33. Pelvic Vessels, Nerves, and Lymphatics Flashcards

1
Q

What major vessel has branches responsible for supplying the pelvic structures?

A

Abdominal aorta

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2
Q

What branches of the abdominal aorta supply the ovaries?

A

Ovarian aa.

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3
Q

What branch off the abdominal aorta supplies the lower lumbar vertebrae, sacrum, and coccyx?

A

Middle (median) sacral a.

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4
Q

The common iliac arteries bifurcate at the level of _____ intervertebral disc into the _____ and ______ iliac arteries

A

L5-S1; external; internal

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5
Q

The external iliac artery becomes the ____ a., while the internal iliac artery supplies the pelvic structures and _______

A

Femoral; perineum

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6
Q

What are the 4 branches off the abdominal aorta responsible for supplying pelvic structures?

A

Ovarian aa.
Median sacral a.
Common iliac aa.
Inferior mesenteric a.

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7
Q

_____ ______ = terminal branch of inferior mesenteric a. whose 2 branches supply both sides of the rectum as far inferiorly as the internal anal sphincter

A

Superior rectal a.

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8
Q

What artery consists of both anterior and posterior divisions, supplying many pelvic structures?

A

Internal iliac a.

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9
Q

What are the 3 major branches of the posterior division of the internal iliac a.?

A

Lateral sacral aa.
Iliolumbar a.
Superior gluteal a.

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10
Q

What are the 9 major branches of the anterior division of the internal iliac a. (Females)?

A
Umbilical a.
Superior vesical a.
Inferior vesical a.
Middle rectal a.
Obturator a.
Internal pudendal a.
Inferior gluteal a.
Uterine a.
Vaginal a.
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11
Q

The ________ arteries (2 or more vessels) supply the piriformis then enter the anterior sacral foramina to supply the structures of the sacral canal. They eventually exit the posterior sacral foramina to supply the _____ _____ muscles and the skin posterior to the sacrum

A

Lateral sacral; erector spinae

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12
Q

The _______ artery courses between the obturator nerve and the lumbosacral trunk to supply the psoas major, iliacus, and quadratus lumborum plus the _____ _____ in the vertebral canal

A

Iliolumbar; cauda equina

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13
Q

What is the terminal branch of the posterior division of the internal iliac a.?

A

Superior gluteal a.

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14
Q

The superior gluteal a. exits the greater sciatic foramen and supplies what 3 muscles?

A

Piriformis m.
Gluteal mm.
Tensor fascia lata m.

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15
Q

What 2 arteries originate from the same trunk and supply the urinary bladder? Which one is obliterated after birth?

A

Umbilical a. (Obliterated after birth)

Superior vesical a.

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16
Q

What structures does the inferior vesical a. supply in males?

A

Urinary bladder
Seminal vesicle
Prostate
Ureter

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17
Q

What artery supplies the rectum, prostate, seminal vesicle in males, and the rectum and vagina in females?

A

Middle rectal a.

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18
Q

The _______ artery supplies the pelvic muscles, head of femur, then leaves the pelvic cavity via the ________ ______ to enter the medial thigh

A

Obturator; obturator canal

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19
Q

The __________ artery exits the pelvis via the greater sciatic foramen, loops around the spine of the ischium to enter the perineum via the lesser sciatic foramen, and supplies all the perineal structures

A

Internal pudendal

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20
Q

What muscles/structures are supplied by the inferior gluteal a.?

A
Piriformis m.
Pelvic diaphragm
Quadratus femoris m.
Gluteus maximus m.
Sciatic n.
21
Q

The uterine artery supplies the ____ and superior ______, and ultimately anastomoses with the ______ artery. It also supplies the ______ of the uterus

A

Uterus; vagina; ovarian; ligaments

22
Q

The ______ artery supplies anterior and posterior vaginal surfaces

A

Vaginal

23
Q

Each pelvic organ has a _____ ______ which freely communicates with those of other organs. These have no valves and have important connections with the vertebral venous plexuses (_______ veins)

A

Venous plexus; Batson’s

24
Q

Pelvic venous plexuses are drained by tributaries of _______ veins, ______ vein, and ______ veins

A

Internal iliac; inferior mesenteric; lateral sacral

25
Q

The _________ veins form superior to the greater sciatic foramen and lie postero-inferior to the internal iliac arteries. These veins merge with the _______ veins to form the common iliac veins, which unite at the ______ intervertebral disc to form the ________

A

Internal iliac; external iliac; L4/L5; IVC

26
Q

What vessels are included in the term “pelvic veins”?

