Shared Flashcard Set

Details

Pelvic Innervation and Circulation
Cole 5/6/11 2.5 hrs
114
Anatomy
Undergraduate 4
05/04/2011

Additional Anatomy Flashcards

 


 

Cards

Term
L1
Definition
what spinal level are preganglionic sympathetics from that innervate the pelvic and perineal structures?
Term
1) prearotic ganglia
2) prevertebral ganglia
3) paravertebral ganglia
4) inferior hypogastric plexus
Definition
where do synapses for pelvic & perineal structures sympathetics occur?
Term
T1-L2
Definition
where do sympathetics come out of the spinal cord (in general)?
Term
S2-S4 via pelvic splanchnic nerves
Definition
what spinal level are parasympathetic preganglionics from that innervate the pelvic and perineal structures?
Term
they also synapse in minute ganglia scattered throughout the inferior hypogastric plexus
Definition
what is the exception to the parasympathetics synapsing in the organ walls of the structures innervated?
Term
S2-S4, ventral rami via the pudendal nerve mostly
Definition
where does somatic and sensory & motor information come from that innervates the pelvic and perineal structures?
Term
the erectile tissue vasculature

***this is an exception to the rule, normally parasympathetics don't do body wall structures
Definition
where do parasympathetic nerves innervate body wall structures?
Term
the hypogastric plexus
Definition
____ supplies autonomic innervation to the lower abdomen and pelvis. It also supplies visceral sensory info (both types) to the same region
Term
aortic bifurcation to S2-S4 (where the pelvic splanchnic nerves originate)
Definition
where is the superior hypogastric plexus located?
Term
from S2 down
Definition
where is the inferior hypogastric plexus located?
Term
they ascend from S2-S4
Definition
how do parasympathetics reach the superior hypogastric plexus?
Term
both
Definition
what kind of parasympathetic nerves (pre/post synaptic) are found in the lumbar splanchnic nerves
Term
paravertebral ganglia
Definition
where do sacral nerves S1-S3(sacral splanchnic nerves) synapse?
Term
pre-ganglionic parasympathetics from S2-S4
Definition
what type of nerves are pelvic splanchnic nerves?
Term
the vesical plexus
Definition
name the nerve plexus posterior to the bladder and seminal vssicals?
Term
he mentioned that they come from the ureter
Definition
what plexus do the parasympathatic nerves that ascend to the superior hypogastric plexus go though?
Term
when the pelvic splanchnic nerves join, it is the transition to inferior hypogastric plexus
Definition
where is the point of transition between superior and inferior hypogastric plexus?
Term
the spermatic cord, cause the contraction/relaxation of ductus deferens and cremaster/dartos
Definition
where do the autonomics to the testes and epididymis travel? what do they do?
Term
sacral splanchnic nerves come out paravertebral ganglia, pelvic nerves come out ventral rami
Definition
where do sacral splanchnic nerves come out of the spine vs pelvic nerves?
Term
S2 (they come out S2-S4)
Definition
at what spinal level do the first parasympathetics join the inferior hypogastric plexus?
Term
the urogenital hiatus
Definition
where do the autonomics pass through the pelvic diaphragm?
Term
cavernous nerve
Definition
name the nerve that reaches the blood supply of the erectile tissues
Term
they pierce it with tiny holes along with vasculature
Definition
how do autonomics go through the perineal membrane?
Term
the pathway MUST be intact for ANY function at all with sympathetic and somatic innervation

parasympathetics are special
Definition
what is the rule on the pathway between the target and brain for somatic(motor and sensory) to function? sympathatics
Term
the pathway must be intact for normal function, BUT, reflexive action (no brain) can still occur sometimes
Definition
what is the rule about the pathway between the brain and the target for parasympathetic innervation?
Term
all sympathetics have left the spinal cord at T1-L2, and there are no sympathetics in the cord beyond that point
Definition
why do not all spinal injuries affect sympathetics: for example, why can sympathetic function can remain fully intact with injuries to the inferior end(lumbar/sacral) of the spinal cord?
Term
1) brain to spine intact from T1-L2
2) on at least one side the sympathetic trunk must be intact
Definition
what are the requirements for sympathetic function?
Term
alongside sympathetic pathways (like abdominal organs in general)
Definition
where do pain impulses run above the pelvic pain line?
Term
alongside parasympathetic pathways (just remember p = pelvis, parasympathetic pain path)
Definition
where do pain impulses run below the pelvic pain line?
Term
alongside parasympathetic pathways
Definition
where do visceral afferents OTHER THAN PAIN run?
Term
top of bladder, most of uterus and colon (cuts halfway through the sigmoid colon)
Definition
what structures are directly above the pelvic pain line?
Term
visceral afferents in the vagus nerve, may have a role in orgasm in the female sexual response.

