Pelvic wall and cavity 2 of 2 Flashcards
1
Q
describe the somatic pelxuses broadly
- fibers
- supply
A
- somatic plexuses
- from anterior rami of spinal nerves :GSA,GSE, GVE sympathetic fibers
- supply
- pelvis wall
- lower limb
- peineum
2
Q
describe the plexus at the following level
A
- sacral plexus
- L4-S4
- located in lesser plevis
- coccygeal plexus
- S4-Co
- located in lesser pelvis
- lumbar plexus
- L1-L4
- located in greater pelvis
- obturator
- passes through lesser pelvis
- iliolinguinal and genitofemoral
- innervatire perineum
- obturator
3
Q
what part of the somatic plexus lies at L1-L4?
A
lumbar plexus
4
Q
what part of the somatic plexus lies at L4-S4?
A
sacral plexus
5
Q
what part of the somatic plexus lies at S4-Co
A
coccygeal plexus
6
Q
this nerve is L4-S3
A
sacral plexus
- sciatic nerve
7
Q
This nerve is S2 to S4
A
sacral plexus
- pudendal nerve
- innervates most of the perineum and pelvic diaphragm
8
Q
thes nerves are L5-S2 (3)
A
sacral plexus
- inferior gluteal nerve
- nerve to obterator internus
- superior gemellus
9
Q
what nerves originate from L4-S1?
A
Sacral plexus
- quadratus femoris
- inferior gemellus
10
Q
what ner originates from S1-S3?
A
sacrala plexus
- posterior femoral cutaneous nerve
- perineal branch to crotum or labuim majorum
11
Q
what is the nerve oridinating from S2-S3?
A
sacral plexus
- perforating cutaneous nerve
12
Q
what nerves originate from S1-S2
A
sacral plexus
- Nerve to piriformis
13
Q
what nerve originates from S4?
A
sacral plexus
- nerve to levator ani
- rectal sphincter
14
Q
what nerves originatefrom S4-S5?
A
sacral plexus
- nerve to coccygeus
15
Q
what are the nerves originateing from Co?
A
coccygeal plexus
- anococcygeal nerves
- to anococcygel ligamen
- peinanal skin
- pelvic diaphragm
16
Q
What is compressed during childbirth to produce pain in lower limbs?
A
compression of sacral plexus by fetal ahead during childbirth produces pain in lower limbs
- pudendal nerv-innervates most of theperineum and pelvic diaphragm
- posterior femoral cutaneous nerve- perineal branch of labium majorum
- perforating cutaneous
- nerve to piriformis
- nerve to leavtor ani-recal sphincter
17
Q
removal of cancerous lymph nodes or pregnancy causes painful reactions, what are they and what nerve is involved
A
injury to the obturator nerve - removal of cancerous lymph nodes or pregnancy- causes painful spasms of thigh adductors and sensory deficicts in medial thigh region.
18
Q
a patient is experiencing numbness to the right limb below the knee behind the thigh and difficulty moving the leg as well. What could be causing the symptoms
A
sciatic nerve invovlement by a pelvic tumor can affect function of the muscles of the posterior thigh and all muscle below the knee and cause sensory deficits in most of the skin covering those areas
19
Q
A female patient presents to you with a symptoms of difficulty urinating, pass a bowel movement and sexual dysfunction. what could be happening?
A
pudendal nerve entrapment syndrom / pudendal neuralgi
- nerve compression between sacrotuberous and sacrospinous ligaments (70%), in puudendal canal (20%) or elswhewhere along its course that results in
- pain in the perineum
- urincary problems
- bowel problems
- sexual dysfunction
20
Q
what forms the inferior hypogastric plexus?
A
- formed by nerve fibers from
- hypogastric nerves
- pelvic splanchnic nerves
- sacral splanchnic nerves
- contain
- GVA and GVE
- both sympathetic and parasympathetic fibers
- GVA and GVE
21
Q
what forms sub-plexuses around pelvic organs?
