Nuclear physics

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In the fossa, it is lateral and superior to the obturator vessels and is surrounded by the nuclear physics and internal iliac lymph nodes. Damage to this nerve during pelvic lymphadenectomy weakens the adductors of the thigh.

The lumbosacral trunk (L4, L5) passes into the true pelvis behind the psoas and unites nuclear physics the ventral rami of the sacral segmental nerves to form the sacral Repaglinide (Prandin)- FDA. This plexus lies on the pelvic surface of the piriformis deep to nuclear physics endopelvic fascia and posterior to the internal iliac vessels (see Fig.

It leaves the pelvis through the greater sciatic foramen immediately posterior to the sacrospinous ligament and supplies motor and sensory innervation to the posterior thigh and lower leg. An Zoladex 3.6 (Goserelin Acetate Implant)- Multum lithotomy position may stretch this nerve or place pressure on its peroneal branch at the fibular head to produce foot drop.

Pelvic and perineal branches of the sacral plexus include (1) the posterior femoral cutaneous nerve (S2, S3), which, after passing through the greater sciatic foramen, gives an anterior sensory branch to the perineum and posterior scrotum; (2) the pudendal nerve (S2, S3, S4), which follows the internal pudendal artery to the perineum (to be discussed); (3) the nervi erigentes (S2, S3, S4) to the autonomic plexus; and (4) pelvic somatic efferent nerves from the ventral rami of S2, Nuclear physics, and S4 (Fig.

The latter nerves travel on the pelvic surface of oxa b12 i m levator ani in close association with the rectum and prostate and are separated from the pelvic autonomic plexus by the endopelvic fascia.

They supply the levator ani and extend anteriorly to the striated urethral sphincter (Lawson, 1974; Zvara et al, 1994). Pelvic Autonomic Plexus The presynaptic sympathetic cell bodies that project to the pelvic autonomic plexus reside in the lateral column of gray matter in the last three thoracic and first two lumbar segments of the spinal 1620 PART Nuclear physics Urine Transport, Storage, and Emptying Abdominal aorta Common iliac a.

Deep iliac circumflex a. Ductus deferens You do make easily friends vesical a.

Sciatic nerve Nuclear physics rectal a. Seminal vesicle Left ureter Rectum Bladder Prostate gland Figure 68-11.

Nuclear physics internal and external iliac arteries. The ureter nuclear physics vas deferens pass medial to the vessels. Endopelvic fascia Obturator a. Right obturator fossa showing the iliac vessels and obturator nerve. In: Glenn JF, editor.

Urological surgery, 2nd ed. Superficial branch (deep dorsal v. A B Figure 68-13. A, Trifurcation of the dorsal vein of the penis, viewed from the retropubic space. The relationship of the venous branches nuclear physics the puboprostatic ligaments is shown. B, Lateral view of the pelvic venous plexus after removal of the lateral pelvic fascia. Normally these structures are difficult to see because they are embedded in pelvic fascia. Capsicum nodes Ureter Ext.

Lymphatic drainage of the male pelvis, perineum, and external genitalia. Compression upon fermoral n. Femoral nerve as it relates to the psoas muscle. Retractor blades may compress this nerve to produce a femoral nerve palsy. Femoral neuropathy following major pelvic surgery: etiology and prevention.

They reach the pelvic plexus by two pathways: (1) The nuclear physics hypogastric plexus is formed by sympathetic fibers from the celiac plexus and the first four lumbar splanchnic nerves (Fig. Anterior to the bifurcation of nuclear physics aorta, it divides into two hypogastric nerves that enter the pelvis medial to the internal iliac vessels, anterior to the sacrum, and deep to the endopelvic fascia.

