Lower limb

Question 1

Plexus lumbalis

Answer 1

T12-L4

T12 n. subcostalis 
T12-L1 n. iliohypogastricus
L1 n. ilioinguinalis 
L1-L2 n. genitofemoralis 
L2-L3 n. cutaneous femoralis lateralis 
L2-L4 n. obturatorius 
L1-L4 n. femoralis --> n. saphenous 

–> come out from foramen intervertebrale and form ansae

Question 2

n. iliohypogastricus

Answer 2

T12-L1

• mixed nerve
• lateral side of m. psoas major
• -> passes over anterior surface of m. quadratus lumborum parallel to n. subcostalis
• above crista iliaca penetrates m. transversus ab. –> between it and m. ob. int. ab. (supplies them)
• -> between it and m. ob. ext. ab.

1. r. cutaneous anterior
   - penetrates aponeurosis of m. ob. ex, ab. at level of anulus inguinalis superficialis
   - -> innervates skin of regio inguinalis/pubica
2. r. cutaneous lateralis
   - innervates skin below crista iliaca and in the gluteal area

Question 3

n. ilioinguinalis

Answer 3

L1

• anterior surface of m. quadratus lumborum
• behind kidney
• b. m. tr.ab. and m. ob.int. ab.
• -> enters canalis inguinalis
• -> passes ventrally funicular spermaticus / lig. teres uteri
• -> comes out anulus inguinalis superficialis

1. nn. scrotales/ labiales anteriores
   - -> innervate skin of external genitals
   - -> regio pubica
   - -> upper third of medial surface of the thigh
2. rr. musculares
   > lower part of the lateral abdominal muscles

Question 4

n. genitofemoralis

Answer 4

• penetrates m. psoas major > out in the anterior surface

1. r. femoralis
   - sensory branch
   - laterally from a. femoralis
   - through lacuna vasorum
   - penetrates fascia lata at the region of hiatus saphenous
   - innervates skin of trigonum femorale
2. r. genitalis
   - mixed
   - penetrates dorsal wall of the inguinal channel
   - innervation to funiculus spermaticus/lig. teres uteri
   and skin of scrotum/labia major pudendi

Question 5

n. cutaneous femoralis lateralis

Answer 5

L2-3

• 2nd longest branch of plexus lumbalis
• SENSORY
• comes out at the lateral edge of m. psoas major
• crosses m. iliacus (and caecum on right, colon descendens on left)
• penetrates abdominal wall near spina iliaca anterior superior
  –> passes through lacuna musculorum > lateral region of the thigh
  > penetrates fascia lata
  –> innervates the skin at the lateral part if the thigh until knee joint

Question 6

n. obturatorius

Answer 6

L2-4

• medial side of m. psoas major
  > crosses linea terminalis
  > passes the lateral wall of the lesser pelvis
• accompanied by a./v. obturatoria in canalis obturatorius

1. r. anterior
   - b. m. adductor breves and longus
   > innervates them and m. pectinous, m. gracilis

• penetrates fascia lata –> r. cutaneous; medial part of the thigh until knee joint

2. r. posterior
   - behind m. adductor breves
   - innervates m. adductor magnus, m. obturatorius externae, art. coxae

Question 7

n. femoralis –>

Answer 7

L1-4

• largest, thickest and most important of lumbar plexus
• MIXED
• b. m. psoas major and m. iliacus
• innervates hip joint
• -> lacuna musculorum
• in trigonum femorale laterally from a. femoralis
• -> rr. musculares to m. quadriceps femoris, m. sartorius, m. pectineus (also n. obturatorius)

1. rr. cutanei anteriores; skin of anterior region until knee joint
2. n. saphenous;
   - passes behind m.sartorius
   - enters canalis adductorius with a. femoralis
   > penetrates anterior wall –> comes out together with a. descendens genus
   –> turns around condylus medals femurs (posteriorly)
   > reaches medial side of the lower leg: together with v. saphena magna
   - innervates medial lower leg until base of the great toe
   (goes in front of malleolus medialis)

Question 8

Plexus sacralis

Answer 8

In lesser pelvis, on the pelvic surface of the sacral bone; facies pelvina ossis sacri; and on the anterior surface of m. piriformis

Ventral branches
- part of L4
- all L5, S1-S5, Coccus spinal nerves
L4-L5 spinal nerves join and form a thick truncus lumbosacralis
–> laterally from the foramina intervertebralia
–> crosses linea terminals; joins the lower part of the sacral plexus in lesser pelvis

> > the thick ventral branches of the lower part of the sacral plexus come out through foramina sacralia pelvina
form triangular plate and continue as n. ischiadicus

Question 9

Plexus sacralis short branches

Answer 9

Innervate the muscles of the pelvic gridle, the perineal muscles, the skin of the external genitals

! Most important nerve for perineum innervation; branches to perineal muscles, skin, external genitals, and organs of the lesser pelvis. –> communicating branches to vegetative plexus –> plexus hypogastricus inferior!

