IT 23 - 24 - Sistem Urinarius, Pelvis, Dan Perineum - TSA

Sistem Urinarius, Pelvis & Perineum
Dr.Tri Suciati, M.Kes
MATERI
Cavum pelvis & diaphragma pelvis Fossa Ischiorectalis & isinya Innervasi dan & Vaskularisasi dinding pelvis Sistem urinarius Rectum
Pelvis - TOPOGRAFI
Komponen tulang Pelvis

Innominate bone (Ilium, ischium and pubis) Sacrum Coccyx Joined anteriorly by pubic symphysis Posteriorly by sacro-iliac joint
Komponen Sendi
Articulatio: Diarthrosis yaitu amphiarthrosis sacroiliaca Synarthrosis: 1. Syndesmosis elastica sacrococcygeus 2. Syndesmosis fibrosa: lig sacrospinosum et tuberosum 3. Synchondrosis: symphysis ossium pubis
Apertura Pelvis Superior
Apertura Pelvis Inferior
Klasifikasi Caldwell dan Molloy
Pelvimetry

Pelvic planes Diameters of inferior aperture of lesser pelvis (female). Pelvic inlet: The line between the narrowest bony points formed by the sacral promontory and the inner pubic arch is termed obstetrical conjugate: It should be 11.5 cm or more. This anteroposterior line at the inlet is 2 cm less than the diagonal conjugate (distance from undersurface of pubic archto sacral promontory). The transverse diameter of the pelvic inlet measures 13.5 cm. Midpelvis: The line between the narrowest bone points connects the ischial spines; it typically exceeds 12 cm. Pelvic outlet: The distance between the ischial tuberosities (normally > 10 cm), and the angulation of the pubic arch
Fetal relationship
Engagement: The fetus is engaged if the widest leading part (typically the widest circumference of the head) is negotiating the inlet. Station: Relationship of the bony presenting part of the fetus to the maternal ischial spines. If at the level of the spines it is at 0 (zero) station, if it passed it by 2cm it is at +2 station. Attitude: Relationship of fetal head to spine: flexed, neutral (military), or extended attitudes are possible. Position: Relationship of presenting part to maternal pelvis, i.e. ROP=right occiput posterior, or LOA=left occiput anterior. Presentation: Relationship between the leading fetal part and the pelvic inlet: cephalic, breech (complete, incomplete, frank or footling), face, brow, mentum or shoulder presentation. Lie: Relationship between the longitudinal axis of fetus and long axis of the uterus: longitudinal, oblique, and transverse. Caput or Caput succedaneum: oedema typically formed by the tissue overlying the fetal skull during the vaginal birthing process.
Greater Pelvis (pelvis major)/ False Pelvis

Tempat beberapa visera abdomen (ileum and sigmoid colon) Bounded by abdominal wall anteriorly, the iliac fossa posteriolaterally and L5 S1 vertebrae posteriorly
Lesser Pelvis ( pelvis minor)/True Pelvis

Tempat viscera pelvis urinary bladder and reproductive organs such as the uterus and ovaries dikelilingi permukaan pelvis,al: tulang panggul, sacrum, and coccyx Sebelah inferior dibatasi oleh musculofascial pelvic diaphragm
Pelvic Walls and Floors

Anterior pelvic wall terbentuk terutama oleh corpus dan ramus pubic bones and pubic symphysis Lateral pelvic walls dibentuk oleh tulang panggul dan m. obturator internus (O: proximal surface of the ilium and ischium; obturator membrane I: greater trochanter of the femur)
Pelvic Walls and Floor
Posterior Pelvic Wall dibentuk oleh sacrum and coccyx, bagian terdekat the ilia, and the S-I joints; ditutupi oleh m.piriformis (O: pelvic surface of 2nd and 4th sacral segments, superior margin of the greater sciatic notch and sacrotuberous ligament, I: greator trochanter of femur)
Pelvic Floor
Dibentuk oleh diaphragma pelvis yang berbentuk seperti terowongan tdd otot levator ani & coccygeus serta fasianya Membentang sebelah anterior pubis dan coccyx sebelah posteror, dan dari satu dinding pelvis lateral ke dinding lainnya
Diaphragma Pelvis
Terdiri dari Pars Muscularis terdiri dari m. Levator ani Pars membranacea Terdapat di sebelah caudal pars muscularis menutupi segitiga depan, disebut juga diaphragma urogenital
Levator Ani

