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SF3.07_Pelvic Viscera_MULHERON > Pelvic Viscera Blood Supply and Nervous Innervation > Flashcards

Pelvic Viscera Blood Supply and Nervous Innervation Flashcards

1
Q

Neurovascular organization of the pelvis:

A
  • NVA runs within endopelvic fascia.
  • Arranged in concentric layers, lateral to medial: SVA
    • somatic nerves (lateral)
    • blood vessels
    • autonomic nerves (medial)
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2
Q

Label all:

A
  • NVA of pelvis; lateral to medial: SVA
    • somatic nerves (yellow)
    • blood vessels (blue/red)
    • autonomic nerves (white)
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3
Q

Label all:

A
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4
Q

Largest nerve passing through the greater sciatic foramen:

A
  • sciatic nerve (L4-S3). Joins with the lumbosacral trunk before exiting.
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5
Q

Route of lumbosacral trunk to it union with the sciatic nerve:

A

crosses over pelvic brim

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6
Q

Somatic nerves making up the lateral component of the pelvic neurovasculature are the:

A
  • obturator nerve, sciatic nerve, and pudendal nerve.
  • Lumbosacral trunk passes over the pelvic brim to unite with sciatic.
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7
Q

Label all:

A
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8
Q

Primary blood supply to pelvic structures:

A
  • arterial: branches of internal iliac artery
  • venous: branches of internal iliac vein
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9
Q

The two trunks of the internal iliac artery and their target blood supply:

A
  • posterior division: blood supply to pelvic body wall.
  • anterior division: blood supply to pelvic viscera.
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10
Q

The superior gluteal artery typically passes posteriorly between what two structures to enter the gluteal region from the pelvis?

A
  • lumbosacral trunk and S1
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11
Q

The inferior gluteal artery typically passes from the pelvis to the gluteal region by exiting between what two structures?

A
  • piriformis and coccygeus, typically between S2 and S3.
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12
Q

Lymphatics of the pelvis follow along what structures:

A
  • vasculature of the respective pelvic viscera.
    • ovary = ovarian artery (branch of abdominal aorta)
    • uterus = uterine artery (branch of internal iliac)
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13
Q

Blood supply to ovary and derivation:

A
  • ovarian artery.
  • branch of abdominal aorta near kidney level.
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14
Q

Blood supply to cervix/uterus and derivation:

A
  • uterine artery.
  • branch of internal iliac artery.
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15
Q

How will ovarian cancer metastasize?

A
  • follow vasculature (ovarian artery and vein).
  • spread along the lateral aortic lymph nodes.
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16
Q

How will cervical cancer metastasize?

A
  • follow vasculature (uterine artery).
  • spread along internal iliac lymph nodes.
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17
Q

Two important characteristics of the uterine arteries:

A
  1. pass superior to ureter (“water under the bridge”).
  2. course within transverse cervical (cardinal) ligaments.
18
Q

Function of pelvic sympathetic nervous innervation (3):

A
  • vasoconstriction of pelvic arteries
  • contraction of smooth muscle sphincters
  • (Males) peristalsis of sperm through vas deferens
19
Q

The two sphincters controlled by pelvic sympathetic nervous innervation and effect of this innervation:

A
  • internal urethral sphincter.
  • internal anal sphincter.
  • Sympathetics keep tonically closed so can fill.
20
Q

Function of pelvic parasympathetic nervous innervation (3):

A
  • contraction of detrusor muscle (bladder excretion).
  • rectal peristalsis.
  • inhibit smooth muscle sphincters (urethral and anal).
21
Q

How are the internal urethral sphincter and internal anal sphincter relaxed so that they can be emptied?

A
  • parasympathetics inhibit sympathetic tonic contraction of these sphincters.
  • sphincters then relax.
22
Q

Label all (pelvis):

A
23
Q

Location of PREganglionic sympathetic cell bodies innervating the pelvic visecera:

A

lateral horn L1 and L2.