1. rr. musculares: L4-L5, S1-S2
   - supply m. piriformis, m. obturatorius internus, m. gemellus superior, m. gemellus inferior, m. quadratus femoris
2. n. gluteus superior: L4-L5, S1
   - motor nerve
   - passes together with a. glutea superior through foramen suprapiriforme
   - -> lodges between m. gluteus medius, m. gluteus minimus
   - -> supplies m. gluteus medius, m. gluteus minimus
3. n. gluteus inferior: L5, S1-S2
   - motor nerve
   - passes with a. glutea inferior through foramen infrapiriforme
   - innervates m. gluteus maximus, and sensory for art. coxae
4. n. pudendus S1-S4
   (other slide has info)

Question 10

n. pudendus

Answer 10

S1-S4

• mixed nerve
• passes together with a. pudenda internal through foramen infrapiriforme
• -> turns around spina ischiadica,
• -> through foramen ischiadicum minus
• -> reaches fossa ischioanalis
• -> passes along the lateral wall
• -> then the nerve passes between 2 layers of fascia obturatoria
• -> forms canalis pudendalis
• -> passes forwards along m. transverses perinei profundus
• -> reaches symphysis pubica

Male:
- runs along dorsum penis as n. dorsalis penis; innervates skin of the penis

Female:
- passes along dorsum clitordiis as n. dorsalis clitoridis

• -> gives off rr. musculares to m. transversus perinei profundus and m. sphincter urethrae
• -> rr. urethrales innervates the mucosa of the urethrae

Side branches:

1. nn. rectales inferiores (S3-S4)
   - mixed nerves
   - arise in the area of fossa ischioanalis
   - pass together a./vv. recitals inferiors through corpus adiposum fossa ischioanalis to the anus where they supply m.sphincter ani externus, m. levator ani, and skin of the perineum in the anal region
2. nn. perineales (S2-S4)
   - anastomose with rr. perineales from n. cutaneous femoris posterior
   - mixed nerves
   - located superficially
   - pass in trigonum urogenital in the ventral direction
   - supply superficial muscles of diaphragm urogenitalis; m. transverses perinei superficialis, m. ischiocavernous, and m. bulbospongiosus
   - terminate the skin of perineum
   a. in male as nn. scrotales posteriores
   b. in female nn. labiales posteriors –> innervates the skin in corresponding region

–> the lower part of vagina gets innervation from n. pudendus - deep sensory perineal branches; responsible for temperature and touch sensation

Question 11

Plexus sacralis long branches

Answer 11

• innervate the free lower extremity
• n. cutaneous femoris posterior
• n. ischiadicus

1. n. tibialis (L4-L5, S1-S2)
2. n. peroneus communis (L4-L5, S1-S2)
3. n. ischiadicus (L4-L5, S1-S3)
4. n. cutaneous femoris posterior (S1-S3)

Question 12

n. tibialis

Answer 12

(L4-L5, S1-S2)

• mixed nerve
• along the middle popliteal fossa
• placed superficially and laterally from the blood vessels (a./v. poplitea)
• placed ventrally from arcus tendineus musculi solei
• -> runs together with vasa tibilia posteriora between the superficial and deep flexor muscles
• it turns around the medial malleolus
• -> passes below retinaculum musculorum flexor into the 3rd osteofibrous channel (together with a./v. tibialis posterior)
• divides into 2 terminal branches:

1. n. plantaris medialis
   - runs into sulcus plantaris medialis with vasa plantaria medialia
   - innervates the medial group muscles of the foot (expect m. adductor hallucis) ; m. abductor hallucis, m. flexor hallucis brevis, m. flexor digitorum brevis, mm. lumbricales 1 and 2

• -> the nerve ends with 3 nn. digital plantares communes and 7 nn. digitales plantares proprii
• innervate the skin of the plantar side of the foot and the skin of 1-3 and the medial surface of 4 toe

2. -“- lateralis
   - runs into sulcus plantaris lateralis with vasa plantaria lateralia and divides into:
   - -> ramus superficialis:
   - gives off nn. digitales plantares communes > divide into 3 nn. digitales plantares proprii
   - innervate m. flexor digiti minimi brevis, mm. lumbricales 3-4, the plantar skin of the half 4th and 5th toes.

• -> ramus profundus
• accompanies arcus plantaris profundus
• innervates m. adductor hallucis, m. opponens digiti minimi, m. quadratus plantae, mm. interossi dorsales et plantares
• gives off side branches:

a. n. cutaneous sure medialis
- arise at the upper region of fossa poplitea
- -> passes distally b. 2 heads of m. gastrocnemius
- -> runs together with v. saphena parva beneath fascia cruris
- at the middle of the lower leg it penetrates fascia cruris; joins with n. cutaneous surae lateralis (from n. peroneus communis)
- -> forms n. suralis
* runs downwards and innervates the skin of the dorsal and lateral side of the lower leg
* gives off rr. calcanei laterales to the lateral surface of calcaneus
* the terminal branch n. cutaneous dorsalis lateralis –> innervates the lateral side of the foot and lateral side of the 5th toe

b. rr. articulares
- arise at the level of fossa poplitea
- innervate art. genus
- at the level of the lower third of the lower leg - art. talocruralis

c. rr. musculares
- innervate the superficial and the deep dorsal muscles

d. rr. calcanei mediales
- innervate the medial part of the calcaneus region skin

Question 13

n. peroneus communis

Answer 13

(L4-L5, S1-S2)

• mixed nerve
• passes along the medial edge of m. biceps femoris
• under the skin to thee region of column fibulae
• gives off two side branches before terminal branches:

a. rr. articulares
- innervate art. genus

b. n. cutaneous surae lateralis
- passes along caput laterale m. gastrocnemii below fascia cruris –> penetrates it and gives skin innervation to the lateral side of the lower leg till malleolus lateralis
> joins with n. cutaneous surae medialis and forms n. suralis