Tdd 3 bagian pubococcygeus, puborectalis dan iliococcygeus. Secara berkelompok berjalan dari corpus os pubis, dg arcus tendinosa pada fascia obturatorius dan spina ischial KE perineal body, os coccygeus, ligament anococcygeal, dinding prostate atau vagina, rectum & anal canal Innervasi dari S4 untuk levator ani, dan inferior anal (rectal) dari (S2-S4) , dan coccygeal plexus Mensupport visera pelvis; bekerja bersama, mengangkat dasar pelvis dan membantu otot abdomen pada kegiatan dengan expirasi yang kuat
Beberapa serabut otot pre rectalis yang berhubungan dengan prostat pada pria = m. Levator prostat, dan dengan vagina= m.pubovaginalis. Serabut tersebut membagi hiatus levatorius menjadi 1. Hiatus genitalis 2. Hiatus analis
Coccygeus Muscle
O: ischial spine, I: inferior end of the sacrum, I: cabang dari S4 and S5 Membentuk bagian kecil dari diafragma pelvis, mensupport visera pelvis, fleksi coccygeus
Diaphragma urogenitalis
Penguatan dari m.levator ani, dan menutup hiatus urogenitalis dari arah bawah, ditembus oleh: Pars membranacea urethra pada lakilaki Urethra dan vagina pada wanita
Diaphragma urogenitalis
Tdd 2 lembar fascia: Fascia diaphragmatis urogenitalis superior et inferior Di antara kedua fascia terdapat m. Transversus perinei profundus (sebelah belakang) dan m. Sphincter urethre membranaceae. Sebelah ventral---lig transversum pelvis, dan lig. Arcuatum pubis Di permukaan, terdapat m.transversus perinei superfisialis
Pelvic Floor - Male
Pelvic Floor- Lateral Inferior
Viscera
Organ sistem urinarius pelvis Ureters Saluran otot polos dari ginjal ke VU , p= 25 -30 cm Bladder/VU a hollow container surrounded by a strong smooth muscular wall Bagiannya: Apex, Body, Fundus, Neck, Uvula
Ureters
Bladder
Bladder
Pelvic Viscera - Female
M v. F Bladder
Viscera
Bladder/VU Detrussor muscle otot polos yang mengelilingi VU Otot sfingter interna I Parasympathetic to detrussor (S2S4)); Sympathetic to internal sphincter (T12-L1/L2)
Viscera
Ureter Urinary urethral orifice in bladder to external urethral orifice External sphincter somatic nerves from S2-S4) Prostate
Female Urethra
Female Urethra
Male Urethra
Male Urethra
Uterus
Rectum
Alimentary canal (GI Tract) menghubungkan colon sigmoideus dengan anus Mengikuti curva sacrum dan coccyx I=sympathetic (T12/L1)and parasympathetic nerves (S2-S4)
Rectum
Rectum and Anal Canal
Perineum / Regio perineal
Berada pada outlet pelvis dan dipisahkan dari cavitas pelvis oleh diafragma pelvis(Levator ani and coccygeus muscles) Batas-batas: Anterior : symphysis pubis Anterolateral: inferior pubic rami and ischial rami Lateral: ischial tuberosity posterolateral: sacrotuberous ligament inferior sacrum and coccyx
Perineum
2 Trigonum
Trigonum Analis (posterior) Trigonum Urogenital (anterior) contains the root of the scrotum and penis in males or the external genitalia in females
Membran perineal membentang antara dua sisi arkus pubis dan meliputi bagian anterior outlet perineal body/corpus perineal : massa fibromuscular irregular berlokasi antara anal canal dan perineal membrane
Triangles
Fascia Perinealis Superfisialis

