Fascia and Neurovasculature of the Pelvis Flashcards
Where in general is pelvic fascia found
in the space between the parietal peritoneum and the pelvic floor that is not occupied by pelvic organs
What are the two types of membranous pelvic fascia
Parietal pelvic fascia and visceral pelvic fascia
What does the parietal pelvic fascia cover
Pelvic surfaces of obturator interns, piriformis, coccygeus, levator ani, and a portion of the sphincter urethrae muscles.
What does the visceral pelvic fascia cover
pelvic organs
What creates the tendinous arch of the pelvic fascia?
Parietal and visceral layers of membranous pelvic fascia become continuous where the pelvic viscera perforate the pelvic floor.
What ligaments compose the tendinous arch of pelvic fascia?
Puboprostatic ligament, pubovesical ligament, sacrogenital ligament
Where is endopelvic fascia located
Between the parietal and visceral membranous layers of pelvic fascia.
wWhat two types of packing material does the endopelvic fascia form?
Loose areolar tissue or fascial condensations/ligaments
What is contained in the loose areolar fatty tissue?
minor lymphatics and nutrient vessels, parametrium,
What spaces does the loose areolar fatty tissue fill?
Retropubic and retrorectal spaces and pararectal and paravesical spaces.
What ligaments are contained in the hypogastric sheath?
lateral ligament of the bladder, pre sacral fascia, rectovesical septum, transverse cervical ligament
What vessels are found in the lateral ligament of the bladder?
The superior vesicle arteries and veins
What vessels are contained in the pre sacral fascia?
The middle rectal artery and vein
What vessels are contained in the transverse cervical ligament?
The uterine vessels
Arteries of the posterior division of the internal iliac artery
Iliolumbar artery, lateral sacral arteries, and superior gluteal artery
What does the lateral sacral artery supply?
muscles and skin over the sacrum
what branches come off of the lateral sacral artery?
The sacral spinal arteries
Between what landmarks does the superior gluteal artery pass
The lumbosacral trunk and S1 ventral ramus
Arteries of the anterior division of the internal iliac artery
inferior gluteal artery, obturator artery, uterine artery, superior vesical artery, inferior vesical artery, umbilical artery, internal pudendal artery, middle rectal artery,
Between what landmarks does the inferior gluteal artery pass?
Between S2 and S3 and inferior to the performs muscle
Where does the obturator artery run
Runs antero-inferiorly along the obturator fascia on the lateral walls of the pelvis to the medial compartment of the thigh.
What does the middle rectal artery form an anastomoses with
The superior rectal artery and inferior rectal artery.
Where does the superior rectal artery come from (review)
The IMA
Where does the inferior rectal artery come from
The internal pudendal artery
What does the internal vesicle artery branch into in males?
Prostatic artery, ureteric artery, and deferential artery
What does the patent umbilical artery close to form?
The medial umbilical ligament
Where does the superior vesical artery come from?
Usually a branch off of the uterine artery
Where do the external iliac receive lymph from?
inguinal nodes
Where do internal iliac nodes receive lymph from?
The pelvic viscera and gluteal regions
Where do sacral lymph nodes receive lymph from?
The postero-inferior pelvic viscera.
Were do common iliac nodes receive lymph from?
External iliac nodes, internal iliac nodes, sacral nodes,
Where do common iliac nodes drain to
lumbar nodes
What is the pelvic venous plexus?
A plexus of veins that surrounds pelvic viscera
Where do common iliac veins unite to form the IVC
L4/L5, one level lower than aorta
Does the lumbar plexus provide innervation to the true pelvis?
no, it supplies portions of the perineum and greater pelvis
Ilioinguinal nerve (L1)
Supplies most of skin of mons pubis and anterior aspect of scrotum/labia majora
What supplies the cremaster muscle and skin on the anterolateral aspect of the scrotum/labia majora
Genitofemoral (L1-L2)
What supplies the motor branches to iliopsoas muscle?
Femoral nerve (L2,3,4)
What nerve travels through the lesser pelvis but does not arise or innervate structures of the true pelvis
Obturator Nerve (L2,3,4)
How does the obturator nerve exit the pelvis
Via the obturator foramen
How is the lumbosacral trunk formed?
From descending ramus of L4 and L5
What levels is the sacral plexus?
L4-S3
What general area does the sacral plexus supply?
It lies in the pelvis but primarily supplies the lower limb.
Nerves from the sacral plexus
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
Where do the nerves to levator ani and coccygeus arise?
S3 and S4
Where do nerve to piriformis arise?
S1 and S2
Where does the pudendal nerve arise?
S2,3, and 4
What type of fibers are included in superior hypogastric plexuses
Pre and postganglionic sympathetic fibers and visceral afferents
Fiber types found in inferior hypogastric plexuses
Pre and postganglionic sympathetic fibers and visceral afferents as well as preganglionic parasympathetic fibers.
Fiber types found in pelvic plexuses
Postganglionic sympathetic fibers and preganglionic parasympathetic fibers as well as visceral afferents
What types of fibers are found in pelvic splanchnics
Visceral afferent fibers, preganglionic parasympathetics
How are pelvic plexuses formed
By the merging of pelvic splanchnic nerves and inferior hypogastric plexuses
Ascending parasympathetic fibers
arise from pelvic plexuses and ascend out of the pelvic inlet to reach sigmoid and descending colon
Sacral sympathetic trunk is a continuation of what?
The lumbar sympathetic trunk
Functions of sympathetic nerves in the pelvis
Vasoconstriction, inhibition of peristalsis, constriction of involuntary sphincters, ejaculation, remission of genital erection
Functions of parasympathetic nerves in the pelvis
increase of peristalsis, stimulates contraction of detrusor in bladder, inhibits constriction of involuntary sphincters ,erection
visceral reflex afferents
Travel retrograde with parasympathetics to the dorsal root ganglia
Pelvic pain line
Corresponds to the lower limit of the peritoneum
Pain fibers from intraperitoneal viscera or areas of organs covered in peritoneum follow?
Sympathetic system retrograde to T11-L1
Pain fibers from the sub peritoneal viscera follow?
Parasympathetic fibers retrograde to dorsal root ganglia of S2,3,4
Where does the pain line cross?
The middle of the sigmoid colon
Have you gone over the pathways of sympathetics and parasympathetics for viscera of pelvis
Probably should do it more
Have you reviewed the spinal anesthesia for childbirth?
Probably should look at it again
