diameter depend not only on the size of the organ, but also on its functional activity.
The patterns of branching of arteries in organs are determined by the structural plan of the organ, the distribution and orientation of connective tissue bundles in it. In organs that have a lobular structure (lung, liver, kidney), the artery enters the portal and then branches according to the lobes, segments and lobules (Fig. 27). To organs that are laid down, for example, in the form of a tube (intestine, uterus, fallopian tubes), the feeding arteries approach from one side of the tube, and their branches have a ring-shaped or longitudinal direction (Fig. 28). Having entered the organ, the arteries branch repeatedly to arterioles.
Venules, which are the last link of the microcirculatory bed, merging with each other and enlarging, form veins. Veins are divided into small, medium and large. The wall of veins is thinner than the wall of arteries. It, like the arteries, has three membranes: internal, middle and external. There are few muscle cells and elastic fibers in the middle tunic of the vein, so the walls of the veins are pliable and the lumen of the vein does not gape when cut. Small, medium and some large veins have venous valves (flaps), valvuae venosae, - semilunar folds on the inner membrane, which are usually located in pairs (Fig. 29). The veins of the lower extremities have the largest number of valves. The valves allow blood to flow towards the heart and prevent it from flowing back. Both vena cavae, the veins of the head and neck, the renal veins, the portal vein, and the pulmonary veins do not have valves. The venous sinuses, into which blood flows from the brain, are located in the thickness (splits) of the dura mater of the brain and have non-collapsing walls that ensure unimpeded flow of blood from the cranial cavity into the extracranial veins (internal jugular).
Depending on the topography and position of the veins in the body and organs, they are divided into superficial and deep. P o-superficial (saphenous) veins, venae super fiddles, usually follow on their own. deep veins, venae profundae, in double quantity (in pairs) they are adjacent to the arteries of the limbs of the same name, therefore they are called accompanying veins (companion veins). Titles of the deep veins are similar to the names of the arteries to which the veins are adjacent (ulnar artery - ulnar vein, brachial artery - brachial vein). The unpaired deep veins are the internal jugular, subclavian, axillary, iliac (common, external, internal), femoral and some other veins. Superficial veins connect to deep veins using so-called perforating veins, which act as anastomoses - anastomoses. Neighboring veins are often connected to each other by numerous anastomoses, collectively forming venous plexuses, plexus venosus, which are well expressed on the surface or in the walls of some internal organs (bladder, rectum). In general, the number of veins exceeds the number of arteries.
The largest veins of the systemic circulation are the superior vena cava and the inferior vena cava. The hepatic veins and their tributaries flow into the latter. The roundabout flow of blood is carried out through veins (collateral), through which venous blood flows away, bypassing the main path. The tributaries of one large (main) vein are connected to each other intrasystemic venous anastomoses. Between the tributaries of various large veins (superior and inferior vena cava, portal vein) there are intersystem venous anastomoses(cavo-caval, cavo-portal, cavo-cavoportal), which are collateral pathways (vessels) for the flow of venous blood bypassing the main veins.
The walls of blood vessels have abundant sensitive(afferent) and motor(efferent) innervation. In the walls of some large vessels (the ascending aorta, the aortic arch, the branching point - the bifurcation of the common carotid artery into the external and internal, the superior vena cava and the jugular vein, etc.) there are especially many sensitive endings, and therefore these areas are called reflexogenic zones. Virtually all blood vessels have abundant innervation, which plays an important role in the regulation of vascular tone and blood flow.
Age-related changes
Vessels of the pulmonary circulation. The arteries and veins of the lungs develop most intensively in the first year of a child’s life, which is associated with the formation of respiratory function, as well as with postnatal obliteration of the arterial (botallian) duct. During puberty, there is a new intensification of the development of pulmonary vessels. At 40-50 years of age, the arteries and veins of the lung reach their greatest size.