A
inferior hypogastric plexus
- supplies pelvic viscera and ciscera of the perineum
- contain GVA and GVE of by sympathetic and parasympathetic fibers
22
Q
Describe the sacral sympathetic trunks
A
- descending pre-ganglionic sympathetic fibers from lumbar level L1-L2
23
Q
describe the paravertebral ganglia
A
- 4 pairs (S1-S4)
- contain post-ganglionic sympathetic neurons
24
Q
what tunksare they and what are the main function of sacral sympathetic trunk
A
- main function is sympathetic innervation of pelvic and perineal walls, lower limbs
- Gray communicas = white arrow
- splanchnic nerves +black arrow
25
what type of fibers innervate the pelvic vessels, hair erector smooth muscle and sweat glands?
sympathetic GVE fiber
26
describe the sympathetic trunk with respect to the spinal cord and directionality of nerve inferior of L1
***_Sympathetic GVE fibers_*** innervating vessels (vasomotion), hairerector smooth muscle (pilomotions) and sweat glands (sudomotion) of ***_pelvic wall and part of periunem_***
1. preganglionic neurons in ***_spinal cord level L1-L2 enter sympathetic ganglia via white rami communicantes_***
2. preganglionic fibers travel down the ***_sympathetic trunk to reach ganglia beyond L2 (NO WHITE RAMUS COMMUNICSNS BELOW L2!!!!)_***
3. Synapse on postganglionic sympathetic neurons in lumbar and sacral ***_paravertebral ganglia L4 to Co_***
4. ***_postganglionic fibers join L4 to Co spinal nerves via GRAY RAMI COMMUNICANTES_***
27
the pelvic visceral plexus: inferior hyposgastric , receives what type of fibers and from where?
* receives GVE and GVA fibers from
* superior hypogastric nerves
* pelvic splanchnic nerves
* sacral splanchnic nerves
* form sub plexuses around pelvic organs
* rectal plexus
* vesical plexus
* males- in perineum
* prostatic plexus- cavernous nerve of penis
* vas deferent plexus
* females- in perineum
* uterovaginal plexus- clitoris plexus
28
explain the nerve fiber types involved in the viscera(organs, glands,vessels) of the pelvis and perineum
inferior hypogastric plexus
1. supply viscera (organs, glands,vessels) or the pelvis and perineum
1. GVE:contraction of smooth muscles and glands secretion
1. sympathetic postganglionic fibers
2. parasympathetic preganglionic fibers (synapse on ganglia in wall of viscera)
2. GVA:distention, pain
1. reflective sensations: GVA fibers accompany **_*parasympathetic fibers***_ to spinal levels _***S2-S4*_**
2. pain follows ***_PELVIC PAIN LINE_***
29
describe the pelvic pain line
GVA fibers in the pelvis and perineum are part of the inferior hypogastric plexus
1. reflective sensations :pass along information for distention and pain
1. GVA fiber accompany parasympathetic fibers to spinal levels ***_S2-S4_***
2. _pain follows the pelvic line_
1. pain***_superior to pelvic pain line_***
1. **_****_travels in GVA fibers accompanying_***sympathetic fibers***_ to the levels _***L1-L2*_**
2. pain ***_inferior to pelvic pain line_***
1. **_****_travels in GVA fibers accompanying _***parasympathetic fibers***_ to spinal levels _***S2-S4*_**
30
Pain to the following organs will reffer pain through which direction?
ovaries, uteine tubes, body of uterus/ureters and superior bladder
pain ***_superior to pelvic line_***
1. from viscera above or in contact wit hthe peritoneum
2. ***_pain referred to dermatomes of lower abdomen and inguinal region L1-L2_***
31
pain from the following organs will be referred where?
cervix of uterus, upper vagina, inferior bladder, urethra and prostate, rectum and anal canal
pain ***_inferior to the pelvic pain line_***
1. from viscera not in contact with the peritoneum
2. ***_pain referred to dermatomes of perineum S2-S4_***
32
what are the contents of the hypogastric nerve?
hypogastric nerves
1. contain
1. ***_descending_*** postganglionic sympathetic fibers from suprerior hypogastricplexus
1. GVE:
1. descending postganglionic fibers from***_superior hypogastric plexus_***
1. origin in ***_prevertebral ganglia/_***preganglionic fibers are thoracic T11-T12 and lumbar splanchnic n L1-L2
2. ***_main source of sympathetic innervation of pelvic viscera_***
2. GVA:
1. from sensory ganglia T11-L2 for pain superior to pelvic line
2. ***_ascending_*** preganglionic parasympathetic fibers
1. GVE
1. pelvic splanchnic S2-S4
2. accompaning GVA fibers from ***_inferior hypogastric plexus_*** going to HINDGUT
33
what is the main source of sympathetic innervation to the pelvic viscera?
Superior hypogastric plexuses
34
what fibers do the hypogastric nerves contain?
