Simon Menno Yutzy.

A manual and atlas of dissection online

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Ileo-colic artery



C/ECUM



VERMIFORM
APPENDIX



Left colic artery

Superior meseji-
teric artery and
vein



Vasa intfstini
tewiii



SMALL INTESTINES



Superior mesenteric vein and tributaries.

Note the mesenteric glands. (See Fig. 177.)

Inferior mesenteric artery and branches.

Inferior mesenteric vein and tributaries. (See Fig. 174.)

Portal vein and tributaries. (See Figs. 173, 174, and 175.)



THE MESENTERY ARTERY



149



FIG. 174. THE INFERIOR MESENTERIC ARTERY AND VEIN. (Morris.')



Middle colic artery



Inferior pancreatico-
diKjdenal artery

Xii}ii:rior meseiitcric
artery

Riyht colic artery



Abdominal aorta
Vena cava inferior



Riijht common iliaf

artery

Middle sacral artery
and vein




Lffl colic artery

Inferior mesenteric
vein

Inferior mesenteric

artery

Left colic- artery
Inferior mesenleric

artery



Left common iliac
rein

Sir/moid artery



Superior hiemor-
rhoidai artery



'50



VEINS OF STOMACH



FIG. 175. THE VEINS OF THE STOMACH AND THE PORTAL VEIN. (Morris.)
(From a dissection by W. J. Walsham.)



Cystic vein

Right branch of
portal vein

Portal vein



Hepatic arterii

Continuation of

hepatic artery

Gastro-diiodenal

branch of hepatic

artery

Pyloric vein



Right gaftro-
epiploic vein



Omental veins




Left branch oj
portal rein



Veins corre-
spond ing lo
ruxii brecia
arteries

Gastric artery

Hepatic artery
Splenic artery

Gastric or
coronary vein



Left ffastro-
rpip/oic vein



ABDOMINAL VISCERA



DEMONSTRATION IV.
REMOVAL OF ABDOMINAL VISCERA.

SMALL INTESTINES:-

Place two ligatures around the jejunum at its beginning and cut be-
tween the ligatures. Similarly divide the ileum six inches above its ter-
mination. Divide the mesentery close to the intestines. Cut off about
ten inches of the upper part of the jejunum and the same length of the
lower part of the ileum, wash them, distend with air, and dry them. After
they are dry cut them open and study them.

. What is the length of jejunum; length of ileum?

What is Meckel's diverticulum?

Mesentery attachments and extent.

Structure of intestinal wall.

Four coats describe each.

In mucous coat valvulae conniventes, villi, solitary glands, and Fever's
patches.



FIG. 176. PORTIOX OF THE SMALL INTESTINE, LAID OPEN TO SHOW THE VALVUL.* CONNI-
VE XTES. (Brinton.) (Morris.)




What is. the blood-supply? (See Fig. 173.)
What is the nerve-supply?
Lymphatics of small intestines.



ABDOMINAL VISCERA
FIG 177. VESSELS OF THE SMALL INTESTINE. (Morris.)




Veins



LARGE INTESTINES.

Note the position of the different parts of the large intestines.

Divide the ascending colon six inches above the entrance of the ileum.
Remove, wash, distend with air and dry the caecum. Then cut open and
study caecum, walls, ilio-caecal valve, opening of appendix, and appendix.

FIG. 178. SECTION THROUGH THE JUNCTION OF THE LARGE AND SMALL INTESTINE TO

SHOW THE ILEO-C.ECAL VALVE AND APPENDIX VERMIFORMIS. (Holden.}

i. Ileum. 2. Caecum or caput coli. 3. Appendix Vermiformis.







Types of caecum (Fig. 179).

Remove the rest of the large intestines down to the rectum. Note
hepatic, splenic, and sigmoid flexures.

Clean, distend with air, and dry part of the ascending colon and sig-
moid flexure, then cut open and study their walls, blood-supply, and nerve-
supply.



