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Anatomy Unit 4 > Pelvic Fascia, Vessels, Nerves, Rectum, Anal Canal > Flashcards

Pelvic Fascia, Vessels, Nerves, Rectum, Anal Canal Flashcards

1
Q

What makes the anterior wall of the pelvic cavity?

A

pubic bone + pubic symphysis, and anterior portions of levator ani muscles.

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2
Q

What makes up the lateral wall of the pelvic cavity? Include bone, muscles, vessels, and fascia

A

Ilium, ischium, obturatur internus muscle and fascia, lateral portions of levator ani muscle, obturator artery + nerve and other branches of internal iliac artery

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3
Q

What makes up the posterior wall of the pelvic cavity?

A

Sacrum, coccyx, sacroiliac joint, sacrotuberous + sacrospinous ligaments, piriformis + coccygeal muscles, sacral plexus, autonomic plexuses, and branches of internal iliac artery

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4
Q

What makes up the inferior wall of the pelvic cavity?

A

UG diaphragm, puborectalis muscle

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5
Q

What is the origin of the internal and external iliac arteries?

A

They are branches of the common iliac artery, which are branches of the abdominal aorta around LV4.
External iliac goes towards the lower limb
Internal iliac goes towards the pelvis / perineum

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6
Q

What are the two major branches of the internal iliac artery? Which one has the greatest difference between genders?

A

Anterior and posterior trunk.

Anterior trunk has the greater variation

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7
Q

What are the three branches of the posterior trunk of the internal iliac and where do they go?

A
  1. Iliolumbar - First branch, travels upward to posterior abdominal wall and iliac fossa following lumbosacral trunk
  2. Lateral sacral - pass through anterior sacral foramina to supply sacral canal
  3. Superior gluteal - to supply gluteal muscles and skin
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8
Q

What is the path of the superior gluteal artery?

A

Branch of posterior trunk of internal iliac artery, goes between lumbosacral trunk and S1 superior to the piriformis muscle and enters gluteal region

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9
Q

What is the umbilical artery and what is its primary branch seen in adults?

A

Vestigial remnant which carried blood from fetus to placenta, can be found as a peritoneal fold.

It arises from the anterior trunk of internal iliac, and its primary branch is the superior vesical artery

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10
Q

What does the superior vesical artery?

A

Branch of anterior trunk of internal iliac, arises from umbilical artery to supply the bladder and distal ureter

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11
Q

What is the inferior vesical artery and how does it differ in males and females?

A

Branch of anterior trunk of internal iliac, supplies inferior bladder, seminal vesical, prostate, and ureter.

In females, there is typically no inferior vesical artery and blood to the inferior bladder is supplied by the vaginal artery.

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12
Q

What is the middle rectal artery? What does it anastomose with?

A

Branch of anterior trunk of internal iliac, it runs medially to supply middle rectal area.

Anastomoses with:

  1. Superior rectal - from IMA
  2. Inferior rectal - from internal pudental
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13
Q

What is the obturator artery? What are common variants?

A

Branch of anterior trunk of internal iliac artery, accompanies obturator nerve to supply medial thigh.

Variants:
Often branches from external iliac artery or inferior epigastric artery

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14
Q

What is the internal pudendal artery?

A

Branch of anterior trunk of internal iliac, exits pelvis through greater sciatic foramen inferior to piriformis, returns through lesser sciatic foramen with pudendal nerve and supplies perineum after passing thru pudendal canal.

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15
Q

What is the inferior gluteal artery? How can it be distingushed from superior gluteal?

A

Branch of anterior trunk of internal iliac, exits pelvis through greater sciatic foramen passing between S1-S3 (one of two) and supplying gluteal region and hip joint.

Remember, superior gluteal passes between lumbosacral and S1 and is a branch of posterior trunk.

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16
Q

Where does the ovarian artery travel?

A

It is a branch of the abdominal aorta, travels in suspensory ligament of the ovary. (Testicular is also a gonadal artery and enters inguinal canal)

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17
Q

What is the median sacral artery?

A

Artery the arises posterior to the aorta bifurcation and anastomoses with lateral sacral artery (from posterior trunk) and iliolumbar aterties

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18
Q

What are the two special arteries of the anterior trunk of the internal iliac artery for females?