1. GVE
1. T11-L2
1. superior hypogastric plexuses
2. S2-S4
1. Ascending preganglionic parasympathetic fibers
2. GVA
1. T11-L2,
1. from pain superior to pelvic pain line
2. S2-S4
1. pelvic pain inferior to the pelvic pain line (hind gut)
35
DESCRIBE THE SACRAL SPLANCHNIC NERVES
1. GVE
2. GVA
3. travel
4. contribution to plexus
1. GVE
1. preganglionic fibers
1. origin in intermediate horn of spinal cord L1-L2 and descend in sacral sympathetic trunk to synapse in sacral paravertabral ganglia
2. postganglionic sympathetic
1. origin in ***_sacral paravertebral ganglia (_***note the red arrows)
2. GVA fibers for pain
1. origin in spinal ganglia L1&L2
1. superior to pelvic pain line
2. accompany the GVE in the sacral splanchnic nerves
3. travel to viscera via inferior hypogstric plexus
4. minor sympathetic contribution to plexus
36
describe the pelvic splanchnic nerves
1. branch from anterior rami of spinal nerves S2-S4
2. travel to pelvic viscera via ***_inferior hypogastric plexus_***
3. contains
1. GVE
1. preganlionic parasympathetic fibers
2. origin in intermediate column of spinal cord S2-S4 and will synapse in ganglia located in viscera walls
2. GVA
1. origin in spinal ganglia S2-S4
2. reflective sensations from pelvic viscera
3. visceral pain inferior to pelvic pain line
37
what does the pereitoneum encompass?
1. pelvic cavity contain inferior portions of serous peritoneum
1. intraperitoneal organs
1. broad ligamament- part of the peritoneum that covers the uterine tubes and ovaries
2. peritoneal recesses
1. male
1. rectovesical pouch
2. female
1. rectouterine pouch (of douglas)
2. vesicouterine pouch
38
with the female body supine, what is the lowest part of the pelvic portion of the peritoneal cavity? explain complications
rectouterine pouch (pouch of douglas) is the lowest poart of the pelvic portion of peritoneal cavity when body is supine and site where infection and fluids typically collect
1. can be examined by transvaginal digital palpitation
2. abscess of fluid can be drained by needle (***_culdocentesis)_*** placed through posterior fornix of vagina
39
what is the connective tissue layer between parietal peritoneum, wall and floor of pelvis? Explain and describe dividends
pelvic fascia- divided into three parts
1. parietal fascia
1. lines pelvic muscles
1. continuous with transvresalis fascia and iliopsoas fascia
2. forms a continuous longitudinal band along the the pelvic floor
1. ***_tendinous arch of pelvic fascia_***
2. visceral facia
1. covers and supports pelvic viscera
3. subperitoneal fascia
1. continuation of extraperitoneal fascia
1. ***_fat_***
1. retropubic space
2. condenses to form
1. ***_transverse/lateral ligament_***
40
what is continuous with the transvesalis fascia and iliopsoas fascia? What does it form on the pelvic floor?
pariteal fascia division of the pelvic fascia.
1. lines pelvic muscles
1. continuous with transvresalis fascia and iliopsoas fascia
2. forms a continuous longitudinal band along the the pelvic floor:
1. ***_tendinous arch of pelvic fascia_***
41
Explain the structure formed from the subperitoneal fascia
1. continuation of extraperitoneal fascia :
1. fat
1. retropubic space
2. condenses to form: ***_transverse/lateral ligament_***
42
describe the pelvic fascia and ligament
1. structure
2. function
3. important ones tto know
1. structure
1. condensed, fibrous regions of endopelvic fascia
2. function
1. provide passive support (anchor) of
1. pelvis viscera
2. vessels
3. nerves
3. important ones
1. tendinous arch of pelvic fascia
2. bladder supporters
1. female
1. pubovesical ligament
2. male
1. puboprostatic ligament
3. uterus support
1. transverse cervical ligaments
1. main passive support of uterus
2. uterosacral ligaments
43
which ligaments support the bladder?
1. male
1. puboprstatic ligament
2. female
1. pubovesical ligament
44
Which ligaments provide passive support of hte uterus, main one =?
1. transverse cerivical ligaments
1. main passive support of uterus
2. uterosacral ligaments
45
what are the nerves found in the hypogastric:
postganglionin, preganglionic, GVA,GVE,GVE,GSE
Hyposgastric:
1. postganglinoic
2. parasympathetic
3. GVA
4. GVE
5. GSE
46
what is the difference in the innervation for the hypogastric and sacral/lumbar nerves?
hypogastric: parasympathetic nerves
lumbar: preganglionic
hypogastric/sacral: postganglionic