ABDOMIXAL VISCERA



FIG. 179. THE FOUR TYPES OF CAECUM. (Treves.) (Morris.)
ABC D




FIG. 180. SECTION- OF THE ASCENDING COLON. (Allen Thomson.) (Morris.}

Cr?sceTltie ridge of mucous

membrane which divides the sacculi Longitudinal muscle



Serous coat



Anterior band
Mucous membrane



Crescentic ridge of
mucous membrane



Circular muscle



Appendix epiploica




Posterior band
Mucous membrane



Crescentic ridge of
mucous membrane



Serous coat



Inner band



Circular muscle



i 5 4 ABDOMINAL VISCERA

For blood-supply see Figs. 173 and 174.

A close network of tissue surrounds the branches of the abdominal
aorta. This tissue consists almost entirely of nerve -plexuses of the sym-
pathetic system. The solar plexus is the largest and surrounds the cceliac
axis.

Study the solar plexus and the offsets of the solar plexus.

Expose and study the cceliac axis and its branches. Xote especially
the branches going to the stomach. To expose these pull down the stomach
and cut through the peritoneum above the stomach.



FIG. 181. THE CCELIAC ARTERY AND ITS BRANCHES. (Morris.}

Abdominal aorta LEFT CRUS OF DIAPHRAGM

(ESOPHAGEAL BRANCH



RIGHT CRUS OF DIAPHRAGM



Cfgliac axis

Gastric Vasa

artery l/revia



Cystic artery

Right phrenic artery

HEPATIC DUCT

CYSTIC DUCT

Splenic artery

COMMON BILE DUCT

Pyloric artery

Gastro-dnodenal artery



Superior pancreatico-
ditodeital artery
HEAD OF PANCREAS

Inferior pancrealico-

duodenal artery

ight gastro-epiploic

' artery




Left gas/ro-ejiiploic artery



Pull the stomach down and cut the oesophagus just below the dia-
phragm, and ligate and divide the duodenum at its beginning. Cut the
blood-vessels going to the stomach and remove the stomach; clean, dis-
tend with air, and dry it.
Study the stomach:

General description.

Cardiac orifice; cardiac end, or fundus.

Borders and surfaces.

Relation to surrounding parts.

Relation to peritoneum.

Alterations in position.

Structures of its wall four coats.



ABDOMIXAL VISCERA
FIG. 182. ANTERIOR SURFACE OF THE STOMACH. (Morris.)

PYLORUS CARDIAC ORIFICE



ANTRUM PYLORI




FIG. 183. MUSCULAR COAT OF THE STOMACH. (Luschka.) (Morris.)




LONGITUDINAL LAYER



CIRCULAR LAYER



Blood-supply of stomach. (See Fig. 181.)

Nerve-supply vagus and sympathetic.

Lymphatics.

Innate the duodenum in place; note its form, parts, and its relation
to pancreas, common bile-duct, pancreatic duct, kidney, superior mesen-
teric artery and vein (Figs. 184, 185, 186).

Observe the fossa duodeno-jejunalis. (See Fig. 172.)

Also study the pancreas in place and its relation to surrounding struc-
tures. See same figures as for duodenum.



ABDOMINAL VISCERA

FIG. 184. THE DUODENUM FROM ix FRONT. (Morris.)

SUPERIOR LAYER OF TRANSVERSE MESO-COLON



SECOND PART OF
DUODENUM




FOURTH PART OF DUODENUM



INFERIOR LAYER OF TRANSVERSE MESO-COLON

THIRD PART OF DUODENUM



SUPERIOR MESENTERIC VESSELS



FIG. 185. THE DUODENUM FROM BEHIND. (Morris.) (Also see Fig. 182.)



Portal rein




FOURTH PART OF DUODENUM



HEAD OF PANCREAS



Next raise the liver and expose the common bile-duct, the hepatic
artery, and the portal vein by cutting through the lesser omentum. Notice
their relative positions.

Trace the common bile-duct down to its entrance into duodenum and
junction with the pancreatic duct. Also trace the common bile-duct up
toward the liver to where it is formed by the hepatic ducts; trace the
hepatic ducts and cystic duct. Also trace the hepatic artery and portal
vein up to the liver. (See Figs. 186, 187, 188, and 189.)



ABDOMIXAL VISCERA



157



FIG. 186. DIAGRAM OF THE BRANCHES OF THE CCELIAC Axis. (Holden.)

