1: Anatomy - Pelvic side wall Flashcards

1
Q

What is the relationship between the ureters and the uterine arteries?

A

WATER UNDER THE BRIDGE

Ureters run deep to the uterine arteries (in women)

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2
Q

Which vasculature is closely associated with the ureters?

A

Uterine arteries

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3
Q

Which structures are the uterine arteries closely associated with?

A

Ureters

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4
Q

During surgery, how would you be able to differentiate the ureters from the uterine arteries?

A

Ureters are deep to the uterine arteries

And the ureter vermiates when you touch it

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5
Q

Which bony features are also known as the sit bones?

A

Ischial tuberosities

Not the spines

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6
Q

Which bony feature is the distal attachment for coccygeus, a landmark on vaginal examination and can also be identified on pelvic X-rays?

A

Ischial spines

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7
Q

Which two pelvic ligaments must you remember?

What are their proximal and distal attacments?

A

Sacrospinous ligament - closely related to pudendal nerve; sacrum to ischial spine

Sacrotuberous ligament - sacrum to ischial tuberosity

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8
Q

Which three holes on each side of the pelvis must you remember?

A

Greater sciatic foramen

Lesser sciatic foramen

Obturator foramen

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9
Q

What is the covering of the obturator foramen?

A

Obturator membrane

:)

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10
Q

What structures run through the obturator foramen?

A

Obturator artery, vein and nerve

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11
Q

Which muscle is found superficial to the obturator membrane?

What is its function?

A

Obturator internus

LATERAL ROTATION of hip

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12
Q

Obturator ___ is a lateral rotator of the hip joint.

A

Obturator internus

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13
Q

The tendinous arch of which muscle runs from the pubic bone to the ischial spine?

A

Levator ani

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14
Q

The ___ ___ of levator ani runs from the pubic bone to the ischial spine.

A

tendinous arch of levator ani

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15
Q

Which fat-filled space contains the pudendal canal and is found deep to the tendinous arch of levator ani?

A

Ischioanal fossa

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16
Q

What is the clinical relevance of the ischioanal fossa?

A

Site of development of perineal abscesses and fistulae

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17
Q

Apart from obturator internus, which other lower limb muscle is found in the pelvis?

A

Piriformis

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18
Q

Which blood vessels are closely related to piriformis?

A

Superior and inferior gluteal arteries

Branches of the posterior division of internal iliac

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19
Q

At which vertebral level does the common iliac artery bifurcate?

A

L4

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20
Q

From which artery do all pelvic and perineal arteries arise?

A

Internal iliac artery

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21
Q

Which areas of the body are supplied by the

a) internal iliac artery
b) external iliac artery?

A

a) Pelvis and perineum
b) Lower limb

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22
Q

All pelvic and perineal arteries are supplied by the internal iliac artery.

What are the two exceptions, and from which vertebral levels do these arteries arise?

A

Gonadal artery @ L2 (think about developmental origin of the gonads)

Superior rectal artery from IMA @ L3

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23
Q

Name the vertebral levels at which

a) the common iliac artery bifurcates

b) the gonadal arteries come off the abdominal aorta

c) the IMA comes off the abdominal aorta.

A

a) L4

b) L2

c) L3

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24
Q

In the pelvis, the internal iliac artery splits into two ___.

A

two divisions

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25
Q

What are the two divisions of the internal iliac artery?

A

Anterior division

Posterior division

26
Q

The posterior division of the internal iliac artery is (the same / different) in males and females.

A

the same

27
Q

The anterior division of the internal iliac artery is (the same / different) in males and females.

A

different

28
Q

What are the branches of the anterior division in men?

A

Inferior gluteal artery

Internal pudendal artery

Inferior vesical artery

Middle rectal artery

Obturator artery

29
Q

In men, what does the inferior vesical artery supply?

A

Prostate gland

Seminal vesicles

30
Q

What are the branches of the anterior division in females?

A

Inferior gluteal artery

Internal pudendal artery

Vaginal artery

Middle rectal artery

Obturatory artery

Uterine artery

31
Q

Do women have an inferior vesical artery?

A

No

Instead they have a uterine artery which gives off the vaginal artery

32
Q

Where is the inguinal triangle?