ex: females with a transected spinal cord can still orgasm despite lack of somatic sensory info in the genitalia
Definition
what does the vagus nerve have to do with the pelvis?
Term
sympathetics make you retain urine, so they relax the detrusor (inhibit contraction) and contract the sphincter
Definition
what do sympathetics do to the detrusor muscle? the internal sphincter?
Term
pelvic splanchnic nerves
Definition
what is visceral afferent information carried in for the bladder?
Term
it is above and below the pelvic pain line, so some travels with sympathetics, some with para.
Definition
how does visceral pain information from the bladder travel?
Term
pudendal nerve
Definition
what innervates the external urinary sphincter (and the other somatic muscle structures around the bladder in females)?
Term
helps you retain urine (inhibits urination)
Definition
an increase in somatic motor innervation signals to the bladder does what?
Term
sympathetics intact (already in chain ganglia) - no spasticity, no incontinence

reflexive parasympathetics
Definition
if you have an L5 lesion of the spinal cord, describe your innervation to the bladder.
Term
absence of sympathetic innervation (so any lesion above L2)
Definition
what causes spasticity of the detrusor muscle?
Term
reflex is upper motor neurone
Definition
if you have a neurogenic bladder, upper motor neuron type, is it reflex or non-reflex type?
Term
it means that parasympathetic innervation is reflexive only to the stretch receptors. Therefore the patient cannot completely empty their bladder, just to the point where the detrusor is not stretched leading to a stagnant pool of urine and more likely UTI's
Definition
what does "reflex type" neurogenic bladder mean?
Term
spastic incontinence
Definition
what kind of incontinence results from an upper motor neuron neurogenic bladder?
Term
upper motor neuron reflex type
Definition
what kind of neurogenic bladder results from a T9 lesion, or a lesion above L2 in general?
Term
1) antagonize the activity of parasympathetics (act oppositely on the tissue)
2) synapse with parasympathetic neurons and prevent the neurotransmitters from crossing the synapse (act on the nerve)
3) they inhibit myogenic and "normal" contraction
Definition
what do sympathetics do to inhibit urine release?
Term
S2-S4
Definition
where in the spinal cord would a lesion cause lower motor neuron or "non-reflexive" neurogenic bladder?
Term
there will be no parasympathetic innervation, but the myogenic cells of the bladder will be activated with stretch to contract causing overflow incontinence
Definition
if there is a lesion to the root or ventral rami of an S2-S4 neuron, will there still be bladder function?
Term
overflow incontinence
sympathetics will work, they will allow the bladder to hold urine and fill
parasympathetics will not function except reflexively, providing the sensory and motor neurons are intact
Definition
with lower motor neuron or non-reflexive neurogenic bladder, what kind of incontinence will there be? describe the nerve function
Term
parasympathetics to push out the poop (more p's)
Definition
what innervation contracts the rectum?
Term
the pectinate line
Definition
where is the transition in the rectum between visceral sensory innervation and the somatic body wall innervation
Term
they cross the pectinate line and when they hit the somatic sensory part, they burn
Definition
why don't you feel hot peppers until you poop them out?
Term
1)deep part
2) superficial part
3) subcutaneous part
Definition
list the 3 parts of the external anal sphincter
Term
inferior to the anal columns/valves
Definition
where is the pectinate line?
Term
S2-S4, pudendal nerve
Definition
what innervates the external anal sphincters?
Term
1)somatic motor to the sphincter
2)somatic sensory info from below the pectinate line
Definition
what type of information is carried by the pudendal nerve's branch to the anus/rectum?
Term
inferior hypogastric plexus (L1-L2)
Definition
where does the sympathetic innervation to the anal sphincters come from?
Term
pelvic splanchnic nerves
Definition
name the parasympathetics that innervate the rectum?
Term
1) visceral afferents with the sympathetics above the pelvic pain line
2) visceral afferents with parasympathetics below the pelvic pain line
3) somatic pain via the pudendal nerve to the skin and perineum
Definition
what are the 3 pain paths in child birth?
Term
between L1 and L2 via lumbar puncture, anasthetic is injected into the spinal column (CSF) numbing everything from the waist down.