(Pancreas in dotted outline behind the stomach.)

i. Coronaria ventriculi. 2. Splenic a. 3. Hepatic a. 4. Pyloric a. 5. Gastro-duode-
nalis. 6. Gastro-epiploica sinistra. 7. Vasa brevia. 8. Superior mesenteric a.




\ - Spleen



Commencement of the intes-
tinum jejunum.



FIG. 187. DIAGRAM OF THE VENA PORT^E (Holden.)
(The arrow is introduced behind the free border of the lesser omentum.)



rv-T.. SPLENIC. V

&hs?




158 ABDOMINAL VISCERA

FIG. 188. RELATION OF STRUCTURES AT AND BELOW THE TRANSVERSE FISSURE. (Thane.)

(Morris.)



GALL BLADDER



BILE DUCT




Portal rein



Expose the pancreatic duct or canal of Wirsung, and trace it^to^its
junction with the common bile-duct or entrance into duodenum.
Also trace duct of Santorini.



FIG. 189. THE PANCREAS AND ITS DUCT. (Morris.}

DUCT OF PANCREAS DUCT OF SANTORINI COMMON BILE DUCT




DUCT OF WIRSUNG



Now remove the duodenum and pancreas.

Study the duodenum, its structure, blood- and nerve-supply.
Study the pancreas, head, neck, body, and tail, ducts, blood- and
nerve-supply, and lymphatics.



SPLEEN:

Note its position, shape, surfaces, borders, and supplementary spleens,
or lienculi.

Trace splenic artery from cceliac axis to spleen.

Remove the spleen. Study its structure, size, and weight.

What is its nerve-supply?

Lymphatics of spleen.



ABDOMIXAL VISCERA



159



DEMONSTRATION V.
LIVER :

What is its position in relation to the ribs, stomach, kidney, and colon?

Peritoneum and ligaments.

Remove the liver. Study its borders, surfaces, lobes, fissures and
structures. Describe the gall-bladder or cyst.

FIG. 190. SUPERIOR SURFACE OF THE LIVER. (Morris.)



Site of the Spigelian lobe




GALL BLADDER



Falciform or suspensory ligament



FIG.. 191. THE INFERIOR SURFACE OF THE LIVER. (Morris.)

Vena cara



BILE DUCT
Portal vein
Hepatic artery
SPIGELIAN LOBE




UMBILICAL FISSURE



i6o



ABDOMINAL VISCERA



Trace the hepatic ducts, portal vein, hepatic artery into the liver. Note
hepatic veins. How many sets of capillaries does the liver have?

FIG. 192. POSTERIOR SURFACE OF THE LIVER. (Morris.}

Vena cava

LEFT LOBE




TUBER OMENTALE



ATTACHMENT OF CASTRO-HEPATIC OMENTUM

!

SPIGELIAN LOBE



IMPRESSION FOR RIGHT
SUPRARENAL



Review the hepatic artery; the portal vein and its tributaries.



KIDNEY AND SUPRARENAL BODY.

Expose the kidneys and suprarenal bodies by removing the tissue in
front of them.

Study their position and relations to surrounding parts.
Study the investment or capsule of kidney.

FIG. 193. DIAGRAM SHOWING RELATION OF KIDNEY TO CAPSULE. (W. A.) (Morris.)



TRANSVERSE COLON



DESCENDING COLON

PERITONEUM

FATTY CAPSULE

KIDNEY

PERITONEAL CAVITY
Diaphragmatic



Parietal muscle




CUT EDGE OF
PERITONEUM

Muscular fibre in
subperitoueal
tissue

PANCREAS

Sup. mesenteric vein
DUODENUM

LYMPHATIC GLAND



LUMBAR VERTEBRA



SUBPERITONEAL TISSUE FATTY CAPSULE Renal vesselt embedded In subperitoneal tism,



ABDOMIXAL VISCERA



161



Xote the relative position of the renal artery, renal vein, and ureter.

Remove one kidney with its ureter, cutting the ureter at the brim of
pelvis. Do not remove the other kidney at this dissection.

General description of the kidney, shape, size, hilum, and sinus.

Cut the kidney lengthwise, as seen in the figure below. Study the
parts exposed by the cut.



