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100 Cards in this Set
- Front
- Back
the symphasis pubis is |
a median cartilaginous joint between the bodies of the pubic bones |
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the luboscaral joint is |
the L5 vertebra and the S1 vertebra articulate with one another by an anterior fibrocartilaginous joint between their bodies and by 2 posterior synovial joints between their articular processes |
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the L5 vertebra is also attached to the ilium and sacrum by the |
iliolumbar ligaments that unite each thick transverse process of L5 vertebra to the internal lip of the iliac crest posteriorly; these ligaments help to stabilize the lumbosacral joint; they are important because they limit axial rotation of L5 vertebra on the sacrum and they assist the vertebral articular process by preventing forward gliding of L5 vertebra on the sacrum |
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the sacroiliac joints |
very strong synovial joints between the articular surfaces oft he sacrum and the ilium; sting weight bearing joints which are responsible for transmitting the weight of the body of the ossa coxae or hip bones |
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what are the accessory ligaments of the sacroiliac joints |
the sacrotuberous and sacrospinous ligaments; they bind the sacrum to the ischium and resist backward rotation of the inferior end of the sacrum; they convert sciatic notches into greater and lesser sciatic foramina |
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position of the pelvis |
tipped anteriorly such that the pubic symphysis and anterior superior iliac spines lie in the same coronal plane |
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the piriformis muscle origin |
anterior aspect of 2nd, 3rd, and 4th lateral masses of sacrum and sacrotuberous ligament |
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piriformis muscle insertion |
greater trochanter of femur; leaves the pelvis via the greater sciatic foramen and passes posterior to the head of the femur to reach its insertion; forms a muscular bed for the sacral plexus |
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piriformis muscle innervation |
S1, S2; aka nerve to piriformis |
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piriformis muscle action |
laterally rotates thigh and abducts thigh (non-weight bearing); assists in holding the head of femur in acetabulum (weight bearing) |
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obturator internus origin |
anteriolateral wall of pelvis minor including margins of obturator foramen and obturator membrane |
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obturator internus insertion |
greater trochanter of femur; passes through the lesser sciatic foramen and makes a right angle turn around the lesser sciatic notch |
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obturator internus innervation |
nerve to obturator internus (L5, S1, S2) |
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obturator internus action |
laterally rotates thigh (non-weight bearing); assists in holding the head of the femur in acetabulum (weight bearing) |
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what forms the funnel shaped pelvic diaphragm |
the 2 lavatories ahi muscles and the 2 coccygeus (ischiococcygeus) muscles |
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where is the pelvic diaphragm and what does it do |
forms the fibromuscular floor of the confluent abdominopelvic cavities and supports the contents of the pelvis |
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the 3 parts of the levator ani muscle |
pubococcygeus muscle which encircles the urethra, vagina, and anus and merges in the perineal body (fusion of the urorectal septum with the cloacal membrane); the puborectalis which arises from the pubis and the muscles from the 2 sides loop around the posterior surface of the anorectal junction forming a U shaped rectal sling; and the iliococcygeus which is the thin part of the levator ani that arises from the tendinous arch and the ischial spine, muscle on each side inserts into the coccyx and the anococcygeal ligament |
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what is the urinary bladder |
a muscular vesicle for urine storage |
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where does the bladder sit in the adult |
in the pelvis minor posterior to the pubic bones from which it is separated by the connective tissue space called the retropubic space |
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where does the bladder sit in an infant |
in the abdomen |
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the ligaments of the bladder |
the bladder is relatively free in the loose extra peritoneal fatty tissue except for its neck which is held firmly by the puboprostatic ligaments in the male and the pubovesical ligaments in the female |
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the mucous membrane in the bladder |
if empty it is in numerous folds or rugae except in the trigone where the mucous membrane is smooth because here it is firmly attached to the muscular wall |
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structure of the bladder |
wall composed chiefly of smooth m uncle called the detrusor urinae muscle; at neck these muscle fibers form the involuntary internal sphincter; the openings of the ureters and urethra form the angles of the thrigone; the ureters pass obliquely through the bladder wall in an inferomedial direction which helps prevent urine from backing up the ureters |
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the male urethra does what and what are the names of its 3 parts |
