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ANAT 214 > Pelvic Neurovasculature > Flashcards

Pelvic Neurovasculature Flashcards

1
Q

Describe abdominal aorta - what branches supply pelvic region

A

2 common iliac arteries
Transition to 2 lower limbs
Bypasses rectum
L4

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2
Q

Describe common iliac artery

A

4 cm long
Originate from aortic bifurcation at L4
Runs inferomedially, along medial aspect of psoas major
Ends over sacroiliac joint

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3
Q

What does common iliac artery give

A

Internal iliac artery = into lesser true pelvis, reaches pelvis and gives many brnaches, for pelvic cavity
External iliac artery = lower limb, outside = passes under inguinal lig and then becomes femoral

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4
Q

Describe internal iliac artery

A

1 on each side of pelvis
From common iliac artery
Courses inferiorly over pelvic inlet

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5
Q

Where does internal iliac artery divide

A

At level of greater sciatic foramen = divides into anterior trunk and posterior trunk

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6
Q

What does internal iliac artery divide into

A

Anterior trunk and posterior trunk

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7
Q

Describe anterior trunk of internal iliac

A

Aims anterior
To all pelvic viscera
Perinuem - erectile tissue
Gluteal region

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8
Q

Describe posterior trunk of internal iliac

A

Not for viscera
Lower abd wall
Posterior pelvic wall
Gluteal region - muscle mainly

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9
Q

What branches does posterior trunk give

A

Iliolumbar artery
Lateral sacral arteries
Superior gluteal Artery

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10
Q

Describe iliolumbar artery

A

Acends laterllay out of pelvic inlet
Will reach lumbar region and iliac bone and region

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11
Q

What branches does iliolumbar artery give

A

Lumbar branches = to post abd wall, psoas, quadratus
Iliac branches to iliac fosssa for iliacus muscle and iliac bone, colon sits here

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12
Q

Describe lateral sacral arteries

A

Course medically and inferiorly to posterior pelvic wall = skin, dermis, thoracolumbar fascia
Supplies sacrum and skin of sacral region
Feeds sacrum, passes through sacral formamina

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13
Q

describe superior gluteal artery

A

Largest and terminal branch of posterior trunk, int iliac artery
Leaves pelvis through greater sciatic foramen above piriformis
Supplies muscle and skin of gluteal region, part of lumbar and sacral plexus, between lumbosacral trunk and s1

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14
Q

What does anterior trunk of internal iliac give

A
  • Umbilical artery
  • Superior vesical artery
  • Inferior vesical
  • Vaginal artery
  • Uterine artery
  • Middle rectal artery
  • Obturator artery
  • Internal pudendal artery
  • Inferior gluteal artery
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15
Q

Describe umbilical artery

A

1st brnach of anterior trunk
Will give superior vesicle arteries
Rest of vessel is obliterated forming medial umbilical ligament- remnant of fetal circulation
No anatomical variation

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16
Q

Describe medial umbilical ligament

A

Bit lateral,remnant of obliterated umbilical artery, fibrotic tissue
When umbilical cord cut = segment of tube between bladder and umbilicus = collapse and becomes fibrotic
Recall*median umbilical ligament that suspends bladder

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17
Q

Describe superior vesical artery

A

Originates from umbilical artery
Supplies superior bladder and distal part of ureter
Little branches, right where obliterated portion starts

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18
Q

Describe anterior trunk amab branches

A

Inferior vesical artery = supplies bladder, ureter, seminal vesicles and prostate
Under bladder, = prostate, seminal vesicles,

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19
Q

Describe anterior trunk afab branches

A

Vaginal and uterine -variations

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20
Q

Describe uterine artery

A

Courses in broad ligament - transverse cervcial ligament - fibrotic thickening protecting uterine and vaginal arteries
Crosses ureter to reach cervix
Supplies = uterus, also contributes to ovary and vagina vasculature
From lateral pelvis to lateral cervix

21
Q

Describe vaginal artery

A

Euqavlent of inferior vesicle in amab
Somtimes from uterine artery
Supplies = vagina, bladder and rectum

22
Q

Describe what afab arteries/veins do

A

Ovarian connects with uterine connects with vaginal
All interconnected
Veins do the same = big venous system
Anastomotic system
Link to vulvar region

23
Q

Describe middle rectal artery

A

Course medially to supply rectum
Anastomoses with superior rectal artery - from inf mesenteric artery and ifnerior rectal artery - from internal pudendal of perinuem

24
Q

Describe obturator artery

A

Courses anteriorly along pelvic wall
Leaves pelvic cavity through obturator Foramen, from ant wall
Supplies medial adductor region of thighs

25
Q

Describe internal pudendal arteyr

A

Leaves pelvic cavity through greater sciatic foramen inf to piriformis
Loops around ischial spine and sacrospinous ligament
Enters lesser sciatic foramen to reach perineum
Supplies perineum (urogenital and anogenital triangles) and related structures

26
Q

Describe inferior gluteal artery

A

Terminal branch of internal iliac
Passes between sacral nerve s2 and s3
Leaves pelvic cavity through greater sciatic foramen ifnerior to pirifomis

27
Q

How to tell apart inferior gluteal and internal pudendal

A

Inferior gluteal = post posterior vessel
Compared to internal pudendal -more anterior - close to tip of coccygeus muscle

28
Q

Describe veins - Gen

A

Follow course of arteries
Except for umbilical and iliolumbar arteries = no veins