FIG. 194. LONGITUDINAL SECTION OF THE KIDNEY (Tyson, after Henle). (Holden.)
Cortex, i". Labyrinth, i'. Medullary Rays. 2. Medulla. 2". Boundary layer of
medulla. 2'. Papillary portion of medulla. 3. Transverse section of tubules in boun-
dary layer. 4. Fat of renal sinus. *. Transversely coursing medullary rays. 5.
Artery. C. Renal calyx. U. Ureter. A. Branch of renal artery.




What is the blood- and nerve-supply of the kidney.
Describe the suprarenal bodies.



162



ABDOMINAL VISCERA



The figures below show the relations of some of the abdominal and
thoracic viscera.



p IG I9 ^ RELATION OF THE ABDOMINAL VISCERA TO THE PARIETES. (Treves.) (Morris.)




ABDOMINAL VISCERA



163



FIG 196. ABDOMINAL VISCERA, FROM BEHIND. (Riidinger.) (Morris.}



LARYNX




DESCENDING COLON -

Inferior mesenteric
vein



Superior mesenteric

rein
ASCENDING COLON



1 64 STRUCTURES ON POSTERIOR WALL OF ABDOMEN

DEMONSTRATION VI.

STRUCTURES ON THE POSTERIOR WALL OF ABDOMEN.

Sympathetic nerves.

You will find a close network of tissue in front of the abdominal aorta
and around its branches. This tissue is nearly entirely sympathetic nerve
tissue. It is arranged in plexuses, each plexus taking the name of the
artery around which it is placed. The plexus around the cceliac axis is
the largest and is called the solar plexus.

The other plexuses are offsets of the solar plexus.

SOLAR PLEXUS :-

Position.

Semilunar ganglion.

Expose the ganglia. Note their position, shape and the connection
of the great splanchnic and small splanchnic nerves.
Study the splanchnic nerves.
Offsets of the solar plexus.

These take the names of the arteries with which they pass out to the
viscera.

Expose the gangliated cord in the abdomen. (See Fig. 197.)
Arteries :

Abdominal arteries.

Expose the abdominal aorta, notice the position of its branches, study
those with which you are not already familiar.
Branches :

Phrenic. Renal.

Cceliac. Suprarenal.

Sup. mesenteric. Spermatic.

Inf. mesenteric. Ovarian.

Lumbar. Middle sacral.

Veins :

Inferior vena cava and tributaries. Note the relation of the veins to
the arteries. What difference between right and left spermatic vein?
(See Fig. 198.)

Note the beginning of the azygos veins by the ascending lumbar (Fig.
199).

Expose the receptaculum chyli, the beginning of the thoracic duct.
It lies behind the aorta, and between the aorta and right crus of the
diaphragm in front of the second lumbar vertebra (Fig. 199).

Study the iliac fascia. Do not remove it at this time in the dissection.
Observe and study the muscles:
Psoas.

Psoasparvus.
Iliacus.
Quadratus lumborum.



STRUCTURES ON POSTERIOR WALL OF ABDOMEX



165



FIG. 197. LUMBAR PORTION OF THE GANGLIATED CORD, WITH THE SOLAR AND HYPO-
GASTRIC PLEXUSES. (Henle.) (Morris.}



GANGLION DIAPHRA GMA TICUM



^UPRARENAL
CAPSULE



GREAT SPLANCH-
NIC NER VE
RIGHT SEMI LU-
NAR GANGLION



RENAL GANGLION

SMALL SPLANCHNIC
NER VE

Renal artery



GANGLIATED CORD



RAMUS COMMUNICANS



Hepatic artery



BRANCH TO A OR TIC
PLEXUS




LEFT SEMILV-
NAR GANGLION

GREAT SPLANCH-
NIC NERVE

SMALL SPLANCH-
NIC NER VE

Superior mesenteric
arter;/

RENAL GANG LION
Renal artery



SUPERIOR MESEKTERIC
GANGLION-



BRANCH TO AORTIC
PLEXUS



GANGLIATED CORD OP
SYMPA THE TIC



Inferior mesenteric artery



INFERIOR MESEN-
TERIC GANGLION



Disc between last lumbar
and first aacral vertebra

Common iliac vein
Common iliac artery



i66



STRUCTURES ON POSTERIOR WALL OF ABDOMEN



FIG. 198. THE ABDOMINAL AORTA AND ITS BRANCHES, WITH THE INFERIOR VENA CAVA

AND ITS TRIBUTARIES. (Morris.)