• divides into terminal branches

1. n. peroneus superficialis
   - mixed nerve
   - motor fibres
   - rr. musculares innervate only m. peroneus longs/brevis
   - penetrates m. peroneus longus, passes between m, peroneus longus et m. peroneus brevis
   - runs along the lateral surface of m. extensor digitorum longus
   - at the middle of thee lower leg; penetrates fascia cruris
   - -> divides into:
   * n. cutaneous dorsalis medialis
   * n. cutaneous dorsalis intermedius

–> form 7 nn. digitales dorsal that innervate the skin of dorsum pedis expect the space between the 1st and 2nd toe and the lateral side of 5th toe

2. n. peroneus profundus
   - motor nerve, mostly
   - lies proximally from n. peroneus superficialis near caput fibulae
   - -> penetrates m. peroneus longus, m. extensor digitorum longus
   - passes together with vasa tibilia anteriora along the anterior surface of membrana interossea cruris
   - proximal part placed between m. extensor digitorum longus and m. tibialis anterior
   - at the distal part it passes between m. tibialis anterior and m. extensor hallucis longus
   - runs below retinaculum mm. extensorum superius and inferius together with vasa dorsala pedis to the dorsal side of the foot
   - placed below the tendon of m. extensor hallucis brevis

• -> terminal branches nn. digitales dorsales (2)
• reach the 1st interdigital space and innervate the skin
• gives off rr. musculares to the anterior group of the muscle of the lower leg and rr. musculares to the dorsal group of the foot muscles
• -> gives off rr. articulares that innervate the joints of the foot

Question 14

n. ischiadicus

Answer 14

(L4-L5, S1-S3)

• largest nerve in the human body
• direct continuation of the sacral plexus
• comes out from the pelvis through foramen infrapiriforme
• passes down along the dorsal surface of m. obturatorius internus, m. gemellus superior, m, gemellus inferior, m, quadratus femoris
• m. gluteus maximus covers the nerve
• runs between the muscles of the dorsal femoral group and m. adductor magnus
• above fossa popliteal it splits into 2 terminal nerves

1. n. tibialis
2. n. peroneus communis

Gives off side motor branches that supply:

• muscles of the pelvic girdle: m. piriformis, m. obturatorius internus, m. gemellus superior, m, gemellus inferior, and m. quadratus femoris
• muscles of the upper leg: m. biceps femoris, m. semitendinosus, m. semimembranosus, and partly m, adductor magnus

Question 15

n. cutaneous femoris posterior

Answer 15

(S1-S3)

• foramen infrapiriforme
• placed medially from n. ischiadicus
• downwards along the dorsal surface of m. obturatorius internus, gemellus superipor/inferior, m. quadratus femoris
• m. gluteus maximus covers it
• -> near the lower margin gives off:

1. nn. clunium inferiores (2-3) > turn around the edge of m. gluteus maximus, pass upwards and supply the skin at the lower part of regio glutea
2. rr. perianeales turn around tuber ischiadicum
   - supply the skin of perineum
   - make anastomosis with nn. perineales from n. pudendus

• penetrates fascia lata
• supplies the skin at the dorsal side of the thigh till fossa poplitea

Question 16

Lymph vessels

Answer 16

Superficial:

• follow superficial veins
• divided into:
  1. medial LV; v. saphena magna
• begin on dorsal surface of the foot and flow into the superficial inguinal lymph nodes
• nodi lymphoid inguinales superficiales

2. lateral LV; v. saphena parva
   - flow into the deep popliteal lymph nodes (nodi lymphoidei popliteal profundi)
   - pass upwards and medially to the superficial lymph nodes (node lymphoidei inguinales superficiales)

Deep:

• follow deep veins
• flow into the deep popliteal nodes: nodi lymphoidei poplitei profundi
• or deep inguinal lymph nodes: nodi lymphoidei inguinales profundi
• The lymph from free lower extremity flow to the external iliac lymph nodes (nodi lymphoidei iliaci externi)

Question 17

Nodi lymphoidei membri inferioris

Answer 17

Divided into 3 groups:

1. nodi lymphoidei tibiales anteriores et posteriores
   - small and changeable lymph nodes that are placed in the upper part of the lower leg along aa./vv. tibiales anteriores et posteriores
2. nodi lymphoidei poplitei
   - placed in the popliteal fossa and subdivided into 2 groups:

a. superficiales
- arranged below fascia popliteal near proximal v. saphena parva
- collect lymph from thee foot and lateral part of the lower leg

b. profundi
- disposed on the dorsal side of the knee joint along a. poplitea
- collect the lymph from lymph vessels that run in the company of the vasa tibilia anterior et posteriora

–> efferent lymph vessels transmit the lymph to the deep inguinal lymph nodes (nodi lymphoidei inguinales profundi)

3. Nodi lymphoidei inguinales
   - in trigonum femorale
   - the lymph nodes are from 12-20
   - flow into the nodi lymphoidei iliac externii
   - divided into 2:

a. superficiales
- beneath the skin above fascia lata
- collect the lymph from external genitals, from regio ani, from the perineum, from the anterior wall of the abdominal cavity and superficial tissue of the lower extremity

• arranged into 3 groups
• -> 1- superomediales: medially under the lig. inguinale
• -> 2- superolaterales: laterally under the lig. inguinale
• -> 3- inferiores: disposed in a vertical chain along the proximal part of the v. saphena magna
• superficial lymph vessels from the lower extremity fall into them

b. profundi
- below fascia lata in the region of hiatus saphenus

3:
* nodus lymphoideus inguinalis profundus proximalis
* nodus lymphoideus inguinalis profundus intermedius (inconstant)
* nodus lymphoideus inguinalis profundus distalis (inconstant)

