dr. sama-ul-haque dr. rania gabr dr safaa ahmed. describe the origin, termination, course and...
TRANSCRIPT
Dr. Sama-ul-Haque
Dr. Rania Gabr
Dr Safaa Ahmed
Describe the origin, termination, course and
branches of the internal iliac artery.
Discuss the origin, site, relations, branches & their
final distribution of the sacral plexus.
Discuss the anatomy of the autonomic supply of the
pelvic organs.
Common iliac artery divides
in front of the sacroiliac joint
into external and internal
iliac arteries.
The Internal Iliac Artery
passes down into the pelvis.
At the upper margin of
greater sciatic foramen it
divides into anterior and
posterior divisions.
The Posterior division supplies:
1- Posterior abdominal wall.
2- Posterior pelvic wall.
3- Gluteal region.
The Anterior division supplies:
1. Pelvic viscera (Except Ovary).
2. Perineum.
3.Gluteal region.
4.Adductor (medial)region of the thigh.
5.The fetus (through the umbilical arteries)
1- Umbilical artery
Gives the superior vesical artery
The distal fibrous part of this
artery becomes the “Medial
Umbilical Ligament”.
2- Obturator artery: pelvic musc. , ms of
med comp of thigh, nutrient arts.
3- Inferior vesical artery (Male)
It supplies, the Prostate, inferior
part of the bladder and the Seminal
Vesicles.
It gives the artery to the Vas
Deferens.
4- Middle rectal artery: supplies: Semin.
vesicle, prostate (vagina), inf part of the
rectum
5- Internal pudendal artery
Leaves pelvis through greater
sciatic foramen
Enters perineum by passing
through lesser sciatic foramen
Enters into pudendal canal with
pudendal nerve
Supplies anal canal musculature,
skin & muscles of perineum.
6- Inferior gluteal artery: pelvic
diaphragm, piriformis, QF, upper
hamstrings,Glut. Max. and Sciatic nerve
7- Uterine artery (Female)
Crosses the ureter superiorly
Ascends in the layers of broad
ligament of uterus
Ends by anastomoses with ovarian
artery
8- Vaginal artery (Female): divides into:
1- vaginal: to vagina
2-inferior vesical : to urinary bladder
1- Iliolumbar artery: ps. Major,
quadr. Lumb, iliacus,and cauda
equina
2- Lateral sacral artery:
piriformis, erector spinae and
skin over, str. In sacral canal
3-Superior gluteal artery:
piriformis, gluteii, tensor fascia
lata
*The pelvis is drained:
•1- Mainly by the internal iliac veins and their tributaries.
•2- Superior rectal veins
•3- Median sacral vein.
•4- Gonadal veins.
•5- Internal vertebral venous plexus
*(A) Somatic:
Sacral plexus
- From Ventral rami of a part of L4 & whole L5 (lumbosacral trunk) + S1,2,3 and most of S4.
- It gives Pudendal nerve to perineum
*(B) Autonomic:
1. Pelvic splanchnic nerves (From S 2 , 3 & 4)
They are the Preganglionic parasympathetic nerves to pelvic viscera & hindgut.
It is formed of:
(a) Pelvic part of sympathetic trunks:
They are the continuation of the abdominal trunks.
They Descend in front of the ala of the sacrum &
terminate inferiorly
in front of the coccyx and form a single ganglion (Ganglion Impar).
(b) Superior & Inferior
Hypogastric plexuses.
2. Sympathetic:
Lies on the posterior pelvic wall in front
of Piriformis muscle.
Formed from:
The anterior rami of 4th & 5th lumbar
nerves
The anterior rami of 1st, 2nd, 3rd & 4th
sacral nerves
4th lumbar nerve joins the 5th lumbar
nerve to form Lumbosacral Trunk
*The pudendal nerve (S2 to 4) supplies most of the perineum.
*It contains motor, sensory (pain and reflex), and postganglionic sympathetic fibers.
* It can be "blocked" medial to the ischial tuberosity, e.g., during labor.
1- The pelvic splanchnic nerves:
*The pelvic splanchnic nerves (S2 to 4) contain parasympathetic preganglionic and sensory fibers.
*They help to form the inferior hypogastric plexus.
Pelvic Part of Autonomic Nervous System
The inferior hypogastric plexuses contain:
*(1) Postganglionic sympathetic fibers;
*(2) Preganglionic parasympathetic fibers, which supply the descending and sigmoid colon and the pelvic viscera.
* (3) Sensory fibers including :
1- Pain fibers (many of which travel in the lumbar splanchnic nerves)
2- Reflex fibers from the bladder (which ascend in the pelvic splanchnic nerves).
*They give origin to the following plexuses, which innervate the pelvic viscera:
1-the rectal plexus;
2-the uterovaginal plexus;
3-the prostatic plexus; and
4-the vesical plexus.
2- Sympathetic fibers
Reach the pelvis by downward
continuations of the 1- sympathetic
trunks and of the 2- aortic plexus.
*The aortic plexus is continued as the
superior hypogastric plexus which
divides in front of the sacrum into right
and left hypogastric nerves.
*The hypogastric nerve descends &
unites with the pelvic splanchnic
nerves to form the right and left
inferior hypogastric plexuses , which
give branches to the pelvic viscera
(e.g., the rectum, bladder, and uterus).