blood vessels, lymph nodes and innervation of urogenital organs … · nerves of the...
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Blood vessels, lymph nodes and innervation of
urogenital organs
The Retroperitoneum
David Sedmera
Sec. Miloš Grim & Petr Valasek
Institute of Anatomy
First Faculty of MedicineMarch 2020
Why retroperitoneum?
• Deep body (what‘s left in the body after
we remove the innards)
• Abdominal aorta and its branches
• Inferior vena cava and its tributaries
• Lymphatics (nodes and collectors)
• Nerves – L-S plexus and the
autonomics
• Organs
Clinical notes
• Abdominal aorta - aneurysm
• Inferior vena cava - trombosis
• Lymphatics - metastasis
• Organs – access to the kidney, adrenal
gland
• Nerves – regional anaesthesia
Nerves of the retroperitoneal and subperitoneal space
Lumbal and sacral plexuses,
Abdominal and pelvic plexuses and
ganglia of the autonomic system
Vena cava inferior, aorta abdominalis, a. mesenterica inferiorPortal circulation vs. inferior v. cava; porto-caval anastomoses
Porto-caval anastomoses
• Cardia-esophagus (varices – bleeding)
• Rectum - hemorrhoids
• Parietal branches and retroperitoneal
parts of the colon, spleno-renal shunt
• Periumbilical veins (caput Medusae)
• Intrahepatic, patent ductus venosus
Lymph nodes in the
retro- a sub-peritoneal
space
Cross-section of the abdomen
Mid-sagittalsection of
the abdomen
• Body wall
• Peritoneal cavity
• Omental bursa
(lesser sac, in blue)
• Retroperitoneum
• Branches of the
abdominal aorta:
-parietal (paired)
-visceral -paired
-unpaired
-terminal: AIC (2x)
median
sacral a,
Retroperitoneal space, topography of its organs and main vessels
Vessels of pelvic organs
venous vesical plexus, venous vesicovaginal plexus
Male vs. female
Female pelvis, transverse cross-section
Female pelvis, fixation of the uterus
Principle of blood supply to the pelvic organs
Blood supply to the uterus
Arteries of the
pelvis
AA AIC
AIC
AIE
AII
A. iliaca
interna
Vena iliaca interna
Clinical note:
bleeding!
Lymph nodes on
posterior abdominal
wall and sides of pelvis
If you know the blood
supply of the organs…
you know the lymphatic
drainage!
Important: uterus
(multiple sources/lymph
node groups)
testis (NOT the inguinal
lymp nodes!)
Lymphaticdrainage ofthe uterus & other female
genitalorgans
• Multiple blood
supply of the
uterus –
anastomoses:
-via the ovarian
aa.
-uterine artery
-vaginal artery
-along the
round ligament
Lymphaticdrainage of
the male genitalorgans
• Blood supply to
the testis!
• Embryology is
the key…
Lymphaticdrainage ofthe urinary
system
• Inguinal lymph
nodes
• External iliac l.n.
• Internal iliac l.n.
• Common iliac l.n.
Lympnodes of
the rectum
• 3 arteries
=> 3 ways
of
lymphatic
drainage!
Nodi lymphatici pelvici
Internal iliac artery, blood vessels of the pelvis
Lacuna vasorum, lac. musculorum, canalis obturatorius
Foramen supra- and infrapiriforme
Perineal region - blood supply, innervation
Pudendal nerve and Internal pudendal artery
Plexus hypogastricus Inferior,
parasympathetic fibres from the
sacral nerves
Function!
Pudendal nerve block
during childbirth
• Next to the sacro-
spinous ligament
Episiotomy
• To do, or not
to do?
- culture
- wishes
- age & parity
- always with
the forceps
delivery
• During delivery – to avoid tear to the rectum
Figure credits:
Gray´s Anatomy,
Sobottův atlas anatomie člověka, Grada, 2007
Grim, Druga: Základy anatomie, 5. díl
Benninghoff, Drenckhahn: Anatomie I., II.
Carlson,B.M.: Human Embryology and Developmental
Anatomy, archive of the authors
Recommended reading (additional to Sobotta‘s):
Čihák R: Anatomie 2, Grada 2002, (3. vydání březen 2013)
Grim, M., Druga, R.et al: 5. Anatomie krajin těla. Praha,
Karolinum, Galén, 2010; 3. Trávicí, dýchací, močopohlavní a
endokrinní systém, Praha, Karolinum, Galén, 2005,
Lüllmann-Rauch R.: Histologie, překlad 3. vydání , Grada 2012
Sadler T. W: Langmanova lékařská embryologie, překlad 10.
vydání , Grada 2011,
Junqueira´s Basic Histology 12th Edition, 2010