Pelvic Nerves, ANS, Lymphatics Flashcards
(108 cards)
1
Q
What spinal levels are found in the lumbosacral trunk
A
L4-L5
2
Q
What is the sacral plexus
A
Lumbosacral trunk and ventral rami S1-S4
3
Q
What are the levels of the sacral plexus
A
L4-S4
4
Q
Where is the sacral plexus located
A
anterior to piriformis, exits the sacral foramina
5
Q
What spinal levels are seen in the obturator nerve
A
L2-L4
6
Q
What are the nerves of the sacral plexus
A
pudendal nerve to levator ani, coccygeus, and external anal sphincter nerve to piriformis sciatic superior gluteal inferior gluteal pelvic spanchnics
7
Q
What spinal level is Pudendal nerve
A
S2-S4
8
Q
What spinal level is nerve to levator ani, coccygeus, and external anal sphincter
A
S4
9
Q
What spinal level is nerve to piriformis
A
S2
10
Q
What spinal level is sciatic enrve
A
L4-S3
11
Q
What is the spinal level for superior gluteal
A
L4-S1
12
Q
What is the spinal level for inferior gluteal
A
L5-S2
13
Q
What is the spinal level for splanchnic nerves
A
S2-S4
14
Q
What is the course of the pudendal nerve
A
exits GSF and enters perineum through LSF
15
Q
Where does the pudendal nerve travel
A
in pudendal canal
16
Q
What are the branches of the pudendal nerve in males
A
Perineal
dorsal nerve of penis
inferior rectal
17
Q
What are the branches of the pudendal nerve in females
A
perineal
dorsal nerve of clitoris
inferior rectal
18
Q
What are the branches of the perineal nerve
A
superficial and deep
19
Q
Where does the perineal nerve divide
A
UGD
20
Q
What does the deep perineal nerve innervate
A
mainly muscles: transverse perinei, bulbospongiosus, ischiocavernosus
21
Q
What does the superficial perineal nerve supply
A
scrotal skin and labia majora
posterior scrotal nerves
22
Q
What is the course of the dorsal nerve of the penis
A
runs a long ischial and pubic rami within deep perineal space
branch to corpus cavernosum, pierces perineal membrane
runs between corpus cavernosa and pubic symphysis onto dorsum of penis (clitoris)
23
Q
What skeletal muscle is supplied by the dorsal nerve of the penis (clitoris)
A
none
24
Q
What anatomical landmarks can be used for a pudendal nerve block
A
ischial spine
25
Why is the ischial spine used as a landmark for pudendal nerve block
pudendal nerve runs over ischial spine
26
Where will parasympathetics and sympathetics distribute
sympathetics: superficial and deep
parasympathethetics: only deep
27
What is the ganglion impar
swelling over the coccyx where the two sympathetic trunks unite
28
Where is the superior hypogastric plexus found
around the branch of the aorta
29
What is contained within white and gray rami and what levels will they be seen at
white rami: preganglionic
gray rami: pre/post ganglionic
white: T12-L2
Gray: all levels
30
Where will lumbar and sacral splanchinc nerve cell bodies be found
IML L1-L2
31
Where will the postganglionic cell bodies of lumbar and sacral splanchnic nerves be found
hypogastric plexus
32
Where do lumbar splanchnic nerves originate from
from chain at lumbar levels
33
Where do sacral splanchnic enrves originate from
chain at sacral levels
34
Where are preganglionic cell bodies of pelvic splanchnic nerves found
IML-like area of S2-S4
35
What are the two places in which sacral splanchnics may travel after leaving the sympathetic chain
hypogastric nerve
| hypogastric plexus
36
What is stimulated by sympathetics from the hypogastric plexus
contraction of smooth muscle to move fluid and blood through structures
37
What is stimulated by parasympathetics from the hypogastric plexus
vasodilation
bladder contraction
erection
digestion
38
How is the inferior hypogastric plexus named
the viscera it is surrounding
39
What are the names of the inferior hypogastric plexus
middle rectal
vesical
prostatic
uterovaginal
40
What is the sympathetic innervation of the upper ureter
T10-L1
41
What is the sympathetic innervation of the lower ureter
L1-L2
42
What is the sympathetic innervation of the gonad
T10-T11
43
What is the sympathetic innervation of the bladder
L1-L2
44
What is the sympathetic innervation of the prostate
L1-L2
45
What is the sympathetic innervation of the uterus
L1-L2
46
What is the sympathetic innervation of the uterine tube
L1-L2
47
What are cavernous nerves
nerves that are extensions from prostatic plexus
48
Where do cavernous nerves pass
between arcuate ligament and perineal membrane to innervate erectile tissue
49
What stimulates stretch receptors involved in defecation
increased pressure in rectal ampulla
50
What aspects of defecation are under parasympathetic control
internal anal sphincter relaxation
| contraction of circular muscle fibers
51
What aspects of defecation are under voluntary control
relaxation of puborectal sling
increase in intra-abdominal pressure
relaxation of external anal sphinctor
contraction of levator ani
52
What affect do parasympathetics have on micturition
excite detrusor muscle
| inhibit internal sphincter
53
What affect do sympathetics have on micturition
inhibit detrusor muscle
| excite internal sphincter
54
What control is the external urethral sphincter under
voluntary
55
Where will pain fibers associated with micturition run
sympathetics and parasympathetics
56