Lanjutan fascia abdominalis superfisialis,ada 2 lapis Lapis permukaaan Fascia camperi, ke medial bersatu dg lapis dalam mbntk tunica dartos pd scrotum, dan jar lemak pada vagina Pd regio analis brhub dg fossa ischiorectalis
Lapis dalam Lanjutan fascia scarpae Di namakan fascia collesi Lateral berhub dg ramus inferior os pubis dan os ischii, ke depan berlanjut sbg lig. Suspensorium penis Ke belakang membentuk spatium interfasciale
Spatium interfasciale
Terdapat Crura cavernosis penis dengan mm.ischiocavernosi Corpus cavernosum urethrae dengan m. Bulbocavernosus A,v, n, perinealis
Fossa ischiorectalis
Rongga yang terdapat di kiri dan kanan rectum, di bawah m. Levator ani Batas-batasnya: Cranial: arcus tendineus m.levator ani Lateral: fascia obturatoria Medial: fascia diaphragmatis pelvis inferior Dorsalis: m.gluteus maximus & lig.sacrotuberosum Caudalis: depan oleh diaphragma urogenital
Perineal Body
Perineal Membrane
Perineum-Female
Perineum - Male
Perineum
M. BULBOSPONGIOSUS FO : tendon central perineum, MO : tendon central dan bulb of penis; FI : dorsum clitoris, diaphragma urogenital, MI : akar penis; A : kompressi orifisium vagina atau kompressi urethra, N : perineal nerve, pudenal nerve M. ISCHIOCAVERNOSUS O : ramus ischium, I : dekat symphysis pubic, menjaga ereksi penis atau klitoris
Muscles - Female
Muscles - Female
Muscles Male
Muscles - Male
Perineum
External anal sphincter (skeletal muscle) O : kulit atau fasia di sekeliling anus dan coccyx I : perineal body A : menutup anal canal N : Inferior Anal Nerve (Somatic nerve from S2-S4) inhibits voiding Internal Anal Sphincter Smooth muscle innervated by sympathetic NS (S2,S3,S4) inhibits voiding
External/Internal Anal Sphincter
Superficial Transverse Perineal
O I A N
: Ischial tuberosity : Perineal body : Support perineal body : Pudenal nerve
External Urethral Sphincter

O: Ischial tuberosity I: surround urethra A: compress urethra to maintain urine continence N: Pudenal (S2-S4)
Superficial Transverse Perineal Female
Superficial Transverse Perineal Female
Superficial Transverse Perineal M
Deep Transverse Perineal

O I A N
:aspek medial ramus ischium : Pineal Body : stabilisasi posisi perineal body : Pudenal N (S2-S4)
Deep Transverse Perineal - F
Deep Transverse Perineal -M
Deep Transverse Perineal - M
Deep Transverse Perineal M
Superficial Perineum Female
Superficial Perineum Female
Superficial Perineum Male
Superficial Perineum Male
Peritoneum
lanjutan peritoneum abdomen Drapes over pelvic viscera in the midline to form: - Pouches/kantong - Lipatan antara viscera dan dinding pelvic - Pouches melindungi viscera dari rectum
Female Peritoneum
Female Peritoneum
Male Peritoneum
Male Peritoneum
Major Blood Supply
The lymphatic drainage of pelvis

Internal iliac lymph node

Surround internal iliac vessels Receive afferents from pelvic viscera, perineum, buttock and back of thigh
External iliac lymph nodes

Lie along external iliac artery Receive afferents from lower limb and some parts of pelvic viscera
Sacral lymph node Common iliac lymph node

