Pelvic Vessels, Nerves, and Lymphatics

Question 1

What major vessel has branches responsible for supplying the pelvic structures?

Answer 1

Abdominal aorta

Question 2

What branches of the abdominal aorta supply the ovaries?

Answer 2

Ovarian aa.

Question 3

What branch off the abdominal aorta supplies the lower lumbar vertebrae, sacrum, and coccyx?

Answer 3

Middle (median) sacral a.

Question 4

The common iliac arteries bifurcate at the level of _____ intervertebral disc into the _____ and ______ iliac arteries

Answer 4

L5-S1; external; internal

Question 5

The external iliac artery becomes the ____ a., while the internal iliac artery supplies the pelvic structures and _______

Answer 5

Femoral; perineum

Question 6

What are the 4 branches off the abdominal aorta responsible for supplying pelvic structures?

Answer 6

Ovarian aa.
Median sacral a.
Common iliac aa.
Inferior mesenteric a.

Question 7

_____ ______ = terminal branch of inferior mesenteric a. whose 2 branches supply both sides of the rectum as far inferiorly as the internal anal sphincter

Answer 7

Superior rectal a.

Question 8

What artery consists of both anterior and posterior divisions, supplying many pelvic structures?

Answer 8

Internal iliac a.

Question 9

What are the 3 major branches of the posterior division of the internal iliac a.?

Answer 9

Lateral sacral aa.
Iliolumbar a.
Superior gluteal a.

Question 10

What are the 9 major branches of the anterior division of the internal iliac a. (Females)?

Answer 10

Umbilical a.
Superior vesical a.
Inferior vesical a.
Middle rectal a.
Obturator a.
Internal pudendal a.
Inferior gluteal a.
Uterine a.
Vaginal a.

Question 11

The ________ arteries (2 or more vessels) supply the piriformis then enter the anterior sacral foramina to supply the structures of the sacral canal. They eventually exit the posterior sacral foramina to supply the _____ _____ muscles and the skin posterior to the sacrum

Answer 11

Lateral sacral; erector spinae

Question 12

The _______ artery courses between the obturator nerve and the lumbosacral trunk to supply the psoas major, iliacus, and quadratus lumborum plus the _____ _____ in the vertebral canal

Answer 12

Iliolumbar; cauda equina

Question 13

What is the terminal branch of the posterior division of the internal iliac a.?

Answer 13

Superior gluteal a.

Question 14

The superior gluteal a. exits the greater sciatic foramen and supplies what 3 muscles?

Answer 14

Piriformis m.
Gluteal mm.
Tensor fascia lata m.

Question 15

What 2 arteries originate from the same trunk and supply the urinary bladder? Which one is obliterated after birth?

Answer 15

Umbilical a. (Obliterated after birth)

Superior vesical a.

Question 16

What structures does the inferior vesical a. supply in males?

Answer 16

Urinary bladder
Seminal vesicle
Prostate
Ureter

Question 17

What artery supplies the rectum, prostate, seminal vesicle in males, and the rectum and vagina in females?

Answer 17

Middle rectal a.

Question 18

The _______ artery supplies the pelvic muscles, head of femur, then leaves the pelvic cavity via the ________ ______ to enter the medial thigh

Answer 18

Obturator; obturator canal

Question 19

The __________ artery exits the pelvis via the greater sciatic foramen, loops around the spine of the ischium to enter the perineum via the lesser sciatic foramen, and supplies all the perineal structures

Answer 19

Internal pudendal

Question 20

What muscles/structures are supplied by the inferior gluteal a.?

Answer 20

Piriformis m.
Pelvic diaphragm
Quadratus femoris m.
Gluteus maximus m.
Sciatic n.

Question 21

The uterine artery supplies the ____ and superior ______, and ultimately anastomoses with the ______ artery. It also supplies the ______ of the uterus

Answer 21

Uterus; vagina; ovarian; ligaments

Question 22

The ______ artery supplies anterior and posterior vaginal surfaces

Answer 22

Vaginal

Question 23

Each pelvic organ has a _____ ______ which freely communicates with those of other organs. These have no valves and have important connections with the vertebral venous plexuses (_______ veins)

Answer 23

Venous plexus; Batson’s

Question 24

Pelvic venous plexuses are drained by tributaries of _______ veins, ______ vein, and ______ veins

Answer 24

Internal iliac; inferior mesenteric; lateral sacral

Question 25

The _________ veins form superior to the greater sciatic foramen and lie postero-inferior to the internal iliac arteries. These veins merge with the _______ veins to form the common iliac veins, which unite at the ______ intervertebral disc to form the ________

Answer 25

Internal iliac; external iliac; L4/L5; IVC

Question 26

What vessels are included in the term “pelvic veins”?

