APOSTLEJOHN'

SSMARTANATOMYPREVI
EW

PELVI
S
BONYPELVI
S
 Pl
aneoft
hebr
imi
sobl
i
gue.
 Li
esat60°wi
tht
hehor
izont
al.Samepl
anewi
thv
agi
na.
 Pel
vi
ccav
itypr
oject
sbackt
obut
tocksf
rom t
hebr
im.
Sexdi
ff
erences
 I
sDuet
othef
actt
hatf
emal
epel
vi
sisbr
oadert
hant
hatofmal
e.
 I
sduet
ofemal
bonesi
ncl
udi
ngheadoff
emurar
emor
esl
endert
hant
hoseofmal
e.
 I
nmalethestur
dybonesmakeACUTEsubpubi
cangl
epoi
ntedl
i
keaGot
hicar
chwhi
l
einf
emal
etheymake
WIDEsubpubi
cangl
eroundedl
i
keRomanarch.
 I
nmale,sacr
alpr
omont
oryi
ndent
stheout
li
neofpel
vi
cbr
im andt
hebr
imi
swi
destt
owar
dst
hebacki
.e.
HEARTSHAPPED
 I
nfemalether
e'sl
esseri
ndent
ati
onbysacr
alpr
omont
oryandbr
imi
swi
destf
urt
herf
orwar
dsi
.e.
TRANSVERSELYOVAL.
Posi
ti
onofpel
vi
s
 I ner ectindi vi
dual ,
ASI Sanduppermar ginofpubi csy mphy sislieinsamev er t
ical plane.
 Thi spl anepassest hroughpel v i
ccav i
tyatl evelwi t
ht ipofclinician'sf i
ngerdur ingr ectalorv
aginal
exami nation.
 Ov ariesandsemi nal vesiclesliei nt hepl ane.
Pelv i
cwal l
 Pel v i
cbr im dividesf alsepel vis( abov ethebr i
m anddpar tofgener al abdomi nal cavity)fr
om tr
uepelvi
s
(belowt hebr i
m) .
 Muscl esofpel v i
sar e:obt uratori nternus, pirif
ormi s( par
tofl owerl imbmuscl es),lev at
oraniandcoccygeus
(formspel vi
cdiaphr agm) .
 Si dewal lsofpel visisf ormedbyhi pbonescl adwi thobturatori nternusandf asci a.
 Cur vedpost eri
orwal l
isf ormedbysacr um wi thpiriformis.
PI
RIFORMI S
 Ar i
sesFr om mi ddle3pi ecesofi tsownhal fofsacr um.
 Sacr al nervesandsacr alplexusl ieont hemuscl e.
OBTURATORI NTERNUS
 Ar i
sef rom whol emembr aneandf r
om bonymar ginsoft hef oramen.
 Or i
ginext endst ofalciformr idgeoni schial tuberosity.
 Tendi nousar chofor i
ginofl ev atorani slopesacr ossobt uratorinter nusfasci a.
PELVI
CFLOOR
 Muscl esofpel v i
cf l
oorar el evat orani andcoccy geus.
 I tslopesdownwar dsandf acesf orwar ds.
Lev atorAni
Pubococcy geus
 Ar i
sef rom ant erior1/2oft endi nousar chandpost er i
orsurfaceofbodyofpubi s.
 I nser t
edbyt endinouspl atet of rontofcoccy x.
Il
iococcy geus
 Ar i
sef rom post er i
or1/ 2oft het endi nousar chandpel vi
csur faceofi schialspine.
 Ov erlapspel vicsur f
aceofcoccy geus.
 I nser t
edi ntosideofcoccy xandanococcy geal r
aphe.
Coccy geus
 Ar i
sef rom t i
pofi schial spine.
 I nser t
edi ntosideofcoccy xandl owestpi eceofsacr um.
 Li esedget oedgewi thl owerbor derofpi ri
f ormis.
 Ov erlaidant eri
orlybyi li
ococcy geus.
Ner vesuppl y
 Lev atorani i
ssuppl iedbybr anchesofS3andS4.

