Neurovasculature of Pelvis

Question 1

Arteries of Pelvis

Answer 1

Branches off Common Iliac a.

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Iliolumbar a.

Lateral Sacral a.

Gluteal a. (sup+inf)

Pudendal (internal) a. + n.

Inf vesicals/ Uterine in female

Middle rectal a.

Vaginal a.

Obturator a.

Umbilical a.

Question 2

Female and Male Pelvic A.

Answer 2

Question 3

Uterine & Vaginal A.

Answer 3

Uterine a. homologus to ductus deferens

Ureter runs under the bridge (uterine a.)

Br.

• descending vaginal br.
• ascending br.

Hysterectomy & ovariectomy

Question 4

Anastamoses

Answer 4

Lumbar & iliolumbar

Median sacral & lateral sacral

Sup rectal & middle rectal

Inf gluteal & deep a. of the thigh

Question 5

Female Blood Supply

Answer 5

Uterine a. enters broad ligament lat to the pelvic cavity

Question 6

Anastamosis

Answer 6

Ovarian a. & ovarian br. of uterine a.

Question 7

Anastamosis

Answer 7

vaginal br. of uterine a. & vaginal a.

Question 8

Female V.

Answer 8

Question 9

Male V.

Answer 9

Question 10

Cancer metastasize

Answer 10

Pelvic organs to vert column, s.c. & brain :

• pelvic v.–> vert venous plexus–> cranial dural sinus

Prostatic or uterine cancer to heart & lungs:

• prostatic or vesical venous–> internal iliac v.–> IVC

Question 11

LN around aorta

Answer 11

1. Inf phrenic LN
2. Celiac LN (preaortic)
3. Sup mesenteric (preaortic)
4. inf mesenteric (preaortic)
5. L lateral aortic (preaortic)
6. R lateral aortic/caval (preaortic)
7. Retroaortic (preaortic)
8. common iliac
9. internal iliac
10. external iliac
11. horizonal (sup inguinal)
12. vertical (sup inguinal)
13. deep inguinal
14. sacral

Question 12

Lymph Drainage

Answer 12

Fundus of uterus around round lig= sup inguinal LN

Glans/clitoris & labia minora= deep inguinal & external iliac LN

ovary, uterine tube, fundus= para aortic LN

uterine body, cervix & bladder= internal & external iliac nodes

prostate & rectum= internal iliac LN

Question 13

Somatic

Answer 13

Sacral plexus L4,L5, S1-4

Coccygeal plexus

S4,S5, cocygeal n.

Question 14

Autonomic

Answer 14

Sacral symp

Periarterial plexus

Hypogastric Plexus- sup, R & l , inf/pelvic plexus (mixed autonomic)

Pelvic splanchnic n.- parasym

Question 15

Sacral Plexus

Answer 15

Sensory to genitalia

M. br to perineal m.

External urethral sphincter

Anal sphincter

Question 16

Dermatomes

Answer 16

S4 & S5

Elicited by scratching perianal skin & evoking reflex contraction of external sphincter

Question 17

Female Genitilia

Answer 17

Visceral afferent fibers conduct pain from intraperitoneal viscera travel w/ symp to T12-L2

Visceral afferent fibers conducting pain from subperitoneal viscera travel w/ parasym to S2-4

Question 18

Pelvic Pain line

Answer 18

Inf limit of peritoneal

Above= sym T12 TO L2

Below= parasym S2-4

Question 19

Anaesthesia

Answer 19

Spinal= subarach space= complete inf to wait level

Caudal epidural block- catheter in sacral canal= entire birth canal

Pudendal n. bloc ischial spine= S2-S4 dermatomes, quarter of vagina

Question 20

Male pelvic organs

Answer 20

Pudendal N. Br

Into lesser sciatic foramen & pudendal canal

Inf rectal n.

Perineal n.

Dorsal n. of penis/ clitoris

Post scrotal/labial n.

Question 21

Bladder

Answer 21

T11-L2 sym relax detrusor & contract sphincter

S2-4 parasym relax sphincter & contract detrusor

Pudendal n. - relax sphincter

automatic- reflex contraction 2-4 hr in babies

Autonomous- detrusor flaccid