Fascia and Neurovasculature of the Pelvis

Question 1

Where in general is pelvic fascia found

Answer 1

in the space between the parietal peritoneum and the pelvic floor that is not occupied by pelvic organs

Question 2

What are the two types of membranous pelvic fascia

Answer 2

Parietal pelvic fascia and visceral pelvic fascia

Question 3

What does the parietal pelvic fascia cover

Answer 3

Pelvic surfaces of obturator interns, piriformis, coccygeus, levator ani, and a portion of the sphincter urethrae muscles.

Question 4

What does the visceral pelvic fascia cover

Answer 4

pelvic organs

Question 5

What creates the tendinous arch of the pelvic fascia?

Answer 5

Parietal and visceral layers of membranous pelvic fascia become continuous where the pelvic viscera perforate the pelvic floor.

Question 6

What ligaments compose the tendinous arch of pelvic fascia?

Answer 6

Puboprostatic ligament, pubovesical ligament, sacrogenital ligament

Question 7

Where is endopelvic fascia located

Answer 7

Between the parietal and visceral membranous layers of pelvic fascia.

Question 8

wWhat two types of packing material does the endopelvic fascia form?

Answer 8

Loose areolar tissue or fascial condensations/ligaments

Question 9

What is contained in the loose areolar fatty tissue?

Answer 9

minor lymphatics and nutrient vessels, parametrium,

Question 10

What spaces does the loose areolar fatty tissue fill?

Answer 10

Retropubic and retrorectal spaces and pararectal and paravesical spaces.

Question 11

What ligaments are contained in the hypogastric sheath?

Answer 11

lateral ligament of the bladder, pre sacral fascia, rectovesical septum, transverse cervical ligament

Question 12

What vessels are found in the lateral ligament of the bladder?

Answer 12

The superior vesicle arteries and veins

Question 13

What vessels are contained in the pre sacral fascia?

Answer 13

The middle rectal artery and vein

Question 14

What vessels are contained in the transverse cervical ligament?

Answer 14

The uterine vessels

Question 15

Arteries of the posterior division of the internal iliac artery

Answer 15

Iliolumbar artery, lateral sacral arteries, and superior gluteal artery

Question 16

What does the lateral sacral artery supply?

Answer 16

muscles and skin over the sacrum

Question 17

what branches come off of the lateral sacral artery?

Answer 17

The sacral spinal arteries

Question 18

Between what landmarks does the superior gluteal artery pass

Answer 18

The lumbosacral trunk and S1 ventral ramus

Question 19

Arteries of the anterior division of the internal iliac artery

Answer 19

inferior gluteal artery, obturator artery, uterine artery, superior vesical artery, inferior vesical artery, umbilical artery, internal pudendal artery, middle rectal artery,

Question 20

Between what landmarks does the inferior gluteal artery pass?

Answer 20

Between S2 and S3 and inferior to the performs muscle

Question 21

Where does the obturator artery run

Answer 21

Runs antero-inferiorly along the obturator fascia on the lateral walls of the pelvis to the medial compartment of the thigh.

Question 22

What does the middle rectal artery form an anastomoses with

Answer 22

The superior rectal artery and inferior rectal artery.

Question 23

Where does the superior rectal artery come from (review)

Answer 23

The IMA

Question 24

Where does the inferior rectal artery come from

Answer 24

The internal pudendal artery

Question 25

What does the internal vesicle artery branch into in males?

Answer 25

Prostatic artery, ureteric artery, and deferential artery

Question 26

What does the patent umbilical artery close to form?

Answer 26

The medial umbilical ligament

Question 27

Where does the superior vesical artery come from?

Answer 27

Usually a branch off of the uterine artery

Question 28

Where do the external iliac receive lymph from?

Answer 28

inguinal nodes

Question 29

Where do internal iliac nodes receive lymph from?

Answer 29

The pelvic viscera and gluteal regions

Question 30

Where do sacral lymph nodes receive lymph from?

Answer 30

The postero-inferior pelvic viscera.

Question 31

Were do common iliac nodes receive lymph from?

Answer 31

External iliac nodes, internal iliac nodes, sacral nodes,

Question 32

Where do common iliac nodes drain to

Answer 32

lumbar nodes

Question 33

What is the pelvic venous plexus?