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 APOSTLEJOHN'
SSMARTANATOMYPREVI
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 Coccy geusi sbybr anchesofS3andS4

 Pubor ect alis, pubour et hr alisandpubov agi nal i
sar esuppl i
edfr om bel owbyper ineal branchofS4andi nf
eri
or
rect al br anchofpudendal ner ve.
PELVICFASCI A
 I nter nal iliacv essel sar ei nf rontoft hef asci aov erpiriformis.
 Lar gel ater al sacr al v einl iesbehi ndpr esacr al oranosacr alfascia.
 Super i
orf asci aofpel v icf loorbl endswi thobt uratorf asci aandat hickeningoft he2f or msTENDI NOUS
ARCHofor i
gi nofl ev atorani .
RECTUM
 Begi nsatl ev el ofS3v er tebr a.
 Mi ddl epar tappear st obul get ot hel ef t
.
 Themi ddl ef oldi st hel ar gestf old.
 I t'
scont inuouswi thsi gmoi dcol onatl ev elof3r dpi eceofsacr um.
 I thasnosaccul ations.
 Ther ear enoappendi cesepi pl
oi caei nrect um.
 Themesor ect um i sbul kierpost er iorly.
 Mesor ect um cont ai nssuper i
orr ect al arteriesandv einswi t
ht heirbr anchesandt r
ibut aries, lymphat ic
vessel sandnodes.
 Pl anebet weenmesor ect al fasci aandpar iet al pelvicf asciaismostev i
dentpost er
iorlyandmi nimal later
all
y.
 Per itoneum cov ersupper3r dofr ect um atf rontandsi des,mi ddle3r datf rontonl yandl ower3r di sbelow
level ofper itoneum.
 I nf rontofr ect out er inepouchi supper mostpar tofv agi na.
 Bel owper itoneal ref l
exi oni sv agi nawi t
hr ect ogeni tal septum i nt
erv ening.
Bloodsuppl y
 I sder ivedpr inci pal lyf rom super iorr ectal ar ter y.
 I nfer iormesent er i
car terychangesi tsnamet osuper i
orr ectal ar
teryoncr ossingpel vicbr im.
 Mi ddl er ect al ar teriesar epr esenti nonl y1i n5peopl e, suppliesmuscl esofmi dandl owerr ectum.
Lymphdr ai nage
 Ly mphat icdr ai nagei smai nl yupwar ds.
 Ly mphoi df olliclesi nmucousmembr anedr aint oepi col i
cnodesi nmesor ectum.
 Upwar dsdr ai nagei sv ianodesal ongi nferiormesent ericarterytopr eaorti
cnodes.
 Ly mphat icdr ai nagef rom l owerr ectum t oi nt ernal il
iacnodesi salongmi ddleandi nfer iorr ectal vessels.
Ner v esuppl y
 Sy mpat het icsuppl yi sf rom i nferiormesent er i
cpl exus.
 Par asy mpat het icsuppl yisf rom S2t oS4bypel visspl anchni cner vesv i
ainferi
orhy pogast ricpl exus.They'r
e
mot ort or ect al muscl es.
 Asf rom bl adderpai nf i
br esaccompanybot hsy mpat het i
candpar asy mpat heticsuppl ies.
Rect al exami nat ion
 Forbot hsexes, coccy xandsacr um canbef eltbehi ndwi thischial spineatsi des.
 I nmal epr ost atecanbef el tinf r
om, inf emal ecer vixcanbef eltinf r
ontwi thut erosacr al l
i
gamentl ateral
l
y
andsomet imesov ar ies.( COMPAREwi thv agi nal exami nati
on) .
URINARYBLADDER
 Domesupi nt oabdomi nal cav i
t yasi tdi stends.
 Apexhast her emai nsofur achusat tachedt oi t.
 Mostoft hebasel iesbel owl evel ofr etrovesi cal pouch.
 Onl yt heupper mostpor tioni scov er edbyper itoneum.
 Pubov esi cal ligamentext endsf rom bl adderneckt oI nf er
ioraspectofpubi cbone.
 I nmal et heneckl iesagai nstbaseofpr ost at e.
 Di st endi ngbl adderst ripsper it
oneum f r
om behi ndr ect usabdomi nis.
 Whencol lapsed, mucousmembr anei st hickandt hrowni ntof ol
dsbuti sthinandsmoot hwhendi st
ended.
 Thet r i
gonev ar iesbutl ittlei nst at ei sdi stent ion.
 Tr igonei sf ixedont opofpr ostat ebyur ethr a.
 Tr igonei st hel eastmobi lepar toft hebl adder .
 Tr igonei ssmoot hwal l
ed.
 URETERSpi er cemuscl eandmucouswal l
sv eryobl iguel y,i
mpor tantf actorinpr ev entingr efluxofur ine.

