Vasculature, Innervation, and Functional Anatomy of Pelvis and Perineum

Question 1

What is another name for the internal iliac artery and what does it arise from

Answer 1

hypogastric artery

from common iliac anterior to the sacroiliac joint

Question 2

What does the internal iliac divide into

Answer 2

Anterior and posterior internal iliac arteries

Question 3

What does the posterior division of the internal iliac artery provide for

Answer 3

provides parietal branches to pelvic wall and gluteal region

Question 4

What are the branches of the posterior division of the internal iliac

Answer 4

Illiolumbar
Lateral sacral
Superior Gluteal

Question 5

Where does the illiolumbar branch go to/ what are its branches

Answer 5

passes superiorly into iliac fossa

divides into
iliac branch :to iliacus
lumbar branch: to psoas major and quadratus lumborum

Question 6

How many lateral sacral arereies are there and what are they termed

Answer 6

Can be one or two

if two named superior and inferior

Question 7

WHere do the lateral sacral arteries go (path)

Answer 7

descend down and usually enter anterior sacral foramina

Question 8

Where does the superior gluteal branch from the posterior division of the internal iliac

Answer 8

Is the continuation of the posterior division of the internal iliac

Question 9

Where does the Superior gluteal branch travel and where does it exit the pelvis

Answer 9

passes between the lumbosacral trunk and s1

exitsthe pelvis through the greater scieatitc foramen superior to the piriformis muscle

Question 10

What does the superior gluteal artery supply

Answer 10

gluteus meiddus
gluteus minnimus
tnesor fasciae lateae
some branches to gluteus maximus

Question 11

Which of the branches of the internal iliac is a direct continuation of the main stem

Answer 11

anterior division

Question 12

What does the anterior division provide ateries to

Answer 12

thigh
perineum
gluteal region
branches to pelvic viscera

Question 13

What are the branches of the anterior division of the internal iliac

Answer 13

Obturator
internal pudendal
inferior gluteal
umbilical
inferior vesical
uterine
vaginal 
middle rectal

Question 14

What is the first branch off of the anterior division of the internal iliac

Answer 14

Obturator

Question 15

Where does the obturator exit the pevis and what does it supply

Answer 15

exits via the obturator foramen and supplies the adductor compartment of the thigh

Question 16

What is the acetabular a branch of and what does it do

Answer 16

obturator

important artery supply to femoral head in children until closure of the epiphsyesal cartilage

(then done via vessels in retinacula along neck)

Question 17

what arise together of a common stem of the anterior division of the internal iliac

Answer 17

internal pudendal and inferior gluteal

Inferior vesicle and middle rectal (sometimes)

Question 18

WHere does the internal pudendal exit the pelvis and where does it go from there

Answer 18

through the greater sciatic foramen

crosses posterior to ischial spine and enters perinium via lesser sciatic foramen

Question 19

Where does the inferior gluteal exit the pelvis

Answer 19

infgreater sciatic foramen inferior to the piriformis and may exit between s1 and s2 or s2 and s3 anterior rami

Question 20

What does the inferior gluteal supply

Answer 20

Primary supply to the gluteus maximus but also supplies other muscles in that area

Question 21

What happens when the umbilical cord is tied

Answer 21

Umbilical artery between pelvis and umbilicus degenerates and fomrs umbilical ligament

Question 22

What arises from the the proximal part of the umblical artery in the pelvis

Answer 22

superior vesical branches : to urinary bladder

Artery to the ductus deferens

Question 23

WHat can the inferior vesicle sometimes arise with

Answer 23

Middle rectal

Question 24

What does the inferior vesicle supply

Answer 24

urinary bladder
prostate
seminal glands

Question 25

What corresponds to the inferior vesicle artery in females

Answer 25

unnamed artery arising from the vaginal artery

Question 26

What is the female homolog to the artery of the ductus defrerens in males

Answer 26

Uterine artery

Question 27

What variations can the uterine artery arise with

Answer 27

may arise in common with middle rectal or vaginal

Question 28

Where does the uterine artery pass and what passes under it

Answer 28

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)

Question 29

Where can the vaginal artery arise

Answer 29

Directly from anterior division of the internal iliac | or as a branch of the uterine

Question 30

Where can the middle rectal artery arise

Answer 30

with inferior vesical or internal pudendal

Question 31

What is the genral rule of lymphatic drainage for individual organs

Answer 31

it follows their arteries and veins

Question 32

What drains to the superficial inguinal nodes in the superfical pelvis and peritoneum

Answer 32

llymphatic vessesls of th perineum (except glans pens and clit) inferior 2/3rds of vagina anal canal inferior to pectinate line

Question 33

What drains into the internal iliac nodes in the superfical pelvis and peritoneum

Answer 33

upper 1/3rd of the vagna and pelvic viscera

Question 34

Where do lymphatics from the ovaries and testis drain

Answer 34

para aortic lumbar nodes

Question 35

Where is the superior hyogastric plexus

Answer 35

contiunuation of inferior mesenteric plexus before the aortic bifurcation

Question 36

What is contained in the superior hypogastric plexus and what makes up most of it

