⁨أسئلة الأولى أناتومي ثانية Repro - Pelvic Wall  ⁩
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Questions and Answers

The pelvic splanchnic nerves originate from which sacral spinal cord levels?

  • S1, S2, S3
  • S1, S3, S5
  • S3, S4, S5
  • S2, S3, S4 (correct)

The superior rectal artery is a direct continuation of which major artery?

  • Internal iliac artery
  • Inferior mesenteric artery (correct)
  • External iliac artery
  • Common iliac artery

At what vertebral level does the ovarian artery typically originate from the abdominal aorta?

  • L2 (correct)
  • L3
  • L4
  • L1

The median sacral artery originates from the posterior aspect of the aorta at which vertebral level?

<p>L4 (D)</p> Signup and view all the answers

Which of the following is a parietal branch arising from the posterior division of the internal iliac artery?

<p>Iliolumbar artery (A)</p> Signup and view all the answers

The distal part of the umbilical artery eventually obliterates to form which structure?

<p>Medial umbilical ligament (C)</p> Signup and view all the answers

Which of the following structures is supplied by the inferior vesical artery in males?

<p>Seminal vesicle (D)</p> Signup and view all the answers

Which artery directly supplies the uterus and uterine tubes in females?

<p>Uterine artery (C)</p> Signup and view all the answers

Which of the following muscles is responsible for the lateral rotation of the thigh and receives its nerve supply from S1 and S2 nerve roots?

<p>Piriformis (D)</p> Signup and view all the answers

The coccygeus muscle originates from the ischial spine and inserts onto which of the following structures?

<p>Last sacral segment and coccyx (D)</p> Signup and view all the answers

Which nerve(s) provide(s) innervation to the upper surface of the levator ani muscle?

<p>S4 nerve root (C)</p> Signup and view all the answers

Which of the following is NOT a described action of the pelvic diaphragm?

<p>Assisting in hip abduction (D)</p> Signup and view all the answers

The lumbosacral trunk, which contributes to the formation of the sacral plexus, is composed of nerve roots from which levels?

<p>L4 and L5 (A)</p> Signup and view all the answers

Which of the following nerves is formed, at least in part, by the sacral plexus?

<p>Sciatic nerve (D)</p> Signup and view all the answers

The pelvic part of the sympathetic chain is typically formed by how many ganglia?

<p>4 ganglia (A)</p> Signup and view all the answers

What is the name of the structure formed by the fusion of the pelvic sympathetic chains anterior to the coccyx?

<p>Ganglion impar (D)</p> Signup and view all the answers

Which of the following characteristics is typically observed in a female sacrum compared to a male sacrum?

<p>A wider sacrum. (C)</p> Signup and view all the answers

Which of the following structures does NOT contribute to the boundary of the pelvic inlet?

<p>Ischial tuberosity (A)</p> Signup and view all the answers

If a patient has damage to the nerve that supplies the obturator internus, what action of the thigh would be most affected?

<p>Lateral rotation (D)</p> Signup and view all the answers

Which of the following joints of the bony pelvis is classified as a synovial plane joint?

<p>Sacro-iliac joint (B)</p> Signup and view all the answers

What is the primary difference between the false and true pelvis?

<p>The false pelvis is located above the pelvic inlet, while the true pelvis is located below it. (B)</p> Signup and view all the answers

A surgeon is performing a procedure near the pelvic outlet. Which of the following structures marks the posterior border of this outlet?

<p>Tip of the coccyx (A)</p> Signup and view all the answers

During a dissection, a student identifies a muscle originating from the middle three sacral segments. Which muscle is the student most likely observing?

<p>Piriformis (C)</p> Signup and view all the answers

Which of the following best describes the insertion point of both the Obturator Internus and Piriformis muscles?

<p>Greater Trochanter (B)</p> Signup and view all the answers

Which of the following muscles inserts, in part, onto the ano-coccygeal body?

<p>Ilio-coccygeus (B)</p> Signup and view all the answers

Damage to the S4 nerve root would most likely affect which specific function of the pelvic diaphragm?

<p>Innervation of the upper surface of the levator ani muscle (D)</p> Signup and view all the answers

If the communicating branches between the pelvic sympathetic chain and sacral nerves were severed, which physiological function would be most directly affected?

<p>Vasoconstriction in pelvic blood vessels (A)</p> Signup and view all the answers

A lesion affecting the lumbosacral trunk would MOST likely result in weakness in what lower limb movement?

<p>Thigh external rotation (A)</p> Signup and view all the answers

Which of the following actions would be MOST affected by damage to the nerve innervating the piriformis muscle?

<p>Hip external rotation (B)</p> Signup and view all the answers

Which nerve directly innervates the lower surface of the levator ani muscle?

