Vasculature, Innervation, and Functional Anatomy of Pelvis and Perineum Flashcards
What is another name for the internal iliac artery and what does it arise from
hypogastric artery
from common iliac anterior to the sacroiliac joint
What does the internal iliac divide into
Anterior and posterior internal iliac arteries
What does the posterior division of the internal iliac artery provide for
provides parietal branches to pelvic wall and gluteal region
What are the branches of the posterior division of the internal iliac
Illiolumbar
Lateral sacral
Superior Gluteal
Where does the illiolumbar branch go to/ what are its branches
passes superiorly into iliac fossa
divides into
iliac branch :to iliacus
lumbar branch: to psoas major and quadratus lumborum
How many lateral sacral arereies are there and what are they termed
Can be one or two
if two named superior and inferior
WHere do the lateral sacral arteries go (path)
descend down and usually enter anterior sacral foramina
Where does the superior gluteal branch from the posterior division of the internal iliac
Is the continuation of the posterior division of the internal iliac
Where does the Superior gluteal branch travel and where does it exit the pelvis
passes between the lumbosacral trunk and s1
exitsthe pelvis through the greater scieatitc foramen superior to the piriformis muscle
What does the superior gluteal artery supply
gluteus meiddus
gluteus minnimus
tnesor fasciae lateae
some branches to gluteus maximus
Which of the branches of the internal iliac is a direct continuation of the main stem
anterior division
What does the anterior division provide ateries to
thigh
perineum
gluteal region
branches to pelvic viscera
What are the branches of the anterior division of the internal iliac
Obturator internal pudendal inferior gluteal umbilical inferior vesical uterine vaginal middle rectal
What is the first branch off of the anterior division of the internal iliac
Obturator
Where does the obturator exit the pevis and what does it supply
exits via the obturator foramen and supplies the adductor compartment of the thigh
What is the acetabular a branch of and what does it do
obturator
important artery supply to femoral head in children until closure of the epiphsyesal cartilage
(then done via vessels in retinacula along neck)
what arise together of a common stem of the anterior division of the internal iliac
internal pudendal and inferior gluteal
Inferior vesicle and middle rectal (sometimes)
WHere does the internal pudendal exit the pelvis and where does it go from there
through the greater sciatic foramen
crosses posterior to ischial spine and enters perinium via lesser sciatic foramen
Where does the inferior gluteal exit the pelvis
infgreater sciatic foramen inferior to the piriformis and may exit between s1 and s2 or s2 and s3 anterior rami
What does the inferior gluteal supply
Primary supply to the gluteus maximus but also supplies other muscles in that area
What happens when the umbilical cord is tied
Umbilical artery between pelvis and umbilicus degenerates and fomrs umbilical ligament
What arises from the the proximal part of the umblical artery in the pelvis
superior vesical branches : to urinary bladder
Artery to the ductus deferens
WHat can the inferior vesicle sometimes arise with
Middle rectal
What does the inferior vesicle supply
urinary bladder
prostate
seminal glands
What corresponds to the inferior vesicle artery in females
unnamed artery arising from the vaginal artery
What is the female homolog to the artery of the ductus defrerens in males
Uterine artery
What variations can the uterine artery arise with
may arise in common with middle rectal or vaginal
Where does the uterine artery pass and what passes under it
uterine artery passes to the side of the uterus at the base of the broad ligament
ureter passes under the uterine artery at the base of the broad ligament
(water under the bridge)
Where can the vaginal artery arise
Directly from anterior division of the internal iliac
or as a branch of the uterine
Where can the middle rectal artery arise
with inferior vesical or internal pudendal
What is the genral rule of lymphatic drainage for individual organs
it follows their arteries and veins
What drains to the superficial inguinal nodes in the superfical pelvis and peritoneum
llymphatic vessesls of th perineum (except glans pens and clit)
inferior 2/3rds of vagina
anal canal inferior to pectinate line
What drains into the internal iliac nodes in the superfical pelvis and peritoneum
upper 1/3rd of the vagna and pelvic viscera
Where do lymphatics from the ovaries and testis drain
para aortic lumbar nodes