Answer 26

Lateral sacral veins Superior rectal v. Superior gluteal vv. Testicular vv. (Or ovarian vv)

Question 27

What veins provide a metastatic pathway for prostatic or ovaarian cancer cells to the vertebrae or cranial cavity?

Answer 27

Lateral sacral vv., which anastomose with internal vertebral plexus providing a collateral pathway to reach either the inferior or superior vena cava

Question 28

What are the 4 groups of lymph nodes associated with pelvic viscera?

Answer 28

External iliac LNs Internal iliac LNs Sacral LNs Common iliac LNs

Question 29

The external iliac LNs receive lymph from _____ nodes and superior parts of middle to anterior pelvic organs. They drain into ________ nodes

Answer 29

Inguinal; common iliac

Question 30

Which LNs receive lymph from inferior pelvic viscera, deep perineum and the gluteal region, draining into the common iliac nodes?

Answer 30

Internal iliac LNs

Question 31

Which LNs receive lymph from postero-inferior pelvic viscera, and drain into internal or common iliac nodes?

Answer 31

Sacral LNs

Question 32

Which LNs receive lymph from external iliac, internal iliac, and sacral LNs, and drain into the lumbar nodes?

Answer 32

Common iliac nodes

Question 33

Pelvic structures are innervated mainly by the ____ and ____ nerves, and the ________ nerves

Answer 33

Sacral; coccygeal spinal; pelvic splanchnic [sacral and coccygeal = S1-S5, Co; pelvic splanchnics = S2-S4]

Question 34

The sacral plexus is located on the posterolateral wall of the pelvic cavity and has what 4 branches which exit the pelvic cavity through the greater sciatic foramen?

Answer 34

Sciatic n. (L4-S3) Pudendal n. (S2-S4) Superior gluteal n. (L4-S1) Inferior gluteal n. (L4-S2)

Question 35

Which branch of the sacral plexus enters the perineum via the lesser sciatic foramen and is contained in its own canal? What does it supply?

Answer 35

Pudendal n. (S2-S4) — supplies all perineal structures

Question 36

Which branch of the sacral plexus enters the gluteal region to supply the gluteaus maximus?

Answer 36

Inferior gluteal n. (L4-S2)

Question 37

Which branch of the sacral plexus enters the gluteal region to supply the gluteus medius and minimis?

Answer 37

Superior gluteal n. (L4-S1)

Question 38

Which branch of the sacral plexus travels inferior to piriformis to enter gluteal region, descending into the posterior thigh to supply the hamstring muscles, leg, and foot?

Answer 38

Sciatic n. (L4-S3)

Question 39

What makes up the coccygeal plexus?

Answer 39

Anterior rami from S4-S5 and Co

Question 40

The coccygeal plexus lies on the pelvic surface of the ______ m. The ______ nerve arises from this plexus and supplies the skin between the tip of the coccyx and the anus

Answer 40

Coccygeus; anococcygeal

Question 41

What 3 structures are supplied by the coccygeal plexus?

Answer 41

Coccygeus m. Levator ani Sacrococcygeal joint

Question 42

The pelvic autonomic nn. include what 2 groups of nerves?

Answer 42

Hypogastric plexuses | Pelvic splanchnic nerves

Question 43

The ______ plexus supplies the sympathetic innervation to pelvis viscera. In addition, _____ _____ fibers pass through this plexus

Answer 43

Hypogastric; visceral afferent

Question 44

What nerves supply parasympathetic innervation to the pelvic viscera, including the rectum and proximal anal canal (internal anal sphincter)?

Answer 44

Pelvic splanchnic nn.

Question 45

Branches of the inferior hypogastric plexuses continue to the pelvic viscera upon which they form sub-plexuses collectively known as pelvic plexuses What are these sub-plexuses associated with in males vs. females?

Answer 45

In both male and female, sub-plexuses are associated with the lateral rectum and the inferolateral urinary bladder In males = prostate and seminal vesicles; parasympathetic fibers in prostatic plexus penetrate pelvic diaphragm to reach erectile tissues in penis, producing erection In females = cervix of uterus and lateral fornices of vagina

Question 46

What supplies sympathetic innervation superior to the pectinate line?

Answer 46

Lumbar and sacral splanchnic nn

Question 47

What supplies parasympathetic innervation superior to the pectinate line?

Answer 47

Pelvic splanchnic nn

Question 48

Below the pelvic pain line, both visceral pain and visceral non-pain are conveyed via _______ nerves

Answer 48

Pelvic splancnic

Question 49

What supplies somatic innervation inferior to the pectinate line?

Answer 49

Inferior rectal nn. (Branches of pudendal n.)