Cystic artery

HEPATIC DUCT

CYSTIC DUCT

COMMON DUCT

Portal vein

Gastro-dnodenal br.

Superior jiyloric l:

Hepatic artery

Right suprarenal vein
Inferior suprarenal
artery
Renal artery

Renal vein

Inferior vena cava
KIDNEY



Right spermatic rein



Right spermatic artery

Quadratus lumborum
muscle

Right lumbar artery and
left lumbar vein
Ureteric branch of
spermatic artery



Middle sacral vessels




LEFT LOBE OF LIVER



(ESOPHAGUS

Left phrenic artery



Right phrenic artery



Superior suprarenal
Gastric artery
Inferior suprarenal
Splenic artery

Left phrenic vein
Left suprarenal vein
Superior mesenteric

artery
KIDNEY

Ureter ic branch of renal
Left spermatic vein



URETER

Left spermatic artery

Inferior mesenteric artery

Ureteric branch of
spermatic



Ureteric branch of

common iliac
Common iliac artery



External iliac artery
Internal iliac artery



STRUCTURES OX POSTERIOR WALL OF ABDOMEN



167



FIG. 199. THE SUPERIOR AND INFERIOR VEN^ CAV^, THE INNOMINATE VEINS, AND

THE AZYGOS VEINS.



Right common carotid

artery

Right internal jugular
vein



RIGHT LYMPHATIC DUCT

Innominate artery

RIGHT PXEUMO-

GASTRIC SER VE

Right innominate vein

Internal mammary vein

Trunk of the pericardiac
ami thymic reins
Vena cava superior



Vena azygos major



Vena azygos minor, cross-
ing spine In enter vena
azygos major

Hepatic veins



Vena cava inferior

Right phrenic artery
Cieliac axis

Right middle suprarenal
artery



Right spermatic artery
Right spermatic vein




Left common carotid

artery

LEFT PXEUMOGAS-
TRIC SER VE

THORACIC DUCT

Left innominate vein

Left subclavian artery



Left superior intercostal
rein

RECURRENT
LARYSGEAL
NERVE



Vena azygos lertiut

(ESOPHAGUS

Ijeft upper azygos vein

fExophageal branches
from aorta

Vena mygos minor



THORACIC DUCT



Left phrenic artery



Left middle suprarenal
artery

RECEPTACULUM CHYLI

Superior mesenterie
artery

Left ascending lumbar

vein
Left spermatic vessels



Inferior mesenterie
artery



168 STRUCTURES ON POSTERIOR WALL OF ABDOMEN



FIG. 200. PSOAS, ILIACUS, AND QUADRATUS LUMBORUM. (Morris.}



Quadratus lutnborum



Paoas parvus



Fsoaa maguus



Iliaous




transversalis
anterior



ratus lumborum



LUMBAR PLEXUS



169



LUMBAR PLEXUS:

A plan of the formation of the lumbar plexus is given in the figure
below.



FIG. 201. DIAGRAM OF THE LUMBAR AND SACRAL PLEXUSES. (Modified from Paterson.)

(Morris.}



FROM LAST THORACIC



GEX1TO-CRURAL

ILIV-HYPOGASTRIC

ILIO-ING UIXA L



EXTERN A L
CUTANEOUS



OBTURATOR



ACCESSORY
OBTURATOR



BRANCH TO ILIACUS
ANTERIOR CRURAL



SUPERIOR GLUTEAL
INFERIOR GLUTEAL

GREAT SCIATIC

NERVE TO

QUADRATIC

FEMUR1H



EXTERNAL

POPLITEAL

SECTION

INTERNAL

POPLITEAL

SECTIO.\




FIRST LUMBAR



SECOND LUMBAR



THIRD LUMBAR



FO UR TH L UMBA R



FIFTH LUMBAR



FIRST SACRAL



SECOND SACRAL



THIRD SACRAL

VISCERAL
FOURTH SA CRAL

PERFORA TIXG

CUTANEOUS
PERIN^EAL
FIFTH SACRAL

JfKRVK TO COCCTGEUS

NER VE TO LE VA TOR
ANI

FIRST COCCYGEAL



TO HAMSTRINGS /' SMALL SCIATIC
NERVE TO OBTURATOR INTERNUS



VISCERAL



PUDIC



Expose the lumbar plexus:

Genito-crural (X. genito-femoralis) lies on the anterior surface of the
psoas muscle. Trace it back through the psoas muscle to its origin and
down to its division.

