Pelvic ANS/Neurovasculature Flashcards
What are the divisions of the peripheral nervous system?
autonomic and somatic
What are the divisions of the autonomic nervous system?
sympathetic and parasympathetic
What are the structural divisions of the nervous system?
central and peripheral
What are the functional divisions of the nervous system?
somatic and visceral
somatic = body visceral = organ
Where do CNS and PNS derive from?
CNS from neural tube
PNS from neural crest cells
Group of neuronal cell bodies in the CNS is called
nucleus
Group of neuronal cell bodies in the PNS called
Ganglion
Glia cells in CNS are called
astrocytes, oligodendroglia, microglia
Glia cells in PNS are called
Schwann
Sympathetic nervous system:
where are pre ganglionic cell bodies?
Pre-ganglionic cell bodies in lateral horn of thoracolumbar spinal cord (T1-L2)
Sympathetic nervous system
Where are post-ganglionic cell bodies?
3 options post-ganglion cell bodies:
- sympathetic chain ganglion
- collateral ganglion (pre-vertebral ganglion)
- chrommafin cells in adrenal gland
Parasympathetic nerouv system. Where are pre-ganglionic cell bodies?
CNs nuclei, S2-S4, lateral horns of craniosacral
Parasympathetic nervous system. Where are post-ganglionic cell bodies?
4 cranial ganglia
WALLS OF THE ORGANS THEY INNERVATE
What are the 4 collateral ganglia pairs?
- celiac ganglia
- superior mesenteric ganglia
- Aorticorenal ganglia
- Inferior Mesenteric ganglia
What is the pathway of sympathetic post-synaptic cells if they synapsed in the sympathetic chain?
leave sympathetic chain via gray ramus to enter the ventral or dorsal ramus eo serve the body.
If the sympathetic pre-ganglionic synapse does not occur in the sympathetic chain, how does it leave sympathetic chain?
pre-synaptic axons leave chain via SPLANCHNIC NERVE
What are the 5 splanchnic nerves coming off of the sympathetic chain?
- greater splanchnic nerve
- lesser splanchnic nerve
- least splanchnic nerve
- lumbar splanchnic nerve
- sacral splanchnic nerve
Describe the greater splanchnic nerve
sympathetic presynaptic axons exit sympathetic chain at levels of t5-t9 via greater splanchnic nerve.
They are going to synapse at celiac ganglion.
Describe the lesser splanchnic nerve
sympathetic presynaptic axons exit sympathetic chain at levels t10-t11 via lesser splanchnic nerve.
They are going to synapse at superior mesenteric ganglion.
Describe least splanchnic nerve
sympathetic presynaptic axons exit sympathetic chain at t12 via least splanchnic nerve.
They are going to synapse at the aorticorenal ganglion
Describe the lumbar splanchnic nerves
sympathetic presynaptic axons exit sympathetic chain at L1-L2 via lumbar splanchnic nerves
They are going to synapse at inferior mesenteric ganglion.
___ sacral splanchnics come together with ___ pelvic splanchnics to form the _____.
sympathetic sacral splanchnics and parasympathetic pelvic splanchnics come together to form mixed inferior hypogastric plexus
What are the two ways to exit the sympathetic chain ganglion in the sacral region?
- gray rami communcantes (to ventral ramust)
2. sacral splanchnic nerve to inferior hypogastric plexus
sacral splanchnic nerves contain what kind of axon?
sacral splanchnic nerves are going to inferior hypogastric.
pre-ganglionic axons.
BECAUSE THEY WILL SYNAPSE AT THE COLLATERAL GANGLION
gray ramus communicans carry what kind of axon in the sacral region?
post-synaptic sympathetic.
Because they descended the chain and synapsed IN THE CHAIN.
Pelvic splanchnics exit ___ to enter inferior hypogastric plexus
VENTRAL RAMI at S2 S3 S4
why is hypogastric plexus pre-vertebral?
it is in front of the vertebrae.
What portions of the abdomen does the pelvic splanchnics innervate?
hindgut (distal 1/3 transverse colon)
through pelvic splanchnics coming off ventral ramus going to inferior hypogastric plexus and ascending
THIS IS PARASYMPATHETIC
external iliac exits pelvis as ___
femoral artery
at ilio-inguinal ligament
interna iliac enters ___ and branches into what?
enters true pelvis
3 posterior and 7 anterior branches
supplies pelvic organs, gluteal region, perineum
3 posterior branches
- iliolumbar artery
- lateral sacral artery
- superior gluteal artery
7 anterior branches
- inferior gluteal artery
- internal pudendal artery
- umbilical artery
- superior vesical artery
- obturator artery
- Middle rectal
- vaginal artery OR inferior versical artery
and in women - uterine artery
Iliolumbar artery
- where does it enter?
- what does it supply?
between iliac crest and L5
supplies medial ilium and L5
moves superiorly in cadaver
Lateral sacral
- where does it enter?
- what does it supply?
enter ventral sacral foramina
supplies sacrum and ventral sacral nerves
often comes off as multiple branches
iliolumbar ultimately branches into ____ and ____
ilial branch and lumbar branch
Superior gluteal artery
- where does it enter?
- what does it supply?
between L5 and S1
enters gluteal region superior to piriformis muscle
supplies gluteal muscle with superior gluteal nerve
exits greater sciatic foramen
Inferior gluteal artery- where does it enter?
- what does it supply?
