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GIGU Exam 2 > Pelvic & Perineal Neurology > Flashcards

Pelvic & Perineal Neurology Flashcards

1
Q

Ilioinguinal Nerve

A
  • Paired nerve
  • Second branch off of L1 (iliohypogastric is the first branch of the lumbar plexus)
  • Enters the inguinal canal with the spermatic cord (M) or round ligament (F) to provide innervation to the medial thigh and associated genital areas
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2
Q

What external genitalia of the male is innervated by the Ilioinguoinal Nerve?

A
  • Root of the Penis
  • Anterior Scrotum
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3
Q

What external genitalia of the female is innervated by the Ilioinguinal Nerve?

A
  • Mons Pubis
  • Labia Majora
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4
Q

Anterior Labial Nerve

A
  • Paired terminal branch of the ilioinguinal nerve, stemming from it near its exit at the superficial inguinal ring
  • Travels anteroinferior to reach the mons pubis and anterior labium majus, and collects sensory information
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5
Q

Anterior Scrotal Nerve

A
  • Paired terminal branch of the ilioinguinal nerve, stemming from it near its exit at the superficial inguinal ring
  • Travels anteroinferior to reach the penis, anterior scrotum, and surrounding tissue; provides sensory information from these areas
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6
Q

Genitofemoral Nerve

A
  • Paired nerve
  • Branch from L1 and L2 of the Lumbar Plexus
  • Pierces the psoas major muscle on either side and travels down the muscle belly until it splits into a femoral and genital branch
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7
Q

Genital Branch of the Genitofemoral Nerve

A
  • Paired branch that travels through the superficial inguinal ring
  • Provides sensory innervation to the anterior labia majora, anterior scrotum, and adjacent thigh
  • Provides motor innervation to the Cremaster muscle
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8
Q

Obturator Nerve

A
  • Paired nerve
  • Branch from the anterior rami of L2-L4 of the lumbar plexus
  • Runs inferiorly into the lesser pelvis and laterally to the obturator canal (opening through the obturator membrane)
  • Exits the pelvis with the obturator artery without supplying the pelvic structures
  • Once it enters the thigh it divides into two parts to supply the medial thigh muscles
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9
Q

Lumbosacral Trunk

A
  • Created by the L4 and L5 nerves traveling inferiorly and combining with the sacral plexus
  • Located on both sides of the body
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10
Q

Sacral Plexus

A
  • Located on either of the posterolateral walls of the lesser pelvis
  • Made up of the lumbosacral trunk and anterior rami of S1 to S4
  • Most of its branches leave the pelvis via the greater sciatic foramen; there are also several branches for muscles associated with the pelvis (quadratus femoris, obturator internus, piriformis)
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11
Q

Sciatic Nerve

A
  • Paired nerve
  • Stems from L4-S3 spinal nerves of the sacral plexus
  • Forms on the piriformis and runs out of the pelvis inferior to the piriformis muscle
  • Runs down the posterior thigh and splits around the popliteal fossa into two branches (tibial and common fibular)
  • Supplies various parts of the lower extremity including the entire leg and foot
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12
Q

Pudendal Nerve

A
  • Paired nerve comes from S2-S4 of the sacral plexus
  • Runs outside of the pelvis with the internal pudendal artery via the greater sciatic foramen
  • Runs around the sacrospinous ligament to reenter the pelvis via the lesser sciatic foramen (pudendal canal)
  • Innervates the perineum
  • Provides motor innervation to the perineal muscles, external urethral sphincter, and external anal sphincter
  • Provides sensory innervation to the external genitalia
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13
Q

3 Branches of the Pudendal Nerve

A
  • Inferior Rectal N (Inferior Anal N)
  • Dorsal N of the Clitoris
  • Dorsal N of the Penis
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14
Q

Inferior Rectal Nerve (Inferior Anal Nerve)

A
  • Paired branch of the pudendal nerve (sacral plexus)
  • Travels medially from the pudendal nerve near the pudendal canal and goes into the ischioanal fossa
  • Innervates the external anal sphincter and puborectalis
  • Provides sensory innervation to the area inferior to the Pectinate line
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15
Q