Don't feel contractions, delivery, or episiotomies
Definition
what is anesthetized with a spinal block?
Term
anasthetic is injected into the epidural space, not CSF. Anasthsia diffuses through the epineurium to the epidural fat and through the nerve roots wrapped in dura

basically sympathetics still have pain up to L1, so they will feel contractions, but nothing below that (no distension or episiotomy)
Definition
what is anesthetized by a caudal block?
Term
just the somatic pain from the pudendal nerve from the skin/episiotomies
Definition
what is anesthetized by a pudendal nerve block?
Term
to relieve somatic pain, form an episiotomy for example, anasthesia is injected into the pudendal canal before the perineal branches, but after the inferior rectal nerve. Trans vaginal palpation is used to locate the ischial tuberosity and aim needle towards the physician's fingers
Definition
how is a pudendal nerve block performed, and for what purpose?
Term
parasympathetics cause dilation of the blood vessels to fill the erectile tissue (pelvic splanchnic nerves)
Definition
what branch of the autonomic system causes erection by innervating the vascular smooth muscle in the root of the penis?
Term
parasympathetics-secretory epithelium of the seminal vessicles, the prostate, the bulbourethral gland, and the root of the penis
Definition
what branch of the ANS is responsible for secretion in the male sexual response? where does secretion occur?
Term
sympathetics- act on the smooth muscle of the epididymis, vas deferens, seminal vessicles, and prostate gland
Definition
what branch of the ANS causes the peristaltic contractions in the emission phase of the male sexual response?
Term
somatic motor to the secretory epithelium of the bulbourethral land, and striated muscle in the root of the penis
Definition
what innervates ejaculation?
Term
sympathetics
Definition
what type of innervation ends erection?
Term
typically parasympathetics, but sympathetics can do erections in sleep
Definition
what type of innervation typically is responsible for erection? in your sleep?
Term
yes, sory of like neurogenic bladder
Definition
if the S2-S4 innervation is cut, does erection still occur?
Term
parasympathetic
Definition
what type of innervation typically is responsible for secretion?
Term
para's make semen, sympathetics move it, sympathetic squeezes the product into the lumen of the tube by acting on the smooth muscles of the glands, sympathetics also inhibit urine outflow during emission (don't want semen in the bladder)
Definition
what type of innervation typically is responsible for emission?
Term
somatic motor: skeletal muscle around the erectile tissues
Definition
what type of innervation typically is responsible for ejaculation?
Term
bulbospongiosus and ischiocavernosus contract reflexively to squeeze the urethra
Definition
what muscles are responsible for ejaculation?
Term
internal iliac artery
Definition
what artery supports pregnancy, has a lot of anastamoses, and is hard to identify?
Term
L4
Definition
what is the spinal level at which the aorta divides?
Term
iliolumbar artery
Definition
what is the only body wall artery that descends from behind to supply pelvic structures?
Term
the external iliac
Definition
what artery becomes the femoral artery?
Term
the obliterated umbillicus artery
Definition
what artery delivers deoxy blood to the placenta and goes to the umbilicus?
Term
males: lower bladder, prostate, seminal vessicles
females: cervix, uterus, baginal, lower bladder
Definition
what is supplied by the inferior vesicle artery(in males)? in the uterine artery(females)?
Term
lateral sacral artery
Definition
what vessel supplies blood to the ventral rami and the back pelvic wall/floor?
Term
superior gluteal artery
Definition
what artery exits the pelvis above piriformis?
Term
inferior gluteal artery
Definition
what vessel exits below piriformis and is found between the lumbosacral trunk and S1?
Term
internal pudendal artery
Definition
what artery supplies the perineum (body wall) and leaves the pelvic cavity?
Term
middle rectal artery
Definition
what artery typically branches off the internal pudendal artery?
Term
1)mostly the ovarian artery in the suspensory ligament
2) also the ovarian branch of the uterine artery
Definition
what does the dual blood supply to the ovary consist of?
Term
the uterine artery
Definition
what does the vaginal artery branch from, if present at all (it is variable)
Term
the ureter passes alongside the cervix between uterine and vaginal arteries
Definition
where is the ureter in relation to the blood supply to the uterus?
Term
sampson's artery aka the tubal branch of the uterine artery
Definition
what artery supplies the fallopian tubes?
Term
the close proximity of the ureter to the cervix
Definition
why can pelvic abcesses or cervical cancer infect the urinary system?
Term
the tubal branch of the uterine artery (Sampson's artery)
Definition
what artery is not cut in a tubal ligation, and can rupture in an ectopic pregnancy causing a lot of severe bleeding?
Term
usually from the internal iliac, but 27% of the time it comes from the inferior epigastric artery
Definition
what vessel does the obturator artery usually arise from? 27% of the time?
Term
pubic fractures(bleeding into retropubic space), hernia repairs, & bladder suspension surgery
Definition
what puts an aberrant obturator artery at risk?
Term
external iliac
Definition
what vessels does the inferior epigastric artery arise from?
Term
there is a venous plexus around the organ, named for the organ that drains to the internal iliac vein with the same name as the arteries
Definition
what is the general drainage pattern for the pelvis?
Term
1) the ovarian vein (the ovary migrates)
2) the superior rectal vein (to portal vein)
3) median sacral vein (to common iliac)
Definition
what pelvic veins do not drain to the internal iliac vein?
Term
deep dorsal vein -> prostatic plexus, but also directly to the vetbral plexus
Definition
where does blood drain from the erectile tissue of the penis drain? what is clinically significant about this?
Term
through the external pudendal veins to the saphenous veins (skin & mucus drains laterally)
Definition
how does blood drain from the superficial penis and clitoris?
Term
superior rectal artery/vein and middle rectal artery/vein