Lie along common iliac artery Receive afferents from all the above nodes Efferents pass to lumbar lymph node
Sacral plexus
Formation: formed by anterior rami of L4 and L5 spinal nerves (the lumbrosacral trunk) and anterior rami of sacral and coccygeal nerves Position: lies in pelvic cavity, anterior to sacrum and piriformis
Branches

Superior gluteal Inferior gluteal Pudendal Posterior femoral cutaneou Sciatic Common
Pudendal nerve block
Episiotomi
Relationships of rectus
Anteriorly In male

Fundus of bladder Seminal vesicle Prostate Ampulla ductus deferentis neck of uterus Vagina
In female
The Urinary System

PART 1
The Urinary System
Important functions of the kidneys

Maintain the chemical consistency of blood Filter many liters of fluid from blood Send toxins, metabolic wastes, and excess water out of the body
Main waste products Urea Uric acid Creatinine
Copyright 2008 Pearson Education, Inc., publishing as Benjamin Cummings
Organs of the Urinary System

Kidneys Ureters Urinary bladder Urethra
Figure 23.1a
Location and External Anatomy of Kidneys

Located retroperitoneally Lateral to T12L3 vertebrae Average kidney
12 cm tall, 6 cm wide, 3 cm thick
Hilus
On concave surface Vessels and nerves enter and exit
Renal capsule surrounds the kidney
Relationship of the Kidneys to Vertebra and Ribs
Figure 23.1b
Position of the Kidneys with in the Posterior Abdominal Wall
Figure 23.2a
Internal Gross Anatomy of the Kidneys
Frontal section through the kidney

Renal cortex Renal pyramids Renal pelvis
Major calicies Minor calicies
Gross vasculature
Renal arteries
Branch into segmental arteries
Summary of Blood Vessels Supplying the Kidney
Figure 23.3c
Internal Gross Anatomy of the Kidneys
Nerve supply renal plexus

A network of autonomic fibers An offshoot of the celiac plexus
Internal Anatomy of the Kidneys
Figure 23.3b
Microscopic Anatomy of the Kidneys
Uriniferous tubules
Composed of
Nephron
Renal corpuscle plus renal tubules Involved in concentrating urine
Collecting duct
PLAY
Nephron
Mechanisms of Urine Production

Filtration
Filtrate of blood leaves kidney capillaries

Most nutrients, water, and essential ions reclaimed Active process of removing undesirable molecules
Reabsorption
Secretion
Basic Kidney Functions
Figure 23.4
The Urinary System

PART 2
Uriniferous Tubule
Figure 23.5a
The Nephron
Renal corpuscle
Glomerulus and glomerular capsule

Glomerulus tuft of capillaries Capillaries of glomerulus are fenestrated Glomerular (Bowmans) capsule Parietal layer simple squamous epithelium Visceral layer consists of podocytes
Renal Corpuscle and the Filtration Membrane
Figure 23.6a
Renal Corpuscle and the Filtration Membrane
Figure 23.6c
Tubular Section of Nephron
Filtrate proceeds to renal tubules from glomerulus

Proximal convoluted tubule Loop of Henle
Descending limb Thin segment Thick segment
Distal convoluted tubule
Micrograph through the Renal Medulla
Figure 23.7
Classes of Nephron

Cortical nephrons
85% of nephrons
15% of nephrons
Juxtamedullary nephrons
Collecting Tubules (Collecting ducts)
Collecting tubules
Receive urine from distal convoluted tubules
Figure 23.8
Classes of Nephron
Figure 23.9a
Microscopic Blood Vessels
Nephrons associated with two types of capillary beds (a portal system)
Glomerulus
Fed and drained by arterioles Afferent and efferent arterioles
Peritubular capillaries
Arise from efferent arterioles Low-pressure, porous capillaries Absorb solutes
Microscopic Blood Vessels
Vasa recta
Thin-walled looping vessels Part of the kidneys urine-concentrating mechanism
The Urinary System

PART 3
Microscopic Anatomy of the Kidney
Juxtaglomerular apparatus
Functions in the regulation of blood pressure Juxtaglomerular cells secrete renin
Macula densa
A portion of distal convoluted tubule