conveys urine from the urinary bladder to the external urethral orifice and provides an exit for semen; the prostatic part, the membranous part, and the spongy part |
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the prostatic male urethra |
the first part; begins at the internal urethral orifice at the apex of the trigone and descends through the prostate and ends at the superior layer of deep fascia of the sphincter urethrae muscle; the posterior wall of the prostatic part has- a urethral crest, prostatic sinus, seminal colliculus, prostatic utricle (vestigial homolog of uterus and vagina), and openings of ejaculatory ducts |
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the membranous male urethra |
2nd part; shortest and least dilatable; traverses the sphincter urethrae muscle and the perineal membrane; bulbourethral gland is located on each side |
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the spongy male urethra |
3rd part; longest segment; begins where the urethra passes into the corpus spongeosum of the penis and ends at the eternal urethral orifice |
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the female urethra |
is a short (4 cm) muscular tube; the external urethral orifice is located in the vestibule of the vagina; passes with the vagina through the pelvic and urogenital diaphragm and the perineal membrane; is surrounded but he sphincter urethrae muscle; urethral glands are present |
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the male genital organs comprise the |
testes, the deferent ducts, the seminal vesicles, and the ejaculatory ducts; prostate and bulbourethral glands are accessory or auxiliary genital glands |
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the ductus deferens |
a thick walled muscular tube which begins in the tail of the epididymis and ends in the ejaculatory duct carrying sperm from one to the other; enlarges to form the ampulla then narrows to form the ejaculatory duct |
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the seminal vesicles |
consist of long coiled tubes which form vesicle like masses on the base of the bladder; they do not store sperm; secrete a thick secretion which mixes with the sperm; are situated at the base of the bladder, anterior to the rectum; are separated from the rectum by the rectovesical pouch; the duct of each seminal vesicle joints the ductus deferens to form the ejaculatory duct |
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the ejaculatory ducts |
open by slit like apertures into the prostatic urethra one on each side of the orific of the prostatic utricle |
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the prostate |
the largest of the accessory glands of the male reproductive tract; surrounds the first part of the urethra; is enclosed by the fascial sheath of the prostate; the base of the prostate is related to the neck of the bladder; its apex is related to the superior fascia of the UG diaphragm and rests on the sphincter urethrae muscle |
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what passes through the prostate |
the prostatic urethra and the ejaculatory ducts which divides the prostate into the median and lateral lobes (physicians may refer to a posterior lobe when palpating the prostate through the rectum but this isn't an additional area) |
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the median lobe of the prostate |
in older men commonly produces a projection into the cavity of the bladder called the uvula of the bladder |
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veins of the prostate |
form the prostatic venous plexus which drains into the internal iliac veins but also communicates with the vesicle plexus and the vertebral venous plexuses |
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cancer of the prostate metastasizes via |
blood and lymph to the vertebral column and pelvis; valveless venous communications between the prostatic plexus of the veins and the vertebral plexuses are the basis of this metastasis; straining to urinate, necessary when the cancer impedes the flow of urine causes excess shunting of blood to vertebral plexuses |
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the bulbourethral glands |
lie posterolateral to the membranous urethra; open by minute apertures into the proximal part of the spongy urethra; receive blood supply from the arteries to the bulb of the penis |
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the internal female genitalia consist of |
the vagina, the uterus, the uterine tubes, and the ovaries |
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the vagina |
the female organ of copulation is a musculomembranous tube; serves as the inferior end of the birth canal; descends anteroinferiorly from the rectouterine pouch; opens inferiorly into the vestibule of the vagina; communicates superiorly with the cavity of the uterus; tis posterior wall extends superior to the cervix of the uterus to the posterior fornix; the hymen membrane surrounds the entrance |
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the vagina lies posterior to what and anterior to what |
posterior to the urinary bladder and anterior to the rectum |
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the superior and inferior limit of the vagina |
the superior limit is usually covered by peritoneum thus injuries may involve the peritoneal cavity through the rectouterine pouch; the vagina is related inferiorly to the perineal body |
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relations of the uterues |
