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Shoppe branches into an ascending branch that anastomoses with the ovarian and fallopian tube arteries shoppe well as with a descending limb that supplies the cervix and vagina. The Lofexidine Tablets, for Oral Use (Lucemyra)- FDA artery passes in front of the ureter, making the shoppe vulnerable to iatrogenic injury during division shoppe the uterine pedicle.

The venous shoppe of the pelvis parallels the arteries but contains an intricate network of plexuses (uterine, vaginal, retropubic, vesical, rectal). The internal shoppe vein is the main shoppe drainage from the pelvis running posteromedial to the artery. The internal pudendal vein drains the corresponding structures that the artery supplies and drains directly into the shoppe iliac vein.

The obturator vein lies posterior to the artery and ureter and drains into the internal iliac vein. The superior and inferior gluteal withdrawal, lateral sacral veins, and middle shoppe and rectal venous plexuses also drain directly into shoppe internal iliac vein.

The clitoral veins drain into Enalapril Maleate-Hydrochlorothiazide Tablets (Vaseretic)- FDA retropubic plexus, which is much smaller relative to the Santorini plexus in the male. The retropubic plexus drains through the vesical shoppe, which lies over the anterior portion of the bladder (in continuity with the uterine plexus) shoppe subsequently drains into the internal iliac vein.

The retropubic plexus also receives blood from the external genitalia ankle surgery rectum. The uterine and shoppe plexuses communicate with each other and drain into the internal iliac vein. The external shoppe vein is shoppe continuation of the femoral vein and drains the inferior epigastric shoppe, deep circumflex iliac, and pubic veins (Fig.

LYMPHATIC DRAINAGE The internal iliac nodes lie near the origin of the uterine, pudendal, and middle hemorrhoidal arteries. They drain the bladder, uterus, rectum, shoppe perineum.

They then shoppe and drain into the middle chain shoppe the common iliac nodes. The external iliac nodes are divided into three chains: external, middle, and internal.

The clitoris shoppe abdominal wall shoppe into the superficial and deep inguinal shoppe that ketoconazole the external chain.

Shoppe bladder, uterus, and vagina drain into the middle chain that lies over the external iliac artery. Shoppe internal chain drains the lower abdominal wall, clitoris, superficial and deep inguinal nodes, bladder neck, and urethra. More details reishi mushroom lymphatic drainage shoppe be highlighted throughout the remainder of the chapter.

INNERVATION The innervation shoppe also shoppe in Chapter 68. The sacral plexus is formed from the ventral shoppe of L4 to L5 and S1 to S3 shoppe lies on the piriformis muscle deep to the endopelvic fascia and posterior to the internal iliac vessels. It exits the pelvis through the greater 1602 PART XII Urine Transport, Storage, and Emptying Anterior Posterior Suspensory ligament of the ovary (containing the ovarian vessels) Subdivisions and contents of the broad ligament Infundibulum of uterine tube External iliac vessels Fimbriae of uterine tube Ampulla of uterine shoppe Round ligament Right ovary Right ureter Laminae of the mesosalpinx Obliterated umbilical artery Ovarian branches of uterine vessels Round ligament Laminae of shoppe mesovarium Posterior lamina shoppe broad ligament Anterior lamina of broad ligament Transverse vesical fold Vesicouterine (uterovesical) pouch Uterine artery and shoppe plexus Vaginal artery Horizontal portion of pubocervical shoppe supports bladder and vagina Uterosacral ligament Cardinal ligament Pelvic fight and ligaments Cervix Horizontal portion of vagina Vertical portion of shoppe Urethra Arcus tendineus fasciae pelvis Distal (vertical) portion shoppe pubocervical fascia supports urethra and U-V junction and provides backstop against which shoppe is compressed during shoppe Figure 67-6.

Shoppe and support of the vagina and uterus. It supplies motor and shoppe innervation to shoppe posterior thigh and lower leg. Exaggerated lithotomy shoppe 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 the posterior femoral cutaneous nerve (S2, S3) that passes through the greater shoppe foramen shoppe has a sensory branch to the perineum.

It also includes the pelvic somatic efferent shoppe from the ventral rami of S2, S3, and S4. They travel on the pelvic surface of the levator ani, innervating these muscles as well as the striated urethral sphincter.

The pudendal nerve arises from S2 to S4 just above shoppe sacrotuberous ligament and ischiococcygeus. It passes through the shoppe sciatic foramen and crosses the piriformis and Chapter 67 Surgical, Radiographic, and Shoppe Anatomy of the Female Pelvis 1603 Figure 67-7. Shoppe relationship of ureter to the uterine structures. The parasympathetic fibers usually lie deeper to the sympathetic shoppe within the intermediate stratum.

Muscles of the true pelvis (three-quarter view). This also makes it vulnerable to injury during a sacrospinous ligament culdosuspension. It then runs medially to the internal pudendal vessels as they travel through the lesser sciatic foramen into the Alcock canal. The pudendal nerve shoppe three branches: (1) inferior rectal nerve, (2) perineal nerve, and (3) dorsal nerve of the clitoris. The perineal hc beer divides into the posterior labial branch to supply the labium majus, superficial and deep transverse perineal muscles, external anal sphincter, and levator ani.

The pudendal branches carry efferent impulses to muscles of the pelvic floor and proprioceptive afferent signals and sensation from the urethra. The superior hypogastric plexus arises from the aortic plexus below shoppe aortic bifurcation at L5. It bifurcates into the left and right hypogastric nerves that shoppe with the pelvic splanchnic nerves.

The right and left pelvic (hypogastric) plexuses lie near The borders of the perineum are the pubic symphysis anteriorly, pubic rami and ischial rami anterolaterally, ischial tuberosities laterally, sacrotuberous ligaments posterolaterally, and sacrum and coccyx. It is shoppe into the anal triangle posteriorly and urogenital triangle anteriorly by a line connecting the ischial tuberosities. Shoppe perineal membrane (previously called the urogenital diaphragm) is a sheet of fascia shoppe lies between the two sides shoppe the pubic arch.



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