Term
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Definition
| what spinal level are preganglionic sympathetics from that innervate the pelvic and perineal structures? |
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Term
1) prearotic ganglia
2) prevertebral ganglia
3) paravertebral ganglia
4) inferior hypogastric plexus |
|
Definition
| where do synapses for pelvic & perineal structures sympathetics occur? |
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Term
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Definition
| where do sympathetics come out of the spinal cord (in general)? |
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Term
| S2-S4 via pelvic splanchnic nerves |
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Definition
| what spinal level are parasympathetic preganglionics from that innervate the pelvic and perineal structures? |
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Term
| they also synapse in minute ganglia scattered throughout the inferior hypogastric plexus |
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Definition
| what is the exception to the parasympathetics synapsing in the organ walls of the structures innervated? |
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Term
| S2-S4, ventral rami via the pudendal nerve mostly |
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Definition
| where does somatic and sensory & motor information come from that innervates the pelvic and perineal structures? |
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Term
the erectile tissue vasculature
***this is an exception to the rule, normally parasympathetics don't do body wall structures |
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Definition
| where do parasympathetic nerves innervate body wall structures? |
|
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Term
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Definition
| ____ supplies autonomic innervation to the lower abdomen and pelvis. It also supplies visceral sensory info (both types) to the same region |
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Term
| aortic bifurcation to S2-S4 (where the pelvic splanchnic nerves originate) |
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Definition
| where is the superior hypogastric plexus located? |
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Term
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Definition
| where is the inferior hypogastric plexus located? |
|
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Term
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Definition
| how do parasympathetics reach the superior hypogastric plexus? |
|
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Term
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Definition
| what kind of parasympathetic nerves (pre/post synaptic) are found in the lumbar splanchnic nerves |
|
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Term
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Definition
| where do sacral nerves S1-S3(sacral splanchnic nerves) synapse? |
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Term
| pre-ganglionic parasympathetics from S2-S4 |
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Definition
| what type of nerves are pelvic splanchnic nerves? |
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Term
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Definition
| name the nerve plexus posterior to the bladder and seminal vssicals? |
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Term
| he mentioned that they come from the ureter |
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Definition
| what plexus do the parasympathatic nerves that ascend to the superior hypogastric plexus go though? |
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Term
| when the pelvic splanchnic nerves join, it is the transition to inferior hypogastric plexus |
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Definition
| where is the point of transition between superior and inferior hypogastric plexus? |
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Term
| the spermatic cord, cause the contraction/relaxation of ductus deferens and cremaster/dartos |
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Definition
| where do the autonomics to the testes and epididymis travel? what do they do? |
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Term
| sacral splanchnic nerves come out paravertebral ganglia, pelvic nerves come out ventral rami |
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Definition
| where do sacral splanchnic nerves come out of the spine vs pelvic nerves? |
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Term
|
Definition
| at what spinal level do the first parasympathetics join the inferior hypogastric plexus? |
|
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Term
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Definition
| where do the autonomics pass through the pelvic diaphragm? |
|
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Term
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Definition
| name the nerve that reaches the blood supply of the erectile tissues |
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Term
| they pierce it with tiny holes along with vasculature |
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Definition
| how do autonomics go through the perineal membrane? |
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Term
the pathway MUST be intact for ANY function at all with sympathetic and somatic innervation
parasympathetics are special |
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Definition
| what is the rule on the pathway between the target and brain for somatic(motor and sensory) to function? sympathatics |
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Term
| the pathway must be intact for normal function, BUT, reflexive action (no brain) can still occur sometimes |
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Definition
| what is the rule about the pathway between the brain and the target for parasympathetic innervation? |
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Term
| all sympathetics have left the spinal cord at T1-L2, and there are no sympathetics in the cord beyond that point |
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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? |
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|
Term
1) brain to spine intact from T1-L2
2) on at least one side the sympathetic trunk must be intact |
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Definition
| what are the requirements for sympathetic function? |
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Term
| alongside sympathetic pathways (like abdominal organs in general) |
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Definition
| where do pain impulses run above the pelvic pain line? |
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Term
| alongside parasympathetic pathways (just remember p = pelvis, parasympathetic pain path) |
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Definition
| where do pain impulses run below the pelvic pain line? |
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Term
| alongside parasympathetic pathways |
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Definition
| where do visceral afferents OTHER THAN PAIN run? |
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Term
| top of bladder, most of uterus and colon (cuts halfway through the sigmoid colon) |
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Definition
| what structures are directly above the pelvic pain line? |
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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 |
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Definition
| what does the vagus nerve have to do with the pelvis? |
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Term
| sympathetics make you retain urine, so they relax the detrusor (inhibit contraction) and contract the sphincter |
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Definition
| what do sympathetics do to the detrusor muscle? the internal sphincter? |
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Term
|
Definition
| what is visceral afferent information carried in for the bladder? |
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Term
| it is above and below the pelvic pain line, so some travels with sympathetics, some with para. |
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Definition
| how does visceral pain information from the bladder travel? |
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Term
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Definition
| what innervates the external urinary sphincter (and the other somatic muscle structures around the bladder in females)? |
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Term
| helps you retain urine (inhibits urination) |
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Definition
| an increase in somatic motor innervation signals to the bladder does what? |
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Term
sympathetics intact (already in chain ganglia) - no spasticity, no incontinence
reflexive parasympathetics |
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Definition
| if you have an L5 lesion of the spinal cord, describe your innervation to the bladder. |
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Term
| absence of sympathetic innervation (so any lesion above L2) |
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Definition
| what causes spasticity of the detrusor muscle? |
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Term
| reflex is upper motor neurone |
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Definition
| if you have a neurogenic bladder, upper motor neuron type, is it reflex or non-reflex type? |
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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 |
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Definition
| what does "reflex type" neurogenic bladder mean? |
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Term
