Lecture 7 - Pelvic Viscera

Question 1

FUnction of sympathetic nerves in the pelvic region

Answer 1

• Contraction of smooth muscle sphincters, which keep sphincters such as bladder and anal canal tonically closed.
• vasoconstriction of pelvic arteries
• peristalsis of male reproductive tract, the vas defrens

Question 2

function of Parasympathetic nerves in the pelvis region

Answer 2

These are the pelvic splanchnic nerves

• contraction of detrusor muscle.
• responsible for rectal peristalsis
• it inhibits smooth muscle sphincters when you are ready to defecate

Question 3

Blood supply to vagina

Answer 3

pelvic vagina - vaginal artery off of internal iliac

perineal vagina - internal pudendal artery

Question 4

Vagina inervation

Answer 4

Pelvic: uterovaginal plexus, which is a subset of the hypogastric plexus (autonomic).
- Pain is transmitted via pelvic splanchnic nerves
Perineal: all is transmitted via the pudendal nerve (somatic)

Question 5

What are the names of the angles of the uterus?

Answer 5

Anteflexed - the bending of the uterus over the vagina

Anteverted - the angle at which the uterus enters the vagina

Question 6

3 layers of the uterus

Answer 6

endometrium, myometrium, perimetrium.

- the myometrium is the thickest part of the uterus.

Question 7

Uterus blood supply

Answer 7

uterine artery - ureter will pass inferior to this. Runs onto the ureter and then coils back onto itself.
vaginal artery

Question 8

Innervation to ovaries and uterus

Answer 8

Depends on if its above the pelvic floor (the pain line) or not. If above will go to the sympathetic route. If below it will go to the parasympathetic route. In the case of the ovaries, the reason people have lower back pain is because the pain is referred to T10-T11 during painful ovulations and brought back via lesser splanchnic nerves

Question 9

Pessary

Answer 9

Intrauterine device used to keep the uterus in place after a uterine prolapse.

Question 10

3 types of hysterectomy

Answer 10

radical - remove uterus, tubes, and vagina
total - remove uterus, tubes, and leave most of the vagina and downwards
partial - remove uterus, tubes, and leave the pericervical ring and downwards.

Question 11

Rectum

Answer 11

Once you pass the rectosigmoid junction you get to the rectum, which has no teniae, no haustra, or appendices.

Question 12

rectum blood supply

Answer 12

Superior rectal - comes off of superior mesenteric
Middle rectal - comes off of internal iliac
Inferior rectal - comes off of internal iliac

Question 13

puborectalis

Answer 13

acts as a sling around the rectum. In order to defecate, the muscle must relax.

Question 14

Urethra

Answer 14

pre-prostatic –> prostatic –> membranous –> spongy

Question 15

ampulla

Answer 15

area of the vas defrens where sperm is stored

Question 16

landmarks within the prostatic region of the urethra

Answer 16

• seminal colliculus is the big hole and elevation in the middle
• ejaculatory duct is the two holes just distal to the superior colliculus
• prostatic sinus

Question 17

Male pelvic blood supply

Answer 17

Artery: Inferior Vesicle Artery
Vein: Dorsal vein of the penis goes to the prostatic venous plexus

Question 18

function of parasympathetic and sympathetic Innervation of the prostate

Answer 18

Parasympathetics - pelvic splanchnic nerves - serves a secretomotor function. Essentially they will drive the fluid secretion from the prostate.
Sympathetics - Smooth muscle contraction during ejaculation

Question 19

Prostatic Zones

Answer 19

Transition (smallest in size and responsible for 10% of cancers) –> central (middle in size and responsible for only 5% of cancers) –> peripheral (largest and responsible for most cancers)

Question 20

Benign Prostatic Hyperplasia (BPH)

Answer 20

Increase in size of the prostate

Question 21

Pelvic Lymphatics

Answer 21

Generally follow arteries

• ovarian goes to lateral aortic
• cervical goes to internal iliac