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 APOSTLEJOHN'
SSMARTANATOMYPREVI
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 Inmal e, thet rigoneov erliesmedi anpar tofcent ral zoneofpr ost ate.
Bloodsuppl y
 Most l
ysuper i
orandi nf er iorv esi cal art eries.
 Smal l cont ribut iont ol owerpar tbyobt ur ator ,v agi nal ,uterineandi nf eri
orgl uteal arteries.
 Vei nsdonotf ol l
owt hear teriesbutf or mv esi copr ost aticpl exusbet weenbl adderandpr ostate.
Ly mphdr ai nage
 Mai nl yt oext er nal ili
acnodes.
 Somedr ai nt oi nt ernal iliacnodesandnodesi nobt ur atorf ossa.
Ner v esuppl y
 Sy mpat het icf ibr esar ef rom L1andL2segment sv iasuper iorandi nfer
iorhy pogast ricplexuses.
 Sensat ionf ordi stent ionofnor mal bl addert rav elswi thpar asy mpat heticfibres.
Cont rol ofmi ctur ition
 Skel et al muscl eofext ernal ur et hr al sphi ncteri scont roll
edbyper i
neal branchofpudendal nerve
(predomi nant lyf rom ant er i
orhor ncel lsofS3segment-ONUF' SNUCLEUS) .
PELVI
CURETER
 Runsov erext er nal iliacar teryandv ei nandi nf rontofi nternal ili
acar t
eryandbehi ndov ary.
 Inmal e, duct usdef er enscr ossesabov eur et erandr unsdownmedi al t
ot heur eter.
 Inf emal e, ur eterl iesi nbaseoft hebr oadl i
gament ,cr ossedabov ebyut er i
near tery .
PROSTATE
 Li esbeneat hbl adderabov eur ogeni tal diaphr agm.
 Penet r atedbypr oxi mal par tofur et hra.
 Femal ehomol oguei spar aur ethr al glands.
 Pr ost at i
cur ethr aemer gesf rom f rontoft heapex.
 Ant er iorsur facei sconnect edt obodi esofpubi cbonesbypubopr ost ati
cl i
gament .
 Post er i
orsur f acei si nf rontofl owerr ect um separ at edf rom i tbyr ectovesical fasci a.
 Ej acul ator yduct spi er cepost er iorsur facebel owbl adder .
 Pr ost at i
cpl exusofv ei nsl iesbet weent r
ueandf alsecapsul e.
Prost at i
cur ethr a
 Pr ost at i
cur ethr ai scl osert oant eriort hanpost er iorsur face.
 Emer gesf rom ant er i
oraspectofapex.
 Mi dliner idge, theur et hr al cr estpr ojecti nt ot hel umenf r
om post er i
orwal lthroughouti tslength.
 Shal lowdepr essi ononei thersi deoft hecr esti spr ost aticsi nus.
 Pr ost at i
cut r i
cl er epr esent sf usedendofpar amesonephr i
c( Mul lerianduct s).
 Ej acul ator yduct sopenonei thersi deoft heut ricle.
 Pr oxi mal par tofpr ost at icur et hr ai ssur roundedbycy li
nderofsmoot hmuscl e.
 Per ipher al z onesur roundscent ral zonef rom behi ndandbel owbutdoesnotr eacht hebase, extendstofr
om
l
owerpar toft hegl and.
 Duct soft ransi tionzoneopenont hev erumont anum j ustabov ewher educt sofper ipher alzoneopen.
 Per ipher al z onei sal mostexcl usi vel ysi t
eofofor iginofcar cinomaofpr ostate.
 Cent ral zonei sr ar elyi nv ol vedi nanydi seasepr ocess.
 Ant er iorpar tofpr ost at ei smai nlyf i
br omuscul ar.
 Ther e'sv eryl i
t tl
egl andul art issueant er i
ort opr ost aticur ethr a.
Bloodsuppl y
 Pr ost at i
cbr anchofi nf er i
orv esi cal art ery.
 Vei nsr uni nt opl exusbet weent r ueandf alsecapsul e.Thi sj oinsv esicopr ostaticpl exus.
 Muscl est hatcont ractt oempt yt hegl andsdur i
ngej aculationar eundersy mpat het ic(adr energi
c)contr
ol
from i nfer iorhy pogast ricpl exus.
DUSTUSDEFERENS
 Ini t
scour se, noot herst r uct ur ei nt er venesbet weeni tandt heper i
toneum.
 Cr ossesext er nal ili
acar ter yandv ein, obl i
terat edumbi l
ical arteryandobt uratorar tery,ner veandv ei
n
hooki ngar oundi nt erf ov eol arl i
gamentandi nf eriorepi gast ricar t
er y.
 Cr ossesabov eur et erandappr oachesi t
sopposi tef ellow.
SEMINALVESI CLES
 Thepai rpr oduceabout60%ofsemi nal fluid.
 Ar eappl iedt obaseofbl adderabov et hepr ost ate.

