PELVIS FLOOR + VISCERA

Question 1

Where is pain felt in relation to the pelvic pain line for Sympathetics? How about for Parasympathetics?

Answer 1

SNS felt ABOVE the pelvic pain line;

PSNS felt BELOW the pain line

Question 2

Preganglionic sympathetics in the pelvis span from ____ to ___ spinal levels. These are responsible for _______ of pelvic arteries that supply __________ organs. These help us sense pain _____ the pelvic pain line.

Answer 2

T10-L2 spinal cord regions;
Vasoconstriction of pelvic arteries;
Peritoneal structures;
ABOVE the pain line.

Question 3

Preganglionic parasympathetics are found in the ___ to ___ spinal cord levels. The postganglionics function to cause _______ at erectile tissues which are _________ structures. These help us sense pain _____ the pelvic pain line.

Answer 3

S2-S4 spinal levels;
Vasodilation at erectile tissues;
Subperitoneal structures;
BELOW the pelvic pain line.

Question 4

Describe the significance of the intermesenteric plexus in the pelvic autonomic.

Answer 4

These nerves are located on front of the aorta between SMA and IMA plexus. They communicate between the Superior Hypogastric plexus (below L4 bifurcation), Hypogastric nerves (that run down the pelvic wall) and the Inferior Hypogastric Plexus (at the pelvic floor).

Question 5

Unlike most other organs, the body and fundus of the uterus is a _______ _______ type of organ. The bladder, cervix and vagina are considered ___________ organs, since they are partly covered by peritoneum.

Answer 5

Secondary Peritoneal;

Subperitoneal organs

Question 6

Ovarian and Fallopian tube pain can be felt _____ the pelvic pain line at around the ___/___ dermatome. This can be similar to ________ that can be felt in the same region. The uterine body and fundus are felt as _________ pain at the ___ to __ dermatome.

Answer 6

Above the pelvic pain line @ T10/T11 dermatome;
Similar to Appendicitis;
Suprapubic pain @ T11-L1

Question 7

The Pelvic brim separates the ______ ______ from the abdominal cavity.

Answer 7

True pelvis

Question 8

The Greater Sciatic foramen connects the true pelvis with the ________ ________. The _______ muscle and ________ nerves pass through it.

Answer 8

Gluteal region;

Piriformis, Sciatic nerves

Question 9

In response to an increase in abdominal pressure, the pelvic floor ___________ in order to prevent urinary and fecal _________.

Answer 9

Contracts;

Incontinence.

Question 10

What is the cause of Stress Urinary Incontinence?

Answer 10

A fully detached or stretched fascias support leading to a hyper mobile urethra in which urine escapes with an increase in abdominal pressure. For instance, if a menopausal woman sneezes, she might wet them panties.

Question 11

Describe cystocele.

Answer 11

Lateral detachment of the fascia white line. This causes the bladder to push posteriorly on the anterior wall of the vagina. If the urethra cannot straighten, the patient cannot urinate.

Question 12

Define rectocele.

Answer 12

This is a posterior vaginal wall prolapse associated with defects of the pelvic floor too. Older age or a prior hysterectomy are risk factors associated with this condition.

Question 13

The lymphatics for ovaries are found along the lateral ________ nodes.

Answer 13

Aortic nodes

Question 14

The lymphatics supplying the scrotum are ________ lymph nodes.

Answer 14

Inguinal lymph nodes

Question 15

The anatomical position of the uterus is both _______ and ________. This reduces the likelihood of a uterine prolapse and allows room for the uterus to grow during pregnancy.

Answer 15

Anteverted;

Anteflexed

Question 16

The sympathetic preganglionic fibers for the pelvis originate from _____ to _____ vertebral levels. The SNS postganglionics ________ the smooth muscle sphincters and cause ______ of the vas deferens.

Answer 16

SNS preganglionics: T10 - L2
Contract the SM sphincters;
Peristalsis of vas deferens.