29
Q

Name all veins

A
  • Superior vesical vein
  • Inferior vesical / vaginal vein * Uterine vein
  • Middle rectal vein
  • Obturator vein
  • Internal pudendal vein
  • Inferior gluteal vein
30
Q

Describe drainage of pelvic cavity- Gen

A

Veins drain into internal iliac vein
Leaves pelvic cavity
Joints external iliac vein
Form common iliac vein
2 iliac vein- one on each side - join to form Ivc
*drains INTO CAVAL system not portal system

31
Q

Describe drainage of pelvic cavity - plexuses

A

Venous drainage of Pelvic cavity: interconnected venous plexuses Associated with organs:
Bladder, rectum, prostate, uterus, vagina
All together to form pelvic venous plexus

32
Q

Describe portosystemic anastomosis- gen

A

Superior rectal = inf mesenteric vein - portal system (portal)
Middle rectal = internal iliac - systemic (CAVAL)
Inferior rectal = internal pudendal - systemic (CAVAL)

33
Q

Describe portosystemic anastomosis - specifics issue

A

If porto caval hypertension
Blood pools, superior rectal cannot drain since drains into portal system
So mid and inf rectal veins drain into ivc, so sup rectal vein no longer capable fo absorbing blood so pools down into mid and inf rectal veins = swollen, hemorrhoids

34
Q

Describe pelvic congestion syndrome - pcs

A

Medical condition that causes chronic pelvic pain in afab
Due to reduced venous drainage form left ovarian vein
Could lead to Vulvar varicosities
Network ovarian vessels, Anastomose with uterine and vaginal = veins reach vulva - during cycle = pain, congestion, discomfort

35
Q

Describe somatic innervation of pelvis

A

Sacral plexus and perinuem

36
Q

Describe sacral plexus - somatic innervation

A

Formed by ant rami of s1-4 (each comes from sacral foramina)+ l4-5 = lumbosacral, joins to form big nerve
Found on anterior surface of priformis
Mostly for lower lim but also for pelvis and perinuem =forms sacral plexus, motor and sensory to lower limb and post thigh
= sciatic nerve, biggest nerve, leaves via greater sciatic formaen under piriformis

37
Q

Describe perineum - somatic innervation

A

Pudendal nerve s2,3,4 = motor and sensory
Leaves pelvic cavity through greater sciatic foramen udner piriformis
Pass around sacrospinous ligament and loops over ischial spine
Through lesser sciatic foramen to reach perineum with internal pudendal vessels

38
Q

Describe pudendal block

A

Pudendal block: Anesthesia is performed by infiltration near attachment of sacrospinous ligament, ischial spine

39
Q

Describe superior hypogastric plexus

A

Same as aortic plexus but below aortic bifurcation
Connected to inferior hypogastric plexus via hypogastric nerv
Below stomach, bifurcation around rectum, extension, hypogastric nerv and will reach inf hypo plexus

40
Q

Describe visceral innervation - Gen

A

Plevic extension of superior hypogastric plexus
Carry autonomic innervation - sympathetic and parasympathetic
Enter pelvis via 2 hypogastric nerves, one on each side
Will form inferior hypogastric plexus, around plevic vsicera
*vagus doesn’t supply hindgut, stops 2/3 trasnverse colon

41
Q

Describe visceral innervation - pathway

A

Lumbo sacral trunk —>lumbo sacral plexus
Sacral splanchnic = leaves chain, sympathetic,reaches inf hypogastric plexus
Pelvic splanchnic = parasympathetic,leaving sacral nerve
SPLANchNIc NOT JUST PSNS - sns too

42
Q

Describe visceral innervation sympathetic - paravertebral sympathetic trunk

A

Inferior end of sympathetic trunk in pelvic cavity Pass anterior to paramedial aspect of sacrum, Join to form one terminal single ganglion (impar)

43
Q

Describe visceral innervation sympathetic - paravertebral sympathetic trunk DISTRIBUTIONN

A

Postganglionic fibers reach sacral nerves
Preganglionic fibers reach inferior hypogastric plexus by using a splanchnic nerve
Sympathetic: S = Sacral splanchnic nerves

44
Q

Describe visceral parasympathetic invvertaion

A

Originate from S2-S4 anterior rami of sacral nerve
Carry preganglionic parasympathetic fibres to inferior hypogastric plexus
Pelvic splanchnic nerves (S2-S4): P=Parasympathetic

45
Q

Describe direction of symp/parasymp

A

Vagus goes down therefore psns (ascending) goes up
And sns goes Down (descending)

46
Q

Describe psns and action

A

From pelvic splanchnic
Action:
* Generally vasodilator of vessels
* Stimulate bladder contraction: voiding
* Stimulate erection: Relaxation of branches of deep penile arteries
* Modulate activity of hindgut

47
Q

Describe sns and action

A

Enters from hypogastric nerve & sacral splanchnic
Action:
* Innervate blood vessels
* Cause contraction of internal urethral sphincter
* Cause contraction of smooth muscle associated with reproductive
tract, accessory glands
* Peristalsis for moving secretion of epididymis and associated
glands during ejaculation

48
Q

Describe pathway of parasympathetic

A

S2,3,4 —> pelvic splanchnic —> Reach inf hypogastric plexus —> Hypogastric nerve —> superior hypogastric plexus —> Aortic plexus —> Inferior mesenteric artery and plexus —> Hindgut

ANAT 214 (34 decks)

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