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 APOSTLEJOHN'
SSMARTANATOMYPREVI
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 Rectov esi cal fasci ali

esabov et hem.
 Theirtopsar ecov er
edbyper itoneum ofr ect ov esi cal pouch.
 Eachliesl at eral toampul laofduct usdef erensofi tssi de.
 Ductsofsemi nal vesicl ej oinst of or m ej acul ator yductatl owerendoft heampul labehindt hepr ostate.
 Theirsmoot hmuscl er eci ev essy mpat het icf ibresf rom 1stl umbargangl ionandar emot or.
UTERUS
Fundus
 Possesser ouscoatofpel v icper itoneum.
Body
 Eachupperangl e( cor nu)r eci ev est heut erinet ubes.
 Isencl osedbyper itoneum whi chl ater all
ybecomebr oadl i
gament .
 Intest i
nal sur f
aceofbodyf acesupwar dswi thi nt estinal coilslyingoni t.
 Vesi cal sur facef acesdownwar dsr est ingofbl adderwi t
hper i
toneum ofv esicouteri
nepouchi nterv eni
ng.
Cer vix
 For ni xi sdeepestpost er i
orly.
 Post er iorsur f
aceofcer vixi scov er edbyper i
toneum.
 Ant eriorsur facehasnoper itoneal cov eringbei ngdeept ov esicout er i
nepouchandat tachedt obl adder
abov et rigone.
 Ur et erpasses1stl at eral l
yandt heni nf r
ontoff ornix.
 Bodyofut erusi sr ar elyexact lyi nmi dline.
 Canal ofcer v i
xiscont i
nuouswi thcanal ofbodyati nternal os.
 Loweropeni ngint ov agi nai sext er nal os.
 Ant eriorl i
pofext er nal osl iesatl owerl ev el thanpost eri
oraf terchi l
dbi rt
h.
 Ext er nal osi snor mal lyonal ev el wi thi schi al spi ne.
 Ext er nal osi scircul ari nnul lipar ous.
UTERI
NETUBES
 Liesi nupperedgeofbr oadl igament .
 Thepar tadj acentt out er us( ist hmus)i sst raightandnar row.
 Wi derampul lafor msmor et han1/ 2l engt hoft het ube.
 Oneoft hef imbr i
aeoft hei nf undi bul um i sl ongerandt ypicallyappl iedt otheov ary.
 Openendoft het ubel iesbehi ndt hebr oadl igament .
Bl
oodsuppl
yofut er usandut er i
net ube
 Ut er i
near ter ypassesmedi allyacr osspel vicf loori nbaseofbr oadl igamentabov eur eter
.
 Thev essel t
ur nsupwar dsbet weent hel ay ersofbr oadl igament .
 Atj unct i
onofut er usandut er i
net ubet hear teryt ur nsl aterally,endsbyanat omi si
ngwi thtubal branchof
ov ar ianar t ery.
 Vei nsofut eruscour sebel owt hear tery .
Ly mphdr ainage
 Lowerpar tofut er usdr ainst oext er nal il
iacnodes.
 Body ,fundusandut erinet ubeaccompanyt hoseofov arytopar a-aor t
icnodes, af ewpasst oext ernal
ili
acnodes.
Ner vesuppl y
 Div isionofal l ut
er inener vesorhi ght ransect ionofspi nalcor ddoesnotaf f
ectut eri
necont racti
lity.
 Sy mpat het icfibresar ef rom T10t oL1segment s.
 Abol itionofut er
inesensat ionr equi resdi v i
sionofal lner ves,ort ransect ionoft hecordabov eT10l evel
.
 Ut er i
net ubei ssensi tivet ot ouchi ngandcut ting.
 Cer vixandbodyar ei nsensi tivet ot ouchi ngandbur ning.
Suppor t
 Ext er nal osopenst hroughant eriorwal lofv agi na.
 Mostf ixedpar tofut er usi st hecer vixbecauseofi tsat t
achmentt obackofbl adderandv aginalfornix.
Broadl i
gament
 Consi stsofl axdoubl ef oldofper i
toneum l yingl at eral tout erus.
 Play sl ittlepar ti
nut er inesuppor t
.
 Medi al edgei satt achedt osi dewal lofut erus.
 Lat er al edgei sat tachedt osi dewal lofpel vis.

