Pelvic Neurovasculature Flashcards
The (superficial) epigastric anastomoses with what?
Paraumbilical a.
Which vessel is a branch off the abdominal aorta right at the bifurcation that travels right down the midline of the sacrum?
Median sacral a.
What are the 3 branches of the posterior trunk of the internal iliac
Iliolumbar a, lateral sacral aa, and superior gluteal a.
Which artery runs between the iliac crest and L5 and what does it supply?
Iliolumbar; medial ilium and L5
Where does the lateral sacral a enter and what does it supply?
ventral sacral foramina; sacrum and ventral sacral nn.
Which artery runs between the ventral rami L5 and S1? Where does it enter the gluteal region?
Superior gluteal a.; in the greater sciatic foramen superior to the piriformis
Which ventral rami does the inferior gluteal a. run through? Where does it exit the pelvic cavity?
S2-S3 (sometimes S1-S2); greater sciatic foramen inferior to piriformis
Which 3 nn exit thru the greater sciatic foramen?
Sup gluteal, inf gluteal, and pudendal nn.
Which artery enters the gluteal region inferomedially to the piriformis? What does it supply? Where does it re-enter the pelvic cavity?
Internal pudendal; Urogenital and anal triangles; lesser sciatic foramen
Which artery is responsible for supplying erectile tissue?
Internal pudendal
Which structure carries the internal pudendal a. and pudendal n. in the pelvis? What forms this structure?
Pudendal canal; fascia of the obturator internus m
What are the 7-8 vessels of the anterior trunk of the internal iliac?
Umbilical a., sup vesical, obturator, uterine a (females), Vaginal (females)/Inf vesical (males), internal pudendal, inferior gluteal, and middle rectal
The umbilical artery is usually the first branch off the anterior trunk and runs toward the ant abdominal wall where it terminates as what?
medial umbilical ligaments
Which vessel sends off 3-4 superior vesical arteries
The umbilical a.
What does the obturator a. supply?
Medial thigh
Where do the proximal ductus deferens and seminal vesicles receive blood from?
Superior vesical aa.
What anastomosis is called the corona mortis or “crown of death”? Why?
Anastamosis of a branch of the obturator a. with the inferior epigastric aa which are branches off the external iliac; these branches are both early branches so damage opens the internal and external iliac systems
Where do we have an anastomosis between the iliac artery and the abdominal aorta?
Between the ovarian a (from aorta) and uterine a (internal iliac)
What does the uterine a supply?
uterus, cervix, and superior vaginal canal
The ureter runs ___ the uterine a
below
Which a supplies the inferior vaginal and the adjacent bladder and rectum?
vaginal a
The vaginal a is homologous to what male vessel?
Inferior vesical
The rectum has anastomoses from 3 different sources, what are they?
Middle rectal (from anterior internal iliac), superior rectal (IMA), and inferior rectal (from internal pudendal)
Where does the superior rectal a branch from?
IMA
Where does the inferior rectal a branch from?
internal pudendal
The ureter runs between which two arteries?
Uterine and vaginal
What does the inferior vesical artery supply?
posterior inferior bladder, ureter, seminal vesicle, and prostate
What is an artery only present in males?
Inferior vesical a
What is the portal-caval anastomosis associated with the pelvic cavity?
Superior rectal vv (from IMA) with the middle and inferior rectal (from internal iliac)
What is the downside to valveless veins within plexuses?
metastasis, which is where an open flow of bad things (tumor cells) can openly flow between systems
The primary nerve plexus of the pelvic cavity is called what? It is formed by contribution from which 3 sets of nerves?
Inferior hypogastric plexus (pelvic plexus); hypogastric nn., sacral splanchnic nn. (sympathetic), and pelvic splanchnic nn (parasympathetic)
Which vessels form the sciatic n?
The anterior rami of spinal nerve L4-S3
The sacral plexus is what kind of innervation?
Somatic
Which nerves make up the sacral plexus?
Sciatic, gluteal, and pudendal nn
Which ventral rami form the lumbosacral trunk?
L4-L5
Which ventral rami emerge through the piriformis?
S2-S3
Which ventral rami contribute to the pudendal n?
S2-S4
Which ventral rami contribute to the sciatic and gluteal nn?
L4-S3
Sympathetic fibers from which vertebral levels form the prevertebral plexus of the pelvis?
T10-L2(3)
The sympathetics from which vertebral levels form the sacral splanchnic nn?
S2-S4
Describe the travel of parasympathetic fibers from the pelvis to the hindgut
pelvic splanchnic parasympathetics branch off ventral rami -> inf hypogastric plexus -> hypogastric n -> sup hypogastric plexus -> hindgut structures
What is a condensation between the inferior hypogastric plexus and superior hypogastric plexus?
hypogastric n
Where do the sacral splanchnics feed into?
Inf hypogastric plexus
The hypogastric n contains mostly sympathetic or parasympathetic fibers?
Sympathetic
What is the main autonomic plexus of the pelvis?
Inferior hypogastric plexus
The gray rami communicantes deliver what kind of fibers to anterior rami of the sacral nn for distribution ot periphery?
postganglionic sympathetic fibers
The pelvic sympathetic chain is ___ to the sacral foramen?
medial
The sympathetic trunk converges and terminates anterior to the ____ as _____
coccyx; ganglion impar
Which nn can be easily injured in hysterectomies and prostate surgeries which can lead to impaired bladder control or sexual function?
The splanchnics (pelvic and sacral)
Where does the lymphatic system begin?
In the ECM in the capillary beds
Describe the lymphatic drainage pathway.
Superficial below umbilicus -> inferiorly to inguinal -> then deep -> then superiorly -> cisterna chyli -> thoracic duct
Where is the thoracic duct?
Left side, root of neck, left venous angle
What is the venous angle?
between left subclavian and internal jugular
Why are we concerned with lymphatics?
It’s how we manage edema as the lymphatic system is connection between the ECM and venous system
In general terms, where does lymph travel
through vessels, nodes, and cisterna