Where is the superior hyogastric plexus
contiunuation of inferior mesenteric plexus before the aortic bifurcation
What is contained in the superior hypogastric plexus and what makes up most of it
contains parsympathetic and sympathetic compoonents
but principally sympthetic vasomotor and sensory
What feeds into the Superior hyopgastric plexus
parasympthetic from pelvic splanchnic nerves
lower two lumbar splanchnic nerves (sympathetic)
What happens caudally to the hypogastric plexus
contiues on the promontory of the sacrum and desncends into each side of pelvis as right and left hypogastric nerves
What do the left and right hypogastric nerves contribute to
join parasympathetic pelvic splanchnic nerves to form the inferior hypogastric plexus
What proides innervation to the pelvic viscera
inferior hypogastric plexus
Where is the inferior hypogastric plexus located
each side of the
rectum
urinary bladder
uterinecervix (or prostate)
what do extensions of theinferior hypogasttric pleus follow
branches of internal illiac
rectal, vesical, prostatic, uterine, vaginal, and cavernous
what do the branches of the inferior hypogastric plexus do once they reach the viscera
form visceral plexuses in the walls of pelvic viscera
Where do preganglionic sympathetic (splanchnic) contributions to pelvic plexuses synapse
in the ganglion cells within the plexuses
postganglionics distribute along vessels
Where do preganglionic parasympathetic (splanchnic) contributions to pelvic plexuses synapse
do not synapse in ganglion
distribute along vessels
synapse on postanglionic nerve cell bodies in the walls of organ to be innervated
What forms the pudendal nerve and what does it provide
anterior divisions of S2 S3 and S4
principle nerve to peritoneum
What types of spinal nerves are contained in the pudendal nerve
all 4 components voluntary motor GSE visceral motor (sympathtetic) GVE visceral sensory somatic sensory
NO PARASYMPATHETIC AUTONOMICS
Where does the perinieum get parasympathetic autonomics
from the prostatic plexus (male)
or uterovaginal plexus (female)
What types of spinal inervation does sexual functioninvolve
all of them
sensory
autonomic (sym parasym)
and somatic
What is the sexual response cycle divided into (4)
excitement
plateau
orgasm
resolution
What may be extragenital reactions may be included in an orgasm reaction(5)
breasts skin cv system resp system digestive system
What characterizes the exitement phase in male
erection
What characterizes the exitement phase in female
vaginal wetness
What causes engorgement of the erictile tissue on errection
dilation and straghtening of arteries from parasympattheitc innervation (activated by sensory stimuli [thoughts,visual, tactile])
What helps maintain errections and how/with what innervation
Bulbospongiosus and ischiovavernosus via pudendal
contract and interfere with venous return of blood from cavernous tissues
What is wetness in females and what causes it
fluid passing across vaginal wall
increased bloodflow and vasocongestion to vagina
What is also seen alongside wetness in female excitement and how
enlargement of clitoris from vasocongestion
What mediates the vaginal and clitoral excitement responses in females
parasympathetic nervous
What happens in the plateu phase of males and what innervation mediates it
Further engorgement of the penis
parasympathetic nervous
What happens in the plateu phase of females and what innervation mediates it
additional vasocongestion of vagina
parasympathetic nervous
What is the orgasm phase synonymous with in males
ejaculation
What is the emission phase of orgasm in males and what mediates it
peristaltic like contractions of
ductus defrens
seminal glands
prostate
this delivers sperm and glandular secretion to prostatic urethra
sympathetic nervous
What does contraction of the internal urethral sphincter do during ejaculation and what mediates it
prevent retrograde ejaculation
sympathetic nervous
What accomplishes the actual ejaculation in males
rapid succession of alternating contractions of
bulbospongiousus and ischiocavernosus muscles
expels semen from tip of penis
What does orgasm in females involve and what innervation is it mediated by
rhytmic contractions of the vagina and uterine fundus
sympathetic
what my orgasm in females cause and where is its origin
fluid gush from urethra
likely from paraurethral glands
What is the resolution phase of sexual response characterized by
return to the normal or pre excitement condition
what is the refractory period and which phase of sexual response is it associated with
state in which no amount of stimulation will cause an erection
associated with resolution phase