<p>Inferior rectal nerve (A)</p> Signup and view all the answers

A patient reports a complete loss of sensation from the perineum, as well as difficulty controlling urination and defecation. Which nerve is MOST likely affected?

<p>Pudendal nerve (B)</p> Signup and view all the answers

What is the most likely consequence of disrupting the ganglion impar?

<p>Altered sympathetic control of pelvic organs (B)</p> Signup and view all the answers

Which of the following accurately describes a key difference between the male and female sacrum?

<p>The male sacrum tends to be narrower, while the female sacrum is generally wider. (A)</p> Signup and view all the answers

A patient presents with difficulty in the lateral rotation of their thigh. If the issue stems from a muscle within the pelvis, which of the following muscles is MOST likely affected?

<p>Piriformis (A)</p> Signup and view all the answers

A surgeon is describing the boundaries of the pelvic inlet during a lecture. Which of the following is an accurate and complete description of the pelvic inlet's boundaries?

<p>Anteriorly by the upper border of the symphysis pubis, posteriorly by the sacral promontory and ala of the sacrum, and laterally by the iliopectineal line. (C)</p> Signup and view all the answers

Following a traumatic injury, a patient experiences paralysis of muscles responsible for the lateral rotation of the thigh. Imaging reveals damage to a nerve exiting the pelvis through the lesser sciatic foramen. Which muscle is MOST likely affected?

<p>Obturator internus (B)</p> Signup and view all the answers

A 60-year-old male patient experiences pain originating from a ligament attached to the ischial tuberosity and the sacrum. Which of the following ligaments is MOST likely involved?

<p>Sacrotuberous ligament (D)</p> Signup and view all the answers

During a pelvic examination, a physician palpates the ischial spines to assess the pelvic outlet. Which of the following structures also contributes to the boundary of the pelvic outlet?

<p>Pubic arch (D)</p> Signup and view all the answers

A patient is diagnosed with a condition affecting the true pelvis. Which of the following best describes the location of the true pelvis?

<p>The area inferior to the pelvic inlet, housing the pelvic organs such as the bladder and rectum. (A)</p> Signup and view all the answers

Which type of joint is the Sacro-iliac joint, and what kind of movement does it allow?

<p>Synovial plane joint; allows gliding movement. (E)</p> Signup and view all the answers

A patient presents with damage to the S3 spinal nerve. Which of the following functions would be most directly affected, considering the typical distribution of pelvic splanchnic nerves?

<p>Parasympathetic innervation of the descending colon (B)</p> Signup and view all the answers

Following a surgical error during a bowel resection, a patient experiences impaired blood supply to the upper rectum. Which artery was MOST likely compromised during the procedure?

<p>Superior rectal artery (B)</p> Signup and view all the answers

A 35-year-old woman undergoing a diagnostic imaging procedure is found to have an anatomical variation where her ovarian artery originates at the L1 vertebral level, instead of the typical L2 level. This variation would mean that:

<p>The artery would be shorter than typically observed. (D)</p> Signup and view all the answers

During an autopsy, it is noted that the median sacral artery is significantly larger than normal. This unusual size most likely indicates increased blood flow to which structure?

<p>The glomus coccygeus (C)</p> Signup and view all the answers

A patient undergoing a pelvic lymph node dissection experiences damage to a branch of the internal iliac artery, leading to impaired blood flow to the iliacus muscle. Which artery was MOST likely affected?

<p>Iliolumbar artery (A)</p> Signup and view all the answers

A newborn infant presents with an anomaly where the medial umbilical ligaments are absent. This condition indicates a failure of obliteration of which arteries?

<p>Distal portions of the umbilical arteries (D)</p> Signup and view all the answers

A male patient undergoing a prostatectomy experiences damage to an artery, leading to reduced blood supply to the seminal vesicle. Which artery was MOST likely affected during the procedure?

<p>Inferior vesical artery (A)</p> Signup and view all the answers

A 45-year-old female patient undergoes a hysterectomy, and during the procedure, a surgeon must carefully ligate an artery that supplies the uterus and uterine tubes. Which of the following arteries is the MOST appropriate target for ligation?

<p>Uterine artery (A)</p> Signup and view all the answers

Flashcards

Pelvic splanchnic nerves

Originate from S2, S3, and S4 spinal nerves.

Pelvic splanchnic nerve distribution

Supplies the hindgut and pelvic organs.

Ovarian artery origin

Originates from the abdominal aorta at the L2 level.

Ovarian artery end

Anastomoses (unites) with the uterine artery.

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Superior rectal artery origin

A continuation of the inferior mesenteric artery.

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Superior rectal artery end

Supplies the upper part of the rectum.

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Median sacral artery origin

Arises from the back of the aorta at the L4 level.