anteriorly the body of the uterus is separated from the bladder by the vesicouterine pouch (is empty when the uterus is in its normal position); posteriorly lies the sigmoid colon; uterus separated from the rectum by the rectouterine pouch; the ureter is crossed superiorly by the uterine artery at the side of the cervix |
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the orientation of the uterus |
bent anteriorly (ante flexed 170 degrees) between the cervix and the body; the body and the entire uterus is normally bent or inclined forward (anteverted 90 degrees) |
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the body of the uterus is enclosed between the layers of the |
broad ligament and is freely moveable (as bladder is fully distended uterus becomes retroverted) |
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the broad ligaments are |
folds of peritoneum with mesothelium on their anterior and posterior surfaces; they extend from the sides of the uterus to the side walls and the floor od the pelvis; they hold the uterus in relatively normal position; enclosed in the free edge of each broad ligament is a uterine tube; the ligament of the ovary lies posterosuperirly and the round ligament of the uterus lies anteroinferiorly within the broad ligament |
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the 4 parts of the broad ligament |
the suspensory ligament of the ovary, mesosalpinx, mesovarium, and mesometrium |
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the cervix of the uterus is held in position by |
the transverse cervical ligaments (cardinal ligaments) that extend from the cervix and the lateral fornices of the vagina to the side walls of the pelvis; the sacrocervical (uterosacral) ligaments that pass from the sides of the cervix toward the sacrum (they tend to hold the cervix in its normal relationship to the sacrum); and the pubocervical (pubouterine) ligemants that pass front he cervix to the pubic bone (continuation of the pubovesical ligaments) |
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the principal supports of the uterus |
the pelvic floor (tone of levator ani muscles) and the structures surrounding the uterus (transverse cervical, sacrocervical, and pubocervical ligaments) |
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the uterine tubes |
extend from the cornea or horns of the uterus; are designed to receive the oocytes discharged from ovarian follicles and to convey the zygote to the uterus; also convey sperm to the ampulla of the tube where the oocyte waits for fertilization; these tubes open at distal ends into the peritoneal cavity |
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the ovaries |
located one on each side in the ovarian fossa (bounded anteriorly by the obliterated umbilical artery and posteriorly by the ureter an the internal iliac artery; each ovary is attached to the posterosuperior aspect of the broad ligament and is suspended from the posterior layer of this ligament by the mesovarium, through which the ovarian vessels pass) |
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the ovaries are attached to the uterus by |
the ligament of the ovary which runs in the broad ligament |
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near the pelvic brim the ovary it attached by |
*the suspensory ligament of the ovary which contains the ovarian vessels and nerves |
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the oocyte is expelled into |
*the peritoneal cavity |
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ovarian arteries arise from |
abdominal aorta at L1-L2 below the renal arteries and on reaching the pelvic brim they cross over the external iliac vessels internal to the ureter |
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ovarian veins form |
a brace of vessels called the pampiniform plexus which communicates with the uterine plexus; 2 veins leaving the ovarian plexus form one ovarian vein; *the right ovarian vein ascends to the IVC whereas the left ovarian vein drains into the left renal vein |
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the rectum is continous with |
the sigmoid colon superiorly and begins on the pelvic surface of the 3rd piece of the sacrum (S3); rectum ends by turning posteroinferirly to become the anal canal |
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shape and flexures of the rectum |
terminal part bends sharply backward to join the anal canal; inferior part is distended into the rectal ampulla; rectum is S-shaped in the coronal plane; at the concavities there are folds called transverse rectal folds which partly close the lumen |
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relations of the rectum |
posteriorly it rests on the inferior 3 sacral vertebrae, the coccyx, the anococcygeal ligament, the median sacral vessels, branches of the superior rectal artery and the inferior ends of the sympathetic trunks; anteriorly in male it is related to the bade of the bladder, terminal parts of ureters, deferent ducts, seminal vesicles, and prostate; in the female the anterior relation of the rectum is the vagina |
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peritoneal covering of the rectum |
covers the superior 1/3 of the rectum (intraperitoneal); the middle 1/3 had peritoneum in front only (retroperitoneal); the inferior 1/3 has no peritoneal covering (extra peritoneal) |
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the the male the peritoneum is reflected from |
anterior surface of rectum to posterior wall of the bladder where is forms the floor of the rectovesical pouch |
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in the female the peritoneum is reflected from |
the rectum to the posterior fornix of the vagina where it forms the floor of the rectouterine pouch |
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nerves of the lateral wall of the pelvis |