38
 APOSTLEJOHN'
SSMARTANATOMYPREVI
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 Upperbor derofbr oadl igamenti sf reef ormi ngmesosal pinxandcont ainsut er

inet ube.
 Upperl ater al par tcont ainsov ar i
anv essel sandl ymphat ics, ext endsov erexternal i
liacv esselsas
suspensor yl igamentofov ary.
 Ant er iorlay erofbr oadl igamenti sbul gedbyr oundl i
gamentofut erusbel owut eri
net ube.
 Bet ween2l ay ersofbr oadl i
gamenti spar amet rium i nwhi chl ieut erinev esselsandl y
mphat i
cs,round
l
igamentofut erus, ligamentofov aryandv est igial r
emnant sofmesonephr ictubules( epoophoronand
par oophor on) .
Roundl i
gamentofut erus
 Liesi nbr oadl igamentbel owut er inet ubeandbul gesant eri
orl ay eroft hel i
gamentf orwar ds.
 The2l i
gament s( br oadandr ound)r epr esentguber nacul um ( count erpar tofguber nacul um oftestis)
.
 Roundl i
gamentpassest hr oughi ngui nal canal .
 It'
ssuppl iedbyabr anchofov ar ianar teryi nt hebr oadl igamentandbyabr anchf rom i nfer
iorepigastr
ic
arter y.
 Itconsi stofsmoot hmuscl eandf ibrof at t
yt issue.
 Ithol dsut er usi nant ef lexi onandant ev ersion.
Transv ersecer v i
cal ligament
 Consi st sofconnect iv et issuei nbaseofeachbr oadl igament .
 Ext endsf r om cer vixandv aginal for nixl at eral lyt osidewal lofpel v i
s.
Uter osacr al ligament s
 Ext endbackwar df rom cer v i
xbel owper i
toneum t of rontofsacr um.
 Theyar epal pabl eonr ect al butNOTv agi nal exami nat ion.
OVARY
 Ov oi di nshapeandsmal lert hant est i
s.
 They 'resmal lerbef or emenar cheandpost menopausal .
 Liesal mostv er ti
cal l
y .
 Itsl owerpol ei st i
ltedt owar dsut er us, andi sat tachedt oitbyl i
gamentofov ary.
Ligamentofov ar y
 Cont inuouswi thr oundl i
gamentandar ebot hat tachedt ocor nuofut erus.
 Ant er iorbor derofov ar yi scont inuouswi thpost eriorl eafofbr oadl i
gamentbymesov arium.
 Per itoneum doesnoti nv estr estofov ar y,cov er edbycuboi dal epi thelium andf acesper i
tonealcavity
.
 Ov ar yi sov erlai dbycoi lsofsi gmoi dcol onandi leum occupy i
ngr ect out eri
nepouchofDougl as.
Bloodsuppl y
 Ov ar i
anar tery .
 Thev essel sr undownbehi ndper i
toneum ofi nfracol iccompar tment .
 Cr ossesur eterobl iguel yonPsoasmuscl e.
 Ent er ssuspensor yl igamentatl ater al ext remi t
yofbr oadl i
gament .
 Rightov ar i
anv einsj oi nI VC.
 Thatont hel ef tjoinsl ef tr enal v ein.
 Ov ar i
anv ei nsf orm pl exusi nmesov ar ium.
Ly mphdr ai nage
 Dr aint opar a-aor ticnodesal ongor igi nofov arianar ter y( L2l ev el)justabov eumbi l
icus.
Ner v esuppl y
 Sy mpat hetic( vasoconst r i
ct or)f iber sr eachov aryf rom aor ticpl exus.
 Thepr egangl i
oni ccel l bodi esar ei nT10andT11.
 Aut omat i
cf ibresdonotr eachov ar ianf ollicles.
 Ani ntactner vesuppl yi snotr equi redf orov ulat i
on.
VAGI
NA
 Is10cm l ong, direct edupwar dsandbackwar dsf rom i tsl owerend( vagi nalor i
fi
ce).
 Itliesi nf rontofr ect um, anal canal andper ineal body .
 Liesbehi ndt hebl adderandur ethr a.
 It'
ssepar at edf rom r ect um byt hinr ect ov agi nal sept um.
 Upperendi ssl ightlyexpandedandr eci ev escer vix.
 Post eriorwal lofv agi nai sl ongert hanant er iorwal l.
 Post eriorf or nixi sdeepert hanot herf or nices.
 Post eriorf or nixi scov er edbyper itoneum ofr ect out erinepouchofDougl as.