Dorsal Nerve of the Clitoris

A
  • Female only!
  • Paired Pudendal N branch
  • Travels with the dorsal artery of the clitoris into the deep perineal pouch to the suspensory ligament of the clitoris; from there it runs along the dorsal body of the clitoris to the glans clitoris
  • Picks up sensation information from the clitoris (important in the arousal response)
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16
Q

Dorsal Nerve of the Penis

A
  • Males only!
  • Paired pudendal nerve branch
  • Travels with the dorsal artery of the penis into the deep perineal pouch, along the suspensory ligament of the penis, and along the dorsal body of the penis to the glans penis
  • Picks up sensation information from the penis that is important in the arousal response
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17
Q

Perineal Nerve

A
  • Paired branch of the Pudendal Nerve (Sacral Plexus)
  • Branches off from the pudendal nerve within the pudendal canal and exits with it at the end of the canal; from there it ravels medially and divides into a superficial and deep branches
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18
Q

Posterior Labial Nerve

A
  • Females only!
  • Paired terminal branch of the superficial perineal nerve (pudendal nerve) that travels superficially to reach the labia minora and labia majora (except for most anterior aspects)
  • Provides sensory innervation to the labia minora and majora
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19
Q

Deep Perineal Nerve

A
  • Paired terminal branch of the perineal nerve (pudendal nerve) that travels deep into the superficial perineal pouch
  • Provides motor innervation to the superficial perineal pouch (ischiocavernosus, bulbospongiosus, superficial perineal muscles)
  • In females it also provides sensory innervation to the vestibule of the vagina and inferior vagina
20
Q

Posterior Scrotal Nerve

A
  • Males only!
  • Paired terminal branch of the superficial perineal nerve (pudendal nerve) in the male that travels superficially to reach the posterior aspect of the scrotum
21
Q

Superior Gluteal Nerve

A
  • Paired nerve comes from L4-S1 of the sacral plexus
  • Runs out of the pelvis superior to the piriformis muscle
  • Enters the gluteal region and innervates the gluteus medius and minimus, and tensor fascia latae
22
Q

Inferior Gluteal Nerve

A
  • Paired nerve stems from L5-S2 of the sacral plexus
  • Passes out of the pelvis inferior to the piriformis muscle and superficial to the sciatic nerve
  • Travels with the inferior gluteal artery (anterior division of the internal iliac artery) to supply the gluteus maximus muscle
23
Q

Posterior Cutaneous Nerve of the Thigh

A
  • Paired nerve stems from S1-S3 of the sacral plexus
  • Sends cutaneous branches to the skin of the gluteal region, and upper medial and upper posterior thigh
24
Q

Perineal Branch of the Posterior Cutaneous Nerve of the Thigh

A
  • Paired nerve comes off the posterior cutaneous nerve of the thigh (sacral plexus) near the inferior border of the gluteus maximus muscle
  • Travels medially to provide sensory information to the lateral perineum
  • Innervates the labia majora, scrotum, genitofemoral sulcus, and superior-most medial thigh
  • Overlaps with the pudendal nerve
25
Q

Inferior Cluneal Nerve

A
  • Paired nerve comes from the posterior cutaneous nerve of the thigh (sacral plexus)
  • Branches near the inferior border of the gluteus maximus muscle
  • Runs into the subcutaneous tissue to supply the inferior gluteal region
26
Q

Pelvic Splanchnic Nerve

A
  • Preganglionic parasympathetic fibers from the anterior rami of S2-S4 spinal nerves
  • Paired nerves that go into the inferior hypogastric plexus
  • Provide innervation to the descending colon, sigmoid colon, rectum, and anal canal (hindgut), and associated structures of the pelvis and perineum
27
Q

Coccygeal Plexus

A
  • Paired network of nerves is formed by the anterior roots of S4, S5, and coccygeal nerves
  • Lies on the surface of the coccygeus muscle
  • Nerves coming from this plexus supply the coccygeus muscle, some of the levator ani muscles, the sacrococcygeal joint and the skin between the coccyx and anus
28
Q

Sacral Sympathetic Trunk

A
  • Continuation of the right and left sympathetic trunk from the lumbar region into the pelvis
  • Found along the sacrum near the sacral foramina and behind the rectum
  • Provides sympathetic innervation to the lower limb
  • Since it is nearing the ned of the sympathetic trunk it becomes smaller in size
  • Four ganglions are found in this part of the sympathetic trunk
29
Q