• the proximal inguinal lymph node (Rosenmulleri) is usually placed in the region of the femoral canal in anulus femoralis

Question 18

Nodi lymphoidei pelvis viscerales

Answer 18

Nodi lymphoidei paravesicales

• placed around the urinary bladder
• collect lymph from urinary bladder and prostata
• divided into:
  1. nodi lymphoidei prevesicales; disposed between the urinary bladder and symphysis pubica
  2. nodi lymphoidei postvesicales: disposed behind the urinary bladder
  3. nodi lymphoidei vesicales laterales: disposed near the lower part of lig. umbilical mediale

Nodi lymphoidei parauterini

• along lateral part of the uterus
• collect the lymph from cervix uteri

Nodi lymphoidei paravaginales
- placed along the lateral part of the vagina and collect the lymph from it

Nodi lymphoidei pararrectales s. anorectales

• placed laterally from rectum
• collect lymph from rrectum and partly from vagina

Question 19

Nodi lymphoidei pelvis parietales

Answer 19

• placed along the pelvic parietal blood vessels

1. Nodi lymphoidei iliaci communes
2. Nodi lymphoidei iliaci externi
3. Nodi lymphoidei iliaci interni

Question 20

Nodi lymphoidei iliaci communes

Answer 20

• along a./v. iliaca communes
• lymph from the organs and walls of the pelvis, genitals, from the walls of the abdominal cavity and the muscles of the pelvic gridle
• flow into lumbal lymph nodes ; nodi lymphoidei rumbles sinistri/dextri
• divided into:

1. nodi lymphoidei iliaci communes mediales
   - medially from vasa iliaca communia
2. nodi lymphoidei iliaci communes intermedii
   - behind vasa iliaca communia
3. nodi lymphoidei iliaci communes latérales
   - laterally from vasa iliaca communia
4. nodi lymphoidei iliaci communes subaortici
   - downwards bifurcatio aortae in front of L4 vertebrae
5. nodi lymphoidei iliaci communes promontory
   - in front of promontorium

Question 21

Nodi lymphoidei iliaci externi

Answer 21

• around vasa iliaca external
• collect the lymph from the urrinary bladder and vagina and from the inguinal lymph nodes
• effent LV send the lymph to the Nodi lymphoidei iliaci communes

1. Nodi lymphoidei iliaci externi mediales
   - medially from vasa liaca externa
2. Nodi lymphoidei iliaci externi intermedii
   - behind a. iliaca externa between medial and lateral groups of the iliac external lymph nodes
3. Nodi lymphoidei iliaci externi laterales
   - laterally from vasa iliaca externa
4. Nodi lymphoidei iliaci externi interiliaci
   - disposed at the place of division a. iliaca communis to a. iliaca interna et externa
5. Nodi lymphoidei iliaci externi obturratorii
   - disposed near a. obturatoria
6. Nodi lymphoidei lacunaris medialis
   - separate unique lymph node in the region of the lacuna vasorum medially from blood vessels
7. Nodi lymphoidei lacunaris intermedius
   - placed in the middle of lacuna vasorum
8. Nodi lymphoidei lacunaris lateralis
   - placed in lacuna vasorum laterally from blood vessels

Question 22

Nodi lymphoidei iliaci interni

Answer 22

• concentrate around a. iliaca interna
• send the lymph from organs of the lesser pelvis, and its walls and perineum walls to nodi lymphoidei iliaci communes

1. Nodi lymphoidei gluteals superiores
   - around a. glutea superior
   - collect the lymph the walls of the lesser pelvis
2. Nodi lymphoidei gluteals inferiores
   - along a. glutea inferior
   - collect the lymph from prostata and pars prostatic urethrae
3. Nodi lymphoidei sacrales
   - placed in front of sacrum
   - collect the lymph from prostata and cervix uteri

Question 23

skin innervation foot

Answer 23

> n. peroneous superficialis form 7 nn. digitales dorsal that innervate the skin of dorsum pedis expect the space between the 1st and 2nd toe and the lateral side of 5th toe

> the medial surface of the skin of the foot is innervated by n. saphenus

> but the lateral surface of the foot and the 5th toe is innervated by the terminal branch of n. suralis - n.cutaneous dorsalis lateralis.

> The space between 1st and 2nd toe is innervated by n. peroneus profundus

Question 24

A. iliaca communis

Answer 24

Aorta abdominalis terminates at bifurcation aortae L4 and divides into a. iliaca communis dextra et sinistra.