39
 APOSTLEJOHN'
SSMARTANATOMYPREVI
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 Bel owcer vixt heant eriorwal l isincont actwi thbase( post er i

orsur face)ofbl adder.
 Bel owbl adder , theur ethr ai sembeddedi nv agi nal wal l.
 Mi nut eopeni ngsofv est ibul argl andsar ebet weenv aginal andur ethral ori
fices.
Bloodsuppl y
 Mai nlyv agi nal br anchofi nt er nal ili
acar ter y.
Ly mphdr ai nage
 Likecer v i
xdr ainsi ntoi nt er nal andext er nal il
iacnodes.
 Lowestpar tdr ainst osuper ficial ingui nal nodesl i
keot herper i
neal structures.
Ner v esuppl y
 Lowerendofv agi nar eciev essensor yf ibresf rom per ineal andpost eriorlabial br
anchesofpudendal
ner veand( wi thant eriorpar tofv ul va)f rom i l
ioi nguinal ner ve.
 Upperpar tofv agi nai ssensi tiveonl yt ost retch.
 Vagi nal exami nat ion
 Bodyofut er us, ov ar i
esandut erinet ubescanbef elt.
FEMALEURETHRA
 Is4cm l ongandi si nf rontofv agi nal or i
f i
ceand2. 5cm behi ndcl itoris.
 Excepti tsupper mostend, i
t'sembeddedwi thinant eriorv agi nal wal l.
 Fibr esofpubov agi nal i
spar tofl ev at orani lieadj acentt oi tandpl aysomepar tincompr essingi
t.
 Vagi nst retchi ngdur ingbi rthcani ncr easeur et hral l
engt ht o10cm.
PELVI
CVESSELS
 Pel vicwal lsandv i
scer aar esuppl iedbybr anchesofi nt ernal il
iacar teryanddr ainint
ointernali
li
acv ei
ns.
 Ar teriesandv einsl iewi thi nt hepar i
et al pel v i
cf ascia.
 Obt ur at orv essel sdonotpi er cet hisf asci a.
I
NTERNALILIACARTERY
 Commoni l
iacar ter ybi fur cat esatpel v i
cbr i
m opposi t
esacr oil
iacj oint.
 Inter nal i
liacar terydi videsi nt oashor tpost eriorandl ongerant er iordi vi
sions.
 Post eriordi v isionbr eaksupi nt o3br anches.
 Ant er iordi visionhas9br anches.3associ atedwi thbladder ,3ot herv i
scer albranchesand3par iet
al
branches.
 Inter nal pudendal andi nf er i
orgl ut eal aret er mi nal branchesofant eriordiv i
sion.
 Obl iter atedumbi l
ical ar teryi sacont inuat ionofsuper iorv esi cal andi s1stbr ancht oari
sef rom anteri
or
div i
si on.
Br anchesoft hepost eriordi v ision
Il
iolumbarar ter y
 Passesi nf rontofl umbosacr al trunkandbehi ndobt urat orner v e.
 Runsl at eral lydeept oPsoasmuscl e.
 Giv esspi nal br anchi ntof or amenbet weenL5v er t
ebr aandsacr um.
Lat er al sacr al ar tery
 Isf requent lydoubl e.
 Runsdownl at er al toant er iorsacr al for ami nai .e.inf r
ontofr oot sofsacr al plexus.
 Itsuppl i
est her oot sandpi rifor mi s.
Super i
orgl ut eal arter y
 It'
st hel ar gestofal lthebr anchesofi nt er nal ili
ac.
 Pier cespel vicf asci abet weenl umbosacr al trunkandS1ner ve.
 Leav espel v ist hr oughgr eat ersci at i
cf oramenabov eupperbor derofpi ri
formi s.
Br anchesoft heant er i
ordi v ision
Super i
orv esi cal ar tery
 Ist heper si stentpat entpr oxi mapar toff et al umbi l
ical arter y.
 Thedi st al par tbecomesobl iter atedt of or m medi al umbi lical l
igament .
 Runsf irstal ongt hesi dewal loft hepel vis.
Mi ddl er ect al ar tery
 Isf requent lyabsent .
Ut erinear ter y
 Cr ossespel visi nt hebaseofbr oadl igament .
 Passesabov eur et er.