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Definition
| what kind of incontinence results from an upper motor neuron neurogenic bladder? |
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Term
| upper motor neuron reflex type |
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Definition
| what kind of neurogenic bladder results from a T9 lesion, or a lesion above L2 in general? |
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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 |
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Definition
| what do sympathetics do to inhibit urine release? |
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Term
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Definition
| where in the spinal cord would a lesion cause lower motor neuron or "non-reflexive" neurogenic bladder? |
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Term
| there will be no parasympathetic innervation, but the myogenic cells of the bladder will be activated with stretch to contract causing overflow incontinence |
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Definition
| if there is a lesion to the root or ventral rami of an S2-S4 neuron, will there still be bladder function? |
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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 |
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Definition
| with lower motor neuron or non-reflexive neurogenic bladder, what kind of incontinence will there be? describe the nerve function |
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Term
| parasympathetics to push out the poop (more p's) |
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Definition
| what innervation contracts the rectum? |
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Term
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Definition
| where is the transition in the rectum between visceral sensory innervation and the somatic body wall innervation |
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Term
| they cross the pectinate line and when they hit the somatic sensory part, they burn |
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Definition
| why don't you feel hot peppers until you poop them out? |
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Term
1)deep part
2) superficial part
3) subcutaneous part |
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Definition
| list the 3 parts of the external anal sphincter |
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Term
| inferior to the anal columns/valves |
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Definition
| where is the pectinate line? |
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Term
|
Definition
| what innervates the external anal sphincters? |
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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? |
|
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Term
| inferior hypogastric plexus (L1-L2) |
|
Definition
| where does the sympathetic innervation to the anal sphincters come from? |
|
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Term
|
Definition
| name the parasympathetics that innervate the rectum? |
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|
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? |
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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 |
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Definition
| what is anesthetized with a spinal block? |
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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) |
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Definition
| what is anesthetized by a caudal block? |
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Term
| just the somatic pain from the pudendal nerve from the skin/episiotomies |
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Definition
| what is anesthetized by a pudendal nerve block? |
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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 |
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Definition
| how is a pudendal nerve block performed, and for what purpose? |
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Term
| parasympathetics cause dilation of the blood vessels to fill the erectile tissue (pelvic splanchnic nerves) |
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Definition
| what branch of the autonomic system causes erection by innervating the vascular smooth muscle in the root of the penis? |
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Term
| parasympathetics-secretory epithelium of the seminal vessicles, the prostate, the bulbourethral gland, and the root of the penis |
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Definition
| what branch of the ANS is responsible for secretion in the male sexual response? where does secretion occur? |
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Term
| sympathetics- act on the smooth muscle of the epididymis, vas deferens, seminal vessicles, and prostate gland |
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Definition
| what branch of the ANS causes the peristaltic contractions in the emission phase of the male sexual response? |
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Term
| somatic motor to the secretory epithelium of the bulbourethral land, and striated muscle in the root of the penis |
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Definition
| what innervates ejaculation? |
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Term
|
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? |
|
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Term
| yes, sory of like neurogenic bladder |
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Definition
| if the S2-S4 innervation is cut, does erection still occur? |
|
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Term
|
Definition
| what type of innervation typically is responsible for secretion? |
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|
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) |
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Definition
| what type of innervation typically is responsible for emission? |
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|
Term
| somatic motor: skeletal muscle around the erectile tissues |
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Definition
| what type of innervation typically is responsible for ejaculation? |
|
|
Term
| bulbospongiosus and ischiocavernosus contract reflexively to squeeze the urethra |
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Definition
| what muscles are responsible for ejaculation? |
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Term
|
Definition
| what artery supports pregnancy, has a lot of anastamoses, and is hard to identify? |
|
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Term
|
Definition
| what is the spinal level at which the aorta divides? |
|
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Term
|
Definition
| what is the only body wall artery that descends from behind to supply pelvic structures? |
|
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Term
|
Definition
| what artery becomes the femoral artery? |
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Term
| the obliterated umbillicus artery |
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Definition
| what artery delivers deoxy blood to the placenta and goes to the umbilicus? |
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|
Term
males: lower bladder, prostate, seminal vessicles
females: cervix, uterus, baginal, lower bladder |
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Definition
| what is supplied by the inferior vesicle artery(in males)? in the uterine artery(females)? |
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Term
|
Definition
| what vessel supplies blood to the ventral rami and the back pelvic wall/floor? |
|
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Term
|
Definition
| what artery exits the pelvis above piriformis? |
|
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Term
|
Definition
| what vessel exits below piriformis and is found between the lumbosacral trunk and S1? |
|
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Term
|
Definition
| what artery supplies the perineum (body wall) and leaves the pelvic cavity? |
|
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Term
|
Definition
| what artery typically branches off the internal pudendal artery? |
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|
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
|
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 |
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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) |
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Definition
| what artery is not cut in a tubal ligation, and can rupture in an ectopic pregnancy causing a lot of severe bleeding? |
|
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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
|
Definition
| what vessels does the inferior epigastric artery arise from? |
|
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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 |
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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? |
|
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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 |
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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
|
Definition
| where does blood pool when an aberrant obturator nerve bursts? |
|
|
Term
|
Definition
| name the space on either side of the bladder in front of the transverse cervical ligament |
|
|
Term
|
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
|
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
|
|
Term
| the retrovesical pouch/space |
|
Definition
| what is the lowest point in the male pelvis? |
|
|
Term
|
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? |
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