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Median sacral artery end

Terminates in front of the coccyx with the glomus coccygeus.

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Coccygeus Muscle

Originates from the Ischial spine and inserts into the last sacral segment & Coccyx. Innervated by S4, S5.

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Action of Pelvic Diaphragm

Supports viscera, acts as a sphincter for vagina & anorectal junction, and maintains intra-abdominal pressure.

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Sacral Plexus Formation

Formed by the lumbosacral trunk (L4,5) & S1,2,3. Terminates into pudendal and sciatic nerves.

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Sacral Plexus Branches

Piriformis, Pelvic diaphragm, Superior gluteal, Inferior gluteal, Sciatic nerve, PCN of thigh, Nerve to obturator internus, Nerve to quadratus femoris, Pudendal

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Pelvic Sympathetic Chain

Formed by 4 ganglia that enter the pelvis, crossing the ala of the sacrum and fusing in front of the coccyx as the ganglion impar.

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Branches of Sympathetic Chain

Communicating branches with sacral & coccygeal nerves, to inferior hypogastric plexus, and vascular branches.

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Sacro-iliac joint type

Synovial plane joint.

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Obturator Internus Action

Lateral rotation of thigh. Nerve supply from S1 & S2

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Levator prostate/sphincter vaginae

Originates from the back of the body of the pubis, inserts into the perineal body

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Secondary cartilaginous joints of pelvis

Symphysis pubis, Lumbo-Sacral, Sacro-coccygeal.

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Sacro-tuberous ligament function

Connects sacrum to ischial tuberosity.

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Sacro-spinous ligament function

Connects sacrum to ischial spine.

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Female sacrum characteristics

Less prominent, short, wide, R.Articular surface Reach S2

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Boundaries of pelvic inlet

Upper border of symphysis pubis, Sacral promontory & ala of sacrum, Iliopectineal line

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Origin of Obturator Internus

Inner surface of Obturator membrane

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Action of Obturator Internus

Lateral rotation of the thigh

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Sacro-tuberous ligament

Connects the sacrum to the ischial tuberosity.

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Sacro-spinous ligament

Connects the sacrum to the ischial spine.

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False pelvis

Above the pelvic inlet; contains abdominal organs.

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True pelvis

Below the pelvic inlet; contains pelvic organs.

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Boundaries of pelvic outlet

Lower border of symphysis pubis, Tip of the coccyx, Pubic arch & Sacrotuberous ligament

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Obturator Internus nerve supply

Nerve to Obturator Internus

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Origin of piriformis

Middle 3 sacral segments

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Coccygeus Origin & Insertion

Originates from the ischial spine and inserts into the last sacral segment & coccyx.

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Puborectalis Muscle

Originates from the white line, it forms loop around ano-rectal junction.

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Iliococcygeus Origin & Insertion

Originates from the ischial spine and inserts into the ano-coccygeal body & coccyx.

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Pelvic Diaphragm Actions

Supports viscera, acts as a sphincter for vagina & anorectal junction, and maintains intra-abdominal pressure.

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Sacral Plexus Formation/Termination

Formed by the lumbosacral trunk (L4,5) & S1,2,3. Terminates into pudendal and sciatic nerves.

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Pelvic Sympathetic Chain Branches

Communicating branches with sacral & coccygeal nerves, to inferior hypogastric plexus, and vascular branches.

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Pelvic part of sympathetic chain Course and End

Formed of 4 ganglia and fusing in front of the coccyx as the ganglion impar

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Internal iliac artery origin

Terminal branch of the common iliac artery at the sacroiliac joint.

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Internal iliac artery function

Supplies structures in the pelvis and gluteal region.

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Posterior division branches of internal iliac artery

Iliolumbar, lateral sacral and superior gluteal arteries.

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Anterior division branches of internal iliac artery

Obturator, umbilical, vaginal/inferior vesical, uterine, middle rectal, inferior gluteal and internal pudendal arteries.

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Iliolumbar artery supply

Supplies iliacus muscle and lumbar region.

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Lateral sacral artery supply

Supplies the sacral canal.

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Superior gluteal artery supply

Supplies the gluteal region

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Umbilical artery branches

Gives off the superior vesical artery.