24
Q

Location of POSTganglionic sympathetic cell bodies innervating the pelvic visecera:

A
  1. superior mesenteric plexus
  2. inferior mesenteric plexus
  3. inferior hypogastric plexus
25
Q

Route of the sympathetic innervation to the pelvis with postganglionic cell bodies in the inferior mesenteric plexus:

A
  1. L1/L2 lateral horn
  2. white rami into sympathetic chain
  3. lumbar splanchnics
  4. synapse on inferior mesenteric plexus on aorta
  5. through superior hypogastric plexus
  6. through hypogastric nerve
  7. through inferior hypogastric plexus
  8. to the pelvic organ it will innervate.
26
Q

Route of the sympathetic innervation to the pelvis with postganglionic cell bodies in the inferior mesenteric plexus using the LUMBAR splanchnics:

A
  1. L1/L2 lateral horn
  2. white rami into sympathetic chain
  3. lumbar splanchnics
  4. through inferior mesenteric plexus on aorta
  5. through superior hypogastric plexus
  6. through hypogastric nerve
  7. synapse in inferior hypogastric plexus
  8. to the pelvic organ it will innervate.
27
Q

Route of the sympathetic innervation to the pelvis with postganglionic cell bodies in the inferior mesenteric plexus using the SACRAL splanchnics:

A
  1. L1/L2 lateral horn
  2. white rami into sympathetic chain
  3. down sympathetic chain
  4. through sacral splanchnics
  5. synapse in inferior hypogastric plexus
  6. to the pelvic organ it will innervate.
28
Q

The two splanchnic nerves carrying preganglionic sympathetic nerve fibers to the pelvis, and where these fiber synapse:

A
  1. lumbar splanchnics
    • synapse in inferior mesenteric plexus or inferior hypogastric plexus.
  2. sacral splanchnics
    • synapse in inferior hypogastric plexus only.
29
Q

Location of PREganglionic parasympathetic cell bodies innervating the pelvic visecera:

A

spinal cord segments S2, S3, S4.

30
Q

Route of the parasympathetic innervation to the pelvis:

A
  1. preganglionic cells bodies in S2, S3, S4.
  2. pelvic splanchnic nerves.
  3. synapse in inferior hypogastric plexus.
  4. to the pelvic organ it will innervate.
31
Q

Visceral afferent nerves running on sympathetic nerves; sensation conveyed and region supplied:

A
  • pain sensation
  • peritoneal structures (covered by peritoneum)
  • above pelvic pain line
32
Q

Visceral afferent nerves running on parasympathetic nerves; sensation conveyed and region supplied:

A
  • pain sensations and reflexes
  • reflex: entire pelvis
  • pain: subperitoneal (not covered by peritoneum)
  • below pelvic pain line
33
Q

Pelvic pain line:

A
  • organs above covered in peritoneum; pain carried on sympathetics.
  • organs below NOT covered in peritoneum; pain carried on parasympathetics.
34
Q

Organs above pelvic pain line covered in peritoneum with pain afferents carried on sympathetics and where pain felt:

A
  • fundus and body of uterus, uterine tubes, ovaries.
  • pain referred to L1/L2 dermatomes.
  • lower back and suprapubic pain.
35
Q

Organs below pelvic pain line NOT covered in peritoneum with pain afferents carried on parasympathetics and where pain felt:

A
  • cervix, upper vagina, and bladder.
  • pain referred to S2-S4 dermatomes.
  • lower leg pain.
36
Q

Route of pain sensation above the pelvic pain line to CNS:

A

along sympathetics

  1. inferior hypogastric plexus
  2. hypogastric nerve
  3. superior hypogastric plexus
  4. lumbar splanchnics
  5. L1/L2 dorsal horn
37
Q

Route of pain sensation below the pelvic pain line to CNS:

A

along parasympathetics

  1. inferior hypogastric plexus
  2. pelvic splanchnics
  3. S2-S4 dorsal horn
38
Q

Nerve fiber types in superior hypogastric plexus:

A
  • pre and postganglionic sympathetics
  • visceral afferents above pelvic pain line
39
Q

Nerve fiber types in hypogastric nerves:

A
  • pre and postganglionic sympathetics
  • visceral afferents above pelvic pain line
40
Q

Nerve fiber types in inferior hypogastric plexus:

A
  • pre and postganglionic sympathetics
  • pre and postganglionic parasympathetics
  • visceral afferents
41
Q

Nerve fiber types found in pelvic splanchnic nerves:

A
  • preganglionic parasympathetics
  • visceral afferents below pelvic pain line
42
Q

Nerve fiber found in lumbar splanchnic nerves:

A
  • preganglionic parasympathetics
  • visceral afferents above pelvic pain line

SF3.07_Pelvic Viscera_MULHERON (4 decks)

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