Answer 36

contains parsympathetic and sympathetic compoonents | but principally sympthetic vasomotor and sensory

Question 37

What feeds into the Superior hyopgastric plexus

Answer 37

parasympthetic from pelvic splanchnic nerves | lower two lumbar splanchnic nerves (sympathetic)

Question 38

What happens caudally to the hypogastric plexus

Answer 38

contiues on the promontory of the sacrum and desncends into each side of pelvis as right and left hypogastric nerves

Question 39

What do the left and right hypogastric nerves contribute to

Answer 39

join parasympathetic pelvic splanchnic nerves to form the inferior hypogastric plexus

Question 40

What proides innervation to the pelvic viscera

Answer 40

inferior hypogastric plexus

Question 41

Where is the inferior hypogastric plexus located

Answer 41

each side of the rectum urinary bladder uterinecervix (or prostate)

Question 42

what do extensions of theinferior hypogasttric pleus follow

Answer 42

branches of internal illiac | rectal, vesical, prostatic, uterine, vaginal, and cavernous

Question 43

what do the branches of the inferior hypogastric plexus do once they reach the viscera

Answer 43

form visceral plexuses in the walls of pelvic viscera

Question 44

Where do preganglionic sympathetic (splanchnic) contributions to pelvic plexuses synapse

Answer 44

in the ganglion cells within the plexuses postganglionics distribute along vessels

Question 45

Where do preganglionic parasympathetic (splanchnic) contributions to pelvic plexuses synapse

Answer 45

do not synapse in ganglion distribute along vessels synapse on postanglionic nerve cell bodies in the walls of organ to be innervated

Question 46

What forms the pudendal nerve and what does it provide

Answer 46

anterior divisions of S2 S3 and S4 principle nerve to peritoneum

Question 47

What types of spinal nerves are contained in the pudendal nerve

Answer 47

``` all 4 components voluntary motor GSE visceral motor (sympathtetic) GVE visceral sensory somatic sensory ``` NO PARASYMPATHETIC AUTONOMICS

Question 48

Where does the perinieum get parasympathetic autonomics

Answer 48

from the prostatic plexus (male) | or uterovaginal plexus (female)

Question 49

What types of spinal inervation does sexual functioninvolve

Answer 49

all of them sensory autonomic (sym parasym) and somatic

Question 50

What is the sexual response cycle divided into (4)

Answer 50

excitement plateau orgasm resolution

Question 51

What may be extragenital reactions may be included in an orgasm reaction(5)

Answer 51

``` breasts skin cv system resp system digestive system ```

Question 52

What characterizes the exitement phase in male

Answer 52

erection

Question 53

What characterizes the exitement phase in female

Answer 53

vaginal wetness

Question 54

What causes engorgement of the erictile tissue on errection

Answer 54

dilation and straghtening of arteries from parasympattheitc innervation (activated by sensory stimuli [thoughts,visual, tactile])

Question 55

What helps maintain errections and how/with what innervation

Answer 55

Bulbospongiosus and ischiovavernosus via pudendal contract and interfere with venous return of blood from cavernous tissues

Question 56

What is wetness in females and what causes it

Answer 56

fluid passing across vaginal wall increased bloodflow and vasocongestion to vagina

Question 57

What is also seen alongside wetness in female excitement and how

Answer 57

enlargement of clitoris from vasocongestion

Question 58

What mediates the vaginal and clitoral excitement responses in females

Answer 58

parasympathetic nervous

Question 59

What happens in the plateu phase of males and what innervation mediates it

Answer 59

Further engorgement of the penis | parasympathetic nervous

Question 60

What happens in the plateu phase of females and what innervation mediates it

Answer 60

additional vasocongestion of vagina | parasympathetic nervous

Question 61

What is the orgasm phase synonymous with in males

Answer 61

ejaculation

Question 62

What is the emission phase of orgasm in males and what mediates it

Answer 62

peristaltic like contractions of ductus defrens seminal glands prostate this delivers sperm and glandular secretion to prostatic urethra sympathetic nervous

Question 63

What does contraction of the internal urethral sphincter do during ejaculation and what mediates it

Answer 63

prevent retrograde ejaculation sympathetic nervous

Question 64

What accomplishes the actual ejaculation in males

Answer 64

rapid succession of alternating contractions of bulbospongiousus and ischiocavernosus muscles expels semen from tip of penis

Question 65

What does orgasm in females involve and what innervation is it mediated by

Answer 65

rhytmic contractions of the vagina and uterine fundus sympathetic

Question 66

what my orgasm in females cause and where is its origin

Answer 66

fluid gush from urethra likely from paraurethral glands

Question 67

What is the resolution phase of sexual response characterized by

Answer 67

return to the normal or pre excitement condition

Question 68

what is the refractory period and which phase of sexual response is it associated with

Answer 68

state in which no amount of stimulation will cause an erection associated with resolution phase