Tall, closely packed epithelial cells Act as chemoreceptors
Juxtaglomerular Apparatus
Figure 23.10
Ureters
Carry urine from the kidneys to the urinary bladder Oblique entry into bladder prevents backflow of urine Histology of ureter
Mucosa transitional epithelium Muscularis two layers
Inner longitudinal layer Outer circular layer
Adventitia typical connective tissue
Microscopic Structure of the Ureter
Figure 23.12
Urinary Bladder
A collapsible muscular sac Stores and expels urine
Full bladder spherical
Expands into the abdominal cavity
Empty bladder lies entirely within the Copyright 2008 Pearson Education, Inc., publishing pelvis as Benjamin Cummings
Figure 23.13
Urinary Bladder
Urachus closed remnant of the allantois Prostate gland
In males
Lies directly inferior to the bladder Surrounds the urethra
Figure 23.14
Urinary Bladder
Wall of bladder
Mucosa
Transitional epithelium Detrus or muscle
Muscular layer
Adventitia
Histology of the Urinary Bladder
Figure 23.15a, b
Structure of the Urinary Bladder and Urethra
Figure 23.16a
Structure of the Urinary Bladder and Urethra
Figure 23.16b
Urethra
Epithelium of urethra
Transitional epithelium
At the proximal end (near the bladder)
Stratified and pseudostratified columnar mid urethra (in males) Stratified squamous epithelium
At the distal end (near the urethral opening)
Urethra

Internal urethral sphincter
Involuntary smooth muscle
External urethral sphincter

Voluntarily inhibits urination Relaxes when one urinates
Urethra

In females
Length of 34 cm
In males 20 cm in length three named regions
Prostatic urethra
Passes through the prostate gland
Membranous urethra
Through the urogenital diaphragm

Passes through the length of the penis
Spongy (penile) urethra
Micturition
Figure 23.17
Disorders of the Urinary System
Urinary tract infections

More common in females Burning sensation during micturition
Renal calculi
Kidney stones
3% of cancers more common in men
Bladder cancer
Kidney cancer
Arises from epithelial cells of uriniferous Copyright 2008 Pearson tubules Education, Inc., publishing
as Benjamin Cummings
The Urinary System Throughout Life
Embryo develops three pairs of kidneys

Pronephros Mesonephros Metanephros
Only metanephros persists to become the adult kidneys Metanephric kidney produces urine by fetal month three Contributes to the volume of amniotic fluid
Development of the Urinary Organs
Figure 23.18a,b
Development of the Urinary Organs
Figure 23.18c, d
The Urinary System Throughout Life
Kidney and bladder function declines with advancing age

Nephrons decrease in size and number Tubules less efficient at secretion and reabsorption Filtration declines Recognition of desire to urinate is delayed Loss of muscle tone in the bladder
Sistem urinarius
Fungsi: Mengatur homeostasis dengan; Mengubah komposisi, pH, volume, dan tekanan darah Osmolaritas darah Produksi hormon Organ; 2 ginjal 2 ureter 1 vesica urinaria 1 uretra
GINJAL
Ginjal
Fungsi utama ginjal: 1. Membentuk dan mengeluarkan urine 2. Menghasilkan dan mengeluarkan erythropoietin yaitu hormon yang mengendalikan kecepatan pembentukan sel darah merah 3. Menghasilkan dan mengeluarkan renin yaitu enzym penting dalam mengatur tekanan darah
Berbentuk seperti kacang buncis, Ukuran; p=10-12 cm l=5-7 cm,tebal=3 cm,berat= 150 g Ginjal, massa cuma 0,5 % massa tubuh, tapi mendapatkan 20-25 % cardiac output
Darah yg mengalir di ginjal 1200 mL/ menit
Ginjal
Posterior dinding abdomen, retroperitoneal, lateral columna vertebralis Proyeksi setinggi VTXII-LIII Ginjal ka rendah dari ginjal ki (hati) Ginjal ki> panjang, dan dekat dgn garis tengah
Organ-organ yang berada di sekitar ginjal

