Pelvic Neurovasculature Flashcards
Abdominal aorta
Splits along the coronal plane into R and L Common Iliac arteries
Left and Right Common Iliac arteries
Splits along the sagittal plane into external and internal iliac arteries
External Iliac artery
Exits the pelvis as the femoral artery inferior to the inguinal ligament
Travels alongside the external iliac vein
Gives off inferior epigastric artery
Internal Iliac artery
Supplies the pelvic organs and gluteal region
Has posterior and anterior branches
What are the branches of the posterior division Internal Iliac artery
Iliolumbar artery
Lateral Sacral artery
Superior Gluteal artery
Iliolumbar artery location
Between the iliac crest and L5
Iliolumbary artery supply
Medial ilium and L5
Lateral sacral artery location
Enters the ventral sacral foramina
Lateral sacral artery supply
Sacrum with ventral sacral nerves
Superior Gluteal artery location
Between L5 and S1
Enters the gluteal region superior to the piriformis
Superior Gluteal artery supply
Gluteus muscles with Superior Gluteal nerves
Inferior Gluteal artery location
Superior or inferior to S2 (varies) and inferior to piriformis muscle
Inferior Gluteal artery supply
Gluteal muscles with Infer Gluteal nerve
Internal Pudenal artery location
Runs with Pudenal nerve
Exits the pelvis through the greater sciatic foramen
Enters the gluteal region inferomedially to piriformis
Crosses over the sacrospinous ligament, and re-enters the pelvis through the lesser sciatic formen
Internal Pudenal artery supply
Urogenital triangle and anal canal
Pudenal canal
Contains the internal pudenal artery and pudenal nerve in the back of the pelvis
Formed by fascia of obturator internis
Runs anteriorly along isciobuc ramus toward the UG triangle
Contents supply the UG triangle
What are the branches of the anterior division of the Internal Iliac artery
Obturatory artery Umbilical artery Middle Rectal artery Uterine artery (f) Vaginal artery (f) or Inferior Visceral artery (m) Internal pudendal Inferior gluteal
Umbilical artery location
Runs towards the abdominal wall and ends as the umbilical ligament
Umbilical artery supply
The bladder
Obturator artery location
Runs through the obturator canal
Obturator artery supply
Medial thigh with the obturator never
Uterine artery location
Runs toward the uterus/vagina
Anastamoses with the ovarian artery of the aorta
Females only
Uterine artery supply
Uterus
Cervix
Superior vaginal canal
Vaginal artery supply
Suplies the inferior vagina, adjacent bladder, and rectum
Females only
Inferior Visceral artery supply
Supplies posterior inferior bladder, ureter, seminal vesicle, and prostate
Middle Rectal artery location
The last branch of the anterior division of the Internal Iliac artery
Middle Rectal artery supply
Rectum
Corona mortis
“crown of death”
Anastomoses vessel between obturator artery and inferior epigastric artery
A rupture opens the internal and external iliac systems and causes death within minutes
Venous drainage of the pelvis, perineum, and gluteal region
All veins in this region mirror the arteries and share the same names
Pelvic venous plexus
Venous network surrounding the bladder, prostate/uterus, and rectum
Plexuses intercommunicate prior to forming veins
Valveless, so venous hypertension or transportation of tumor cells can occur
What provides somatic innervation to the pelvis?
Sacral Plexus
What provides autonomic innervation to the pelvis?
Autonomic plexus
What are the divisions of the sacral plexus?
L4-L5 S1 S2-S3 S2-S4 L4-S3
L4-L5 division of the sacral plexus
Forms the lumbosacral trunk over the sacral ala
S1 division of the sacral plexus
Emerges above the piriformis muscle
S2-S3 division of the sacral plexus
Emerges through the piriformis muscle
S2-S4 division of the sacral plexus
Contributes to the pudenal nerve
L4-S3 division of the sacral plexus
Forms the sciatic and gluteal nerves
Sympathetic innervation of the pelvis
T10-L2/3 = Thoracolumbar
Prevertebral plexus
Sympathetics from S2-S4 is the sacralsplanchnic nerve
Parasympathetic innervation of the pelvis
Craniosacral
S2-S4
Pelvic splanchnic nerve
Superior Hypogastric Plexus
Mostly sympathetics fibers
Bundle of nerves from bifurcation of the aorta to the upper sacrum
Condenses to form 2 hypogastric nerves
Hypogastric Nerve to Inferior Plexus
Mostly sympathetic fibers
Condensed bifurcated sup. hypogastric plexus
Diverge and curve outward bilaterally to rectum
Expands to form Inferior Hypogastric Plexus
Inferior Hypogastric Plexus
Contains both sympathetic and parasympathetic fibers
Main autonomic plexus of the pelvis
Covers the pelvic viscera bilaterally
Sympathetic Chains and Ganglia
In the thorax, the chains are lateral to vertebrae - they go more medially as the descend
Pelvic sympathetic fibers
Chains medial to sacral foramen
Converge and terminate anterior to coccyx as ganglion impar
Sacral splanchnic nerves
Sympathetic fibers off sympathetic chain
Pelvic splanchnic nerves
Parasympathetic fibers off S2-S4
Sacral and Pelvic splanchnic nerves
Both enter inferior hypogastric plexus
Fibers travel on arterial branches to pelvic organs
What are consequences to damage of the pelvic splanchnic nerves
Splanchnic nerves are closely related to lateral rectum and uterus
Easily injured during rectal surgery or radical hysterectomy
Results in impaired bladder control or sexual function
Where are lymphatic vessels and nodes for the pelvis located?
Along the Aorta, IVC, and iliac vessels
How do lymphatics of the pelvis travel?
Superficial to deep, and then superiorly
- as it does this, it passes through several nodes
- if it below the umbilicus, it travels inferiorly to inguinal, then deep, then superiorly
(T/F) Each organs has its own lymphatic drainage?
True
What does the Right Lymphatic duct drain?
R head and neck
R upper limb
R thorax
What does the Left Lymphatic duct drain?
L head and neck
L upper limb
Remainder of the thorax
Abdomen, pelvic, and both lower limbs