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 APOSTLEJOHN'
SSMARTANATOMYPREVI
EW

 Tur nsupwar dsatcer vix.

 Runsal ongsi deut er usi nt hebr oadl igament .
Vagi nal ar ter y
 Cor respondst oi nfer iorv esical arter yi nmal e.
 Maybeabr anchofut er inear ter y.
Obt ur at orar tery
 Passesbel owobt ur atorner ve.
Infer i
orgl ut eal arter y
 Passesbel owS1ner v er ootorsomet imesS2.
 Leav espel vist hr oughgr eat ersci at icf oramenbel owpi ri
formi s.
Inter nal pudendal ar tery
 Liesi nf rontofi nf eriorgl ut eal ar tery .
 Passesoutofpel vist hr oughgr eat ersci ati
cf oramenbel owpi ri
formis.
I
NTERNALILIACVEI N
 Begi nsabov egr eat ersci at i
cnot chbyconf l
uenceofgl uteal v eins.
 Passesupwar dspost er omedi al toi tsar tery.
 Communi cat eswi thv er tebr al venouspl exusbyl at eralsacr al v ei
ns.
 Ther ear eNOv al vesi npel vicv eins.
PELVI
CNERVES
Obt ur at orner v e
 Isabr anchofl umbarpl exus.
 For medi nsubst anceofPsoasmaj orf rom ant eri
ordi visionsofL2t oL4.
 It'
sner veofadduct orcompar tmentoft high.
 Pier cesmedi al bor derofPsoast ot hi gh.
 Cr ossespel v i
cbr im medi al tosacr oi l
iacj ointi.
e.onal aofsacr um.
 Separ at edf rom nor mal lysi tuat edov arybypar ietal peritoneum l ini
ngpelvicwal l
.
 Inobt ur atorf or amen, t
hener v el i
eshi ghestwi t
har teryandv einbeneat hitinthatorder.
 Ant er iordi visionofobt ur atorner v epassesant eriort oupperbor derofobtur at
orexternus.
 Post eriordi v i
sionpi ercesobt ur atorext ernus.
Accessor yobt ur at orner ve
 Occasi onal lypr esent .
 Emer gef rom medi al bor derofPsoas.
 Passesov ersuper iorpubi cr amust ot high.
 Suppl iespect i
neus.
SACRALPLEXUS
 Apar tofL4andal lofL5ant eriorr ami ent ersacral pl
exus.
Lumbosacr al trunk
 Passesov eral aofsacr um.
 Cr ossespel v i
cbr im medi al toobt ur atorner v e.
 Separ at edf rom obt ur at orner vebyi l
iolumbarar t
er yandv ei
ns.
Sacr al plexus
 Rest suponpi ri
f ormi s.
 Lat eral sacr al ar teriesandv einsl iei nf rontofsacr alner ves.
 Super iorandi nf eriorgl ut eal arter iespassbackwar dsabov eandbel owS1r especti
vely.Ormay
beS2.
 Ur eterl iesi nf rontofi nt er nal i
liacv essel sandi swel lant eri
ort oupperpartoft heplexus.
 Inf rontofal lar epar ietal pelv i
cper itoneum andpel vi
cf asci a.
Pirifor mi s
 Suppl iedbyt wi gsf rom post er iordi visionsofS1andS2.
Per for at i
ngcut aneousner v e
 Ar i
sef rom post er i
ordi v isionsofS1andS2.
 Pier cessacr ot uber ousl igament .
 Cur v esr oundl owerbor derofgl ut eusmaxi mus.
 Suppl iesski nofbut tocks.
Post eriorf emor alcut aneousner v e
 For medbybr anchesofpost er iordi v i
sionsofS1andS2andant eri
ordi
v i
sionsofS3andS4.