Ilio-hypogastric and inguinal pass in front of the quadratus lurn-
bommjmuscle ; pick them up here and trace them back through the psoas
muscle to their origin.

External cutaneous (X. cutaneus fenwris lateralis] passes in front



i yo



LUMBAR PLEXUS



of the iliac muscle and behind iliac fascia. Trace it back through the
psoas muscle to its origin and out to where it passes below Poupart's liga-
ment just below the anterior superior spine of the ilium.

Anterior crural (N. femoralis) emerges from the outer border of the
psoas above Poupart's ligament. Trace it through the psoas to its origin
and down to where it passes below Poupart's ligament.

Obturator emerges from the inner border of the psoas at the pos-
terior part of the brim of the pelvis. Trace it back to its origin and out
to the obturator foramen.

Accessory obturator, when present, lies close to the obturator nerve.
Trace it to its origin and down to where it passes anterior to the brim of
the pelvis.

Lumbo-sacral cord lies in front of the ala of sacrum. Trace it to its
origin and to its junction with sacral plexus.

Also expose the last dorsal nerve.



FIG. 202. BRANCHES OF THE LUMBAR AND SACRAL PLEXUS VIEWED FROM BEFORE. (After

Hirschfeld and Leveille'.) (Morris.}



GANGLIATED CORD OF SYMPATHETIC
LAST THORACIC NERVE

FIRST LUMBAR



ILIO-

HYPOGASTRIC
INGUINAL

SECOND
LUMBAR



FOURTH

LUMBAR

INGUINAL

EXTERNAL

CUTANEOUS

GEXITO-CRURAL

LUMBO-SACRAL

CORD

ANTERIOR CRURAL -
OBTURATOR

GE VITAL BRAffCB
OF GEfilTO'-CRURAL

CRURAL BRAXCH OF
GE\[TO-CRURAL

INGUINAL



DISTRIBU-
TION OF
EXTERNAL '
CUTANEOUS

CRURAL

BRANCH

OF GENITO-

CRURAL




AORTIC PLEXUS

LAST THORACIC NERVE



ILIO-HYPO-
GASTRIC



INGUINAL

THIRD
LUMBAR
NER VE



GENITO-
CRURAL



EXTERNA L
CUTANEOUS

GENITAL
BRANCH
OF

GENI TO-
CRURAL

CRT HAL
BRANCH OF
QBNITO-
C RURAL

OBTU-
RATOR



SACRAL
PLEXUS



PELVIC VISCERA



171



DEMONSTRATION VII.

PELVIC REGION.

What is the difference between the male and female pelvis?

Study the positions and relations of the pelvic organs to each other
and to the surrounding landmarks. Remove none of the viscera.

Note in the male pelvis:

Bladder: Position, form, relation, ligaments, and the part covered by
peritoneum.

Rectum. Position arid the part covered by peritoneum.

In female pelvis.

Note the bladder and rectum.

Also uterus. Position, ligaments, and part covered by peritoneum.

Fallopian Tubes. Position, relation to broad ligaments.

Ovaries. Position, relation to broad ligaments, and Fallopian tubes.

Round Ligaments. Position, relation to broad ligaments, and attach-
.ments.

Trace the peritoneum in its course in the pelvis and over the pelvic
viscera.



FIG. 203. DIAGRAM OF THE RELATIVE POSITION OF THE PELVIC VISCERA. (Holden.)



Symphysis pubis.



Corpus cavernosum
penis.

Glans penis.



Corpus spongiosum
urethra.



Bulb of corp. spon-
giosum.
Cowper's gland with

duct.

Membranous part of
urethra surrounded
by compressor
muscle.

Prostate gland.




Peritoneum in
dotted outline.



Ureter.