A
  1. Uterine artery - courses in the broad ligament to reach cervix, ascends lateral to uterus to reach uterine tube where it anastomoses with ovarian artery, passes superior to the ureter
  2. Vaginal artery - branch of uterine but may be from anterior trunk, supplies vagina, inferior bladder, and rectum
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19
Q

What is the important relationship of the uterine artery?

A

Goes superior around the ureter (water under the bridge)

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20
Q

What is the significance of the venous plexuses around pelvic organs?

A

They are found on the surface, and are named accordingly (i.e. rectal, prostatic, uterine, vaginal, vesical, etc)

They have no valves, and anastomose with vertebral venous plexuses + lumbar veins and can thus allow for the extensive spread of cancer.

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21
Q

Where is the important portal-systemic anastomosis in the pelvis?

A

Between the systemic middle (from internal iliac vein) and inferior (from internal pudendal) rectal veins and portal superior rectal vein (from IMV).

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22
Q

Where do all the venous plexuses of the pelvis ultimately drain?

A

Respective branches of the internal iliac vein and thus the inferior vena cava

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23
Q

Where does ovarian / testicular lymph drain?

A

Directly into aortic lymph nodes by following the branching of the gonadal vessels from the abdominal aorta

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24
Q

Where does lymph of the pelvis drain and why are structures close to the surface different?

A

Lymph ultimately follows iliac arteries to drain into the aortic nodes.

However, structures close to the surface (i.e. lower vagina, anal canal, scrotum) drain into the inguinal nodes first

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25
Q

What is the sacral plexus? That is, what spinal cord segments and where is it located?

A

Nerve plexus formed by anterior rami of S1-S4 as well as lumbosacral trunk (L4, L5). It is located on the medial surface of the piriformis muscle and gives motor and sensory to pelvis and lower limb

26
Q

What is the coccygeal plexus?

A

A small plexus derived from S4-S5, and CO. It is sensory to the skin of the perianal skin of anal triangle and sacrococcygeal joint via the anococcygeal nerves

27
Q

What is the sciatic nerve?

A

Largest nerve of sacral plexus, from L4-S3. It is motor to posterior thigh, all of leg and foot

28
Q

What is the posterior femoral cutaneous nerve?

A

Sacral plexus nerve which is sensory to posterior femoral region

29
Q

What is the superior gluteal nerve and what are its spinal cord segments?

A

L4-S1, motor to gluteus medius / minimus, tensor fascia lata.

Exits above the piriformis muscle

30
Q

What is the inferior gluteal nerve and what are its spinal segments?

A

Shift down 1 from superior gluteal: L5-S2. Exits behind the sacrospinous ligament to innervate gluteus maximus

31
Q

What is the pudendal nerve?

A

Branch of sacral plexus, motor to external urethral and anal sphincters, levator ani, sensory to skin of perineum, penis, and clitoris - S2-4

32
Q

Where do the pelvis splanchnics come from?

A

S2-4, for parasympathetics

33
Q

What are the minor branches of the sacral plexus?

A

Nerve to obturator internus + superior gemellus, nerve to quadratus femoris and inferior gemellus, nerve to piriformis, nerves to levator ani, coccygeus, and external anal sphincters, contributions to coccygeal plexus

34
Q

What is the superior hypogastric plexus? What does it split into?

A

An autonomic plexus carrying both SANS and PANS from the sympathetic trunk and pelvic splanchnics to the lower digestive tract up to the splenic flexure.

Splits into left and right hypogastric nerves

35
Q

What do the left and right hypogastric nerves become?

A

They become the inferior hypogastric plexus

36
Q

What is the inferior hypogastric plexus?

A

A plexus formed by sacral splanchnic SANS nerves from sympathetic trunk (which continued into pelvis) as well as pelvic splanchnic nerves for PANS.

37
Q

Where do the PANS and SANS of the inferior hypogastric plexus go?

A

Pelvic viscera, external genitalia, and lower digestive tract in the case of the pelvic splanchnics (PANS)

38
Q

What is endopelvic fascia? What are its two names?

A

A continuation of extraperitoneal connective tissue of abdomen

Visceral - where it envelops pelvic organs with false capsules
Parietal - where it lines muscular walls of pelvis

They are continuous where pelvic walls and viscera meet

39
Q

What are the three specializations of the parietal endopelvic fascia?