Question 17

The pelvic parasympathetic preganglionic fibers, that innervate the pelvis, originate in the _________ regions, since the ________ nerve can no longer reach these structures. The PSNS postganglionics are responsible to _________ erectile tissues

Answer 17

Sacral (S2-S4) region;
Vagus nerve limited down to Transverse colon;
Vasodilate erectile tissue

Question 18

What vessel supplies blood for stimulation of external genitalia? What nerve causes vasodilation of external genitalia in the perineum to maintain an erection?

Answer 18

Internal pudendal artery;
Cavernous Nerves (PSNS)

Question 19

Within the outer ring of the pelvis, the Lumbosacral trunk passes over the pelvic _____, to help form the _______ Nerve (of spinal nerves ____ to _____)

Answer 19

Pelvic brim;
Sciatic Nerve (L4-S3)

Question 20

The _______ iliac artery never enters the pelvis, but becomes the ______ artery once it passes by a certain canal to supply the lower limb.

Answer 20

External iliac artery - never enters pelvis;

Femoral artery within the femoral canal (NAV-L, medial to lateral)

Question 21

Describe the branches of the anterior division of the Internal Iliac artery and what each supplies.

Answer 21

Internal pudendal artery - runs with the nerve to supply external genitalia;
Obturator artery - runs with the obturator nerve towards the canal;
Umbilical artery - supplies the bladder and became the medial umbilical folds;
Uterine artery - tortuous vessel that is coiled in case it stretches during pregnancy

Question 22

Describe the branches of the Posterior Division of the Internal Iliac artery and what each supplies.

Answer 22

Iliolumbar artery - routes back up to the lumbar
Lateral Sacral artery - heads medially towards the sacrum
Superior gluteal artery - supplies the gluteus minimus and medius

Question 23

Which of the following may be responsive to a surgical cut made on the Superior Hypogastric Plexus?
A) Ovarian/ Tubal Pain
B) Uterine Fundic Pain
C) Pericervical Pain

Answer 23

B) Uterine Fundic Pain - the uterus has its afferent sensory fibers ABOVE the pelvic pain line. A surgical cut at this plexus can relieve painful menstruation

Question 24

Define what causes a Rectovaginal fistula?

Answer 24

The stretching of the rectovaginal space after birth can lead to this defect.

Question 25

Why must a surgeon be cautious if performing a hysterectomy? What precautions can he take to prevent bleeding?

Answer 25

If the uterus is taken out without lighting the blood supply prior to it, the uterine artery, within the Suspensory ligament, can rupture leading to massive bleeding. The physician can block the internal Iliac artery temporarily while performing this procedure.

Question 26

What anastomoses exists in the rectum?

Answer 26

A portal-caval anastomoses exists for the rectum, between the Inferior Mesenteric artery (portal) and the Internal Iliac artery (caval).

Question 27

The female perineum separates what two regions?

Answer 27

Separates the female reproductive line from the pelvic line

Question 28

The _________ nerve lies medial to the border of the psoas major passing through the _________ canal. The ________ nerve lies anterior to this muscle but does not innervate it as well.

Answer 28

Obturator, obturator;

Genitofemoral nerve

Question 29

During a Cesarean section, an OBGYN surgeon has to cut through what structure, below the broad ligament, to take out the baby from the womb?

Answer 29

Make a suprapubic transverse incision to cut the Lower Uterine segment of the uterine wall

Question 30

What vessel runs parallel with the Transverse Cervical (Suspensory) Ligament?

Answer 30

Uterine artery that passes over the ureter;

“Water under the Bridge”

Question 31

What is the most common type of prostate cancer?

Answer 31

Peripheral prostate cancer involving surrounding muscle

Question 32

What plexus of nerves takes afferent pain from the bladder, urethra, uterus, vagina, vulva, perineum, prostate, penis and rectum? What fibers make it up?

Answer 32

Superior Hypogastric plexus that if formed from branches of aortic and lumbar splanchnics before they enter the pelvis.