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 APOSTLEJOHN'
SSMARTANATOMYPREVI
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 Passesbackwar dsbel owpi ri

for mi s.
Super iorgl ut eal ner ve
 For medf rom post er i
ordi visionsofL4, 5andS1.
 Passesoutofpel visabov epi r
iformi s.
Infer i
orgl ut eal ner ve
 From post er iordi visionsofL5, ,S1andS2.
 Passesoutofpel visbel owl owerbor derofpi rif
or mis.
Sci aticner v e
 Tibi alpar tisFor medbyuni onofal l5ant eriordi v i
sionsofL4, 5,S1t oS3.
 Commonper oneal par tisf ormedbybr anchesf rom post er i
ordi visionsofL4, 5, S1andS2.
 Theyusual lyj oini nt hepel v i
s.
 Sci aticner v el eav espel vi
sbel owl owerbor derofpi riformi slat er
al toischi alspi ne.
Ner v et oobt ur atori nter nus
 From ant er iordi visionsofL5, S1andS2.
 Suppl i
essuper iorgemel l
us.
 Leav espel visl at eral t opudendal vessel sbel owpi ri
f ormis.
Ner v et oquadr at usf emor i
s
 From ant er iordi visionsofL4, 5andS1.
 Suppl i
esi nf er iorgemel l
us.
 Leav espel visi nf rontofsci at i
cner ve.
Pudendal ner v e
 Ar i
sef rom ant eriordi visionsofS2, 3and4.
 Passesbackbet weenpi r
ifor misandsacr ospi nousl igament .
 Per ineal br anchofS4passesbet weencoccy geusandl evat orani .
Par asy mpat het icpel v i
cspl anchni cner ves
 Ar i
sebysev eral root letsf rom ant er i
orsur facesofS2and3andof ten4.
 S3cont ribut ioni st hel argest .
 Theypassf or war dsi ntoi nfer i
orhy pogast ricpl exus.
 Theymi xwi thsy mpat het i
cner vesandar edi str
ibutedt opel vicv i
scer aanddi stal colon.
SACRALSYMPATHETI CTRUNK
 Cr osspel vicbr im behi ndcommoni l
iacv essel s.
 Rundownal ongt hemedi al mar ginsofant eriorsacr alforami na.
 Thet runksconv er geatf rontoft hecoccy xt ouni tatgangl ioni mpact( smal lswel ling).
 Viscer al br anchesj oint heI nfer i
orhy pogast ricpl exuses.
I
NFERIORHYPOGASTRI CPLEXUSES
 It'
sanaut onomi cpl exusonsi dewal lofpel visoneachsi de.
 Inmal ei t'sl at er al tor ect um andpost erolat eral tosemi nal vesicle,prost ateandpost er i
orpar tofbladder
.
 Mi ddl eoft hepl exusi sl ev el withandj ustbehi ndt opoft hev esicle.
 Inf emal et hepl exusi sl ater altor ect um, cer vix,vaginal fornixandpost er olateral tot hebl adder.
 Itssy mpat het iccomponent sar eder i
v edf rom super iorhypogast ricplexusv iahy pogast r
icner veand
from sacr al sy mpat het icgangl ia.
 Pregangl ioni cf i
br esj oint hepl exusf rom S2, 3and4ner ves.
 About1/ 2t hef i
br esi nt hehy pogast ricner vesi smy el i
nated.
 Muscl esofbl adderandr ect um ar einner vatedbypar asympat heticner v esf r
om pel vi
cspl anchnics.
 Smoot hmuscl eofbl adderneck, prost ate, semi nalv esicl
eandduct usdef erensi ssuppl i
edby
sy mpat het i
cner v esf rom super iorhy pogast ri
cpl exus.
 Smoot hmuscl eofi nter nal sphi ncterofanal canal i
sbybr anchesf rom sacr al sympat heticgangl ia.
 Nor mal sensat ionsofdi st entionofbl adderandr ectum passt hroughpel vicspl anchni cner ves.
 Pel vicspl anchni cner vessuppl yt hecol onf rom spl eni cfl
exur edistallyaswel landpel vi
cv i
scera.
 Pel vicpar asy mpat het i
csar emot ort oempt y i
nguscl eofbl adderandofgut sf rom spl enicf l
exuret o
rect um.
 Theyar eal sosecr et omot ort ogut sandv asodi l
at ort oerect il
et i
ssuesi nper ineum.
 Thesympat het i
csar emot ort ov i
scer al muscl eofbl adderneckandi nt ernal anal sphi ncter.

42