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Lecture 49: Female and Male Internal Iliac Vessels, Sacral Plexus, Splanchnic and Pelvic Splanchnic Nerves

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Posted by lae2 on October 13, 2021 at 17:49:16:

Essay Questions

A 70 year old male presents to your office and upon examination you detect hard, irregular nodules on the posterior aspect of the prostate. Radiologic examination shows osteoblastic lesions associated with thoracic and lumbar vertebrae. Review the anatomy of the internal iliac veins. Include relationships, tributaries, and drainage routes. Explain the mechanism of metastatic prostate cancer from the pelvic cavity to the vertebral and cranial cavities.
Individuals who experience uterine pain due to endometriosis can elect to have the superior hypogastric plexus surgically interrupted or cut to eliminate pain signals. Review autonomic innervation to pelvic viscera. Include three pathways for sympathetic innervation and one pathway for parasympathetic innervation. Differentiate between sacral and pelvic splanchnic nerves.

True False Questions

The iliolumbar artery, a branch of the posterior division of the internal iliac artery, supplies the paravertebral region for the fifth lumbar vertebra.
The iliac branch of the iliolumbar forms an anastomosis with the deep circumflex iliac artery and, thus, provides a shunt across the external iliac artery.
The lateral sacral artery, a branch of the posterior division of the internal iliac artery, supplies the sacral spinal canal and cauda equina.
The lateral sacral vein is a possible route for the spread of prostate cancer to the spinal canal and cranium.
Branches from the lateral sacral artery travel medially to enter the anterior sacral foramina.
Branches of the middle sacral artery travel laterally to enter the anterior sacral foramina.
The superior gluteal artery, the terminal branch of the posterior division of the internal iliac artery, normally leaves the pelvis by passing between the lumbosacral trunk and the ventral ramus of S1 to then pass through the greater sciatic foramen.
The bifurcation of the aorta is located at L4, whereas the superior hypogastric plexus is located anterior to the L5 vertebral body.
The inferior gluteal artery, a branch of the anterior division of the internal iliac artery, often passes between S2 and S3 ventral rami to then leave the pelvis through the greater sciatic foramen.
The internal pudendal artery often passes inferior to the S4 ventral ramus to then cross the ischial spine at the inferior margin of the greater sciatic foramen.
The middle rectal artery, a branch of the anterior division of the internal iliac artery, stays within to pelvis to supply rectum.
The uterine artery, a branch of the anterior division of the internal iliac artery, travels along the superior surface of the transverse cervical ligament to supply the proximal vagina, cervix, and uterine body.
The inferior vesical artery, a branch of the anterior division of the internal iliac artery, supplies the posteroinferior region of the bladder.
The vaginal artery, a branch of the anterior division of the internal iliac artery, supplies the middle region of the intrapelvic vagina and has an ascending branch that anastomoses with the uterine artery.
The umbilical artery, a branch of the anterior division of the internal iliac artery, supplies superior vesical arteries to the anterosuperior regions of the bladder.
The umbilical artery, distal to elaborating the final superior vesical arterial branch, obliterates to continue as the medial umbilical ligament.
The obturator artery, normally a branch of the anterior division of the internal iliac artery, travels the lateral pelvic wall to then leave the pelvis through the obturator canal.
The obturator artery may arise from the external iliac artery near the inferior epigastric artery or from the inferior epigastric artery as an anomalous obturator artery.
The anomalous obturator crosses the pectineal ligament to then enter the obturator canal and, thus, is vulnerable to ligation when suturing to the pectineal ligament for repair of inguinal hernias.
The middle sacral artery, not a branch of the internal iliac artery, branches from the posterior wall of the aorta and enters the pelvis by crossing the midline of the sacral promontory.



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