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Lymph Nodes and Innervation of Pelvic Wall and Floor

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Fill in the information regarding lymph node and innervation of pelvic wall and floor

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Lymph Nodes and Innervation of Pelvic Wall and Floor
 

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Lymph Nodes and Innervation of Pelvic Wall and FloorOnline version

Fill in the information regarding lymph node and innervation of pelvic wall and floor

by Sagar Vellalath
1

Lumbar ( Para - Aortic / Caval ) Lymph Nodes = , , , ,

2

External Illiac Lymph Node = ,

3

Internal Illiac Lymph Node = , , , , ,

4

Superficial Inguinal Lymph Node = ( ) , , , , ,

5

Deep Inguinal Lymph Node = , ,

6

Sacral Lymph = , , , , Rectu m

7

What is the major nerve of the perineum ? .

8

Pudendal Nerve branches into . and n .

Inferior Rectal innervates

Perineal n innervates triangle .

All of these three are ( ) .

9

Sympathetic Innervation :

Pelvic Viscera : and . ( lumbar . ) ; sacral .

Perineum : run with nerve ( to vsaculature glands , and erectile tissues )

10

Parasympathetic nerves :

Pelvic Viscera : nn . ( - )

Perineum = nn . ( - ) - distribute via vasculature to erectile tissue , gland s

11

How is pelvic viscera pain relayed to the spinal cord ?

1 . = Parasympathetic
2 . = Sympathetic

= Dividing Line
Above pelvic pain line =
Below pelvic pain line =

12

Options for anesthesia during childbirth :

A . block at - in ( subdural ) space

B . epidural at - in sacral canal

C . nerve block in canal ( )

13

Parasympathetic = = Excitement and Plateau =

Sympathetic = = Orgasm and Resolution = & Splanchnics nn .

Somatic = N .

14

What is happening in erectile tissue during " point " phase ?
- ( trabecular ) smooth mm .
- Dilation of and . - >
- Sinusoids fill with and
- of veins ( lack of return - > mainly males )
- ( ischiocavernosus m . )
- Engorgemen t

15

" Shoot " = ( orgasm phase )

- Somatic Motor ( efferents ) - - > pudendal nerves
- - rhythmic mm .
- - relaxation of

- Autonomic motor - - > .
- - Female : of ,
- - Male : contraction along course from to orifice
- - - - = fluid from to
- - - - Ejaculation = of from to exterior

16

Clinical Correlate = Ejaculation

retrograde passage of semen into bladder due to disruption of closure during

pharmacological - ex . - , psychotropic medications

anatomical - congenital - valves
- acquired - neck or prostate resection

neurogenic - ex . spinal cord injury , MS , diabetic , autonomic neuropathy

17

Pelvic innervation : Defecation

- At rest / filling phase : sympathetic ( . ) ( Sphincter ) and somatic ( of - ) keep ( sphincter and ) anus tightly closed

- Rectum full phase : sensory signals of fullness relayed to brain for the conscious decision : release or continue to hold ?

- At fecal evacuation phase : release is conscious ( voluntary signal to relax sphincter and ( somatic motor ) ( and - ) and active parasympathetic inhibition of the sphincter ( - )

18

Testes - ( ) =

19

Uterus - ,

20

Seminal Vesicle - ,

21

Lower Vagina - ( Portion Sinus )

22

Prostate - ,

23

Upper Anal Canal -

24

Labia Minora - ,

25

Greater Vestibular Glands - , Gland s

26

Bony Pelvis
Function
Transmits weight from to for activities such as , , &
Provides attachment for , musculature , &
Support &
Structures
Pelvic Inlet
Sacral Promontory
Ala of Sacrum
Arcuate Line of Ilium
Pectinate Line of Pubis
Pubic Crest
Pubic Symphsis
Pelvic Outlet
Coccyx
Sacrotuberous Ligament
Ischial Tuberosities
Ischiopubic ramus
Pubic Symphsis

27

Pernieum
Function

Role in & Function
Supports
Passageway for structures
Protection & compartmentalization
Contribution to pelvic stability
Structures
Urogenital Triangle
Perineal Membrane splits into and
Superficial