Ginjal kanan Superior : glandula adrenal (supra renalis) Anterior : lobus kanan hepar, duodenum dan colon pada flexura hepatica Posterior : diafragma, otototot dinding posterior abdomen Ginjal kiri Superior : glandula adrenal (supra renalis) Anterior : limpa (lien), lambung (gaster), pancreas, jejenum dan colon pada flexura lienalis Posterior : diafragma, otototot dinding posterior abdomen
Pembungkus Ginjal
Diliputi fascia dan fat (perirenal fat dan renal fascia) Permukaan anterior & posterior diliputi capsula fibrosa Hilum renaliscekungan vertikal yg dalam, tmpt masuk;pembuluh darah renalis,limfatik, dan syaraf
Pembungkus ginjal: Capsula renalis ; plg luar, transparan, berlanjut smpai ke ureter Capsula adiposa; Massa lemak, menutupi capsula renalis, peindung dari trauma Fascia renalis; mempertahankan struktur ginjal, dalam dinding abdome,lap paling dalam
Anatomi ginjal potongan melintang
Deskripsi potongan melintang Ginjal
Cortex renalis; bagian superfisial, wrn terang, dibagi menjadi 2 zona; Zona cortical dan juxtamedullary. Bagian cortex renalis yg melebar ke pyramid renalis adalah collumna renalis Satu lobus renalis, tdd; 1 piramid renalis, yg meliputi 1 renal cortex, dan 1,5 columna renalis yg berdekatan
Medulla renalis; lebih dalam, warna merah gelap Tdd, pyramid renalis; bagian, yg dasarnya mengarah ke cortex ren, dan puncaknya membentuk papilla renalis Cortex +pyramid membentuk parenkim renalis, yg didalamnya terdapat nefron, merupakan unit fungsional ginjal
Vaskularisasi dan limfatik renalis
Vaskularisasi dan limfatik renalis

Arteri renalis, cabang lateral aorta abdominalis A.renalis kiri lebih tinggi, a.renalis kanan lebih panjang, dan melewati v. c.inferior Drainase limfatik oleh nodus lumbaris Vena renalis ka dan ki dibentuk multipel vena renalis, sebelah anterior dari arteri renalis
Vaskularisasi Renalis

Arteri utama; a. renalis kiri Masuk ke ginjal mjd a. segmentalis Melewati collumna renalis, menjadi a. interlobaris Melewati basal pyramid menjadi a.interlobular, membentuk percabangan, a. arcuata Memasuki cortex, dikenal arteriole afferent
Vaskularisasi Renalis
1 nefron menerima 1 arteriole afferent, masuk ke glomerulus, lalu keluar sbg,arteriole efferent,yg lalu menjadi kapiler peritubuler pd cortex renalis Pelebarannya di kenal sebagai; vasa recta Kapiler peritubuler saling bersatu mbt venule peritubuler dan v. interlobular, berlanjut ke v. arcuata dan v interlobar, keluar dari hilum dan berlanjut ke v. cava inferior
Fisiologi ren
Nephron
Nephron
CORPUSCULUM RENALIS
GLOMERULUS
NEPHRON
CAPSULA BOWMAN
TUBULUS RENALIS
TUBULUS CONTORTUS PROX LOOP OF HENLE TUBULUS CONVULATED DIST
Corpusculum renalis