Vas deferens.



Vesicula senn-
nalis.



Expose the following arteries and veins:
Arteries. (See Fig. 164):
Common iliac.
External iliac.

Internal iliac (A. hypogastrica).
Hypogastric.

Superior, middle and inferior vesical.
Middle hemorrhoidals.



Uterine.
Ovarian.
Vaginal.



172



PELVIC VISCERA



FIG. 204. DIAGRAMMATIC VERTICAL SECTION THROUGH THE FEMALE PELVIC VISCERA

(H olden.}



Urethra sur-
rounded by its
compressor
muscle.

Vagina.



Rectum.




Veins accompanying the arteries.



FIG. 205. SCHEME OP THE OVARIAN AND UTERINE AND VAGINAL ARTERIES. (Morris.)



Branch Branches Branch nMRRiiTcn

Uterine to round to to EXTREMITY Of

branch ligament isthmus ampulla FALLOPIAN TUBE

\ l \



Cervical branch



Coronal artery




Uterine artery
Internal iliac artery

Vaginal arteries



Azygos artery of rayina



Review the lymphatics of the pelvis and abdomen.
Sympathetic nerves.

Hypogastric plexus.

Pelvic plexus.



THE PERI X ELM



DEMONSTRATION VIII.
PERINEUM.

Read a general description of the perineum.

Examine the osseous and ligamentous boundaries of the lower aper-
ture of the pelvis.

Draw a line from one tuberosity of the ischium to the other. This
divides the aperture into an anterior or urethral region, and a posterior,
ischio-rectal, or anal region.

FIG. 206. DIAGRAM OF THE FRAMEWORK OF THE PERINEUM. (Holden.)




Place the subject on his back in the perineal frame; draw the frame,
with the cadaver, to the end of the table.



FIG. 207. PERINEAL FRAME.




MALE PERINEUM.

Pass a urethral sound along the urethra into the bladder,
prostate gland by inserting the finger into the rectum.



Feel the



174



THE PERINEUM



Moderately distend the rectum with tow, and sew the edges of the
anus together; raise the scrotum by means of hooks.

Dissection of the anal region.

Make an incision through the skin along the line drawn from one
tuberosity of the ischium to the other, crossing in front of the anus; a
second incision parallel to the first across the tip of the coccyx; a third
from the middle of the first incision back, encircling the anus, to the tip
of the coccyx.

Notice the wrinkles of the skin around the anus caused by the corru-
gator cutis ani muscle.



FIG. 208.-



-MuscLES, WITH SUPERFICIAL VESSELS AND NERVES, OF THE PERINEUM.

(H olden.)




Inferior
pudenda]



Dissect the skin carefully away from the anus so as not to destroy the
external sphincter ani and turn it outward onto the thigh. Notice the
superficial fascia. This fascia is common to both anal and urethral re-
gions of the perineum and is continuous with similar structures in adjacent
regions.

Clean and study the external sphincter muscle. (See Fig. 208.)

On each side of the anus you see the base of the ischio-rectal fossa
filled with fat.

The inferior hemorrhoidal arteries and nerves pass through this fat to



THE PERI X RUM 175

the rectum. Remove the fat with care so as to preserve as many as pos-
sible of these hemorrhoidal arteries and nerves.

At the posterior boundary of this fossa is the gluteus maximus muscle ;
at the anterior boundary is the superficial transversus perinei muscle, at
the inner side the levator ani muscle, outer side the internal obturator
muscle. Expose these muscles, but do not destroy any part of them.

Trace on the bony pelvis the internal pudic artery and pudic nerve.

Now study the inferior hemorrhoidal arteries and hemorrhoidal, super-
ficial perineal, and fourth sacral nerves, and hemorrhoidal veins,- plexus
of veins. Also note the long pudendal nerve (Fig. 210).



FIG. 209. THE ARTERIES OF THE PERINEUM. (Morris.)

On the right side of the perinaeum (left side of this figure) Colles's fascia has been turned
back to show the superficial vessels. On the left side the superficial vessels have been cut
away with the anterior layer of the triangular ligament to show the deep vessels.



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Online LibrarySimon Menno YutzyA manual and atlas of dissection → online text (page 7 of 11)