Topographia:
Holotopia
- region umbilicalis

Skeletotopia
- From L4 to art. sacroiliaca dx. et sin

Syntopia

• A. iliaca communis dx. et sin. are only about 5 cm in long arteries
• Run along medial border of m. psoas major

Anteriorly
- ureter
Laterally
- m. psoas major
Posteriorly
- V. iliaca communis

Terminal branches:

• A. iliaca externa et interna
• Gives off rr. ureterici for blood supply to pars distalis ureter

Question 25

A. Iliacae Externa

Answer 25

Topographia: Skeletotopia - From art. sacroiliaca a. iliaca externa descends to linea terminalis along medial border of m. psoas major - Leaves pelvis by continueing to lacuna vasorum - After leaving lacuna vasorum continues as a. femoralis Syntopia - proximally a. iliaca externa is facing v. iliaca externa anteriorly, but distally v. iliaca externa is laterally - Gives off two main side branches: 1. A. epigastrica inferior - ascends obliquely between layers of vagina m. recti abdominis and supplies muscles of the anterior wall of the abdominal cavity - Runs within plica umbilicalis lateralis anastomosis with a. epigastrica superior - Supply anterior wall of mm. abdominalis Gives off side branches: a. r. pubicus - -> Goes along ramus superior ossis pubis - -> Anastomosis (”corona mortis”) with r. pubicus from a. obturatioria b. A. cremasterica (male) --> goes to canalis inguinalis Supplies: * m. cremasterica * coverings of funiculus spermaticus c. A. ligamenti teretis uteri - -> Goes to canalis inguinalis - -> Supplies lig. teres uteri 2. A. circumflexa ilium profunda - passes along lig. inguinale et crista iliaca - communicates with r. iliacus from a. iliolumbalis - Supply mm. abdominalis and mm. cinguli membri inferioris

Question 26

A. Iliacae Interna

Answer 26

Topographia Skeletotopia - From art. sacroiliaca descends down crossing linea terminalis and arriving to pelvis minor. - Runs along paries lateralis pelvis minoris at the level of foramen ischiadicum major where branchers further. - Side branches are divided into visceral (for organs) and parietal (for muscles) branches Visceral branches: 1. A. umbilicalis 2. Aa. vesicalis inferiores - Supply fundus vesica urinaria, prostata (male), anterior wall of vagina (female) 3. A. ductus deferentis / A. uterina 4. A. rectalis media - Supply middle 1/3 of rectum 5. A. pudenda interna Parietal branches: 1. A. iliolumbalis 2. Aa. sacrales laterales 3. A. obturaoria 4. A. glutea superior 5. A. glutea inferior

Question 27

Parietal branches of a. iliaca interna

Answer 27

1. A. iliolumbalis - Ascends and crosses linea terminalis in cavitas pelivis, enterns pelvis major - Supply muscles of the posterior and anterior wall of cavitas abdominalis Gives off: a. R. ilicus - Anastomosis with a. circumflexa ilium profunda (from a. iliaca externa) b. R. lumbalis 2. Aa. sacrales laterales - Descends along facies pelvina ossis sacri - Supply mm. cinguli membri inferioris and the perineum 3. A. obturaoria - Supply medial group of mm. membri inferioris liberi and m. obturatorius externus Gives off: a. r. acetabularis - Runs as lig. capitis femoris inside art. coxae - Supply caput femoris b. r. pubicus 4. A. glutea superior - Leaves cavitas pelvis through foramen ischiadicum majus via foramen suprapiriforme ``` Supply: o M. gluteus minimus o M. gluteus medius o M. tensor fasciae latae o Art. Coxae ``` 5. A. glutea inferior - Emerges through foramen ischiadicum majus via foramen infrapiriforme ``` Supply: o M. gluteus maximus o M. piriformis o M. obturatorius internus o Mm. gemelli (= m. gemellus superior et inferior) o M. quadratus femoris ```

Question 28

A. pudenda interna

Answer 28

- Leaves cavitas pelvis through foramen ischiadicum majus via foramen infrapiriforme - Terminates at organa genitalia externa and supply them o A. dorsalis penis o A. dorsalis clitoridis o A. profunda penis o A. profunda clitoridis o Rr. scrotales posteriors o Rr. labiales posteriors - side branches: 1. A. rectalis inferior: supply lower 1/3 of rectum 2. A. perinealis: supply muscles of the perineum Gives off: x Rr. scrotales posteriores x Rr. labiales posteriores 3. A. urethralis: supply urethra 4. A. bulbi penis / A. bulbi vestibule supply genitalia externa

Question 29

A. ductus deferentis / A. uterina

Answer 29

Male: - Accompanies ductus deferens - Supply ductus deferens, vesiculae seminales and lower 1/3 of ureter Female: - Runs along the lateral wall of cavitas pelvis - turns medially, passes along lig. cardinale uteri s. lig. transversum cervicis to cervix uteri - ascends along lateral side of uterus - Supply uterus Gives off branches: 1. r. tubarius – supply tubae uterinae 2. r. ovaricus – directs to ovarium along lig. latum uteri, anastomoses with a. ovarica 3. r. vaginales – supply vagina

Question 30

A. umbilicalis

Answer 30

- Ascends along the anterior wall of cavitas abdominalis to anulus umbilicalis - A. umbilicalis runs prenatally in plica umbilicalis medialis Side branches: 1. Aa. vesicales superiores 2. Supply apex et corpus vesica urinaria

Question 31

a. femoralis and its superficial branches

Answer 31

- continuation of a. iliaca externa - transverses lacuna vasorum - reaches the anterior surface of the thigh laterally from v. femoralis - runs in the groove - sulcus iliopectineus - further it passes along sulcus femoralis anterior - enters canalis adductorius where it comes out through the lower opening of the channel - hiatus adductorius and reaches fossa poplitea where its name is a. poplitea superficial branch: 1. a. epigastrica superficialis - small subcutaneous artery - crosses anteriorly lig. inguinale - reaches the umbilical region; supplies the superficial structures of the anterior abdominal wall 2. a. circumflexa ilium superficially - passes laterally along the lower edge of lig. inguinale to spina iliaca anterior superior - supplies the skin, subcutaneous and the fascia at that region 3. aa. pudendae externae - pass medially to regio pubica and supply external genitals - -> terminate as rr. scrotales/labiales anteriores 4. rr. inguinalis - supply lymph nodes in the inguinal region