Vessels of the systemic circulation. After the birth of a child, as age increases, the circumference, diameter, thickness of the walls of the arteries and their length increase. The level of departure of the arterial branches from the main arteries and even the type of their branching also changes. The diameter of the left coronary artery is greater than the diameter of the right coronary artery in people of all age groups. The most significant differences in the diameter* of these arteries are observed in newborns and children 10-14 years old. In people over 75 years of age, the diameter of the right coronary artery is slightly larger than the diameter of the left. The diameter of the common carotid artery in young children is 3-6 mm, and in adults it is 9-14 mm; The diameter of the subclavian artery increases most intensively from the moment the child is born to 4 years of age. In the first 10 years of life, the middle artery has the largest diameter of all cerebral arteries. In early childhood, the intestinal arteries are almost all of the same diameter. The difference between the diameter of the main arteries and the diameter of their branches of the 2nd and 3rd orders is small at first, but as the child’s age increases, this difference also increases. The diameter of the main arteries grows faster than the diameter of their branches. During the first 5 years of a child’s life, the diameter of the ulnar artery increases more rapidly than the radial artery, but later the diameter of the radial artery prevails. The circumference of the arteries also increases: for example, the circumference of the ascending aorta in newborns is 17-23 mm, at 4 years old - 39 mm, at 15 years old - 49 mm, in adults - 60 mm. The thickness of the walls of the ascending aorta grows very intensively up to 13 years, and the common carotid artery stabilizes after 7 years. The lumen area of the ascending aorta also increases rapidly from 23 mm 2 in newborns to 107.2 mm 2 in twelve-year-olds, which is consistent with an increase in the size of the heart and cardiac output.
The length of the arteries increases in proportion to the growth of the body and limbs. For example, by the age of 50, the length of the descending aorta increases almost 4 times, while the length of the thoracic part increases faster than the abdominal part. The arteries supplying blood to the brain develop most intensively until 3-4 years of age, surpassing other vessels in growth rates; The anterior cerebral artery grows most rapidly in length. With age, the arteries supplying blood to internal organs and the arteries of the upper and lower extremities also lengthen. Thus, in newborns and infants, the inferior mesenteric artery has a length of 5-6 cm, and in adults - 16-17 cm.
The levels of branches from the main arteries in newborns and children, as a rule, are located more proximally, and the angles at which these vessels depart are greater in children than in adults. The radius of curvature of the arcs formed by the vessels also changes. For example, in newborns and children under 12 years of age, the aortic arch has a larger radius of curvature than in adults. In proportion to the growth of the body and limbs and, accordingly, the increase in the length of their arteries, a partial change in the topography of these vessels occurs. The older the person, the lower
the aortic arch is located: in newborns it is above the level of the first thoracic vertebra, at 17-20 years old - at level II, at 25-30 years old - N A level III, at 40-45 years old - at the height of the IV thoracic vertebra, and in elderly and old people - at the level of the intervertebral disc, between the IV and V thoracic vertebrae. The topography of the arteries of the extremities also changes. For example, in a newborn, the projection of the ulnar artery corresponds to the anteromedial edge of the ulna, and the radial artery corresponds to the anteromedial edge of the radius. With age, the ulnar and radial arteries move in relation to the midline of the forearm in the lateral direction, and in children over 10 years of age, these arteries are located and projected in the same way as in adults. The projections of the femoral and popliteal arteries in the first years of a child’s life also shift in the lateral direction from the midline of the thigh, with the projection of the femoral artery approaching the medial edge of the femur, and the projection of the popliteal artery approaching the midline of the popliteal fossa. There is a change in the topography of the palmar arches. The superficial palmar arch in newborns and young children is located proximal to the middle of the II and III metacarpal bones, in adults it is projected at the level of the middle of the III metacarpal bone.
As age increases, the type of branching of the arteries also changes. Thus, in a newborn, the type of branching of the coronary arteries is scattered; by the age of 6-10 years, the main type is formed, which persists throughout a person’s life.
Vienna. With age, the diameter of the veins, their cross-sectional area and length increase. For example, the superior vena cava is short due to the high position of the heart in children. In the first year of a child’s life, in children 8-12 years old and in adolescents, the length and cross-sectional area of the superior vena cava increase. In mature people, these indicators remain almost unchanged, but in elderly and elderly people, due to senile changes in the structure of the wall of this vein, an increase in its diameter is observed. The inferior vena cava in a newborn is short and relatively wide (diameter about 6 mm). By the end of the first year of life, its diameter increases slightly, and then faster than the diameter of the superior vena cava. In adults, the diameter of the inferior vena cava (at the level of the confluence of the renal veins) is approximately 25-28 mm. Simultaneously with the increase in the length of the vena cava, the position of their tributaries changes. The portal vein and the superior and inferior mesenteric and splenic veins that form it are mostly formed in the newborn.
After birth, the topography of the superficial veins of the body and limbs changes. Thus, a newborn has dense subcutaneous venous plexuses, and against their background large veins are not contoured. By 1-2 years of life, the larger great and small saphenous veins of the leg are clearly distinguished from these plexuses, and on the upper limb - the lateral and medial
saphenous veins of the arm. The diameter of the superficial veins of the leg increases rapidly from the neonatal period to 2 years: the great saphenous vein almost 2 times, and the small saphenous vein 2.5 times.
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