Anatomy: The Pelvis

Front 1

Piriformis Muscle

Back 1

-muscular bed for sacral plexus
-leaves pelvis via GREATER SCIATIC FORAMEN

Origin= Sacrotuberous ligament & sacrun
Insertion= Greater trochanter of the Femur

Action=
1. lateral rotation of the thigh
2. abduct when hip flexed
Innervation= S1-S2

Front 2

Obturator Internus

Back 2

-leaves the pelvis via the LESSER SCIATIC FORAMEN

Origin= ilium and pubis
Insertion= greater tochanter of the femur

Action= lateral rotation of the thigh
Innervation= L5-S2

Front 3

Parts of Levator ani

Back 3

1. puborectalis- forms a sling over jxn of the anal canal and the rectum

2. pubococcygeus

3. iliococcygeus

Front 4

Innervation of Levator ani

Back 4

S3-S4

Front 5

Innervation of Obturator Internus

Back 5

L-5-S2

Front 6

Innervation of Piriformis muscle

Back 6

S1-S2

Front 7

Attachements of Levator ani

Back 7

1. Pubis
2. Arcus Tendinus
3. Ischial Spine
4. Tip of Coccyx

ORIGIN= Tendinous arch

Front 8

Coccygeus origin and insertion

Back 8

ORIGIN= ischial spine

INSERTION= lateral border of the coccyx

Front 9

Innervation of COCCYGEUS

Back 9

S3-S4

(same as levator ani)

Front 10

List the divisions of the POSTERIOR branch of the INTERNAL ILIAC ARTERY

Back 10

1. Iliolumbar A.

2. Lateral Sacral A.

3. Superior Gluteal A.

Front 11

List the divisions of the ANTERIOR branch of the INTERNAL ILIAC ARTERY

Back 11

1. Umbilical A.
2. Obterator A.
3. Uterine A. with superior branch of VAGINAL A.
4. Middle Rectal A. with 5. Inferior Vesical A.
(BACK)

6. Inferior Pudendal A.
7. Inferior Gluteal A.

Front 12

Origin of Median/Middle Sacral Artery

Back 12

Abdominal Aorta

Front 13

Origin of the Superior Rectal Artery

Back 13

Inferior Mesenteric Artery

Front 14

Origin of the Ovarian/Testicular Artery

Back 14

Abdominal Aorta

Front 15

Lumphatic Drainage From Pelive Viscera

Back 15

Internal, External Iliac Nodes with Sacral Nodes
---->
Lumbar and Common Iliac Nodes
------>
L/R Lumbar Trunks
--------------------->
Cisterna Chylii

Front 16

External Iliac LN

Back 16

prostate
uterus
bladder
vagina

Inguinal LN (lower member, perineum, and abdominal wall)

Front 17

Inguinal LN

Back 17

perinuem
abdominal wall
lower member

drains to the external iliac lymph nodes

Front 18

Internal Iliac LN

Back 18

pelvic viscera
thigh
gluteals
perineum

Front 19

Sacral LN

Back 19

cervix
prostate rectum
neck of the bladder
pelvic wall

Front 20

Lymphatic drainage of the Prostate

Back 20

External Iliac LN

Sacral LN

Front 21

Lymphatic Drainage of the Perineum

Back 21

Inguinal LN (to External LN)

Internal Iliac LN

Front 22

Lymphatic Drainage of Female Reproductive Organs

Back 22

Ovaries --> Lumbar LN

Uterus---> External Iliac LN

Cervix---> Sacral LN

Vagina--> External Iliac LN

Front 23

Spinal Nerves in the Pelvis

Back 23

Sacral Plexus
-->in muscular bed deep to PIRIFORMIS
-->gives rise to:
sciatic nerve (L4-S3)
superior gluteal nerve (L4-S1)
Inferior gluteal nerve (L5-S2)
Pudendal Nerve (s2-s4)


Obturator Nerve--->From ant. divisions of L2-L4
-->body wall from lumbar plexus
-->innervates the ADDUCTOR compartment of thigh
-->assoc. with pain referral to the knee
-->can be involved in pelvic cancer/surgery

Front 24

Sacral Plexus

Back 24

in the muscular bed of the piriformis

BRANCHES:
1. Sciatic Nerve (L4-S3)
2. Superior GLuteal Nerve (L4-S1)
3. Inferior Gluteal Nerve (L5-S2)
4. Pudendal Nerve (S2-S4)

Front 25

Obturator Nerve

Back 25

-->ant. divisions of L2-L4

-->goes to the body wall from the lumbar plexus
-->innervates the adductor compartment of the thigh
-->associated with pain referral to the knee

Front 26

Sciatic Nerve

Back 26

Branch of the sacral Plexus

L4-S3

Front 27

Superior GLuteal Nerve

Back 27

Branch of the Sacral Plexus

L4-S1

Front 28

Inferior GLuteal Nerve

Back 28

Branch of the Sacral Plexus

L5-S2

Front 29

Pudendal Nerve

Back 29

Branch of the Sacral Plexus

S2-S4

Front 30

Inferior Hypogastric Plexus
(Pelvic Plexus)

Back 30

a. Superior Hypogastric Plexus--> has NO parasympathetic fibers

b. Visceral Branches of the Sacral Sympathetic Trunk--> post.G sympathetics

c. Pelvic Splanchnik Nerves--> direct branches of ventral primary rami of S2-S4
(also papaympathetic pre.G. fibers and afferents)

Front 31

Superior Hypogastric Plexus

Back 31

-->major contributor to the Inferior Hypogastric Plexus

-->MAIN SOURCE OF SYMPATHETIC FIBERS, also afferent

1. PreG. = synapse on collateral ganglion in superior and inferior hypogastric plexi
2. Post.G = primarily vasomotor

-->extension of aortic plexus inferior to the bifurcation of the aorta

Front 32

Purposes of Fiber Types in SUPERIOR HYPOGASTRIC PLEXUS

Back 32

Sympathetics and Afferents

PreG. = synapse on collateral ganglia in superior and inferior hypogastric plexus

PostG= primarily vasomotor
MALE--> smooth musc. in walls of seminal vesicles, ductus deferens, ejaculatory ducts
FEMALE--> afferent fibers pass through this plexus to the body of the uterus

Afferent Fibers--> from T10-L2 via splanchnic
-->also innervate ovary and body of uterus

Front 33

Afferents of the SUPERIOR HYPOGASTRIC PLEXUS

Back 33

T10-L2

innervate the ovary and the body of the uterus

Front 34

Visceral Branches of the Sacral Sympathetic Trunk

Back 34

minor source to te Inferior Hypogastric Plexus of SYMPATHETIC fibers

POSTGANGLIONIC SYMPATHETIC FIBERS

Front 35

Pelvic Splanchink Nerves

Back 35

S2-S4

direct branches of the ventral primary rami of spinal nerves S2-S4