Question 32

a. femoralis deep branches

Answer 32

1. A. profunda femoris - largest branch (it is almost as large as a. femoralis) - arises 4-6cm below lig. inguinale - passes downwards and dorsally - penetrates m. adductor magnus - goes on the posterior side of the thigh as a. perforans tertia - gives off: * * a. circumflexa femoris lateralis - supplies the anterior muscle group of the thigh, hip joint, kneee joint - arises from a. profunda femoris at trigonum femorale - passes behind m. rectus femoris till trochanter major - -> divides into 3 branches: > r. ascendens: passes below m. tensor fasciae latae and m. gluteus medius >>> forms anastomosis with a. glutea superior > r. descendens: passes below m. rectus femoris till the knee joint and forms anastomisis with knee joint arteries > r. transverses: forms anastomisis with r. transversus from a. circumflexa femoris medialis * * a. circumflexa femoris medialis - supplies the medial group of the thigh and hip joint - arises at trigonum femorale - passes between m. iliopsoas and m. pectineus to trochanter minus - -> divides into > r. transversus: supplies the medial muscle group go thee thigh and forms anastomosis with the branch from a. circumflexa femoris lateralis > r. ascendes: supplies art. coxae and forms anastomosis with a. glutea inferior 2. Aa. perforantes - a. perforans prima: b. m. jectineus and upper margin of m. adductor magnus - a. perforans secunda: along the upper margin of m. adductor brevis - a. perforans tertia: above or below the attachment of m.adductor longus 3. A. descendens genus - arises from a. femoralis at distal third of canalis adductorius - comes out through the anterior opening of the channel together with n. saphenous - supplies the knee joint - takes part in formation of rete articulare genus

Question 33

a. poplitea

Answer 33

- continuation of a. femoralis below hiatus adductors - passes in fossa poplitea - placed medially and deeply from the vein (NEVA; nervus tibialis) - terminal branches a. tibialis anterior/posterior gives off small side branches that form anastomosis and make rete articulate genus 1. a. superior lateralis et medialis genus - at the upper level of the knee joint articular capsule 2. a. inferior lateralis et medialis genus - at lower level of the knee joint articular capsule where a. poplitea passes along the dorsal surface of m. popliteus 3. a. media genus - arise at the level of knee joint and supplies ligg. cruciata genus, the menisci and synovial folds 4. aa. surales - usually 2 - arise from the distal part of a. poplitea - -> pass down ventrally from arcus tendinous muscle solei - supply m. triceps surae and m. popliteus

Question 34

a. tibialis anterior

Answer 34

- arises from a. poplitea at the level of upper opening of canalis cruropopliteus --> passes into it - penetrates membrana interossea cruris in its upper part - arrives at the anterior side of the lower leg - it is accompanied by vv. tibiales anteriores and n. peroneus profundus - all structures pass along the anterior surface of the membrana interossea cruris behind the muscles of the lower leg - beneath retinaculum musculorum inferius continues as a. dorsalis pedis on the dorsalis side of the foot - gives off five branches: 1. a. recurrens tibialis posterior - arises from a. tibialis anterior before it penetrates the interosseus membrane of the lower leg - returns back to fossa poplitea along canalis cruropopliteus - terminates in rete articulare genus 2. a. recurrens tibialis anterior - arises from a. tibialis anterior - passes upwards to popliteal fossa - terminates in rete articulare genus 3. rr. musculares - supply thee muscles of the anterior group of the lower leg 4. a. malleolaris anterior medialis - arises at the level of the malleolus - turns round the medial malleolus - forms rete malleolare mediale - supplies the region of medial malleolus, art. talocruralis, ossa tarsalia 5. a. malleolaris anterior lateralis - arises at the level of the malleolus - turns round the lateral malleolus - forms rete malleolare laterale - supplies the region of lateral malleolus, art. talocruralis, and ossa tarsi

Question 35

a. dorsalis pedis

Answer 35

- terminal branch of a. tibialis anterior - begins midway between malleolus medialis et lateralis - deep to retinaculum musculorum extensorum inferius - on lateral dorsal side from the tendon of m. extensor hallucis longus the pulse may be palpated - gives off a. tarsalis lateralis and then passes distally to the 1st interosseous space > divides into 1. a. plantaris profunda - gives rise to the 1st dorsal metatarsal artery (a. metatarsalis dorsalis) - divides into 3 aa. digitales dorsales and then joins arcus plantaris profundus 2. and a. arcuata - runs laterally from the 1st interosseus space across the basis of four lateral metatarsals, deep to the tendons of m. extensor digitorum longus and gives off 2,3, and 4 aa. metatarsales dorsales which run to the clefts of the toes - -> each of them divides into 2 aa. digitales dorsales Side branches: 1. a. tarsalis lateralis - arises at the level of caput tali - runs arched course laterally beneath m. extensor digitorum brevis - crosses to anastomose with a. arcuata at the level of base of the 5th metatarsal bone 2. aa. tarsales mediales - small arteries that supply the medial side of the foot and partly the muscles of the toe

