S2 Anatomy Exam 1: Pelvis Blood Vessels & Nerves

Front 1

Obj.
1.Describe the pelvic fascia and its subdivisions.

Back 1

-continuous w/ endoabdominal fascia (CT btwn parietal peritoneum & pelvic muscles)
-subdivisions:
1. parietal pelvic fascia-
lines walls & floor of pelvis
named according to muscle covered
forms tendinous arch of pelvic fascia (from pubis to sacrum, along pelvis from, on both sides of viscera)

2. visceral pelvic fascia-
covers & supports pelvic viscera

Front 2

Obj.
2. Define pelvic ligaments

Back 2

-condensed fibrous regions of parietal pelvic fascia
-supports pelvic viscera

Front 3

Obj.
2. Identify the pelvic ligaments in the female pelvis.

Back 3

-pubocervical ligament (cervix to ant. pelvic wall)
-transverse cervical/cardinal/lateral cervical/Mackenrodt ligament (cervix to lat. pelvic wall)
-uterosacral ligament (cervix to post. pelvic wall)

Front 4

Obj.
3.Describe the disposition of the parietal peritoneum of the pelvis

Back 4

-continuous w/ parietal peritoneum of abdomen
-drapes over pelvic organs at midline, forming pouches, folds, & ligaments

Front 5

Obj.
3.Describe the formation of the peritoneal spaces/recesses (pouches).

Back 5

-spaces between adjacent organs created by peritoneum draping over contours of organs
-infection & fluids may accumulated in these spaces (in the lowest one)

Front 6

What pouch is the lowest portion of the abdominopelvic cavity in the supine position?

Back 6

Rectouterine pouch (of Douglas)

Front 7

Obj.
3.Describe the formation of the pelvic folds and ligaments.

Back 7

-folds of peritoneum formed between pelvic organs & walls
-includes broad ligament (created as peritoneum covers uterus & fallopian tubes) & suspensory ligament of the ovary (contains ovarian arteries) (female)

Front 8

Obj.
4. Describe the arteries of the pelvis

Back 8

-internal iliac arteries
(from common iliac a.)
*most important blood supply of pelvis

-superior rectal artery
(continuation of inf. mesenteric a.)

-median sacral artery
(from aorta @ L4 (bifurcation into common iliacs))

-ovarian/testicular artery
(from aorta @ L1)

Front 9

Describe Posterior Divisions of the Internal iliac artery

Back 9

-iliolumbar artery
passes sup. across pelvic inlet

-lateral sacral artery
ant. to sacral plexus

-superior gluteal artery
exits pelvis through greater sciatic foramen, sup. to piriformis m, btwn lumbosacral trunk & S1

Front 10

Describe Anterior Divisions of the Internal iliac artery

Back 10

-obturator artery
(exits pelvis through obturator foramen, into obturator canal, supplies thigh adductors)

-umbilical artery
gives rise to sup. vesical arteries proximally, supplying upper urinary bladder & branching into artery to ductus deferens (males only), distal portion obliterated as medial umbilical ligament

-uterine artery
(females only) crosses ureter* ant., anastomoses w/ vaginal & ovarian arteries

-vaginal artery
(females only, same as inf. vesical in males) supplies vagina & base of bladder

-inf. vesical artery
(males only) supplies prostate, seminal vesicles, & base of bladder

-middle rectal artery
supplies lower rectum

-int. pudendal artery
passes through greater sciatic foramen w/ pudendal nerve

-inf. gluteal artery
below piriformis btwn S1 & 2 or 2 & 3

Front 11

Obj.
4. Describe the veins of the pelvis

Back 11

-veins accompany arteries of same name
-internal iliac vein is main drainage--> joins external iliac vein-->forming common iliac vein-->2 common iliacs form IVC @ L5

Front 12

Obj.
4. Describe the lymphatic supply of the pelvis

Back 12

nodes are arranged along main vessels & drain into:
-external & internal iliac nodes
-common iliac nodes

*most drains into internal iliac nodes
*lymph drainage is same as blood supply

Front 13

Which pelvic ligament provides the main passive support of the uterus?

