neurovascular supply to the pelvis Flashcards
where does the mesosalpinx range fom?
from the round ligament of the uterus to the fallopian tube
where does the mesometrium range from?
its the frontal component associated with the uterus
what is the mesovarian associated with?
the ovaries
what does the aorta bifurcate into?
common carotids A
how do the common carotids divide into?
internal and external iliac A
how does the iliolumbar A travel?
it is the only branch that ascends along the lumbar vertebrae and the ileum of the hip
what does the iliolumbar A provide blood to?
Iliacus, psoas, quadratus lumborum
How can the lateral sacral A be identified in the lab?
it passes through the sacral foramina
how does the lateral sacral A travel?
- Traces down along the sides of the sacrum
* Descends along the curvature of the sacrum
is it possible for the lateral sacral A to be divided into multiple branches?
yes
what recieves blood from the superior gluteal A?
gluteal muscles
how can the superior gluteal A be identified in the lab?
Typically seen in lab between lumbosacral trunk (L4/L5) and S1 spinal nerve
how does the superior gluteal a travel?
Exits pelvis via greater sciatic foramen above piriformis to get to medius and minimus muscles
how can the umbilical A be defined as?
its a blunt/obliterated A
what is the function of the umbilical A?
o Represent arteries that carried deoxygenated blood away from the fetus from the umbilical cord, worked their way to umbilicus
what does the umbilical A give rise to?
superior vesicular aa.
what recieves blood from the superior vesicular A?
bladder
how can the superior vesicular aa be identified?
Can be identified by the dangling vessels going to the top of the bladder
what recieves blood from the obturator A?
Supplies the medial compartment of the thigh
how does the obturator a travel?
travels through obturator formamen and leaves the pelvis
how can obturator A be identified in the lab?
pierces through obturator fascia to reach the foramen (found anteriorly) and exit
what happens when we have an aberrant obturator A?
Obturator A stems exclusively from external iliac A
what happens when we have an accessory obturator A?
Branch from external iliac that merges with obturator from internal iliac A before it merges under the inguinal ligament
what does the middle rectal a supply blood to?
rectum
where does the middle rectal A originate from?
internal iliac A
where does the superior rectal A originate from?
IMA
Where does the inferior rectal A originate from?
internal pudendal A
how can the middle rectal A be identified in the lab?
its the most posterior branch and goes to the rectum
what recieves blood from the inferior gluteal A
glute max
how does the inf. gluteal A travel?
• Exits pelvis via greater sciatic foramen inferior to piriformis to get to glute max
where can the inferior gluteal A be seen in the lab?
typically between S1-S2 spinal N
how can the inferior gluteal a And internal pudendal A be distinguished?
the internal pudendal A will travel near the ischeal spine (locate coccygeus in the lab) where as the inferior gluteal A will be found closer to the coccyx
how does the internal pudendal A travel?
exits GSF inferior to piriformis, posterior to the ischial spine, loops down around levator ani mucle and re-enters the pelvis via LSF
Travels through pudendal canal along the internal surface of the ischial tuberosity and ischopubic ramus towards the perineum (region of external genetilia)
what is the male specific A?
inferior vesicle A
how can the inferior vesicle A be identified?
goes to the back of the bladder to the prostate
where is the superior gluteal commonly found?
lumbosacral trunk (L4-L5) and S1
what are the female specific A?
uterine A
vaginal A
how does the uterine A travel?
travels above the ureter to reach the uterus on either side
the vaginal A branches off of what A?
branches off of the uterine A
what A may anastamose with the vaginal A?
vaginal branches of the uterine A
what are the ascending branches of the uterine A?
tubular and ovarian branches
what may the ovarian branches of the uterine A anastamose with?
with the ovarian A to ensure ovaries get continuously supplied by blood
can the vaginal and uterine A originate from one main branch?
yes
how does the pudendal N travel?
- Exits the pelvis via greater sciatic foramen
- Loops posteriorly around the ischial spine/sacrospinous ligament
- Enters lesser sciatic foramen traveling deep to levator ani
- Gives off rectal branch to external anal sphincter
- Travels through a fascial canal along the ischiopubic ramus called the Alcock’s pudendal canal
- Gives rise to perineal branches (penile and scrotal/clitoral and labial)
where is alcock’s canal located?
Located along the internal aspect of the ischial tuberosity to peritoneum (external genitalial)
what are the main functions of the parasympathetic innervation to the pelvis?
o Increases GIT motility
o Relaxation of sphincters (Urinary and anal)
o Contraction of detrusor muscle
o Relaxation of uterine musculature
o Vasodilation of erectile tissue (erection)
what are the main functions of the sympathetic innervation to the pelvis?
o Decrease of GIT motility
o Contraction of sphincters (Prevents urinary/anal leakage)
o Detrusor muscle relaxation
o Uterine contractions
Ex: child labour
o Contraction of erectile tissue (Ejaculation)
what type of innervation does the lumbar splanchnic N recieve?
o Sympathetic innervation to the hindgut
how does the lumbar splanchnic N travel?
o Travels down, posterior to common iliac A into the pelvis via superior hypogastric plexus, hypogastric nerves and contributes to inferior hypogastric plexuses
what type of innervation does the sacral splanchnic N recieve?
o Sympathetic innervation
how can the sacral splanchnic N be identified in the lab?
Nerves extending from sacral sympathetic trunk located along the vertebral column in te sacral portion
what A travel next to the sacral splanchnic N?
lateral Sacral A
how does the sacral splanchnic N travel?
o Passes through inferior hypogastric plexuses and may send contributions along hypogastric nerve
what type of innervation does the pelvic splanchnic nerve provide?
parasympathetic innervation
where does the pelvic splanchnic nerve come from?
sacral spinal N s3-s4
how does information from the pelvic splanchic N travel?
passes through Inferior hypogastric plexus to pelvic viscera
what provides somatic innervation to the pelvis?
Pudendal N
how can the pudendal N be identified in the lab?
follows the same course as the internal pudendal A
what does the pudendal N give rise to?
rectal branches
how do the rectal branches travel
pass through the pudendal canal and travel towards external genitalia
what type of innervation does the filling phase of micturition involve?
o Sympathetic innervation from lumbar splanchnic nerves will relax the detrusor muscle and constrict the internal urethral sphincter
what type of innervation does the expelling phase of micturition involve?
o Parasympathetic innervation from pelvic splanchnic nerves will constrict the detrusor muscle and relax the internal urethral sphincter
what innervates the external urethral sphincter?
somatic control from pudendal N
what is the function of the external urethral sphincter?
Ability to control the urge to urinate is accomplished via the contraction of the external urethral sphincter and muscles of levator Ani
what is needed for urination to occur?
relaxation of the external urethral sphincter
where can the superior hypogastric plexus be identified in the lab?
L4-L5
where can the inferior hypogastric plexus be identified in the lab?
on organs directly
what is the function of then hypogastric N?
joins both superior and inferior plexuses
how can the suspensory ligament of the ovary be identified in the lab?
suspends ovary to abdomen hence comes higher up
how can the round ligament of the uterus be identified in the lab?
found off to the side, continuous with the ligament of the ovary
how can the ligament of the ovary be identified in the lab?
find ovary and look how it attached downwards to the uterus
