G27 28 Pelvis I II Flashcards
obturator nerve
L2-L4
medial to psoas
branch of lumbar plexus
innervates medial thigh
exits obturator foramen (one of two ways to exit pelvis (other GSF)
lubmosacral trunk
inf 1/2 of anterior ramus L4 and ant ramus of L5
srosses sacral ala to join sacral plexus
compression of sacral plexus
pelvic tumors or childbirth
superior gluteal nerve
inferior gluteal nerve
L4-S1
goes to lesser gluteal muscle
exits superior to piriformis
exits greater sciatic foramen
Inferior: L5-S2
-supllies gluteus maximus
also exits greater sciatic
but inferior to piriformis
posterior cutaneous nerves of the thigh
S1-S3
cutaneous inn to post thigh
sciatic nerve:
L4-S3
two nerves wrapped : tibial and fibular
bound but do not share fibers
exits inf ro piriformis?
pudendal nerve
perineum blocks exit
must exit GSF
enter LSF
wraps around ischial spine,
(coccygeous on deep side of sacrospinus ligament)
arteries of pelvis
ovarian/testicular (L2/L3)
superior rectal artery
iliolumbar (up)
common iliacs…when external iliac crosses the inguinal ligament it changes to femoral artery
portal caval anastimosis
if branch of IMA: vein will drain to the portal system
4 in total
- rectum (superior rectal from IMA)
- umbilicus: caput madusa
- esophagus
- retropertoneal
internal iliac
posterior division-
- iliolumbar artery
- superior gluteal : largest and exits greater sciatic foramen, passes between lumbosacral trunk S1
- lateral sacral
anterior division
- Obturator (out obturator canal)(loose)
- umbilical (medial umb ligament)
- superior vesical artery (bladder) (branch from umbilical)
- inferior gluteal (exit)*
- internal pudendal (exit/enter)* (inferior rectal branches off)
- middle rectal (drains to caval)
- inferior vesical (male) uterine with a vaginal branch (female)
obturator artery
Aberrant Accessory
DOES NOT COME OFF INTERNAL ILIAC
20% off inferior epigastric artery -over pubic ramus (pelvic brim)
requires caution during hernia repairs
uterine and vaginal arteries
ovarian artery (aorta) gonadal
internal iliac branches and single uterine artery with vaginal branch (more inferior)
-vag posterior to ureter, uterine artery passes anterior to ureter in broad ligament.
DO NOT LIGATE URETER DURING HISTORECTOMY
inferior vesical artery
uterin artery
male: inferior vesicle: suplies bladder, ductus def, seminal vesicle and prostate
w: uterine: bladder and vagine
lymphatic drainage
follows venus supply
internal iliac, common ilian, lumbar, lumbar lymph trunks, cisterna chyle, thoracic duct
GONADS: directly to lumbar nodes, sometimes up higher
rectum
rectosigmoid junction
-no tenia coli, haustra or omental appendices
transferse folds : folds within rectu : valves of houston (smooth internally)
pubococcygeous muscle: (puborectalis portion)
- defacation puborectalis ALONE relaxes
- the rest contracts to prevents pelvic herniation
superior rectal V-portal system
middle rectal V- IVC
inferior rectal V- IVC
(internal rectal plexus)
internal hemmaroids: portal hypertension
external : bad luck
arteries
-inferiore rectal arteries branch off internal pudendal
ureters (water under the bridge)
primary retroperitoneal
- no valve, enter at angle as kind of valve
- WATER UNDER THE BRIDGE
male bladder: extra sexual organs
womenL posterior to uterine artery
-important when ligating uterine artery during hysterectomy
malesL inferiore to ductus deferens
pre puberty blasdder
above pubis where it can be injured
bladder parts
apex: at pubic symphysis
fundusL obbosite of apex
neckL where funndus and inferolateral spaces meet
trigone: triangle shaped structure on teh posterior surface of the bladder
sphincter: external urethra: VOLUNTARY (striated)
- in men is below prostate circular
- in woman from bladder to BS
internal urethral sphincter: INVOLULNTARY (ANS):(detrusor/smooth) expell urine, external , prevents retrograde ejaculation of semen in males, less robust in females
RUGAE
femaile sits on perineal membrane
male: sits on prostate, then muscle then perineal mem
both sexes have superior vesicle (can be off umb or int iliac)
surgical access
distended bladder extends into abdomen (esp in men), superpubic incision can gain access to bladder just without getting into peritoneal sac
BROAD LIGAMENT
all over, the mesentary of the uterus
mesosappinx (by fimbrae)
mesoovarium
mesometrium
suspensory ligaments (homologous contents to spermatic chord) (carry ovarian artery and vein)
proper ovarian ligament: obliterated gubernaculum)
round ligament of uterusL goes forward (more obliterated gubernaculum)
-going to inguinal canal
uterine tube and uterus
fimbrae, infundibulum, ampulla, isthmus
pathwaty for infection into peritoneal vacity. pelvic inflammatory disease is much more common in females!
uterus: fundus body isthmus cervix
internal and external os
external os site of pap smear
uterine prolapse (falling uterus into vagina)
uterus stays big for a while
vaginal (current) or abdominal hysterectomy
- no longer have to go through peritoneal sac)
- used to leave cervix intact
uterine ligaments
thickenings of endopelvic fascia beneatch parietal peritoneaom of broad ligament from cervix to pelvic walls
supports the uterus and prevents from descentind thoruhg vagina
uterosacral (ant)
cardinal ligaments (transverse cervical lig)- where the uterine artery and vein)