A
  1. Tendinous arch of levator ani - attachment of pelvic diaphragm to obturator internus
  2. Pudendal canal - from fascia of obturator internus in ischioanal fossa
  3. Superior + inferior fascia of pelvic diaphragm - inferior fascia is continuous with the external anal sphincter and fuses with the fascia of the UG diaphragm
40
Q

What are the specializations of visceral endopelvic fascia?

A
  1. Neurovascular sheaths
  2. Fascial ligaments - support pelvic organs, attach to pelvic walls and more centrally located as viscera and often contain NV bundles - much like a mesentery
41
Q

What is the rectouterine pouch?

A

Pouch of peritoneum only in females which is partially covering and between the rectum and the uterus. It is the most inferior pouch of peritoneum.

42
Q

What is the vesicouterine pouch?

A

Pouch of peritoneum only in females which is partially covering and between the bladder and the uterus.

43
Q

What is the rectovesical pouch?

A

Pouch of peritoneum only in males which is partially covering and between the bladder and the rectum.

44
Q

Between what two junctions does the rectum extend?

A

From rectosigmoid junction (~SV3) to anorectal junction (where it passes through pelvic diaphragm)

45
Q

What shape does the rectum follow and why?

A

Follows contours of the sacrum in the presacral space to turn laterally 3 times (2 to the right and 1 to the left). It is pulled forward between rectum and anal canal by the puborectalis muscle

46
Q

What are transverse rectal folds?

A

Two folds of the mucosa / muscle between the three flexures of the rectum which can be covered in cancer / polyps

47
Q

What is the most distensible part of the rectum? What is its normal state?

A

The most distal part, called the ampulla

Normal state: empty, except just prior to defecation

48
Q

What are the pararectal fossae?

A

Folds of the peritoneum anterior and lateral to the superior part of rectum. The rectum has no mesentery, taenia coli, or epiploic appendages because of this.

49
Q

Where are the columns, valves, and sinuses of the anal canal?

A

Where the mucosa lining has a number of recesses, sinuses and columns between them at the pectinate line. This is where you have stratified, keratinized skin

50
Q

What controls the internal anal sphincter?

A

Parasympathetic innervation

51
Q

What controls the external anal sphincter? What part is special?

A

Voluntary control. It has a deep, superficial, and subcutaneous part. The deep part is special because it is formed from part of the puborectalis muscle

52
Q

Where does the anal canal extend?

A

From anorectal junction to the anus

53
Q

What arteries supply the anal canal above and below the pectinate line? Why do their associated veins matter?

A

Above: superior and middle rectal arteries
Below: inferior rectal artery

They are associated with veins of the same name, which freely anastomose to form 2 venous plexuses

54
Q

What are the two venous plexuses of the anal canal and what are their names?

A

Internal rectal plexus - between internal anal sphincter and mucosal covering of canal; drains into superior rectal vein (portal)
External rectal plexus - Surrounds external sphincter on both sides and drains into middle and inferior rectal veins (systemic)

They anastomose

55
Q

Where does lymph drain below pectinate line?

A

Superficial inguinal nodes

56
Q

Where does upper rectum and anal canal above the pectinate line lymph drain?

A

Internal iliac nodes + aortic nodes.

Upper rectum = superior rectal artery -> inferior mesenteric nodes -> aortic nodes

57
Q

What innervates the blood vessels above the pectinate line?

A

Sympathetics - vasomotor

58
Q

What innervates the smooth muscle including internal anal sphincter above the pectinate line?

A

PANS - pelvis splanchnics -> relaxation

SANS - sacral splanchnics -> contraction

59
Q

What is the primary sensation above the pectinate line provided by?

A

Pelvic splanchnics (PANS) sense distention but not pain

60
Q

What provides innervation to the anal canal below the pectinate line?

A

Pudendal nerve and branches from sacral plexus to the external anal sphincter

Just pudendal nerve for pain, temperature, and touch sensation

61
Q

What are internal vs external hemorrhoids?

A

Internal - above pectinate line, affecting internal venous plexus. Not painful but may bleed and become strangulated (no sensory innervation)

External - below pectinate line, affecting external venous plexus. Highly innervated, painful, and itchy, may contain blood clots.

Anatomy Unit 4 (10 decks)

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