Pelvic Neurovasculature

Question 1

components of the sacral plexus

Answer 1

1. superior gluteal
2. inferior gluteal
3. sciatic
4. posterior femoral cutaneous
5. nerves to obturator internus
6. nerves to quadratus femoris
7. pudendal

Question 2

nerve roots of superior gluteal nerve

Answer 2

L4-S1

Question 3

nerve roots inferior gluteal n

Answer 3

L5-S2

Question 4

nerve roots sciatic nerve

Answer 4

L4-S3

Question 5

nerve root posterior cutaneous

Answer 5

S1-S3

Question 6

nerve root nerve to obturator internus

Answer 6

L5-S2

Question 7

nerve root nerve to quadratus femoris

Answer 7

L4-S1

Question 8

nerve root pudendal nerve

Answer 8

S2-S4

Question 9

nerve root lumbosacral trunk

Answer 9

L4-L5

Question 10

positions of S2-S3

Answer 10

are usually joined or close together

Question 11

path of the superior gluteal nerve

Answer 11

above piriformis

Question 12

path of inferior gluteal nerve

Answer 12

below piriformis (or at piriformis?)

Question 13

path of pudendal nerve

Answer 13

out of the greater sciatic foramen back into the lesser sciatic foramen under the sacrospinous ligament, then through the pudendal canal along the inferior ischial ramus

Question 14

where is pudendal canal located

Answer 14

within fascia of obturator internus muscle

Question 15

what does the pudendal canal contain

Answer 15

pudendal nerve, pudendal artery, pudendal vein

Question 16

branches of pudendal nerve

Answer 16

1. inferior rectal
2. perineal
3. dorsal nerve of penis or clitoris
4. posterior scrotal or labial

Question 17

what does the inferior rectal nerve supply

Answer 17

motor: external anal sphincter
sensory: skin around anus

Question 18

what does the perineal nerve supply

Answer 18

motor: all superficial and deep space muscles
sensory: perineum

Question 19

what does the dorsal nerve of penis or clitoris supply

Answer 19

sensory for penis or clit

Question 20

what does the posterior scrotal or labial supply

Answer 20

sensory for scrotum or labia

Question 21

test for pudendal neuropathies

Answer 21

bulbocavernosus/bulbispongiosus reflex (pull on penis and external anal sphincter contracts)

Question 22

sympathetic innervation of the pelvic cavity

Answer 22

sacral splanchnics and hypogastric nerves from the lumbar splanchnics

Question 23

explain where the hypogastric nerves come from to innervate the pelvic cavity

Answer 23

they come from superior hypogastric plexus, which arises from the lumbar splanchnics (L3-L4), and then post synaptic fibers travel with the blood vessels to pelvic viscera

Question 24

parasympathetic innervation pelvic cavity

Answer 24

pelvic splanchnics (S2-S4)

Question 25

what is the (superior) hypogastric plexus composed of

Answer 25

networks of sympathetic and visceral afferent fibers

Question 26

describe the autonomic innervation of the pelvic cavity

Answer 26

1. the superior hypogastric plexus made up of sympathetic and visceral afferents splits into the right and left hypogastric nerves 2. this combination of sympathetic sacral splanchnics meets up with parasympathetic pelvic splanchnic to make the inferior hypogastric plexus

Question 27

what are the hypogastric plexusus made of

Answer 27

sympathetic fibers, parasympathetic fibers, and visceral afferents

Question 28

function of the sympathetic portion of the hypogastric plexus

Answer 28

1. vasoconstriction 2. contract internal urethral and anal sphincters 3. ejaculation

Question 29

function of the parasympathetic portion of the hypogastric plexus

Answer 29

1. vasodilation 2. stimulate bladder contraction for urination 3. stimulate rectum/anal canal for defecation 4. stimulate erection

Question 30

explain point and shoot

Answer 30

P=parasympathetics=vasodilation and erection | S=sympathetics=ejaculation

Question 31

describe the pelvic pain line/sensory information in the pelvis

Answer 31

sensory information travels into the pelvis with sympathetic vessel up until the perineum, then under the perineum sensory travels with parasympathetics

Question 32

relate pelvic pain line and pectinate line of the anus

Answer 32

sensory information travels into the pelvis with the sympathetic system, but under the pelvic pain line, sensory travels with parasympathetics. once the pectinate line is crossed, it becomes somatic via inferior rectal branches of pudendal nerve

Question 33

where does the IVC bifurcate

Answer 33

L5

Question 34

what does the anterior trunk of the internal iliac artery supply

Answer 34

primarily visceral branches supplying pelvic viscera, perineum, gluteal region, and adductor region

Question 35

branches off the anterior trunk of the internal iliac artery

Answer 35

1. obturator 2. umbilical 3. middle rectal 4. vesical 5. inferior gluteal 6. internal pudendal

Question 36

what does the posterior trunk of the internal iliac artery supplly

Answer 36

parietal branches, posterior pelvic wall, lower posterior abdominal wall, gluteal region

Question 37

branches off the posterior trunk of the internal iliac artery

Answer 37

1. iliolumbar 2. superior gluteal 3. lateral sacral branches

Question 38

where does the superior gluteal artery exit

Answer 38

through the greater sciatic foramen ABOVE piriformis, usually between lumbosacral trunk and S1

Question 39

where does the iliolumbar artery travel

Answer 39

runs with lumbosacral trunk upward

Question 40

how to identify the umbilical artery

Answer 40

runs toward the anterior abdominal wall and obliterates into connective tissue as the medial umbilical ligament

Question 41

describe the course of the internal pudendal artery

Answer 41

continues off of the anterior trunk through the pudendal canal with the pudendal nerve between obturator internus and levator ani

Question 42

what branches does the vesical artery give off

Answer 42

seminal and prostatic

Question 43

what are the anastamoses of the rectal arteries?

Answer 43

1. superior rectal from IMA 2. middle rectal from internal iliac 3. inferior rectal from internal pudendal

Question 44

what vasculature is different in males and females?

Answer 44

males have inferior vesical artery that gives off ductus deferens, seminal and prostatic branches; females have the the vaginal artery (equivalent of inferior vesical) and uterine artery

Question 45

describe the position of the ureter in female vasculature

Answer 45

ureter travels UNDER the uterine artery

Question 46

what is a common deviance from normal anatomy in the anterior of the pelvis

Answer 46

sometimes the obturator gives off accessory obturator artery which meets up with the inferior epigastric artery

Question 47

describe lymph flow in the gonads

Answer 47

gonads (ovaries and testes) and kidneys do not follow normal lymph flow, they flow straight up to the lumbar nodes

Question 48

describe lymph flow in the gonads

Answer 48

gonads (ovaries and testes) and kidneys do not follow normal lymph flow, they flow straight up to the lumbar nodes/trunk

Question 49

describe lymph flow in the uterus

Answer 49

body and cervix flow into pelvic lymph nodes/internal iliac nodes, then up to lateral aortic/lumbar nodes

Question 50

what structures drain into the deep inguinal nodes

Answer 50

1. glans penis/clitoris 2. labia minor 3. lower part of vagina

Question 51

what structures drain into the superficial inguinal nodes

Answer 51

1. superficial tissues of penis and scrotum | 2. superficial tissues of clitoris and labia majora

Question 52

trace flow of lymph from the external genitalia

Answer 52

superficial inguinal nodes to the external iliac nodes, to the lateral aortic lumbar nodes, to the thoracic duct

Question 53

trace flow of lymph from the gonads

Answer 53

gonadal vessels take lymph from testes and ovaries straight to the lumbar nodes