the obturator nerve, the lumbosacral trunk, the sacral plexus- the sciatic nerve and the pudendal nerve |
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the obturator nerve |
arises from the lumbar plexus (not sacral plexus) in the substance of the psoas major muscle form the anterior branches of the ventral rami of L2, L3, L4; runs behind the common iliac vessels and crosses the sacroiliac joint to enter the pelvis minor; it then runs anteroinferiorly int he extra peritoneal fat medial to the fascia over the obturator interns muscle; it passes along the obturator groove superior to the obtuerator artery and vein where it divides into anterior and posterior divisions which leave the pelvis via the obturator foramen to supply the thigh |
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the lumbosacral trunk |
formed by ventral nerve rami of L4 an L5; descends over the sacroiliac joint |
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the sacral plexus |
this large plexus of nerves is located in the pelvis moor; is formed by the lumbosacral trunk an the ventral rami of the first 3 and the descending part of the 4th sacral nerves |
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the sciatic nerve |
formed by ventral rami of L4, L5, S2, S2, and S3; the largest nerve in the body, passes through the greater sciatic foramen inferior to the piriformis muscle along with the inferior gluteal nerve; in the back of the thigh the sciatic nerve divides into the tibial and common perineal nerves |
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the pudendal nerve |
arises from anterior divisions of the ventral rami S2, S3, S4; leaves the pelvis between the piriformis and coccygeus muscles (through the greater sciatic foramen), hooking around the sacrospinous ligament to enter the perineum through the lesser sciatic foramen; it is distributed to the muscles of the perineum including the external anal sphincter and ends as the dorsal nerve of the penis or clitoris; it is sensory to the external genitalia |
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the pelvic autonomic nerves include the |
sympathetic trunks, the branches of the sacral sympathetic trunks, the hypogastric plexuses, the visceral plexuses |
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the sympathetic trunks |
the sacral sympathetic trunks are directly continuous with the lumbar sympathetic trunks; the trunks descend on the pelvic surface of the sacrum just medial to the pelvic sacral foramina; the 2 trunks converge as they pass along the sacrum and unite in the small median ganglion impair on the coccyx |
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branches of the sacral sympathetic trunks |
the sympathetic trunks send gray rami communicantes (post-gangalionic fibers) to each of the ventral rami of the sacral and coccygeal nerves; they also send branches to the median sacral artery and to the inferior hypogastric plexus |
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the hypogastric plexuses |
the superior hypogastric plexus descends into the pelvis and lies just below the bifurcation of the aorta; is is the downward prolongation of the inter mesenteric plexus joined by L3 and L4 splanchnic nerves; branches from the superior hypogastric plexus enter the pelvis and descend anterior to the sacrum as the right and left hypogastric nerves, which descend, mingle with the pelvic splanchnic nerves and form the right and left inferior hypogastric plexuses |
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the pelvic splanchnic nerves are |
parasympathetic and are derived from S2, S3, and S4 hence the inferior hypogasstric plexus contains both sympathetic and parasympathetic fibers |
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each plexus surrounds the corresponding |
internal iliac artery |
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branches from the hypogastric plexuses are distributed to the pelvic viscera along |
the branches of the internal iliac artery |
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the visceral plexuses |
are extensions of the inferior hypogastric plexuses on the walls of the pelvic viscera and include the middle rectal plexus (branches to rectum, sigmoid, and descending parts of the colon), the vesicle plexus (branches to bladder, seminal vesicles, ejaculatory ducts, urethra, bulbourethral glands, and penis), the uterovaginal plexus (branches to vagina, cervix, uterus, uterine tubes, urethra, vestibular bulbs, greater vestibular glands, and clitoris) - the uterovaginal plexus is homologous with the prostatic plexus |
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the 3 types of splanchnic nerves |
thoracic (greater, lesser, and lowest)-sympathetic-originate from branches of thoracic sympathetic ganglia 5 to 12; lumbar-sympathetic-originate from branches of the 4 lumbar sympathetic ganglia; pelvic-parasympathetic-originate from branches of ventral rami of sacral spinal nerves S2, S3, S4 |
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the proximal 2/3 of the colon are innervated by |
the vagus nerve and beginning at the left colic flexure, the distal 1/3 of the oclon is innervated by parasympathetic pelvic splanchnic nerves via the inferior mesenteric artery to the marginal artery of Drummond |
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the 4 different arteries that enter the pelvic minor |
the internal iliac (paired), median sacral, superior rectal, and ovarian (paired) |
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the internal iliac artery |
supplies most of the blood to the pelvic viscera; branch of the common iliac artery which arises medial to the psoas major muscle and anterior to the sacroiliac joint; arrangement of its visceral branches is variable |