Female


- termination of round ligament of uterus , protects urethral & vaginal orifices
- surrounds vestibule
- Erectile Tissue - glans , body , crura
Vestibule
External Urethral Orifice
Vaginal Orifice
Males
Penis
, , , ( bulb & crura ) , prepuce
Testis
In scrotum w / Dartos Fascia
Epidymis
Short term storage and maturation of sperm
Connects to ductus deferens
Spermatic cord - easy way to remember is one vein , nerve , and artery , and one other tube ( remember there are 4 ! ! )
Artery


Nerve
Erectile Tissues / Glands
Female
Clitoris
Composed of paired tissue
Continuation of crus
Surrounded by - maintains erection
Vestibular bulbs
Made of corpora spongiosum
Surrounded by bulbospongiosum to expel glandular secretions into the vestibule
Greater & Lesser Vestibular Glands
Greater ( ? s )
Lesser ( )
Mucus secretion for vaginal / vulvar lubrication
Males

Paired erectile tissue
Crus & Dorsal Body - Surrounded by Ischiocavernosus M . - maintain erecttion by preventing venous return
Corpus spongiosum
Singular midline erectile tissue
Bulb , ventral body , glands spongy penile within
Bulb surrounded by bulbospongiosum
Perineal Musculatures
Perineal Body = fibromuscular aggregate tissue ( stabilizes region
Superficial Transverse Perineal Muscle
Major differences in erectile tissue and musculature between males and females
Vestibule in female ; female does course through
Glands in superficial compartment
Deep

glands ( Male )
Homologues to glands in females
Mucus - like secretions lubricate urethra&neutralize acidity of urine
Empty into spongy urethra which is superficial compartment

Perineal M .
Neurovascular supply
Vagina ( Female )
Anal Triangle
Ischioanal fossa
Horshoe shaped region filling majority of anal triangle ; extends anteriorly , deep to perineal membrane
Contains loose adipose tissue & neurovascular supply to external analsphincter
Inferior Rectal N . and Artery
Anal Musculature
M .
M .
Ani
M .
.
M .
Innervation & Vasculature
Main from Pudendal N . ( S2 - S4 )
Sensation from skin around perineum &anus , external genitalia
Motor to the perineal muscles , urethra & anal sphincter
Course
Leaves pelvic cavity through the greater sciatic foramen
Enters perineum via lesser sciatic foramen
Branches
Perineal = Urogenital
= Anal Triangle
Dorsal nerve of penis / clitoris = Ext . Genitalia
Main artery to perineum = A .

28

Hydrocele = Excess fluid extends into ( )

Cause : patent results in persistent communication between ; injury to or inflammation of epididymis

29

Vasectomy = definitive , procedure that involves disrupting the from the of

30

Cremasteric Reflex = stroke proximal medial thigh to evoke contraction of cremaster m , absence of reflex can indicate

Afferent = n

Efferent - N .

31

Greater Vestibular ( Bartholin ) Gland Cyst / Abscess

Cyst = presents typically as a / ; caused by obstructed duct ? mucus accumulation proximal to obstruction
abscess = presents as large , mass with swelling ; caused by obstructed duct that becomes infected

Treatment : Warm compress , NSAIDS , surgical drainage

32

Episiotomy = procedure developed to augment difficult vaginal deliveries while controlling for & avoiding potentially dangerous perineal lacerations during the delivery process

Tear degrees :
1st =
2nd = & .
3rd =
4th = into

33

Pelvic Floor Injury
most vulnerable because of its location ( near birth canal ) and attachents ( bone to bone )

34

Pregnancy = occurs somewhere other than the uterus

35

Hysterosalpingogram = assess the patency of the uterine tubes = ? uterus ? uterine ?

36

Benign Prostatic Hyperplasia - BPH - growth of the / glands lining the urethra

37

Genital Swellings - -

38

Urethral ( urogenital ) folds - -

39

Urogenital sinus - glands - gland s

40

Urogenital Sinus - glands - glan d

41

Gonad - -

42

Paramesonephric Ducts - , ,

43

Mesonephric Ducts - , , ,

44

Somatic Perineum - pudendal nerve mediates from & around &

Motor innervation to the and . & muscles of the perineu m

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