Pelvic Vessels, Nerves, and Lymphatics Flashcards
Inferior Vesical A in males
- course
- branches
- supplies
- analogous to
travels inferiorly to posterior aspect of urinary bladder and supplies the seminal vesicles, prostate gland, ductus deferens, ureters and urinary bladder
- has a prostatic branch that travels posterolateral on prostate
- artery to ductus deferens travels retroperitoneally to ductus deferens
course of the testicular A
branches directly off aorta, normally at L2, travels inferiorly through inguinal canal into the scrotum w/ the spermatic cord. supplies the testis
Muscular branches of Sacral plexus
nerve to quad fem (L4-S1)
nerve to obturator internus (L5-S2)
nerve to piriformis (S1-S2)
Where do the rectal arteries come from?
Obturator A course
-what does it supply?
courses anteroinferiorly along lateral pelvic wall, exits pelvic cavity through the obturator canal, supplies pelvic muscles, ilium bone, femoral head, and muscles of the medial thigh
Suprapubic cystotomy
distended bladded may be punctured or approched surgically superior to pubic symphysis for introduction of indwelling catheters or instruments.
Pelvic splanchnic nerves
- where are the presynaptic cell bodies
- how do we get from sacral part of spinal cord to visceral pelvic structures
- sacral part of the spinal cord
- Anterior rami of sacral spinal ns, pelvic splanchnic nerves are coming out of anterior rami to put parasympathetics into the plexi
Uterine A
- course
- supplies
- branches
- analgous to
travels medially in broad L of the uterus, supplies uterus, uterine tubes, ovaries, and ureters. branches into a vaginal branch (supplies vagina/cervix) ovarian branches, and tubal branches.
analgous to artery of the ductus deferens in the male
male
Inferior hypogastric plexus in males
-sub plexi, where they go, mixed or not
has mixed vesical plexus, mixed prostatic plexus
-mixed prostatic plexus produces parasympathetic cavernous ns (erection), mixed nerves of ductus deferens (sym: contraction of internal urethral spinchter, peristatltic contraction of ductus deferens), mixed nerves of ejaculatory duct (sympathetic peristaltic conctaction of ejaculatory duct), and mixed nerves of the seminal vesicles (sympathetic contraction/secretion of seminal vesicles to add to semen)
important branches of the femoral A for repro
in males the superficial and deep external pudendal as create the anterior scrotal A, supplies scrotum
in females they create the anterior labial A, supplies labia majora
Mnemonic for internal iliac a
Inferior gluteal N
-spinal levels, what does it innervate
L5-S2, innervates gluteus maximus
branch of sacral plexus
male
inferior rectal a
- course
- supplies
exits pudendal canal crossing ischioanal fossa to anal canal, where it supplies distal anal canal
Relationship between rami communicants, pelvic and sacral splanchnic nerves
- lumbar sympathetic trunk coming down carrying pre-synaptic fibers, mostly, looking for a place to synapse. use the sacral sympathetic ganglia. can synpase at that point, leave the sacral trunk and go into a plexus ie inferior hypogastric plexus. (Sacral splanchnic). leaving sympathetic trunk and going to plexus
- pelvic splanchnics: come out of anterior rami of somatic nerves of sacral plexus and feed into the inferior hypogastric plexus, needs to get out of somatics because needs to get to pelvic viscera naughty bits, doesnt need to continue to lower extremity
- rami communicant: we need to send sympathetics everywhere. need to send to extremities. leave trunk and goes into the somatic nerves of the sacral plexus. IT WILL BE GREY
locate superficial circumflex iliac A and superficial epigastric A
Inferior Hypogastric plexus:
- mixed or not
- where does it get its innervation?
-mixed, gets parasympathetics from pelvic splanchnics, gets sympathetics from hypogastric ns and sacral splanchnic ns
Superior Hypogastric plexus:
- mixed
- nerves it sends out, and where they go
no, only sympathetic
sends hypogastric ns to the inferior hypogastric plexus
female
Iatrogenic compromise of ureteric blood supply
-blood supply of ureter in abdomen, vs pelvis
in abdominal segment, blood supply to ureter approaches medially, while in pelvis blood supply approaches laterally.
Pudendal N
-spinal levels and branches
S2-S4
produces perineal N, inferior rectal N, Dorsal N of penis in males/dorsal N of clitoris females, deep perineal N, superficial perineal N
Inferior hypogastric plexus in women
-sub plexi, where do they go?
- has a vesical plexus (sympathetic causes contraction of the internal urethral sphincter; parasympathetic causes contraction of the detrusor m and relaxation of the internal urethral spinchter
- has a uterovaginal plexus, which has a uterine plexus that innervates uterus/uterine tubes, and has carernous Ns which are parasympathetic innervation of bulbs of vestibule, clitoris, and vestibular glands (produces erection of clitoris)
Iliolumbar A
- course
- branches, and what they feed
travels superolaterally to enter the iliac fossa where it branches into:
iliac branch-supplies ilium and iliacus M
lumbar branch- supplies the psoas major M and Quad Lumborum
internal iliac a branches female
Coccygeal Plexus
- spinal levels
- branches
S4,S5, Coccygeal N
Anococcygeal N, nerve to levator ani (S4), Nerve to the Coccygeus (S4,S5)
Rupture of the bladder
superior position of distended bladder means it can be ruptured by injuries to inferior part of the anterior abdominal wall or by fractures of the pelvis. rupture can result in escape of urine extraperitoneally or intra. rupture of superior part of bladder often leads to urine in peritoneal cavity, posterior rupture usually leads to extraperitoneally escaped urine into the perineum
components of lumbar plexus, and spinal levels
Lumbar plexus is L1-L4
ilioinguinal L1
Genitofemoral (L1-L2)
Obturator (L2-L4)
Lumbosacral trunk (L4-L5)
pelvic autonomic plexi
female
Dorsal N of penis/Dorsal N of clitoris
-come from?
pudendal N
Deep a of penis
- branch of what?