Merupakan unit filtrasi plasma darah dari nephron 2 kutub : polus vascularis, polus urinalis Mengandung glomerulus sistim kapiler yg dirangkai o/ arteriole afferen dan efferen Diliputi oleh lamina visceralis capsula Bowmani, sel disebut Podosit` Podosit mempunyai badan sel ,dimana akan timbul processus primer, secunder (pedicle)
Urine yang dibentuk diginjal dialirkan ke papilla lalu ke apex pyramis masuk ke calyx minor calyx major dan terakhir terkumpul di pelvis renalis sebelum memasuki ureter. Dinding calyx dan pelvis renalis mengandung otot polos dengan gerakan peristaltisnyamengalirkan urine ke ureter lalu ke VU.
Sinus renalis; bagian dari hilum renalis yg melebar tdd; pelvis renalis, calyx, pemb darah dan syaraf, jar lemak. 1 ginjal tdd= 8-18 calyx minor,2-3 calyx mayor Komposisi Urine: Air 96% Urea 2% Asam urat, creatinin, ammonia, Natrium, Kalium, klorida, fosfat, sulfat-dan oxalat 2
Ureter
Ureter

Transport urin dr pelvis renalis ke v. urinaria Dipengaruhi o/ kontraksi peristaltik, tekanan hidrostatik, &gravitasi 3 penyempitan; ureteropelvic junction, a.iliaca communis, dinding v.u Inervasi;renal, aortic, hipogastric superior & inferior Nyeri; illiac crest, regio pubis, scrotum, labia mayora
Ureter
Panjangnya 25-30 cm dan diameter 3 mm. Merupakan kelanjutan dari pelvis renalis, berjalan ke bawah melalui cavum abdomen di belakang peritoneum di depan m.psoas kemudian oblique (miring) berjalan ke dinding posterior VU Fungsi ureter: menyalurkan urine dari ginjal ke VU dengan kontraksi peristaltik lapisan otot polosnya. Kontraksinya dipicu oleh pencetus yang ada di calyx minor. Gelombang peristaltik berlangsung beberapa kali per menit, frekuensinya akan meningkat jika produksi urine meningkat dan masuknya urine ke VU.
Ureter memiliki 3 lapisan jaringan: lapisan terluar berupa jaringan fibrosa kelanjutan capsula fibrosa ginjal. Lapisan tengah berupa lapisan otot yang melingkari ureter seperti spiral dan pada sepertiga bawah ada tambahan otot yang berjalan longitudinal Lapisan luminal (dekat lumen) yaitu mukosa dengan epitel transisional.
Bladder/Vesica urinaria
Lokasi anterior pelvis, saat penuh, menonjol abdomen Saat kosong, berbentuk piramid, 3 sisi. Apex, basis, perm superior dan inferolateral Apexligamen umbilical median Baseinverted triangle,posteroinferior Neck of bladderpaling terfixasi, disupport oleh pita fibromuscular, pd pria ligamen puboprostat Pd wanita ligamen pubovesical. Di posterior terdapat uterus pada wanita dan rectum pada pria.
Bladder/Vesica urinaria

Kapasitas 700-800mL Lebih kecil sdkt pd perempuan Pada VU terdapat 3 orificium (lubang) yang membentuk trigonum (segitiga). Dua (2) di atas pada dinding posterior adalah orificium ureter dan 1 di bawah merupakan orificium urethra. Ketika memasuki urethra terdapat penebalan lapisan otot polos yang membentuk sphincter urethra interna.
Tiga lapisan jaringan VU: 1. Lapisan terluar, jaringan ikat longgar. Mengandung pembuluh darah dan limfe serta saraf/nervus. Bagian superiornya ditutupi peritoneum. 2. Lapisan tengah, mengandung anyaman massa otot polos dan jaringan ikat elastis longgar tersusun dalam 3 lapisan disebut musculus detrusor yang berfungsi mengosongkan VU jika berkontraksi. 3. Lapisan luminal, mukosa yang dilapisi epitel transisional. Jika VU kosong, bagian dalam/mukosa akan berlipatlipat/rugae dan akan hilang bertahap sejalan dengan terisinya VU.
Uretra
Bag. Akhir sistem urinarius

