Pelvic Neurovasculature

Question 1

Abdominal aorta

Answer 1

Splits along the coronal plane into R and L Common Iliac arteries

Question 2

Left and Right Common Iliac arteries

Answer 2

Splits along the sagittal plane into external and internal iliac arteries

Question 3

External Iliac artery

Answer 3

Exits the pelvis as the femoral artery inferior to the inguinal ligament
Travels alongside the external iliac vein
Gives off inferior epigastric artery

Question 4

Internal Iliac artery

Answer 4

Supplies the pelvic organs and gluteal region

Has posterior and anterior branches

Question 5

What are the branches of the posterior division Internal Iliac artery

Answer 5

Iliolumbar artery
Lateral Sacral artery
Superior Gluteal artery

Question 6

Iliolumbar artery location

Answer 6

Between the iliac crest and L5

Question 7

Iliolumbary artery supply

Answer 7

Medial ilium and L5

Question 8

Lateral sacral artery location

Answer 8

Enters the ventral sacral foramina

Question 9

Lateral sacral artery supply

Answer 9

Sacrum with ventral sacral nerves

Question 10

Superior Gluteal artery location

Answer 10

Between L5 and S1

Enters the gluteal region superior to the piriformis

Question 11

Superior Gluteal artery supply

Answer 11

Gluteus muscles with Superior Gluteal nerves

Question 12

Inferior Gluteal artery location

Answer 12

Superior or inferior to S2 (varies) and inferior to piriformis muscle

Question 13

Inferior Gluteal artery supply

Answer 13

Gluteal muscles with Infer Gluteal nerve

Question 14

Internal Pudenal artery location

Answer 14

Runs with Pudenal nerve
Exits the pelvis through the greater sciatic foramen
Enters the gluteal region inferomedially to piriformis
Crosses over the sacrospinous ligament, and re-enters the pelvis through the lesser sciatic formen

Question 15

Internal Pudenal artery supply

Answer 15

Urogenital triangle and anal canal

Question 16

Pudenal canal

Answer 16

Contains the internal pudenal artery and pudenal nerve in the back of the pelvis
Formed by fascia of obturator internis
Runs anteriorly along isciobuc ramus toward the UG triangle
Contents supply the UG triangle

Question 17

What are the branches of the anterior division of the Internal Iliac artery

Answer 17

Obturatory artery
Umbilical artery
Middle Rectal artery
Uterine artery (f)
Vaginal artery (f) or Inferior Visceral artery (m)
Internal pudendal
Inferior gluteal

Question 18

Umbilical artery location

Answer 18

Runs towards the abdominal wall and ends as the umbilical ligament

Question 19

Umbilical artery supply

Answer 19

The bladder

Question 20

Obturator artery location

Answer 20

Runs through the obturator canal

Question 21

Obturator artery supply

Answer 21

Medial thigh with the obturator never

Question 22

Uterine artery location

Answer 22

Runs toward the uterus/vagina
Anastamoses with the ovarian artery of the aorta
Females only

Question 23

Uterine artery supply

Answer 23

Uterus
Cervix
Superior vaginal canal

Question 24

Vaginal artery supply

Answer 24

Suplies the inferior vagina, adjacent bladder, and rectum

Females only

Question 25

Inferior Visceral artery supply

Answer 25

Supplies posterior inferior bladder, ureter, seminal vesicle, and prostate

Question 26

Middle Rectal artery location

Answer 26

The last branch of the anterior division of the Internal Iliac artery

Question 27

Middle Rectal artery supply

Answer 27

Rectum

Question 28

Corona mortis

Answer 28

"crown of death" Anastomoses vessel between obturator artery and inferior epigastric artery A rupture opens the internal and external iliac systems and causes death within minutes

Question 29

Venous drainage of the pelvis, perineum, and gluteal region

Answer 29

All veins in this region mirror the arteries and share the same names

Question 30

Pelvic venous plexus

Answer 30

Venous network surrounding the bladder, prostate/uterus, and rectum Plexuses intercommunicate prior to forming veins Valveless, so venous hypertension or transportation of tumor cells can occur

Question 31

What provides somatic innervation to the pelvis?

Answer 31

Sacral Plexus

Question 32

What provides autonomic innervation to the pelvis?

Answer 32

Autonomic plexus

Question 33

What are the divisions of the sacral plexus?

Answer 33

``` L4-L5 S1 S2-S3 S2-S4 L4-S3 ```

Question 34

L4-L5 division of the sacral plexus

Answer 34

Forms the lumbosacral trunk over the sacral ala

Question 35

S1 division of the sacral plexus

Answer 35

Emerges above the piriformis muscle

Question 36

S2-S3 division of the sacral plexus

Answer 36

Emerges through the piriformis muscle

Question 37

S2-S4 division of the sacral plexus

Answer 37

Contributes to the pudenal nerve

Question 38

L4-S3 division of the sacral plexus

Answer 38

Forms the sciatic and gluteal nerves

Question 39

Sympathetic innervation of the pelvis

Answer 39

T10-L2/3 = Thoracolumbar Prevertebral plexus Sympathetics from S2-S4 is the sacralsplanchnic nerve

Question 40

Parasympathetic innervation of the pelvis

Answer 40

Craniosacral S2-S4 Pelvic splanchnic nerve

Question 41

Superior Hypogastric Plexus

Answer 41

Mostly sympathetics fibers Bundle of nerves from bifurcation of the aorta to the upper sacrum Condenses to form 2 hypogastric nerves

Question 42

Hypogastric Nerve to Inferior Plexus

Answer 42

Mostly sympathetic fibers Condensed bifurcated sup. hypogastric plexus Diverge and curve outward bilaterally to rectum Expands to form Inferior Hypogastric Plexus

Question 43

Inferior Hypogastric Plexus

Answer 43

Contains both sympathetic and parasympathetic fibers Main autonomic plexus of the pelvis Covers the pelvic viscera bilaterally

Question 44

Sympathetic Chains and Ganglia

Answer 44

In the thorax, the chains are lateral to vertebrae - they go more medially as the descend

Question 45

Pelvic sympathetic fibers

Answer 45

Chains medial to sacral foramen | Converge and terminate anterior to coccyx as ganglion impar

Question 46

Sacral splanchnic nerves

Answer 46

Sympathetic fibers off sympathetic chain

Question 47

Pelvic splanchnic nerves

Answer 47

Parasympathetic fibers off S2-S4

Question 48

Sacral and Pelvic splanchnic nerves

Answer 48

Both enter inferior hypogastric plexus | Fibers travel on arterial branches to pelvic organs

Question 49

What are consequences to damage of the pelvic splanchnic nerves

Answer 49

Splanchnic nerves are closely related to lateral rectum and uterus Easily injured during rectal surgery or radical hysterectomy Results in impaired bladder control or sexual function

Question 50

Where are lymphatic vessels and nodes for the pelvis located?

Answer 50

Along the Aorta, IVC, and iliac vessels

Question 51

How do lymphatics of the pelvis travel?

Answer 51

Superficial to deep, and then superiorly - as it does this, it passes through several nodes - if it below the umbilicus, it travels inferiorly to inguinal, then deep, then superiorly

Question 52

(T/F) Each organs has its own lymphatic drainage?

Answer 52

True

Question 53

What does the Right Lymphatic duct drain?

Answer 53

R head and neck R upper limb R thorax

Question 54

What does the Left Lymphatic duct drain?

Answer 54

L head and neck L upper limb Remainder of the thorax Abdomen, pelvic, and both lower limbs