Sacral Splanchnic Nerve

A
  • Postsynaptic sympathetic neurons that come from the sacral sympathetic trunk
  • Travel towards and contribute to the inferior hypogastric plexus
30
Q

Ganglion Impar

A
  • The end of the sympathetic chain near the sacrococcygeal junction (the chain is continuous from the thoracic cavity through the abdominal and into the sacral/pelvic region)
  • Left and right sympathetic chains come together here
  • No white rami communicantes come into the ganglion impar, only gray rami travel out
  • Sympathetic neurons travel to lower pelvic organs including the distal rectum and anus
31
Q

Periarterial Plexus

A
  • Paired sympathetic neurons that enter into the pelvis along vessels traveling into the pelvis
  • Includes the ovarian (mixed), superior rectal, and internal iliac arteries
  • Main function is vasomotion of the arteries they are traveling on
32
Q

Superior Hypogastric Plexus

A
  • Located below the inferior mesenteric plexus and is connected to it
  • Has contributions from the lumbar splanchnic and inferior hypogastric plexus
  • Located on the anterior surface of the abdominal aorta and extends beyond it when it bifurcates into the common iliac
  • Provides innervation to the pelvic viscera
33
Q

Hypogastric Nerve

A
  • Paired nerve connects the superior hypogastric plexus with the inferior hypogastric plexus by traveling into the pelvis
  • Travels along the anterior sacrum, lateral to the rectum; fans out to merge with the pelvic splanchnic nerves and form the inferior hypogastric plexus
34
Q

Inferior Hypogastric Plexus

A
  • Located in the pelvis on either side of the rectum, cervix of the uterus, and urinary bladder
  • Contains both sympathetic and parasympathetic innervation
  • Main source of autonomic innervation to the pelvis
  • Sympathetic contribution comes from the hypogastric nerves (superior hypogastric plexus) and parasympathetic innervation from the pelvic splanchnic nerves
  • Provides innervation to the pelvic viscera by forming subplexuses (pelvic plexuses) associated with the major organs of the pelvic cavity (lateral rectum, inferolateral bladder, prostate, seminal vesicle, cervix, and lateral fornix of the vagina
35
Q

Pelvic Splanchnic Nerve

A

Provides a pathway for parasympathetic neurons

36
Q

Pelvic Pain Line

A
  • Line that divides how visceral afferent fibers conduction pain from the pelvic viscera travels (GI tract is an exception)
  • This division follows roughly where the inferior boundary of the peritoneum falls (intraperitoneal vs subperitoneal)
37
Q

Pectinate Line

A
  • Found at the inferior aspect of the anal valves and demarcates the embryological origins of the anal canal
38
Q

Superior to the Pectinate Line, the Anal Canal derives from the embryological:

A

Hindgut

39
Q

Inferior to the Pectinate Line, the Anal Canal derives from the embryological:

A

Proctodeum

40
Q

Superior to the Pectinate Line, Sympathetic innervation is via the:

A

Lumbar Splanchnic Nerves and associated pelvic plexuses

41
Q

Inferior to the Pectinate Line, Parasympathetic Innervation is via the:

A

Pelvic Splanchnic Nerves

(since this part is below the pelvic pain line, visceral afferents follow the parasympathetic)

42
Q

Inferior to the Pelvic Pain Line division, innervation is via the:

A

Somatic system and the Inferior Rectal Nerve

43
Q

Sympathetic Innervation to the Uterus:

A

T10-L2: Sympathetic Innervation via Superior and Inferior Hypogastric Plexus

44
Q

Parasympathetic Innervation to the Uterus:

A

S2-S4: Parasympathetic innervation via Pelvic Splanchnic N

45
Q

____ innervation stimulates the contraction of the rectum and bladder for voiding

A

Parasympathetic

46
Q

Do Parasympathetic Fibers travel into the Lower Extremity? Sympathetic Fibers?

A
  • Parasymp: No
  • Symp: Yes – use gray rami communicantes to join nerves from the pelvis to get to their intended destinations in the LE
47
Q

Reflexive sensation travels with the:

A

Parasympathetic Fibers

GIGU Exam 2 (9 decks)

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