Wanita Posterior symphysis pubis Pendek, 4cm,berjalan inferior,lantai pelvis---kantong erinealperineal membran--vestibulum Tdpt kelnjar mukosa parauretral (Gland skene) Oue; orificium uretra externa, terletak antara klitoris, dan vagina Dinding tersusun a/mukosa dan muskuler
Pria Panjang, 20 cm, menekuk 2 kali,berjalan inferior ke prostatkantong perineal perineal membranpenis Bagiannya; Prostatic; melewati prostat Membranousa; plg pendek, melewati perineum Spongiosa; paling panjang melewati penis
Uretra
Uretra
Dinding urethra terdiri dari 3 lapisan: 1. Lapisan otot polos, merupakan kelanjutan otot polos dari VU. Mengandung jaringan elastis dan otot polos. Sphincter urethra menjaga agar urethra tetap tertutup. 2. Lapisan submukosa, lapisan longgar mengandung pembuluh darah dan saraf 3. Lapisan mukosa
REFLEKS MIKTURISI/MIKSI

Urinasiproses keluarnya urin Kombinasi kontraksi otot volunter dan non volunter Volume v.urinaria 200400mL---stimulasi reseptor-rangsangan syaraf spinalurinasi Pusat micturasi sacral spinal S2-S3
Rangsangan syaraf menyebabkan kontraksi m. detrussor & relaksasi m.sphincter uretra interna Refleks ini dapat dilatih Latihan pd m.sphincter uretra external, dan otot dinding pelvis Pusat yang di latih cerebral cortex, sehingga dapat menunda urinasi pada periode ttt

IT 23 - 24 - Sistem Urinarius, Pelvis, Dan Perineum - TSA

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IT 23 - 24 - Sistem Urinarius, Pelvis, Dan Perineum - TSA

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Sistem Urinarius, Pelvis & Perineum

Dr.Tri Suciati, M.Kes

Komponen tulang Pelvis

Apertura Pelvis Superior

Apertura Pelvis Inferior

Klasifikasi Caldwell dan Molloy

Greater Pelvis (pelvis major)/ False Pelvis

Lesser Pelvis ( pelvis minor)/True Pelvis

Pelvic Walls and Floors

Pelvic Walls and Floor

Pelvic Floor - Male

Pelvic Floor- Lateral Inferior

Pelvic Viscera - Female

Rectum and Anal Canal

Perineum / Regio perineal

Fascia Perinealis Superfisialis

External/Internal Anal Sphincter

Superficial Transverse Perineal

: Ischial tuberosity : Perineal body : Support perineal body : Pudenal nerve

External Urethral Sphincter

Superficial Transverse Perineal Female

Superficial Transverse Perineal Female

Superficial Transverse Perineal M

Deep Transverse Perineal

Deep Transverse Perineal - F

Deep Transverse Perineal -M

Deep Transverse Perineal - M

Deep Transverse Perineal M

Superficial Perineum Female

Superficial Perineum Female

Superficial Perineum Male

Superficial Perineum Male

Major Blood Supply

The lymphatic drainage of pelvis

External iliac lymph nodes

Sacral lymph node Common iliac lymph node

Pudendal nerve block

The Urinary System

The Urinary System

Important functions of the kidneys

Main waste products Urea Uric acid Creatinine

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Organs of the Urinary System

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Location and External Anatomy of Kidneys

12 cm tall, 6 cm wide, 3 cm thick

Renal capsule surrounds the kidney

Copyright 2008 Pearson Education, Inc., publishing as Benjamin Cummings

Relationship of the Kidneys to Vertebra and Ribs

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Position of the Kidneys with in the Posterior Abdominal Wall

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Internal Gross Anatomy of the Kidneys

Frontal section through the kidney

Major calicies Minor calicies

Branch into segmental arteries

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Summary of Blood Vessels Supplying the Kidney

Copyright 2008 Pearson Education, Inc., publishing as Benjamin Cummings

Internal Gross Anatomy of the Kidneys

Nerve supply renal plexus

Copyright 2008 Pearson Education, Inc., publishing as Benjamin Cummings