How will bladder control be altered if there is damage to peripheral ANS routes
inability to void
| cannot sense fullness
57
How will bladder control be altered if there is destruction of the sacral spinal cord
autonomous bladder: continuous dribbling
| -all parts are paralyzed
58
How is an erection obtained
Parasympathetic muscles stimulate the coiled arteries to relax and fill with blood. Cavernous spaces inside erectile tissue fill with blood
59
What muscles aid in getting an erection and how
bulbospongiosus and ischiocavernosus compress the venous plexus
60
What is the mechanism of emission
peristaltic movement of semen through ejaculatory ducts
61
What nerves aid in emission
sacral splanchnic nerves (L1-L2)
62
What is the mechanism of ejaculation
closure of internal urethral sphincter
contraction of urethral muscles
contraction of bulbospongiosus
63
What nerves aid in closure of the internal urethral sphincter
sympathetic
64
What nerves aid in contraction of urethral muscles
parasympathetic
65
What nerve aids in contractio of bulbospongiosus
pudendal
66
What are the branches of the anterior division of teh internal iliac artery
```
obturator
internal pudendal
inferior gluteal
umbilical
middle rectal
inferior vesical
uterine
```
67
What are the branches of the psoterior division of the internal iliac
lateral sacral
superior gluteal
iliolumbar
68
What does Iliolumbar artery supply
ascends out of pelvis and divides into iliac and lumbar branches
69
What does lateral sacral artery supply
courses along posterior pelvic wall
70
What does superior gluteal artery supply
passes between lumbosacral trunk and S1 through GSF
71
What is the first branch off of internal iliac anterior
umbilical artery
72
What does the inferior vesical artery supply
fundus of bladder, prostate, seminal vesical
73
What is the inferior vesical artery related to in female
vaginal artery
74
What does the middle rectal artery supply
seminal vesicals, rectum, and prostate
75
What are the pelvis arterial anastomoses
deep circumflex to iliolumbar
median sacral to lateral sacral
superior rectal to middle rectal
profundis femoris to inferior gluteal
76
Where will an aberrant obturator artery be seen
when obturator artery goes over pubic bone rather than through obturator canal
77
What are the main sources of blood supply to the female internal genitalia
uterine and vaginal arteries
78
Where does the uterine artery arise from
anterior trunk
79
Where does the vaginal artery arise from
internal iliac or branch off of uterine artery
80
How is the penis venously drained
superficial dorsal veins
| deep dorsal veins
81
What do the superficial dorsal veins drain on the penis
skin and prepuce
82
Where do the superficial dorsal veins of the penis dump
into superficial external pudendal
83
What do the deep dorsal veins on the penis drain
glans and corpora cavernosa
84
Where do teh deep dorsal veins on the penis empty into
prostatic plexus
85
What is the venous drainage of the rectum
internal and external venous plexus
86
What are possible causes of internal hemorrhoids
portal hypertension
| hepatic cirrhosis
87
What type of pain do internal hemorrhoids have
no pain
88
What are internal hemorrhoids
prolapsed anal mucosa which contain dilated veins from internal rectal venous plexus
89
What are possible causes of external hemorrhoids
pregnancy
| constipation
90
What are external hemorrhoids
blood clots in the external rectal venous plexus covered by skin
91
What type of pain do external hemorrhoids have
a lot
92
What is the pain of external hemorrhoids carried by
inferior rectal nerve
93
What are the general rules of lymphatics of the pelvis
follows blood supply in retrograde
| connections made in development so if organ migrates it takes its lymphatics along
94
Where will all lymph from the pelvis end up
lumbar nodes that form lumbar trunks and lead to cisterna chyli
95
How are pelvic lymph nodes named
location
96
What are the pelvic lymph nodes
```
pre-aortic: inferior mesenteric
lumbar
common iliac
internal iliac
external iliac
sacral
```
97
What will drain to superficial inguinal lymph nodes
```
body wall below umbilicus
scrotum
labia majora
bottom of vagina
anus below pectinate line
```
98
What is the lymphatic drainage of the anal canal
above pectinate: internal iliac
| below pectinate: superficial inguinal
99
What is the lymph drainage of the ductus deferens and seminal vesicals
iliac nodes
100
WHat is lymphatic drainage of the penis
internal iliac
| distal glans: deep inguinal
101
What is the lymphatic drainage of the prostate
internal iliac and sacral nodes
102
What is teh lymph drainage of the testes
lumbar
103
What is the lymph drainage of the scrotum and the skin over the penis/perineum
superficial inguinal nodes
104
What is the lymphatic drainage of the uterine tubes and ovaries
lumbar
105
What is the lymphatic drainage of the fundus and body of uterus
lumbar and external iliac
106
What is the lymphatic drainage of the cervix
external and internal iliac, sacral
107
What is lymphatic drainage of the vagina
upper 2/3 internal and external iliac
| lower 1/3 superficial inguinal
108
What is the lymph drainage of the clitoris and labia minora
deep inguinal and external iliac