Question 36

a. tibialis posterior and its side branches

Answer 36

- larger than anterior - direct continuation of a. poplitea - passes in canalis cruropopliteus together with two vv. tibiales posteriores and n. tibialis - after the canalis it lodges behind malleolus medialis - -> then beneath retinaculum musculorum flexorum - on the plantar surface gives 2 terminal branches (a. plantaris lateralis and medialis) - side branches: 1. r. circumflexus fibulae - passes upwards to the popliteal fossa - turns around caput fibulae - forms rete articulate genus 2. rr. musculares - supply the posterior muscles of the lower leg 3. rr. malleolares mediales - turn around the medial malleolus and forms rete malleolare mediale 4. a. nutritia tibiae - supplies tibia 5. rr. calcanei - together with rr. calcanei from a. peronea form rete calcaneum 6. a. peronea - arises at the upper part of canalis cruropopliteus - passes laterally and downwards through canalis musculoperoneus inferior - gives off terminal branches: * * rr. calcanei to rete calcaneum * *rr. musculares to lateral group of the lower leg * * a. nutritia fibulae that supplies fibula * * r. perforans penetrates membrana interossea cruris and forms rete malleolare laterale * * r. communicans which joins a. peronea with tibialis posterior * * rr. malleolares laterales to form rete malleolare laterale

Question 37

a. tibialis posterior terminal branches

Answer 37

1. a. plantaris lateralis - passes in sulcus plantaris lateralis with 2 vv. plantares laterales and n. plantaris lateralis - turn medially opposite the base of the 5th metatarsal - joins a. palmaris profunda from a. dorsalis pedis --> forms arcus plantaris profundus > gives off 4 aa. metatarsals plantares and 3 rr. perforantes > pass to the dorsum of the foot, and give many branches to the skin, fascia, and muscles in the sole of the foot (arising from the arcus) --> give off aa. digitales plantares communes > divide into aa. digitales propriae - the 1st a. metatarsals plantaris divides into 3 aa. digitales plantares - small artery arises straight from the arcus - a. plantaris digiti minimi - supplies 5th toe lateral part 2. a. plantaris medialis - smaller, sometimes may be absent - passes in sulcus plantaris medialis with vv. plantares mediales and n.plantaris medialis from n. tibialis - supplies mainly the muscles of the great toe and helps supply the skin on the medial side of the sole

Question 38

Rete articulare genus

Answer 38

- arterial network that embraces knee joint - supplies knee joint and muscles around it - formed by 1. a. descendent genus from a. femoralis 2. a. superior medialis genus from a. poplitea 3. a. superior lateralis genus from a. poplitea 4. a. media genus from a. poplitea 5. a. inferior medialis genus from a. poplitea 6. a. inferior lateerealis genus from a. poplitea 7. a. recurrens tibialis anterior from a. tibialis anterior 8. a. recurrens tibialis posterior from a. tibialis anterior 9. r. circumflexus fibularis from a. tibialis posterior 10. R. Descendes a. Circumflexa femoris lateralis

Question 39

Rete malleolare mediale

Answer 39

- arterial network suppling medial malleolus, art, talocruralis and ossa tarsalia - formed by: 1. a. malleolaris anterior medialis from a. tibialis anterior 2. rr. malleolares mediales from a. tibiales posterior 3. aa. tarsales medals from a. dorsalis pedis

Question 40

Rete malleolare laterale

Answer 40

- arterial network that embraces the lateral malleolus - supplies lateral malleolus, art. talocruralis and ossa tarsalia - formed by: 1. a. malleolaris anterior lateralis from a. tibialis anterior 2. rr. malleolares laterales from a. peronea /fibularis 3. r. perforans from a. peronea/fibularis 4. a. tarsalis lateralis from a. dorsalis pedis

Question 41

Rete calcaneum

Answer 41

Network by 2 arteries that supplies the calcanei region: 1. rr. calcanei from a. tibialis posterior 2. rr. calcanei from a. peronea/fibularis

Question 42

Venae membri inferioris

Answer 42

- internal and external iliac veins run on both sides of the pelvis and collect venous blood from the walls and organs of the pelvis, regio glutea, and perineum - -> they have visceral and parietal tributaries - parietal have same flow and number as arteries (sometimes may be doubled) - visceral veins start from venous networks in the inner organs and around them - the internal and external iliac veins form v. iliaca communis at art. sacroiliaca level - -> merge at the level of discus intervertebral is 4 and 5 and form inferior vena cava

Question 43

V. iliaca externa

Answer 43

- starts at lacuna vasorum as continuation of v. femoralis and drains the lower limb - ascends along linea terminalis and has tributaries: o V. epigastrica inferior starts at the region of the umbilicus and accompanies the corresponding artery - anastomoses with v. epigastrica superior (v. thoracica interna) and vv. paraumbilicales (v. portae) o V. circumflexa ilium profunda runs along crista iliaca, drains the abdominal and pelvic muscles in the region of crista iliaca