Back 13

Transverse cervical ligament
(cardinal/lateral cervical/Mackenrodt ligament)

Front 14

In males, the puboprostatic ligaments support the urinary bladder. What ligaments serve this function in females?

Back 14

pubovesical ligaments

Front 15

W/i the upper part of the transverse cervical ligament, the _________ artery passes toward the cervix above the ureter.

Back 15

uterine artery

*at risk during hysterectomy

Front 16

Name the pelvic pouches in males & females

Back 16

males-
rectovesical pouch (btwn rectum & bladder)

females-
vesicouterine pouch (btwn bladder & uterus)
rectouterine pouch (btwn rectum & uterus)

Front 17

The ___________ artery is at risk from injury during repair of a femoral hernia as it crosses the femoral ring, superior to the femoral canal

Back 17

obturator artery

Front 18

The obturator artery may be aberrant or replaced, or joined by an accessory, both of which are usually branches from what artery?

Back 18

inferior epigastric artery

Front 19

Pelvic veins form communicating plexuses of veins around pelvic organs, which are mainly drained by the internal iliac veins. Some veins also drain through what vein & plexus?

Back 19

inferior mesenteric vein & vertebral venous plexus


*vertebral venous plexus provides pathway for pelvic cancer to metastasize to spinal cord & brain

Front 20

Obj.
4. Describe the sympathetic nerves of the pelvis

Back 20

sympathetic nerves:
-lumbar splanchnic nerves
(carry preganglionic fibers to inf mesenteric & sup hypogastric plexus)
-sacral splanchnic nerves
(carry postganglionic fibers to inf hypogastric plexus)

-supply pelvic organs, blood vessels, sphincters
-ganglia connect to sacral spinal nerves by gray rami communicantes

Front 21

Obj.
4. Describe the parasympathetic nerves of the pelvis

Back 21

Pelvic splanchnic nerves (S2-4):
-arise from cell bodies in spinal cord corresponding w/ IMLCC @ higher levels
-exit anterior rami of S2-4
-convey preganglionic parasympathetic fibers to inf. hypogastric plexus
-synapse w/ ganglia in plexus or wall of viscera

Front 22

The pelvic pain line signifies the point where pain conduction above & below differs in course. Where is this line?

Back 22

line corresponds to inferior limit of the peritoneum

Front 23

What is the pathway for GVA fibers to conduct pain from the pelvic viscera above & below the pelvic pain line?

Back 23

above- travel w/ abdominopelvic splanchnic nerves (sympathetic) to DRG of T10-L2

below- travel w/ pelvic splanchnic nerves (parasympathetic) to DRG of S2-S4

Front 24

T/F
Abdominal & Pelvic Nerve Plexuses contain sympathetic fibers only

Back 24

FALSE!!!!

contain BOTH sympathetic & parasympathetic fibers!!!!!

Front 25

The superior & inferior hypogastric plexus are connected by __________________ nerves

Back 25

R & L hypogastric nerves

Front 26

Terminal branches of the (inferior/superior) hypogastric plexus penetrate the pelvic floor to innervate the erectile tissues of the penic & clitoris in the perineum as ____________ nerves

Back 26

inferior hypogastric plexus


cavernous nerves

Front 27

What nerve mainly supplies the perineum?

Back 27

pudendal nerve (S2-4)

(somatic)

Front 28

What 2 nerve plexuses provide somatic nerve supply pelvic muscles & viscera, perineum, & lower limbs?

Back 28

sacral & coccygeal nerve plexus


* on ant. surface of piriformis, leaves pelvis through greater sciatic foramen

Front 29

What nerves from the anterior rami of S2-S4 connect w/ the inferior hypogastric plexus?

Back 29

Pelvic splanchnic nerves


*gray rami communicantes connect w/ ant rami carrying postganglionic sympathetic fibers to limbs