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Study Notes

  • ANATOMIST Pelvic Wall, with a male and female gender symbol connected by a heart shape

Bony Pelvis

  • Sacro-iliac joint is synovial plane
  • Remaining pelvic joints are 2ry cartilaginous
  • Symphysis pubis, lumbo-sacral, and sacro-coccygeal are examples of cartilaginous joints.
  • Sacro-tuberous and sacro-spinus ligaments are present

Differences between male and female sacrum

  • Male sacrum promontory: Prominent
  • Female sacrum promontory: Less Prominent
  • Male Sacrum length: Long
  • Female Sacrum length: Short
  • Male sacrum width: Narrow
  • Female sacrum width: Wide
  • Male sacrum articular surface reaches: S3
  • Female sacrum articular surface reaches: S2

Pelvic Inlet

  • Anteriorly by the upper border of the symphysis pubis
  • Posteriorly by the sacral promontory and ala of sacrum
  • Laterally by the iliopectineal line

Pelvic Cavity

  • False Pelvis: Above the pelvic inlet, contains abdominal organs
  • True Pelvis: Below pelvic inlet, contains pelvic organs

Pelvic Outlet

  • Anterior border: Lower border of symphysis pubis
  • Posterior border: Tip of the соссух
  • Lateral border: Pubic arch and sacrotuberous ligament

Muscles of Pelvis

  • Muscles lining the pelvis cavity

Obturator Internus Muscle

  • Originates from the inner surface of the obturator membrane
  • Inserts on the medial border of the greater trochanter
  • Nerve supply from the nerve to the obturator internus
  • Action: Lateral rotation of the thigh

Piriformis Muscle

  • Originates from the middle 3 sacral segments
  • Inserts on the upper border of the greater trochanter
  • Nerve supply from S1 and S2
  • Action: Lateral rotation of thigh

Pelvic Diaphragm

  • Coccygeus: Originates from the ischial spine and inserts on the last sacral segment and coccyx, nerve supply comes from S4 and S5
  • Levator ani has 3 parts: levator prostate/sphincter vaginae, pubo-rectalis, and ilio-coccygeus

Levator Prostate/Sphincter Vaginae

  • Originates from the back of the body of the pubis
  • Insertion: perineal body

Pubo-Rectalis

  • Originates from the white line
  • Insertion: forms a loop around anorectal junction

Ilio-Coccgeus

  • Originates from the ischial spine
  • Insertion: ano-coccygeal body and coccyx
  • Nerve supply to Levator ani, the upper surface comes from S4 and the lower surface is supplied by the inferior rectal nerve of pudendal nerve

Actions of the Pelvic Diaphragm

  • Supports viscera during straining
  • Acts as a sphincter of the vagina and anorectal junction and coccyx
  • Maintains intra-abdominal pressure during expulsive actions

Sacral Plexus

  • Formation: Lumbo-sacral trunk "L4,5" and S1,2,3
  • Termination: Pudendal and sciatic nerves
  • Branches: Piriformis, superior and inferior gluteal, sciatic nerve, nerve to obturator internus, pudendal, pelvic diaphragm, PCN of thigh, and nerve to quadratus femoris

Pelvic part of the sympathetic chain

  • Course: Formed of 4 ganglia that enter the pelvis crossing the ala of sacrum
  • End: Fuses in front of the coccyx forming the ganglion impar
  • Branches: Communicating branches with sacral and coccygeal nerves, to inferior hypogastric plexus and has vascular branches

Pelvic splanchnic nerves

  • Origin: S2,3,4
  • Distribution: Hindgut and pelvic organs

Arteries of Pelvis

Ovarian Artery

  • Originates as a branch from the abdominal aorta at L2
  • Terminates uniting with the uterine artery

Superior Rectal Artery

  • A continuation of the inferior mesenteric artery
  • Supplies the upper part of the rectum

Median Sacral

  • Originates from the back of the aorta at the level of L4
  • Terminates in front of the coccyx by glomus coccygeus

Internal Iliac Artery

  • Originates as a terminal branch of the common iliac at the sacroiliac joint
  • Has parietal and visceral branches

Posterior Division

  • Are all parietal
  • Iliolumbar gives iliac and lumbar branches
  • Lateral sacral goes to sacral canal
  • Superior gluteal goes to gluteal region

Anterior division

  • All branches are visceral except 1, 6, and 7
  • Obturator goes to the thigh
  • The umbilical artery gives a superior vesical branch to the urinary bladder, and the distal part obliterates to form the medial umbilical ligament
  • In females, the vaginal artery supplies the urinary bladder and vagina
  • In males, the inferior vesical supplies the urinary bladder, seminal vesicle, and prostate
  • In females only, the uterine artery supplies the uterus, uterine tube, and vagina
  • The middle rectal supplies the rectum and vagina in females, and the seminal vesicle and prostate in males
  • Inferior gluteal
  • Internal pudendal

Internal Pudendal Artery

  • Origin: Terminal branch of the internal iliac
  • Course: Passes from greater sciatic notch to lesser sciatic notch behind ischial spine, then enters pudendal canal and then deep perineal pouch
  • Termination: A superficial perineal pouch gives the deep and dorsal artery of the penis/clitoris
  • Branches: Inferior rectal, scrotal/labial, artery of bulb, dorsal and deep arteries of penis/clitoris

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