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the anterior branches of the internal iliac artery |
the umbilical artery, the obturator, the inferior vesical, the uterine, the middle rectal, the internal pudendal, and th inferior gluteal |
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the umbilical artery |
crosses the pelvis to the dome of the bladder; gives off superior vesical arteries to the bladder then becomes obliterated and forms the medial umbilical ligament of the anterior abdominal wall; NOTE in the male the ductus deferens can arise front he superior vesical artery, the inferior vesical artery, the internal iliac artery, or the umbilical artery |
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the obturator artery |
usually arises close to the umbilical artery; crossed by the ureter; passes between the obturator nerve and vein and then through the obturator foramen to supply muscles of the thigh and the ligament of the head of the femur; gives off a nutrient artery to the ilium, some muscular branches, and a pubic branch which anastomoses with the inferior epigastric artery of the external iliac (may be large- accessory obturator); a medially placed obturator artery is vulnerable to injury during repair of femoral hernia |
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the inferior vesical artery |
corresponds to the vaginal artery in the female; passes forward to base of bladder and supplies the seminal vesicle, the prostate, and the posteroinferior part of the bladder |
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the vaginal artery |
to the vagina |
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the uterine artery |
homolog of artery of ductus deferens; may arise from umbilical of internal iliac; descends on the side wall of the pelvis anterior to the internal iliac artery to enter the broad ligament; *the uterine artery passes anterior to and above the ureter near the lateral fornix of the vagina and this point of crossing lies about 2 cm superior to the ischial spine and anastomoses with the ovarian artery |
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the middle rectal arteru |
to the middle of the rectum |
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the internal pudendal artery |
leaves the pelvis between the piriformis and coccygeus muscles by passing through the greater sciatic foramen then enters the ischiorectal fossa through the lesser sciatic foramen; passes through the pudendal canal and divides into the deep and dorsal arteries of the penis or the clitoris; also gives off inferior rectal artery |
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the inferior gluteal artery |
usually passes between S2 and S3 and leaves the pelvis through the inferior part of the greater sciatic foramen below the piriformis muscle |
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posterior branches of the internal iliac artery |
the superior gluteal artery, the iliolumbar artery, the lateral sacral arteries |
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the superior gluteal artery |
runs between the lubosacral trunk and the ventral rams of the 1st sacral nerve; leaves the pelvis through the superior parts of the greater sciatic foramen above the piriformis muscle |
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the iliolumbar artery |
separates the obturator nerve from the oumbosacral trunk; divides into an laic branch and a lumbar branch |
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the lateral sacral arteries |
descend anterior to the sacral ventral rami giving off spinal branches that pass through the pelvic sacral foramina and supply the contents of the sacral canal |
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the median sacral artery |
the final unpaired branch of the abdominal aorta; runs anterior to body of sacrum |
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the superior rectal artery |
direct continuation of the inferior mesenteric artery; anastomoses with middle rectal, a branch of the internal iliac and with the inferior rectal, a branch of the internal pudendal |
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the ovarian arery |
paired; these arise from abdominal aorta inferior to the renal arteries; passes inferiorly internal to the ureter; anastomoses with the uterine artery |
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lymphatics - in general the pelvic organs drain through the |
external and internal iliac lymph nodes and the sacral lymph nodes; from these nodes lymph drains to the common iliac and lumbar lymph nodes |
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exceptions |
the upper and middle parts of the oviduct, funds of the uterus, the ovaries and the testes drain directly into the lumbar lymph nodes; the lowest part of the oviduct, the uterine body via the round ligament of the uterus, the vagina below the hymen, the anal canal inferior to the pectinate line, the scrotum (labia majora), and the skin and most of the penis (or clitoris) drain into the horizontal group of superficial inguinal nodes |
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just in case anyone ever asks - as the ureters and the ductus deferens come in on the bladder what are their positions |
the ductus deferens runs superior and then dives down into the prostate to connect with the urethra; the ureters come in at an angle and attach so the ductus deferens slings on top of this connection as it comes in |
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I don't care what netters says there are no BLANK arteries in the female |
inferior vesicle branches from obliterated umbilical (they could come off of vaginal) |