- course, supply
terminal branch of internal pudendal a, pierces perineal membrane to enter and supply copora cavernosa
Sacral plexus of nerves
-Branches and Spinal levels
What are the ending points of the internal iliac
inferior gluteal a, and internal pudendal a
Deep Perineal N
-what does it innervate
innervates superficial and deep transverse perineal Ms., ischiocavernosus M, bulbospongiosus M, vaginal vestibule, and inferior most part of the Vagina
Artery of bulb of penis
- branch of what?
- course
- supply
branch of the internal pudendal A
pierces perineal membrane to supply bulb of penis and bulbourethral gland
female
injury during childbirth common to which nerve?
obturator N causes painful spasms of adductor M, sensory deficit in medial thigh
Artery of Vestibule of Vagina
- branch of
- course, supplies
branch of internal pudendal artery, pierces perineal membrane, supplies vaginal vestibule and greater vestibular gland
Perineal A
- course
- enters what space
- branches and their courses/supply
exits pudendal canal, enters superficial perineal space
terminal branch is posterior scrotal in males, travels in superficial fascia of posterior aspect of scrotum
terminal branch is posterior labial a in females and travels in superficial fascia of labia majora
internal pudendal A
- course
- supplies
- branches male vs female
exits pelvic cavity through greater sciatic foramen, turns around ischial spine and enters perineum through lesser sciatic foramen, enters pudendal canal
- inferior rectal A
- perineal a turns into (posterior scrotal male), (posterior labial female)
- in males gives off artery of bulb of penis
- in males deep a of penis and dorsal a of penis are terminal branches
- in females gives off artery of vestibule of vagina, deep a of clitoris (terminal), and dorsal a of clitoris (terminal)
Superior gluteal N
- branch of
- levels, what does it innervate
branch of sacral plexus, L4-S1
innervates gluteus medius, gluteus minimus
Pelvic Splanchnic nerves
-spinal levels
S2-S4
Dorsal a of penis
- branch of
- course, supply
terminal branch of the internal pudendal A, pierces perineal membrane, passes through the suspensory L of penis, travels on dorsum of penis, supplies skin/erectile tissue
Posterior division of internal iliac
-branches
iliolumbar, lateral sacral a, superior gluteal a
Superficial Perineal N
- branch of what
- male vs female branches
branch of pudendal nerve,
posterior scrotal N
posterior labial N
both terminal branches of perineal N in posterior part of genitalia
what does the lumbar sympathetic trunk make? and where do they go?
makes lumbar splanchnic nerves that primarily head out towards the inferior mesenteric ganglion
Course of the superior rectal A
comes off the IMA at L3, travels over the Left common iliac vessels into the pelvis to supply susperior rectum, anastomoses w/ middle/inferior rectal As
female
male
male
female
Inferior rectal N
- comes from?
- innervates what?
comes from the pudendal N, and innervates the anal canal inferior to the pectinate line and also the external anal sphincter
Superior Gluteal A
- course
- supplies
exits pelvic cavity through greater sciatic foramen superior to piriformis M
supplies piriformis M, glut max, glut medius, minimus, and Tensor fascia lata
Umbilical A course, branches
travels anteriorly, produces superior vesical A, and the other portion becomes medial umbilical L.
-superior vesical A has numerous branches that supply the superior aspect of the vesicle
Sacral splanchnic nerves vs pelvic splanchnic nerves
Sacral=Sympathetic
Pelvic=Parasympathetic
Inferior mesenteric plexus:
- mixed?
- where does it send innervation
no, only sympathetic, sends innervation to descending colon, sigmoid colon, rectum
Median Sacral A course
from posterior aspect of abdominal aorta just prior to common iliacs, travels inferiorly in median plane over L4, L5, sacrum, and coccyx
Inferior gluteal A
- course
- supplies
exits pelvic cavity through the greater sciatic foramen inferior to piriformis.
supplies the coccygeus, 3 levator anis, piriformis, quad fem, upper most posterior thigh muscles, glut max, sciatic N
Sciatic N
- from what plexus?
- spinal levels?
- branches
comes from sacral plexus
L4-S3 travels through greater sciatic foramen to posterior aspect of thigh
branches into tibial N, common fibular N
Lateral Sacral A
- course
- supplies
travels on anteromedial aspect of piriformis, sending branches into the ventral sacral foramina, supplies piriformis M, structure in sacral canal, and erector spinae muscles
Deep A of clitoris
- branch of what
- course, supplies
terminal branch of internal pudendal, pierces perineal membrane supplies skin over clitoris and erectile tissue
Cystocele:
-what is it, how does it happen
loss of bladder support in females by damage to pelvic floor during childbirth, can result in collapse of bladder onto the anterior vaginal wall. when intrabdominal pressure increases the anterior wall of vagina may protrude through vaginal orifice into the vesitibule
posterior femoral cutaneous N
spinal levels, branches male vs female
S1-S3, supplies buttock and upper most region of posterior thigh
perineal branch in males to scrotum, and perineal branch in females to labia majora
Course of the ovarian A, branches
branches off abdominal aorta like testicular, travels inferiorly into the pelvis through the suspensory L of the ovary where it branches into ovarian and tubal branches
lymphatics