Question 44

V. iliaca interna

Answer 44

- drains the walls and organs of the pelvic cavity - formed by fusion of visceral and parietal tributaries Visceral tributaries of v. iliaca interna: 1. V. rectalis media 2. Vv. Vesicales 3. Vv. uterinae (for females) 4. V. pudenda interna There are group of veins, which originate from the different venous plexus of the pelvic cavity and drain the corresponding organs. Venous plexus of the pelvic cavity for male: o plexus venosus rectalis o plexus venosus vesicalis o plexus venosus prostaticus ``` Venous plexus of the pelvic cavity for female: o plexus venosus rectalis o plexus venosus vesicalis o plexus venosus uterinus o plexus venosus vaginalis ``` - -> Plexus venosus rectalis lies in posterior and lateral walls of the rectum and it is drained into three directions: 1. v. rectalis superior – drains the upper part of the plexus to v. mesenterica inferior' 2. v. rectalis media dx. et sin. – drain the middle part of the plexus to v. iliaca interna 3. v. rectalis inferior dx. et sin. – drain the lower part of the plexus via v. pudenda interna to v. iliaca interna --> Plexus venosus vesicalis (male) is fused with plexus venosus prostaticus o both together from the largest venous plexus in the pelvic cavity o Plexus venosus vesicalis is at basis vesicae urinariae o plexus venosus prostaticus is at the lateral and posterior parts of the prostata o Plexus venosus prostaticus receives tributary – v. dorsalis profunda penis - the biggest vein of the penis, lies between aa. dorsales penis x drains glans penis et corpora cavernosa penis o Plexus venosus prostaticus is drained to plexus venosus vesicalis via vv. vesicales to v. iliaca interna --> Plexus venosus vesicalis (female) surrounds fundus vesicae and urethra feminina upper part - it drains the urethra and the upper part of the vagina o receives tributary – v. dorsalis clitoridis, which drains the clitor o drained by vv. vesicales to v. iliaca interna - -> Plexus venosus uterinus et plexus venosus vaginalis are developed in the lateral and posterior parts of the uterus and vagina - drain also tuba uterina et lig. latum uteri - drained by vv. uterinae to v. iliaca interna - V. pudenda interna starts as v. profunda penis (male) or v. profunda clitoridis (female) o receives following tributaries, which drain the corresponding organs: v. bulbi penis (male) v. bulbi vestibuli (female) v. urethralis v. perinealis v. rectalis inferior Parietal tributaries of v. iliaca interna: 1. V. iliolumbalis o drains posterior wall of the abdominal cavity, the abdominal and pelvic muscles 2. Vv. sacrales laterales ascends along facies pelvica ossis sacri o together with v. sacralis mediana forms plexus venosus sacralis o drain abdominal muscles and pelvic lymphatic nodes 3. V. obturatoria drains the medial compartment of the muscles of the thigh 4. V. glutea superior drains m. gluteus medius et minimus, m. tensor fasciae latae 5. V. glutea inferior drains m. gluteus maximus

Question 45

V. iliaca communis

Answer 45

- runs together with corresponding artery | - begins at the level of art. sacroiliaca by junction of v. iliaca externa and v. iliaca interna

Question 46

vv. profundae s. vv. comitantes

Answer 46

- collect the venous blood from the bones, joints, muscles, fascia !! accompany the analogous arteries and their branches from periphery to the center!!! - begin from arcus venosus dorsalis et plantaris pedis - from the toes of the foot to fossa poplitea each artery is accompanied by two deep veins 2 vv. tibiales anteriores and 2 vv. tibiales posteriores = 1 v. poplitea in the lower corner of fossa poplitea --> continues as v. femoralis that passes through lacuna vasorum and continues further to the pelvis as v. iliaca externa

Question 47

vv. superficiales s. vv. subcutaneae

Answer 47

- collect venous blood from the skin and subcutaneous tissue - 2 major: the great and small saphenous vein (magna/parva) - form in the subcutaneous tissue by the union of the * * dorsal vein of the great toe * * and rete venosum dorsale pedis --> forms arcus venosus dorsalis pedis - the veins from skin and subcutaneous tissue of the dorsal foot flow into arcus venosus dorsalis pedis and rete venosum dorsale pedis from arcus venosus dorsalis pedis 1. V. marginalis medialis begins on its medial side --> v. saphena magna 2. V. marginalis lateralis begins on its lateral side - -> continues as v. saphena parva - plantar side form rete venosum plantare pedis - -> some of the veins turn around the medial and lateral edge of the foot and flow into the rete - BUT most of them flows into the deep veins of the plantar side of the foot

Question 48

v. saphena magna

Answer 48

- passes upwards along the medial side of the lower leg together with n. saphenus - at popliteal region placed medially - passes to the medial side of the anterior region of the thigh - -> hiatus saphenous and penetrates covering fascia cribrosa - collects blood from > the medial side of the foot > medial-anterior side of the lower leg (the superficial tissue) - tributaries: a. v. epigastrica superficialis - collects the venous blood from the superficial tissue of the anterior wall of the abdomen b. v. circumflexa ilium superficialis - collects the venous blood from the region at spina iliaca anterior superior c. vv. pudendae externae - they collect the venous blood from the external genitals d. v. saphena accessoria - in the region of the thigh and collects the venous blood from the superficial tissue of its anterior part - varices cruris of it are observed in clinics - vv. perforates play a great role in its pathogenesis --> they join to deep veins, allowing blood flow only to them --> divided into > Cockett veins: region of ankles > Boyd veins: distally from the knee joint > Dodd veins: proximally from the knee joint --> collects venous blood from the superficial tissue which are > on the dorsal side of the foot, > on the medial side of the lower leg, > and the medial and anterior region of the thigh --> anastomoses with v. saphena parva

Question 49

v. saphena parva

Answer 49

- begins from rete venosum dorsale pedis - passes along the posterior side go the lower leg together with n. suralis - penetrates fascia poplitea at fossa poplitea - collects blood from 1. the lateral side of the foot 2. lateral and posterior part of superficial tissues of the lower leg - -> flow into v. poplitea