Part 16: Pelvic Peritoneum, Vessels and Nerves Flashcards

1
Q

Describe the arrangement of pelvic peritoneum in the male

A

Draped over pelvic viscera. Anteriorly roofs retropubic space, behind forms the rectovesical pouch with the retroperitoneal tissue forming rectovesical fascia (of Denonvilliers) betwen bladder and rectum. Laterally peritoneum is continuous with that of the side walls

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2
Q

How does the pelvic peritoneum differ in the female compared with male?

A

Largely the same but altered due to presence of uterus and broad ligaments. Thus has vesicouterine pouch and rectouterine pouch (of Douglas).

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3
Q

Where does the common iliac artery bifurcate?

A

At SI joint, IIA passes down and EIA passes more lateral

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4
Q

How many branches to anterior division of internal iliac artery?

A

3 associated with bladder: Superior vesical, inferior vesical, obliterated umbilical
3 associated with other viscera: Middle rectal, uterine artery, vaginal artery
3 parietal: Obturator artery, internal pudendal artery, inferior gluteal artery

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5
Q

What are the branches to the posterior division of the internal iliac artery?

A

Iliolumbar
Lateral sacral artery
Superior gluteal

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6
Q

Where does iliolumbar artery arise and where does it supply?

A

From posterior branch IIA.
Has lumbar branch (essentially the 5th lumbar artery) which supplies psoas, QL, spinal L5 branch
Iliac branch supplies iliac fossa and anastomoses around ASIS

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7
Q

Where does lateral sacral artery artery arise and where does it supply?

A

Arises from posterior branch IIA.

Runs lateral to anterior sacral foramina supplying roots and piriformis. Spinal branches to meninges.

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8
Q

Where does superior gluteal artery arise and where does it supply?

A

Largest branch of IIA - from posterior division.

Exits through greater sciatic foramen above piriformis to supply gluteals

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9
Q

Where does superior vesical artery arise and where does it supply?

A

Highest branch of anterior division of IIA.
Persistent patent proximal part of foetal umbilical artery (distal part becomes medial umbilical ligament). Runs along wall of pelvis, turns medially to reach upper bladder, supplies adjacent ureter and ductus deferens

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10
Q

Where does inferior vesical artery arise and where does it supply?

A

Branch of anterior division of IIA.

Supplies trigone and lower bladder, ureter, ductus deferens and seminal vesicles

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11
Q

Where does middle rectal artery arise and where does it supply?

A

Branch of anterior division if IIA. Maybe absent in females where uterine artery replaces its supply. Supplies lower rectal wall. May give off prostatic artery.

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12
Q

Where does uterine artery arise and where does it supply?

A

Anterior division if IIA.

Crosses pelvis at base of broad ligament superficial to ureter turing up at cervix. Anastomoses with ovarian artery

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13
Q

Where does vaginal artery arise and where does it supply?

A

Anterior division of IIA but often as branch of uterine. Supplies upper vaginal walls.

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14
Q

Where does obturator artery arise and where does it supply?

A

Anterior division of IIA. Passes along side wal of pelvis. Enters OF, branch to pubic symphysis

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15
Q

Where does internal pudendal artery arise and where does it supply?

A

Anterior division of IIA. Lies in front of inferior gluteal, piercing parietal pelvic fascia. Exist through greater sciatic foramen, below piriformis. Supplies perineum and external genitalia.

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16
Q

Where does inferior gluteal artery arise and where does it supply?

A

Anterior division of IIA.

Runs through GSF into buttock below piriformis

17
Q

Describe the pelvic veins

A

Internal iliac vein is about 3cm long created by confluence of gluteal and other veins. IIV receives blood from various venous plexuses - uterine/vesicoprostatic, rectal
Communicates with vertebral veins via lateral sacral veins. No valves in pelvic veins, therefore blood can be diverted in cases of extreme raised intra-abdominal pressure (eg coughing fit) to aygous veins and drain into SVC

18
Q

Where does the obturator nerve arise?

A

From lumbar plexus (L2,3,4) - passes down side wall of pelvis to exit via OF

19
Q

Where does the accessory obturator nerve arise?

A

Lumbar plexus. More similar to femoral nerve in that it is derived from posterior divisions and passes over pubic ramus. Supplies pecitineus when present in 1/3 of individuals

20
Q

The sacral plexus is comprised of what nerves?

A

Much of L4 and all of L5 form lumbosacral trunk to join anterior rami of 4 sacral nerves

21
Q

Where does sacral plexus lie?

A

On piriformis muscle

22
Q

What are the branches of the sacral nerves?

A

6 - start with P
Piriformis twigs
Perforating cutaneous nerve S2,3 (skin over buttock)
Posterior femoral cutaneous nerve (S2,3)
Parasympathetic pelvic splanchnic nerves from rootlets
Pudendal nerve from anterior S2,3,4
Perineal branch of S4 (coccygeus and levator ani and perineal skin)

23
Q

What are the branches from the anterior divisions of plexus?

A

Nerves to flexor compartments:
Sciatic (tibial part) - L4,5S1,2,3
Nerve to obturator internus
Nerve to quadratus femoris (L4,5,S1)

24
Q

What are the branches from posterior divisions of lumbosacral plexus?

A

Nerves to extensor compartments:
Sciatic (common peroneal part) (L4,L5,S1,S2)
Superior gluteal nerve (L4,5,S1)
Inferior gluteal nerve (L5,S1,2)

25
Q

What is the inferior hypogastric plexus?

A

Consists of 2 - right and left, collectively form single pelvic plexus. Autonomic plexus on side wall of pelvis

26
Q

What is the sympathetic and parasympathetic input to IH plexus?

A

Sympathetic: lumbar and sacral ganglia
Parasympathetic: S2,3,4

27
Q

Parasympathetic nerves from IHP are motor to what organs?

A

Detrusor muscle of bladder and secretomotor to gut from splenic flexure down

28
Q

Sympathetic nerves from IHP are motor to what organs?

A
Bladder sphincter
Anal canal sphincter
Ductus deferens
Seminal vesicles
Prostatic muscles
Uterine muscles