inferior is outside the perineum
Definition
which rectal arteries/veins are above the pelvic diaphragm?
Term
backward along the arterial blood supply
Definition
what is the general rule for lymphatic drainage of the pelvic organs?
Term
it is inferior to the umbillicus, so it drains first to the superficial inguinal nodes which drain to the iliac nodes
Definition
where does the skin of the perineum drain lymph to?
Term
lumbar nodes (they migrate from post. abdominal wall)
Definition
where do the gonads drain lymph?
Term
lymph follows the blood vessels, but below the pectinate line the anala canal drains to the superficial inguinal nodes (with the perineum)
Definition
where does the rectum drain lymph?
Term
some with ovaries to the lumbar nodes, also to the superficial inguinal nodes with the round ligament through the inguinal canal (the fundus drains here)
Definition
where does the uterus drain besides following the blood supply backward?
Term
the 2 lymph channels above and below the pectinate line
Definition
what are the 2 routes of metastases for rectal cancer?
Term
the retropubic space
Definition
where does blood pool when an aberrant obturator nerve bursts?
Term
the paravesical space
Definition
name the space on either side of the bladder in front of the transverse cervical ligament
Term
the pararectal space
Definition
what is a low spot int he body cavity that is likely to become infected (What space posterior to the transverse cervical ligament?)
Term
the retrorectal space (pre-sacral), sacral splanchnic nerves and pelvic splanchnic nerves (with autonomics of both types) run here
Definition
what is the name of the space behind the rectum that allows for surgical instruments to access the rectum to cut it lose? what vessels run through this space?
Term
the rectouterine space (pouch of Douglas)
Definition
where is the lowest part of the demale peritoneal cavity (and likely for infections)?
Term
the vesicouterine space
Definition
what is the name of the space between the uterus and top of the bladder?
Term
checks for abnormal fluid in the abdominal cavity behind the uterus by sticking a needle through the proximal, posterior vaginal wall
Definition
what is a culdocentesis?
Term
the retrovesical pouch/space
Definition
what is the lowest point in the male pelvis?
Term
retrovesical septum
Definition
name the tissue separating the rectum and prostate
Term
both, its the space between the pubic symphysis and bladder in both sexes
Definition
which sex has a retropubic space?
Term
palpating the prostate, or the cervix and posterior vagina
Definition
what are digital rectal exams for?
Supporting users have an ad free experience!