A

Between ASIS and pubic symphysis

33
Q

What are the borders of the inguinal triangle?

A

Rectus abdominis medially

Inferior epigastric artery superiorly

Inguinal ligament inferiorly

34
Q

Which remnants of the foetal umbilical arteries are found paired on the posterior abdominal wall?

A

Medial umbilical folds

35
Q

Which structure is found in the posterior midline of the abdominal wall and is a remnant of the tube draining urine from the foetal bladder?

A

MediaN umbilical fold or Urachus

Remnant of the allantois

36
Q

Which paired umbilical folds are actually functional?

A

Lateral umbilical folds

Contain the inferior epigastric artery and vein

37
Q

Name the folds of the posterior abdominal wall and the structures they are formed from.

A

Median umbilical fold or Urachus - remnant of the allantois

Medial umbilical folds - remnants of the umbilical arteries

Lateral umbilical folds - functioning inferior epigastric artery and vein

38
Q

What is the median umbilical fold also known as?

A

Urachus

39
Q

Which artery supplies most of the perineum in males?

A

Internal pudendal artery

40
Q

Which artery, supplying part of the male perineum, does not derive from the internal pudendal artery?

A

Anterior scrotal artery

Derived from external pudendal artery

41
Q

The perineum is supplied by the internal pudendal artery, which is a branch of what?

A

Posterior division of the internal iliac artery

42
Q

The male perineum is supplied by the internal pudendal artery.

What is the one exception?

A

External pudendal artery gives off the Anterior scrotal artery only

43
Q

Which part of the male perineum is supplied by the external pudendal artery?

A

Anterior scrotum

via anterior scrotal artery

the rest is internal pudendal artery

44
Q

From which vertebral levels are the testicular and ovarian arteries derived?

A

L2

They’re both gonadal arteries

45
Q

In females, which three arteries anastomose to supply the ovaries, uterus and vagina?

A

Ovarian artery (L2)

Uterine artery

Vaginal artery (both derived from posterior division of internal iliac artery)

46
Q

Which ligament does the ovary hang off?

A

Suspensory ligament

47
Q

Which vein is mostly responsible for draining the pelvis?

A

Internal iliac vein

48
Q

Which veins are responsible for draining the pelvis apart from the internal iliac vein?

What is the clinical significance of this?

A

Internal vertebral plexus

Infection / cancer can track up the valveless veins, through the spinal cord to the brain

49
Q

What is the main venous drainage of the pelvis?

A

Internal iliac veins

50
Q

Which artery is usually found superior to the S1 ramus of the lumbosacral plexus?

A

Superior gluteal artery

51
Q

What is the lymphatic drainage of the superior pelvic viscera?

A

External iliac nodes

52
Q

What is the lymphatic drainage of the inferior pelvic viscera?

A

Internal iliac nodes

53
Q

What is the lymphatic drainage of the superficial perineum?

A

Superficial inguinal nodes

54
Q

What is the lymphatic drainage of the

a) superior pelvic viscera
b) inferior pelvic viscera?

A

a) External iliac nodes

b) Internal iliac nodes

55
Q

What is the lymphatic drainage of the

a) perineum
b) superior pelvic viscera
c) inferior pelvic viscera?

A

a) Superficial inguinal nodes

b) External iliac nodes

c) Internal iliac nodes

56
Q

Which nerves (and roots) supply the

a) inferior aspect
b) superior aspect

of levator ani?

A

a) Pudendal nerve (S2,3,4)

b) Nerve to levator ani (S3,4,5)

57
Q

From the external iliac nodes, describe the lymphatic drainage of the superior pelvic viscera.

A

External iliac nodes

Common iliac ““

Para-aortic ““

Thoracic duct

=> Left venous angle

58
Q

From the internal iliac nodes, describe the lymphatic drainage of the inferior pelvic viscera​.

A

Internal iliac

Common iliac

Para-aortic

Thoracic duct

Right venous angle

59
Q

Which muscle are the gluteal arteries closely related to?

A

Piriformis

60
Q

Which blood vessels are closely related to piriformis?

A

Superior and inferior gluteal arteries