A

Lateral sacral veins
Superior rectal v.
Superior gluteal vv.
Testicular vv. (Or ovarian vv)

27
Q

What veins provide a metastatic pathway for prostatic or ovaarian cancer cells to the vertebrae or cranial cavity?

A

Lateral sacral vv., which anastomose with internal vertebral plexus providing a collateral pathway to reach either the inferior or superior vena cava

28
Q

What are the 4 groups of lymph nodes associated with pelvic viscera?

A

External iliac LNs
Internal iliac LNs
Sacral LNs
Common iliac LNs

29
Q

The external iliac LNs receive lymph from _____ nodes and superior parts of middle to anterior pelvic organs. They drain into ________ nodes

A

Inguinal; common iliac

30
Q

Which LNs receive lymph from inferior pelvic viscera, deep perineum and the gluteal region, draining into the common iliac nodes?

A

Internal iliac LNs

31
Q

Which LNs receive lymph from postero-inferior pelvic viscera, and drain into internal or common iliac nodes?

A

Sacral LNs

32
Q

Which LNs receive lymph from external iliac, internal iliac, and sacral LNs, and drain into the lumbar nodes?

A

Common iliac nodes

33
Q

Pelvic structures are innervated mainly by the ____ and ____ nerves, and the ________ nerves

A

Sacral; coccygeal spinal; pelvic splanchnic

[sacral and coccygeal = S1-S5, Co; pelvic splanchnics = S2-S4]

34
Q

The sacral plexus is located on the posterolateral wall of the pelvic cavity and has what 4 branches which exit the pelvic cavity through the greater sciatic foramen?

A

Sciatic n. (L4-S3)

Pudendal n. (S2-S4)

Superior gluteal n. (L4-S1)

Inferior gluteal n. (L4-S2)

35
Q

Which branch of the sacral plexus enters the perineum via the lesser sciatic foramen and is contained in its own canal? What does it supply?

A

Pudendal n. (S2-S4) — supplies all perineal structures

36
Q

Which branch of the sacral plexus enters the gluteal region to supply the gluteaus maximus?

A

Inferior gluteal n. (L4-S2)

37
Q

Which branch of the sacral plexus enters the gluteal region to supply the gluteus medius and minimis?

A

Superior gluteal n. (L4-S1)

38
Q

Which branch of the sacral plexus travels inferior to piriformis to enter gluteal region, descending into the posterior thigh to supply the hamstring muscles, leg, and foot?

A

Sciatic n. (L4-S3)

39
Q

What makes up the coccygeal plexus?

A

Anterior rami from S4-S5 and Co

40
Q

The coccygeal plexus lies on the pelvic surface of the ______ m. The ______ nerve arises from this plexus and supplies the skin between the tip of the coccyx and the anus

A

Coccygeus; anococcygeal

41
Q

What 3 structures are supplied by the coccygeal plexus?

A

Coccygeus m.
Levator ani
Sacrococcygeal joint

42
Q

The pelvic autonomic nn. include what 2 groups of nerves?

A

Hypogastric plexuses

Pelvic splanchnic nerves

43
Q

The ______ plexus supplies the sympathetic innervation to pelvis viscera. In addition, _____ _____ fibers pass through this plexus

A

Hypogastric; visceral afferent

44
Q

What nerves supply parasympathetic innervation to the pelvic viscera, including the rectum and proximal anal canal (internal anal sphincter)?

A

Pelvic splanchnic nn.

45
Q

Branches of the inferior hypogastric plexuses continue to the pelvic viscera upon which they form sub-plexuses collectively known as pelvic plexuses

What are these sub-plexuses associated with in males vs. females?

A

In both male and female, sub-plexuses are associated with the lateral rectum and the inferolateral urinary bladder

In males = prostate and seminal vesicles; parasympathetic fibers in prostatic plexus penetrate pelvic diaphragm to reach erectile tissues in penis, producing erection

In females = cervix of uterus and lateral fornices of vagina

46
Q

What supplies sympathetic innervation superior to the pectinate line?

A

Lumbar and sacral splanchnic nn

47
Q

What supplies parasympathetic innervation superior to the pectinate line?

A

Pelvic splanchnic nn

48
Q

Below the pelvic pain line, both visceral pain and visceral non-pain are conveyed via _______ nerves

A

Pelvic splancnic

49
Q

What supplies somatic innervation inferior to the pectinate line?

A

Inferior rectal nn. (Branches of pudendal n.)