Lecture 5: Pelvic and Perineal Angiology Flashcards
Describe the route of the Testicular artery; where does it come from?
- Travels thru Inguinal Canal into the scrotm; inside spermatic cord; supplies testis
- Branch off the Abdominal Aorta
Where does the Ovarian A. come from; describe its route; and its branches?
- Branches from Abdominal Aorta between Renal A. and IMA; travels through the Suspensory L. of the Ovary
- Branches into Ovarian (supply ovary) and Tubal (supply Uterine Tubes) Branches
Where does the IMA come from; what does it give off; what anastomoses occurs?
- From the Abdominal Aorta
- Gives off Superior Rectal A., which supplies the superior aspect of the Rectum, anastomoses w/ Middle and Inferior Rectal A.
Which artery arises from the posterior aspect of Abdominal Aorta, just prior to Common Iliac branching, and travels inferiorly over L4, L5, sacrum and coccyx?
Median Sacral A.
What are the paired terminal branches of the Abdominal Aorta and what do they branch into?
- Left and Right Common Iliac As.
- External Iliac A.
- Internal Iliac A.
What is the continuation of the External Iliac A. and where is it found?
Femoral A; distal to the Inguinal L.
What branches does the Femoral A. produce relevant to the male and female pelvis?
Males = Anterior Scrotal A.
Females = Anterior Labial A. (supplies labia majora)
What are the branches of the Anterior Division of the Internal Iliac A.?
- Obturator A.
- Umbilical A.
- Inferior Vesical A. (males)
- Uterine A. (females)
- Vaginal A.
- Middle Rectal A.
- Inferior Gluteal A.
- Internal Pudendal A.
Where does the Umbilical A. arise from and what does it produce?
- Arises from the Anterior Division of the Internal Iliac A.
- Produces Superior Vesical A. (supplies superior aspect of bladder)
- Continues on to become Medial Umbilical L.
What is the large tortuos branch of the anterior division of the Internal Iliac A.; describe its route and what it supplies?
- Obturator A.
- Exits pelvic cavity via Obturator Canal, supplies Pelvic muscles, Ilium, Femoral Head, and muscles of the medial thigh
In males what artery supplies the Seminal Vesicles, Prostate Gland, Ductus Deferens, Ureters, and Urinary bladder; what branches does it makes; what is it analoagous to in females?
- Inferior Vesical A.
- Produces a: Prostatic branch and a Artery to Ductus Deferens
- Analagous to the Vaginal A.
The uterine artery travels through what structure and supplies what; has what branches; and is analagous to what in males?
- Travels through the Broad L. of the Uterus
- Supplies the Uterus, Uterine Tubes, Ovaries, Ureters
- Makes: Vaginal branches, Ovarian branches, Tubal Branches
- Analagous to the Artery of the Ductus Deferns
What are the 2 terminal branches of the Anterior division of the Internal Iliac A.?
1) Internal Pudendal A.
2) Inferior Gluteal A.
Describe the route of the Internal Pudendal A.
- Leaves via the greater sciatic foramen
- Loops around sacrospinous L.
- Comes back through the lesser sciatic foramen
- Immediately enters the pudendal canal, made of obturator fascia
- First branch it makes is the Inferior Rectal A.
- Next branch is the Perineal A.
What branches does the Internal Pudendal A. make in girls?
- Inferior Rectal A.
- Perineal A. becomes the Posterior Labial A.
- Artery to the Vaginal Vestibule
- Terminates as a Deep and Dorsal A. of the Clitoris
What branches does the Internal Pudendal A. make in guys?
- Inferior Rectal A.
- Perineal artery becomes the Posterior Scrotal A.
- Artery of the Bulb of penis
- Terminates as Deep and Dorsal Artery of the Penis
What are the arteries off of the Posterior Division of the Internal Iliac A.?
- Iliolumbar A. branches into Iliac branch and Lumbar branch
- Lateral Sacral A.
- Superior Gluteal A.
What does the Deep Artery of the Penis supply?
- Supplies Corpora Cavernosa of Penis
What does the Dorsal A. of the Penis pass through and what does it supply?
- Suspensory L. of the Penis
- Supplies the Skin of the Penis and Erectile Tissue
Where do the 3 rectal arteries arise from?
1) Superior Rectal A. from the IMA
2) Middle Rectal A. from the Anterior Division of Internal Iliac A.
3) Inferior Rectal A. from the Internal Pudendal A.
Where is the Pampiniform plexus found in males and female; what does it drain to?
Males: found in the Spermatic Cord drains to Testicular V.
Females: found inside the Suspensory L. of the Ovary drains to the Ovarian V.
What is the Internal Rectal Venous Plexus?
Superior most anastomosis of the Superior, Middle, and Inferior Rectal V.
What is the External Rectal Venous Plexus?
Near the anus, inferior most anastomosis of the Superior, Middle, and Inferior Rectal V.
CN: Intenal Hemorrhoids “Plies” are the prolapse of; while external hemorrhoids are produced by; which of the two are painful?
- Internal are the prolapse of the mucosa containing the Internal Rectal Venous Plexus, impedes blood flow.
- External are produced by blood clots in the External Rectal Venous Plexus, which bulge out the mucosa and overlying skin and are painful.
What are the pelvic components of the Lumbar plexus and each of these nerves spinal levels?
- Ilioinguinal N. (L1) –> Anterior Scrotal and Labial N.
