Pelvic vessels & nerves

Question 1

Ligaments connected to uterus

Answer 1

1. Round ligaments connect labia majora to uterus via Deep & Superficial Inguinal Rings
   
   • Causes pain during pregnancy
2. Broad ligament encloses uterus & uterine tubes & partially encloses the ovaries
3. Ovarian ligament medial to ovary
4. Suspensory ligament is lateral to ovary & contains ovarian vessels

Question 2

Describe the areas of supply of branches of Internal Iliac Artery in males & females

Answer 2

1. Internal Iliac
   
   • Posterior Division: “I Love Spaghetti”
     
     • ILeulumbar a.
     • Lateral sacral a
     • S. Gluteal a.
   • Anterior Division: everything else
     
     • Internal pudendal a.
     • Inferior gluteal a.
2. External Iliac -> Femoral a.

Question 3

Describe the course of Internal Pudendal a. and Pudendal n. in pelvis & perineurium

Answer 3

• Sciatic n. goes thru Greater Sciatic notch
• Pudendal n. goes thru Greater Sciatic notch, just inferior to Piriformis m. and Sciatic n.

Question 4

Blood supply to prostate & rectum

Answer 4

Arterial supply:

• Umbilical a.
• S. & I. Vesical a. (division of Internal Iliac a.)

Venous drainage

• S. & I. Vesical v.
• Middle rectal v.
• Prostatic venous plexus
• Obturator v.

Question 5

Describe the course of the uterine arteries across the pelvic floor. Explain how/where the female ureter is at risk during ligation of uterine vessels.

Answer 5

• Bridge over water
• Ureter b/w Uterine a. & Vaginal a.

Question 6

Describe the nervous pathways for control of erection, emission, and ejaculation - Preaortic ganglion

Answer 6

• Sacral splanchnics: sympathetic
• Pelvic splanchnics: parasympathetic
• Main fx is to deliver post ganglionic sympathetic fibres to sacral nerves
• However, sacral splanchnic nerves from these ganglia join with hypogastric n. to form I. Hypogastric plexus, supplying pelvic viscera
• Ant to coccyx the 2 trunks join together to form the ganglion.
• Pelvic extensions of preaortic plexus, consists of R. & L. hypogastric n.
• Parasympathetic outlfow from S2, 3, & 4 forms the pelvic splanchnics which joins hypogastric n. and forms the I. Hypogastric plexus which contains sympathetic, parasympathetic and visceral afferents
  *

Question 7

Structures potentially damaged by Prostatectomy

Answer 7

• Parts of I. Hypogastric/Prostatic Plexus of nerves may be removed or damaged resulting in impotence
• During Hysterectomy, similar nerves may be damaged

Question 8

Lymphatic drainage of Fundus with ovaries & uterine tubes & Vagina

Answer 8

• Lumbar nodes: Fundus (with ovaries & uterine tubes)
• External & Internal Iliac nodes: Body of uterus, cervix & upper vagina
• Superficial Inguinal nodes: Lower vagina, labia majora, labia minora
• Pelvic part of vagina: External & Internal Iliac lymph nodes
• Vaginal vestibule: Superficial Inguinal lymph nodes

Question 9

Lymphatic drainage of Male Repro?

Answer 9

• Prostate: Internal Iliac lymph nodes
• Ductus deferens: External Iliac
• Seminal vesicles: Internal Iliac
• Testes: Lumbar
• Scrotum: Superficial Inguinal
• Penis: Superficial inguinal from most of penis but Glans penis drains into Deep Inguinal

Question 10

Lymphatic drainage of pelvic contents (male & female)

Answer 10

• Bladder: Ext. & Int Iliac lymph nodes
• Rectum: Inferior Mesenteric
• Anal canal:
  
  • Above Pectinate line: Internal Iliac
  • Below Pectinate: Superficial Inguinal