Between S2 and S3
inferior to piriformis muscle
supplies gluteal muscle with inferior gluteal nerve
Both inferior and superior gluteal artery exit pelvis via ____
greater sciatic foramen
superior gluteal exits superior to piriformis; inferior gluteal exits inferior to piriformis
Internal pudendal
- where does it enter?
- what does it supply?
runs with pudendal nerve
supplies urogenital triangle and anal triangle
Internal pudendal: trace path
exits pelvis thru greater sciatic foramen
enters gluteal region inferomedial to piriformis
crosses over sacrospinous ligament
re-enters pelvis thru lesser sciatic foramen
What is within the pudendal canal?
internal pudendal artery and pudendal nerve
What is the pudendal canal formed by?
fascia of obturator internus muscle
Pudendal canal runs ___ along _____ towards ____
runs anteriorly along ischiopubic ramus toward urogenital triangle
On a cadaver, how are internal pedundal artery and inferior gluteal artery in relation to each other?
internal pedundal artery is mored medial than inferior gluteal artery
Umbilical artery
- What is it’s orientation?
- What does it terminate into?
runs towards anterior abdominal wall
terminates as medial umbilical ligament (under medial umbilical folds)
What branches off of umbilical artery?
3-4 superior vesical arteries
Superior vesical arteries
- where do they come from
- what do they supply
3-4 branches of superior vesical arteries branch off of umbilical arteries
supply bladder, distal ureter and (males = proximal vas deferens and seminal vesicals)
Obturator artery
- runs through what?
- What does it supply?
runs through obturator canal
supplies medial thigh with obturator nerve
What is the corona mortis?
Crown of death
anastomose between obturator artery and inferior epigastric vessels
damage opens internal and external iliac systems
causes death in minutes
MAY BE ARTERIAL MAY BE VENOUS MAY BE BOTH
Uterine artery anastomoses with ____.
ovarian artery
Uterine artery supplies what?
uterus, cervix, superior vaginal canal
What is the orientation of ureter and uterine artery?
ureter runs immediately below uterine artery
Vaginal artery supplies what?
IN FEMALES
supplies inferior vagina and adjacent bladder and rectum
Inferior vesical artery supplies what?
IN MALES
supplies posterior inferior bladder, ureter, seminal vesicle and prostate
Ureter runs above what? (male and female)
vaginal artery in females
inferior vesical artery in males
Middle Rectal artery
- supplies what?
- anastomoses with what?
supplies rectum
anastomoses with superior rectal from IMA na dinferior rectal from internal pudendal
Inferior rectal is a branch of what?
internal pudendal artery
Ureter runs between what two arteries?
uterine artery and vaginal artery
What makes up the pelvic venous plexus?
bladder, rectum, prostate in males and vagina/uterus in females
Do venous plexueses have valves?
No.
Downfall: transortation of tumor cells or venous hypertension
What is the somatic innervation of the sacral nerve plexus from?
sciatic n, gluteal n, pudendal n
Somatix plexus also called ____
sacral plexus
What are the level of nerves that make up the somatic (sacral) plexus?
L4-S4
Levels: L4-L5 S1 S2-S3 S2-S4 L4-S3
Somatic Sacral plexus L4-L5 pathway
crosses over sacral ala to join rest of sacral plexus
forms lumbosacral trunk
Somatic Sacral plexus S1 pathway
emerges above piriformis
Somatic Sacral plexus S2/S3 pathway
thru body of pifiromis
Somatic Sacral plexus S2-S4 pathway
contributes to pudendal nerve
Somatic Sacral plexus L4-S3 pathway
forms sciatic and gluteal nerve (both superior and inferior)
Sympathetic fibers of pelvis come from what vertebral levels?
come from sympathetic chain T10-L2(3)
or come from sacral splanchnic nns of S2-S4
Parasympathetic fibers of pelvis come from what vertebral levels?
pelvic splanchnic nerves of S2-S4
Superior hypogastric plexus contains mostly ____ fibers.
sympathetic fibers.
but also parasympathetic fibers for the hindgut
Superior hypogastric plexus birfurcates into ____
2 right/left hypogastric nerves
Each hypogastric nerve fans out to form _____
inferior hypogastric plexus
Hypogastric nerve contains mostly _____
sympathetic fibers
but also parasympathetic fibers for hindgut
Hypogastric nerve diverges and curves in which direction?
outward bilaterally to the rectum
Inferior hypogastric plexus contains ____ fibers.
Sympathetic and parasympathetic
Inferior hypogastric is found where?
covering pelvis viscera bilaterally
What serves as the main autonomic plexus of the pelvis?
inferior hypogastric plexus
Sympathetic chain moves ___ as it descends in the pelvis and ultimately converges Where?
medial
Converges and terminates anterior to coccyx as GANGLION IMPAR
Splanchnic nerves innervate what structures? what happens if injured during surgery?
lateral rectum and uterus
injured during hysterectonomy, rectal surgery, prostate surgery
result = impaired bladder control/sexual function
Lymphatic drainage moves in what direction?
superficial to deep and ultimately superiorly
superficial below umbilicus moves inferiorly to inguinal region then deep then superiorly
What are the two ducts that drain the lympahtic system?
right lymphatic duct
thoracic duct
What does the right lymphatic duct drain?
Drains right head, neck, right upper limb, right upper thorax
What does the thoracic duct drain?
lymphatic system
left head and neck
left upper limb
most of thorax
abdomen, pelvis, lower limbs
Where are the right lymphatic ducts and thoracic ducts located?
thoracic duct at left venous angle
right lymphatic duct at right venous angle
How does the lymphatic system fix edema?
connection of ECM and venous system