- Genitofemoral N. (L1-2) —> Genital Branch
- Obturator N. (L2-4)
- Lumbosacral Trunk (L4-5)
What are the nerves of the Sacral Plexus and what are the spinal levels of each?
- Superior Gluteal N. (L4, L5, S1)
- Inferior Gluteal N. (L5, S1, S2)
- Nerve to Quadratus Femoris (L4, L5, S1)
- Nerve to Obturator Internus (L5, S1, S2)
- Nerve to Piriformis (S1-S2)
- Posterior Femoral Cutaneous N. (S1-S3)
- Perforating Cutaneous Branches (S2, S3)
- Pudendal N. (S2-S4)
What are the branches of the Pudendal N. in females?
- Inferior Rectal N. (anal canal inferior to pectinate line; external anal sphincter m.)
- Dorsal N. of Clitoris (dorsum of the clitoris)
- Deep Perineal N. (majority pelvic muscles)
- Superficial Perineal N. —> Posterior Labial N. (posterior labia majora)
What are the branches of the Pudendal N. in males; supplies which structures?
- Inferior Rectal N. (anal canal inferior to the pectinate line; external anal sphincter)
- Dorsal N. of the Penis (dorsum penis)
- Deep Perineal N. (most of the pelvic muscles)
- Superficial Perineal N. —> Posterior Scrotal N. (posterior scrotum)
What makes up the Coccygeal plexus; spinal nerves?
- Coccygeal plexus (S4, S5 and Coccygeal N.)
- Anococcygeal N. (small area of skin in coccygeal region)
- Nerve to the Levator Ani (S4)
- Nerve to the Coccygeus (S4, S5)
What are the components of the Abdominal Sympathetic Trunk and Sacral Sympathetic Trunk?
Abdominal:
- Lumbar Splanchnic Ns.
- Inferior Mesenteric Ganglion
Sacral:
- Sacral Splanchnic Ns.
- Rami Communicants
- Ganglion Impar
How do we form the Inferior Mesenteric Plexus and Superior Hypogastric Plexus and are they sympathetic, parasympathetic, or mixed?
- Lumbar Splanchnics feed into Inferior Mesenteric Ganglion (houses Postsynaptic Cell bodies correspondig to the Pre-synaptic fibers from the Lumbar Splanchnic Ns.)
- Inferior Mesenteric Plexus = sympathetics
- Superior Hypogastric = sympathetics
What plexus supplies the Descending Colon, Sigmoid Colon, and some Rectum?
Inferior Mesenteric Plexus (sympathetics)
The pelvic splanchnic N (parasympathetics) meets with what to form what?
Meet w/ sympathetic fibers of the Hypogastric N. (from the superior hypogastric plexus) and Sacral splanchnic Ns. to form the Inferior Hypogastric Plexus (mixed)
What are the mixed pelvic autonomic plexuses in female?
- Ovarian (periarterial) Plexus
- Inferior Hypogastric Plexus
- Vesical Plexus
- Uterovaginal Plexus
What are the mixed pelvic autonomic plexuses in males?
- Testicular (periarterial) Plexus
- Inferior Hypogastric Plexus
- Vesical Plexus
- Prostatic Plexus
What subplexuses does the Inferior Hypogastric Plexus form in males and what nerves arise from the Prostatic Subplexus?
- From the Inferior Hypogastric Plexus (mixed) —>
Prostatic Plexus (mixed)
- Nerves to the Ductus Deferens
- Nerves to the Ejaculatory Ducts
- Nerves to the Seminal Vesicles
Vesical Plexus (mixed)
Sacral Splanchnic Ns. emerge from where and feed into?
Emerge from the Sacral Sympathetic Trunk to feed into the Inferior Hypogastric Plexus
Pelvic Splanchnic Ns. emerge from where and feed into?
Emerge from the Somatic nerves of the Sacral Plexus (Anterior Rami) to feed into the Inferior Hypogastric Plexus
Rami Communicantes emerge from where and travel where?
Emerge from the Sacral Sympathetic Trunk to travel in the Somatic Nerves of the Sacral Plexus (Anterior Rami)
What forms the Superior Hypogastric Plexus and what does it produce?
- Continous w/ the Intermesenteric Plexus and Inferior Mesenteric Plexus, exculsively sympathetics
- Sympathetic input from Lumbar Splanchnic Ns., lies anterior to the bifurcation of the abdominal aorta
- Produces the Ureteric Plexus and Testicular Plexus, which travel along the Common Iliac As
- Sends paired Hypogastric Ns. to the Inferior Hypogastric Plexus
What forms the Inferior Hypogastric Plexus and what does it form?
- Mixed sympathetic and parasympathetic
- Sympathetic input from Hypogastric Ns and Sacral Splanchnic Ns.
- Parasympathetic input from the Pelvic Splanchnic Ns
- Innervates the Descending and Sigmoid Colon
- Forms multiple subplexuses generically referred to as Pelvic Plexuses: Vesical Plexus (both), Uterovaginal Plexus (females) and Prostatic Plexus (males)
Explain like Olinger did where the rami communicants, sacral splanchnics and pelvic splanchnics come from and go?
- Rami communicants come out the sacral sympathetic trunk and into the anterior rami of sacral spinal Ns (so they can travel w/ somatic nerves into rest of LE)
- Sacral splanchnics come out of the sacral sympathetic trunk and feed into the Inferior Hypogastric plexus
- Pelvic splanchnics come out of the anterior rami of sacral splanchnic Ns. and feed into the Inferior Hypogastric plexus