Answer 33

A plexus of veins that surrounds pelvic viscera

Question 34

Where do common iliac veins unite to form the IVC

Answer 34

L4/L5, one level lower than aorta

Question 35

Does the lumbar plexus provide innervation to the true pelvis?

Answer 35

no, it supplies portions of the perineum and greater pelvis

Question 36

Ilioinguinal nerve (L1)

Answer 36

Supplies most of skin of mons pubis and anterior aspect of scrotum/labia majora

Question 37

What supplies the cremaster muscle and skin on the anterolateral aspect of the scrotum/labia majora

Answer 37

Genitofemoral (L1-L2)

Question 38

What supplies the motor branches to iliopsoas muscle?

Answer 38

Femoral nerve (L2,3,4)

Question 39

What nerve travels through the lesser pelvis but does not arise or innervate structures of the true pelvis

Answer 39

Obturator Nerve (L2,3,4)

Question 40

How does the obturator nerve exit the pelvis

Answer 40

Via the obturator foramen

Question 41

How is the lumbosacral trunk formed?

Answer 41

From descending ramus of L4 and L5

Question 42

What levels is the sacral plexus?

Answer 42

L4-S3

Question 43

What general area does the sacral plexus supply?

Answer 43

It lies in the pelvis but primarily supplies the lower limb.

Question 44

Nerves from the sacral plexus

Answer 44

Nerves to levator ani and coccygeus, nerve to piriformis muscle, pudendal nerve, posterior femoral cutaneous nerve Sciatic nerve, nerve to obturator internus, nerve to quadratus femoris, superior gluteal nerve, inferior gluteal nerve

Question 45

Where do the nerves to levator ani and coccygeus arise?

Answer 45

S3 and S4

Question 46

Where do nerve to piriformis arise?

Answer 46

S1 and S2

Question 47

Where does the pudendal nerve arise?

Answer 47

S2,3, and 4

Question 48

What type of fibers are included in superior hypogastric plexuses

Answer 48

Pre and postganglionic sympathetic fibers and visceral afferents

Question 49

Fiber types found in inferior hypogastric plexuses

Answer 49

Pre and postganglionic sympathetic fibers and visceral afferents as well as preganglionic parasympathetic fibers.

Question 50

Fiber types found in pelvic plexuses

Answer 50

Postganglionic sympathetic fibers and preganglionic parasympathetic fibers as well as visceral afferents

Question 51

What types of fibers are found in pelvic splanchnics

Answer 51

Visceral afferent fibers, preganglionic parasympathetics

Question 52

How are pelvic plexuses formed

Answer 52

By the merging of pelvic splanchnic nerves and inferior hypogastric plexuses

Question 53

Ascending parasympathetic fibers

Answer 53

arise from pelvic plexuses and ascend out of the pelvic inlet to reach sigmoid and descending colon

Question 54

Sacral sympathetic trunk is a continuation of what?

Answer 54

The lumbar sympathetic trunk

Question 55

Functions of sympathetic nerves in the pelvis

Answer 55

Vasoconstriction, inhibition of peristalsis, constriction of involuntary sphincters, ejaculation, remission of genital erection

Question 56

Functions of parasympathetic nerves in the pelvis

Answer 56

increase of peristalsis, stimulates contraction of detrusor in bladder, inhibits constriction of involuntary sphincters ,erection

Question 57

visceral reflex afferents

Answer 57

Travel retrograde with parasympathetics to the dorsal root ganglia

Question 58

Pelvic pain line

Answer 58

Corresponds to the lower limit of the peritoneum

Question 59

Pain fibers from intraperitoneal viscera or areas of organs covered in peritoneum follow?

Answer 59

Sympathetic system retrograde to T11-L1

Question 60

Pain fibers from the sub peritoneal viscera follow?

Answer 60

Parasympathetic fibers retrograde to dorsal root ganglia of S2,3,4

Question 61

Where does the pain line cross?

Answer 61

The middle of the sigmoid colon

Question 62

Have you gone over the pathways of sympathetics and parasympathetics for viscera of pelvis

Answer 62

Probably should do it more

Question 63

Have you reviewed the spinal anesthesia for childbirth?

Answer 63

Probably should look at it again