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ANAT 214 > Pelvic Neurovasculature > Flashcards

Pelvic Neurovasculature Flashcards

(48 cards)

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1
Q

Describe abdominal aorta - what branches supply pelvic region

A

2 common iliac arteries
Transition to 2 lower limbs
Bypasses rectum
L4

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2
Q

Describe common iliac artery

A

4 cm long
Originate from aortic bifurcation at L4
Runs inferomedially, along medial aspect of psoas major
Ends over sacroiliac joint

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3
Q

What does common iliac artery give

A

Internal iliac artery = into lesser true pelvis, reaches pelvis and gives many brnaches, for pelvic cavity
External iliac artery = lower limb, outside = passes under inguinal lig and then becomes femoral

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4
Q

Describe internal iliac artery

A

1 on each side of pelvis
From common iliac artery
Courses inferiorly over pelvic inlet

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5
Q

Where does internal iliac artery divide

A

At level of greater sciatic foramen = divides into anterior trunk and posterior trunk

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6
Q

What does internal iliac artery divide into

A

Anterior trunk and posterior trunk

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7
Q

Describe anterior trunk of internal iliac

A

Aims anterior
To all pelvic viscera
Perinuem - erectile tissue
Gluteal region

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8
Q

Describe posterior trunk of internal iliac

A

Not for viscera
Lower abd wall
Posterior pelvic wall
Gluteal region - muscle mainly

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9
Q

What branches does posterior trunk give

A

Iliolumbar artery
Lateral sacral arteries
Superior gluteal Artery

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10
Q

Describe iliolumbar artery

A

Acends laterllay out of pelvic inlet
Will reach lumbar region and iliac bone and region

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11
Q

What branches does iliolumbar artery give

A

Lumbar branches = to post abd wall, psoas, quadratus
Iliac branches to iliac fosssa for iliacus muscle and iliac bone, colon sits here

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12
Q

Describe lateral sacral arteries

A

Course medically and inferiorly to posterior pelvic wall = skin, dermis, thoracolumbar fascia
Supplies sacrum and skin of sacral region
Feeds sacrum, passes through sacral formamina

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13
Q

describe superior gluteal artery

A

Largest and terminal branch of posterior trunk, int iliac artery
Leaves pelvis through greater sciatic foramen above piriformis
Supplies muscle and skin of gluteal region, part of lumbar and sacral plexus, between lumbosacral trunk and s1

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14
Q

What does anterior trunk of internal iliac give

A
  • Umbilical artery
  • Superior vesical artery
  • Inferior vesical
  • Vaginal artery
  • Uterine artery
  • Middle rectal artery
  • Obturator artery
  • Internal pudendal artery
  • Inferior gluteal artery
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15
Q

Describe umbilical artery

A

1st brnach of anterior trunk
Will give superior vesicle arteries
Rest of vessel is obliterated forming medial umbilical ligament- remnant of fetal circulation
No anatomical variation

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16
Q

Describe medial umbilical ligament

A

Bit lateral,remnant of obliterated umbilical artery, fibrotic tissue
When umbilical cord cut = segment of tube between bladder and umbilicus = collapse and becomes fibrotic
Recall*median umbilical ligament that suspends bladder

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17
Q

Describe superior vesical artery

A

Originates from umbilical artery
Supplies superior bladder and distal part of ureter
Little branches, right where obliterated portion starts

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18
Q

Describe anterior trunk amab branches

A

Inferior vesical artery = supplies bladder, ureter, seminal vesicles and prostate
Under bladder, = prostate, seminal vesicles,

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19
Q

Describe anterior trunk afab branches

A

Vaginal and uterine -variations

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20
Q

Describe uterine artery

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A

Courses in broad ligament - transverse cervcial ligament - fibrotic thickening protecting uterine and vaginal arteries
Crosses ureter to reach cervix
Supplies = uterus, also contributes to ovary and vagina vasculature
From lateral pelvis to lateral cervix

21
Q

Describe vaginal artery

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A

Euqavlent of inferior vesicle in amab
Somtimes from uterine artery
Supplies = vagina, bladder and rectum

22
Q

Describe what afab arteries/veins do

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A

Ovarian connects with uterine connects with vaginal
All interconnected
Veins do the same = big venous system
Anastomotic system
Link to vulvar region

23
Q

Describe middle rectal artery

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A

Course medially to supply rectum
Anastomoses with superior rectal artery - from inf mesenteric artery and ifnerior rectal artery - from internal pudendal of perinuem

24
Q

Describe obturator artery

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A

Courses anteriorly along pelvic wall
Leaves pelvic cavity through obturator Foramen, from ant wall
Supplies medial adductor region of thighs