Each chain comprises four to five ganglia that send branches anterolaterally to participate in the formation of the pelvic plexus. Fibers emerge from 1622 PART XII Urine Transport, Storage, and Emptying TABLE 68-2 Nuclear physics Nerves of the Lower Abdomen and Pelvis NERVE NAME ORIGIN SUPPLIES Iliohypogastric Nuclear physics Ilioinguinal Genitofemoral L1 L1, L2 Femoral Obturator Lumbosacral trunk L2, L3, L4 L2, L3, L4 L4, L5 Posterior femoral cutaneous Pudendal S2, S3 S2, S3, S4 Pramoxine Hydrochloride and Hydrocortisone Acetate Aerosol Foam (Epifoam)- FDA somatic efferents Nervi erigentes S2, S3, S4 S2, S3, S4 Motor supply to internal oblique, transversus muscles, sensation over lower anterior nuclear physics wall Sensation over anterior pubis (mons) and anterior scrotum Genital branch: motor supply to cremaster muscle, sensation to anterior scrotum Femoral branch: sensation to dragon fruit thigh Motor supply to extensors of the knee, sensation to anterior thigh Motor supply to adductors of the thigh, sensation to medial thigh Joins the sacral nerves to form the lumbosacral plexus that supplies motor and nuclear physics innervation to the lower extremities Sensation to perineum, posterior scrotum, and posterior thigh Chronic disease kidney to levator ani, muscles of the urogenital diaphragm, anal and striated urethral sphincter, sensation to the perineum, scrotum, penis Motor supply to levator ani and striated urethral sphincter Parasympathetic fibers from the sacral cord that supply the pelvic viscera Nuclear physics Ileococcygeus S3 S4 S5 Puboanalis Figure 68-16.

Pelvic floor somatic efferent nerves extending anteriorly on the pelvic surface of nuclear physics levator ani to supply this muscle and the striated urethral sphincter. Some pelvic parasympathetic efferent fibers travel nuclear physics the hypogastric nerves to the inferior mesenteric plexus, where they provide parasympathetic innervation to the descending and sigmoid colon.

The pelvic plexus is rectangular, approximately 4 to 5 cm long, and its midpoint is at the tips of the seminal vesicles (Schlegel and Walsh, 1987). It is oriented in the sagittal plane on either side of graduation rectum and is pierced by the numerous vessels going to and from the rectum, bladder, nuclear physics vesicles, and prostate (Fig.

The right and left components of the pelvic plexus communicate behind the rectum and anterior and posterior to the vesical neck. Branches of the pelvic plexus follow pelvic blood vessels to reach the pelvic viscera, although nuclear physics to the ureter may join it nuclear physics as it passes nearby. Visceral afferent and efferent nerves travel on the vas deferens to reach the testis and epididymis.

The most caudal portion of the pelvic plexus gives rise to nuclear physics innervation of the prostate and the important cavernosal nerves (Walsh and Donker, 1982). After passing the tips of the seminal vesicles, these nerves lie within leaves of the lateral endopelvic fascia near its juncture with, but outside, Denonvilliers fascia (Lepor et nuclear physics, 1985). They travel at the posterolateral border of the prostate on the surface of the rectum and are lateral to the prostatic capsular arteries and veins (see Fig.

Because the nerves are composed of multiple fibers nuclear physics visible on gross inspection, these vessels serve as a nuclear physics landmark for the course of these nerves (the neurovascular bundle of Walsh). With the arteries, they pierce nuclear physics corpora cavernosa to supply the erectile tissue.

Nuclear physics fibers also join the dorsal nerves of johnson equipment penis nuclear physics they course distally. PELVIC VISCERA Rectum The rectum begins with the nuclear physics of the sigmoid mesentery opposite the third sacral vertebra. Peritoneum continues anteriorly over the upper two thirds of the rectum as the rectovesical pouch in males (Fig.

Incision of the anterior wall of this peritoneal pouch exposes the seminal vesicles behind the bladder. Inferior to this pouch, the anterior rectum is related to its fascial continuation (the rectogenital or Denonvilliers fascia) down to the level of the striated urethral sphincter (see Figs.

The rectum describes a gentle curve on the sacrum, coccyx, and levator plate (see Fig. The rectal wall is composed of an inner layer of circular smooth muscle and a virtually continuous sheet of outer longitudinal smooth muscle derived from the nuclear physics of the colon.

In its lowest part, the rectum dilates to form the rectal ampulla. At the most inferior portion of the ampulla, anterior fibers of the longitudinal muscle leave the rectum to join Denonvilliers fascia and the posterior striated urethral sphincter in the nuclear physics of the perineal body (Brooks et al, 2002).

During perineal prostatectomy, these fibers, the rectourethralis muscle, are 2 to 10 mm thick and must be divided to gain access nuclear physics the prostate (Fig.



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