Lecture 22 - Blood Vessels, nerves and Lymph of Pelvis

Question 1

Where are the pelvic parasympathetics from?

Answer 1

S2-4

Question 2

bracnhes from the side wall of the pelvis are from what artery?

Answer 2

internal iliac - will usually travel in with a NV bundle

Question 3

the ovarian artery is a branch of what

Answer 3

abdo aorta

Question 4

The superior rectal artery is continuation of what

Answer 4

inferior mesenteric artery

Question 5

What do the parietal branches of internal iliac supply?

Answer 5

wall of the pelvis and sends some vessels into the gluteal region (not worrying about these as much)

Question 6

The internal iliac artery is very…

Answer 6

variable! - look at the structure and work back

Question 7

the superior vesical artery is reinforced by what in males?

what else does this supply

Answer 7

inferior vesicle branch

also supplies the vas, prostate, seminal vescicles

Question 8

What is within the lateral cervical ligament?

Answer 8

uterine artery in females

comesin at level of cervix - crosses ureter

Question 9

What happens to the uterine artery at the cervix?

Answer 9

splits - sends branch down to anastomose with the vaginal artery

sends branch up to meet the ovarian artery

Question 10

vaginal artery is the female equivalent of what

Answer 10

inferior vesicals

Question 11

inferior mesenteric artery is reinforced by..

Answer 11

middle rectal artery - coming off internal iliac in both sexes

Question 12

The inferior rectal artery is a branch of the

Answer 12

pudendal vessels - goes to anal canal

Question 13

obturator nerve is a branch of the

Answer 13

lumbar plexus - goes through obturator canal

Question 14

obturator nerve will supply the parietal perineum, therefore pain will be referred to..

Answer 14

medial thigh above the knee

Question 15

the sacral plexus is formed..

Answer 15

on piriformis with contribution from lumbo-sacral truck formed by L4 remnants

Question 16

The two really important nerves from the sacral plexus are…

Answer 16

pudendal nerve - nerve of perineum

pelvic parasympathetics

Question 17

What is the course of the pudendal nerve?

Answer 17

(S2-4) pelvis - through greater sciatic foramen - winds around ishial spine in gluteal region - back through the lesser sciatic foramen (now beneath the pelvic floor) - now into perineum

Question 18

True or false

The pudendal nerve penetrates the pelvic floor

Answer 18

false - goes in from behind

Question 19

once inside the perineum the pudendal nerve slips into the

Answer 19

pudendal canal

Question 20

The first thing that the pudendal nerve does is

Answer 20

send branches to the anal canal - inferior rectal nerves

Question 21

once beyond the anal triangle what branches are given off?

Answer 21

perineal nerves to sctrutures in the midline.

ends up at the apex of the triangle at the dorsal nerve of clitorus/penis

Question 22

The pelvic sympathetic fibres reach the pelvis via…

Answer 22

superior hypogastric plexus which lies inferior to the bifurcation of aorta

Question 23

superior hypogastric plexus (sympathetics) divides into a

Answer 23

Right and Left hypogastic nerves which descend laterally to rectum to join pelvic splanchnic nerves

Question 24

the combination of pelvic splanchnic nerves and hypogastric nerves creates…

Answer 24

Right and Left inferior hypogastric plexus (an autonomic plexus of para/sympathetic nerves

Question 25

The pelvic pain line (plane of least dimensions) - divides …

Answer 25

the referral of pain

Question 26

structures above the pelvic pain line will convey their pain

Answer 26

accompanying the sympathetic motor fibres - will go up to ant. abdo wall

Question 27

Everything that has peritoneum draped over the top or related to the broad lig relates pain to the

Answer 27

ant. abdo wall T1-L2

Question 28

structures below the pelvic pain line will convey their pain…

Answer 28

accompanying the parasympathetics - referred to the peri-anal region, buttocks

Question 29

What are the componenets of the micturition reflex

Answer 29

1. Stretch receptors in bladder wall
2. Visceral afferents accompany pelvic parasymapthetics
3. Spinal cord segments S2-4
4. Visceral efferents (pelvic parasympathetics)
5. Detrusor muscle of bladder

Question 30

How is micturtion started?

Answer 30

voluntarily relaxing the external urethral sphincter

Question 31

WHAT NERVE is responsible for starting micturition

Answer 31

pudendal nerve