1. Dr. Sama-ul-Haque Dr. Rania Gabr Dr Safaa Ahmed

2.  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.

3.  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.

5. 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)

6.  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.

7.  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.

8.  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

10.  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

12. * 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

13. * (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.

14. 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:

15.  Lies on the posterior pelvic wall in front of Piriformis muscle.  Formed from:  The anterior rami of 4 th & 5 th lumbar nerves  The anterior rami of 1 st, 2 nd, 3 rd & 4 th sacral nerves  4th lumbar nerve joins the 5 th lumbar nerve to form Lumbosacral Trunk

16. * 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.

17. 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

18. 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).

19. * 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.

20. 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).