Pelvic Neurovasculature Flashcards
components of the sacral plexus
- superior gluteal
- inferior gluteal
- sciatic
- posterior femoral cutaneous
- nerves to obturator internus
- nerves to quadratus femoris
- pudendal
nerve roots of superior gluteal nerve
L4-S1
nerve roots inferior gluteal n
L5-S2
nerve roots sciatic nerve
L4-S3
nerve root posterior cutaneous
S1-S3
nerve root nerve to obturator internus
L5-S2
nerve root nerve to quadratus femoris
L4-S1
nerve root pudendal nerve
S2-S4
nerve root lumbosacral trunk
L4-L5
positions of S2-S3
are usually joined or close together
path of the superior gluteal nerve
above piriformis
path of inferior gluteal nerve
below piriformis (or at piriformis?)
path of pudendal nerve
out of the greater sciatic foramen back into the lesser sciatic foramen under the sacrospinous ligament, then through the pudendal canal along the inferior ischial ramus
where is pudendal canal located
within fascia of obturator internus muscle
what does the pudendal canal contain
pudendal nerve, pudendal artery, pudendal vein
branches of pudendal nerve
- inferior rectal
- perineal
- dorsal nerve of penis or clitoris
- posterior scrotal or labial
what does the inferior rectal nerve supply
motor: external anal sphincter
sensory: skin around anus
what does the perineal nerve supply
motor: all superficial and deep space muscles
sensory: perineum
what does the dorsal nerve of penis or clitoris supply
sensory for penis or clit
what does the posterior scrotal or labial supply
sensory for scrotum or labia
test for pudendal neuropathies
bulbocavernosus/bulbispongiosus reflex (pull on penis and external anal sphincter contracts)
sympathetic innervation of the pelvic cavity
sacral splanchnics and hypogastric nerves from the lumbar splanchnics
explain where the hypogastric nerves come from to innervate the pelvic cavity
they come from superior hypogastric plexus, which arises from the lumbar splanchnics (L3-L4), and then post synaptic fibers travel with the blood vessels to pelvic viscera
parasympathetic innervation pelvic cavity
pelvic splanchnics (S2-S4)
what is the (superior) hypogastric plexus composed of
networks of sympathetic and visceral afferent fibers
describe the autonomic innervation of the pelvic cavity
- the superior hypogastric plexus made up of sympathetic and visceral afferents splits into the right and left hypogastric nerves
- this combination of sympathetic sacral splanchnics meets up with parasympathetic pelvic splanchnic to make the inferior hypogastric plexus
what are the hypogastric plexusus made of
sympathetic fibers, parasympathetic fibers, and visceral afferents
function of the sympathetic portion of the hypogastric plexus
- vasoconstriction
- contract internal urethral and anal sphincters
- ejaculation
function of the parasympathetic portion of the hypogastric plexus
- vasodilation
- stimulate bladder contraction for urination
- stimulate rectum/anal canal for defecation
- stimulate erection
explain point and shoot
P=parasympathetics=vasodilation and erection
S=sympathetics=ejaculation
describe the pelvic pain line/sensory information in the pelvis
sensory information travels into the pelvis with sympathetic vessel up until the perineum, then under the perineum sensory travels with parasympathetics
relate pelvic pain line and pectinate line of the anus
sensory information travels into the pelvis with the sympathetic system, but under the pelvic pain line, sensory travels with parasympathetics. once the pectinate line is crossed, it becomes somatic via inferior rectal branches of pudendal nerve
where does the IVC bifurcate
L5
what does the anterior trunk of the internal iliac artery supply
primarily visceral branches supplying pelvic viscera, perineum, gluteal region, and adductor region
branches off the anterior trunk of the internal iliac artery
- obturator
- umbilical
- middle rectal
- vesical
- inferior gluteal
- internal pudendal
what does the posterior trunk of the internal iliac artery supplly
parietal branches, posterior pelvic wall, lower posterior abdominal wall, gluteal region
branches off the posterior trunk of the internal iliac artery
- iliolumbar
- superior gluteal
- lateral sacral branches
where does the superior gluteal artery exit
through the greater sciatic foramen ABOVE piriformis, usually between lumbosacral trunk and S1
where does the iliolumbar artery travel
runs with lumbosacral trunk upward
how to identify the umbilical artery
runs toward the anterior abdominal wall and obliterates into connective tissue as the medial umbilical ligament
describe the course of the internal pudendal artery
continues off of the anterior trunk through the pudendal canal with the pudendal nerve between obturator internus and levator ani
what branches does the vesical artery give off
seminal and prostatic
what are the anastamoses of the rectal arteries?
- superior rectal from IMA
- middle rectal from internal iliac
- inferior rectal from internal pudendal
what vasculature is different in males and females?
males have inferior vesical artery that gives off ductus deferens, seminal and prostatic branches; females have the the vaginal artery (equivalent of inferior vesical) and uterine artery
describe the position of the ureter in female vasculature
ureter travels UNDER the uterine artery
what is a common deviance from normal anatomy in the anterior of the pelvis
sometimes the obturator gives off accessory obturator artery which meets up with the inferior epigastric artery
describe lymph flow in the gonads
gonads (ovaries and testes) and kidneys do not follow normal lymph flow, they flow straight up to the lumbar nodes
describe lymph flow in the gonads
gonads (ovaries and testes) and kidneys do not follow normal lymph flow, they flow straight up to the lumbar nodes/trunk
describe lymph flow in the uterus
body and cervix flow into pelvic lymph nodes/internal iliac nodes, then up to lateral aortic/lumbar nodes
what structures drain into the deep inguinal nodes
- glans penis/clitoris
- labia minor
- lower part of vagina
what structures drain into the superficial inguinal nodes
- superficial tissues of penis and scrotum
2. superficial tissues of clitoris and labia majora
trace flow of lymph from the external genitalia
superficial inguinal nodes to the external iliac nodes, to the lateral aortic lumbar nodes, to the thoracic duct
trace flow of lymph from the gonads
gonadal vessels take lymph from testes and ovaries straight to the lumbar nodes