25
Describe internal pudendal arteyr
Leaves pelvic cavity through greater sciatic foramen inf to piriformis Loops around ischial spine and sacrospinous ligament Enters lesser sciatic foramen to reach perineum Supplies perineum (urogenital and anogenital triangles) and related structures
26
Describe inferior gluteal artery
Terminal branch of internal iliac Passes between sacral nerve s2 and s3 Leaves pelvic cavity through greater sciatic foramen ifnerior to pirifomis
27
How to tell apart inferior gluteal and internal pudendal
Inferior gluteal = post posterior vessel Compared to internal pudendal -more anterior - close to tip of coccygeus muscle
28
Describe veins - Gen
Follow course of arteries Except for umbilical and iliolumbar arteries = no veins
29
Name all veins
* Superior vesical vein * Inferior vesical / vaginal vein * Uterine vein * Middle rectal vein * Obturator vein * Internal pudendal vein * Inferior gluteal vein
30
Describe drainage of pelvic cavity- Gen
Veins drain into internal iliac vein Leaves pelvic cavity Joints external iliac vein Form common iliac vein 2 iliac vein- one on each side - join to form Ivc *drains INTO CAVAL system not portal system
31
Describe drainage of pelvic cavity - plexuses
Venous drainage of Pelvic cavity: interconnected venous plexuses Associated with organs: Bladder, rectum, prostate, uterus, vagina All together to form pelvic venous plexus
32
Describe portosystemic anastomosis- gen
Superior rectal = inf mesenteric vein - portal system (portal) Middle rectal = internal iliac - systemic (CAVAL) Inferior rectal = internal pudendal - systemic (CAVAL)
33
Describe portosystemic anastomosis - specifics issue
If porto caval hypertension Blood pools, superior rectal cannot drain since drains into portal system So mid and inf rectal veins drain into ivc, so sup rectal vein no longer capable fo absorbing blood so pools down into mid and inf rectal veins = swollen, hemorrhoids
34
Describe pelvic congestion syndrome - pcs
Medical condition that causes chronic pelvic pain in afab Due to reduced venous drainage form left ovarian vein Could lead to Vulvar varicosities Network ovarian vessels, Anastomose with uterine and vaginal = veins reach vulva - during cycle = pain, congestion, discomfort
35
Describe somatic innervation of pelvis
Sacral plexus and perinuem
36
Describe sacral plexus - somatic innervation
Formed by ant rami of s1-4 (each comes from sacral foramina)+ l4-5 = lumbosacral, joins to form big nerve Found on anterior surface of priformis Mostly for lower lim but also for pelvis and perinuem =forms sacral plexus, motor and sensory to lower limb and post thigh = sciatic nerve, biggest nerve, leaves via greater sciatic formaen under piriformis
37
Describe perineum - somatic innervation
Pudendal nerve s2,3,4 = motor and sensory Leaves pelvic cavity through greater sciatic foramen udner piriformis Pass around sacrospinous ligament and loops over ischial spine Through lesser sciatic foramen to reach perineum with internal pudendal vessels
38
Describe pudendal block
Pudendal block: Anesthesia is performed by infiltration near attachment of sacrospinous ligament, ischial spine
39
Describe superior hypogastric plexus
Same as aortic plexus but below aortic bifurcation Connected to inferior hypogastric plexus via hypogastric nerv Below stomach, bifurcation around rectum, extension, hypogastric nerv and will reach inf hypo plexus
40
Describe visceral innervation - Gen
Plevic extension of superior hypogastric plexus Carry autonomic innervation - sympathetic and parasympathetic Enter pelvis via 2 hypogastric nerves, one on each side Will form inferior hypogastric plexus, around plevic vsicera *vagus doesn’t supply hindgut, stops 2/3 trasnverse colon
41
Describe visceral innervation - pathway
Lumbo sacral trunk —>lumbo sacral plexus Sacral splanchnic = leaves chain, sympathetic,reaches inf hypogastric plexus Pelvic splanchnic = parasympathetic,leaving sacral nerve SPLANchNIc NOT JUST PSNS - sns too
42
Describe visceral innervation sympathetic - paravertebral sympathetic trunk
Inferior end of sympathetic trunk in pelvic cavity Pass anterior to paramedial aspect of sacrum, Join to form one terminal single ganglion (impar)
43
Describe visceral innervation sympathetic - paravertebral sympathetic trunk DISTRIBUTIONN
Postganglionic fibers reach sacral nerves Preganglionic fibers reach inferior hypogastric plexus by using a splanchnic nerve Sympathetic: S = Sacral splanchnic nerves
44
Describe visceral parasympathetic invvertaion
Originate from S2-S4 anterior rami of sacral nerve Carry preganglionic parasympathetic fibres to inferior hypogastric plexus Pelvic splanchnic nerves (S2-S4): P=Parasympathetic
45
Describe direction of symp/parasymp
Vagus goes down therefore psns (ascending) goes up And sns goes Down (descending)
46
Describe psns and action
From pelvic splanchnic Action: * Generally vasodilator of vessels * Stimulate bladder contraction: voiding * Stimulate erection: Relaxation of branches of deep penile arteries * Modulate activity of hindgut
47
Describe sns and action
Enters from hypogastric nerve & sacral splanchnic Action: * Innervate blood vessels * Cause contraction of internal urethral sphincter * Cause contraction of smooth muscle associated with reproductive tract, accessory glands * Peristalsis for moving secretion of epididymis and associated glands during ejaculation
48
Describe pathway of parasympathetic
S2,3,4 —> pelvic splanchnic —> Reach inf hypogastric plexus —> Hypogastric nerve —> superior hypogastric plexus —> Aortic plexus —> Inferior mesenteric artery and plexus —> Hindgut

ANAT 214 (34 decks)

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