1: Anatomy - Pelvic side wall Flashcards
What is the relationship between the ureters and the uterine arteries?
WATER UNDER THE BRIDGE
Ureters run deep to the uterine arteries (in women)
Which vasculature is closely associated with the ureters?
Uterine arteries
Which structures are the uterine arteries closely associated with?
Ureters
During surgery, how would you be able to differentiate the ureters from the uterine arteries?
Ureters are deep to the uterine arteries
And the ureter vermiates when you touch it
Which bony features are also known as the sit bones?
Ischial tuberosities
Not the spines
Which bony feature is the distal attachment for coccygeus, a landmark on vaginal examination and can also be identified on pelvic X-rays?
Ischial spines
Which two pelvic ligaments must you remember?
What are their proximal and distal attacments?
Sacrospinous ligament - closely related to pudendal nerve; sacrum to ischial spine
Sacrotuberous ligament - sacrum to ischial tuberosity
Which three holes on each side of the pelvis must you remember?
Greater sciatic foramen
Lesser sciatic foramen
Obturator foramen
What is the covering of the obturator foramen?
Obturator membrane
:)
What structures run through the obturator foramen?
Obturator artery, vein and nerve
Which muscle is found superficial to the obturator membrane?
What is its function?
Obturator internus
LATERAL ROTATION of hip
Obturator ___ is a lateral rotator of the hip joint.
Obturator internus
The tendinous arch of which muscle runs from the pubic bone to the ischial spine?
Levator ani
The ___ ___ of levator ani runs from the pubic bone to the ischial spine.
tendinous arch of levator ani
Which fat-filled space contains the pudendal canal and is found deep to the tendinous arch of levator ani?
Ischioanal fossa
What is the clinical relevance of the ischioanal fossa?
Site of development of perineal abscesses and fistulae
Apart from obturator internus, which other lower limb muscle is found in the pelvis?
Piriformis
Which blood vessels are closely related to piriformis?
Superior and inferior gluteal arteries
Branches of the posterior division of internal iliac
At which vertebral level does the common iliac artery bifurcate?
L4
From which artery do all pelvic and perineal arteries arise?
Internal iliac artery
Which areas of the body are supplied by the
a) internal iliac artery
b) external iliac artery?
a) Pelvis and perineum
b) Lower limb
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?
Gonadal artery @ L2 (think about developmental origin of the gonads)
Superior rectal artery from IMA @ L3
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) L4
b) L2
c) L3
In the pelvis, the internal iliac artery splits into two ___.
two divisions
What are the two divisions of the internal iliac artery?
Anterior division
Posterior division
The posterior division of the internal iliac artery is (the same / different) in males and females.
the same
The anterior division of the internal iliac artery is (the same / different) in males and females.
different
What are the branches of the anterior division in men?
Inferior gluteal artery
Internal pudendal artery
Inferior vesical artery
Middle rectal artery
Obturator artery
In men, what does the inferior vesical artery supply?
Prostate gland
Seminal vesicles
What are the branches of the anterior division in females?
Inferior gluteal artery
Internal pudendal artery
Vaginal artery
Middle rectal artery
Obturatory artery
Uterine artery
Do women have an inferior vesical artery?
No
Instead they have a uterine artery which gives off the vaginal artery
Where is the inguinal triangle?
Between ASIS and pubic symphysis
What are the borders of the inguinal triangle?
Rectus abdominis medially
Inferior epigastric artery superiorly
Inguinal ligament inferiorly
Which remnants of the foetal umbilical arteries are found paired on the posterior abdominal wall?
Medial umbilical folds
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?
MediaN umbilical fold or Urachus
Remnant of the allantois
Which paired umbilical folds are actually functional?
Lateral umbilical folds
Contain the inferior epigastric artery and vein
Name the folds of the posterior abdominal wall and the structures they are formed from.
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
What is the median umbilical fold also known as?
Urachus
Which artery supplies most of the perineum in males?
Internal pudendal artery
Which artery, supplying part of the male perineum, does not derive from the internal pudendal artery?
Anterior scrotal artery
Derived from external pudendal artery
The perineum is supplied by the internal pudendal artery, which is a branch of what?
Posterior division of the internal iliac artery
The male perineum is supplied by the internal pudendal artery.
What is the one exception?
External pudendal artery gives off the Anterior scrotal artery only
Which part of the male perineum is supplied by the external pudendal artery?
Anterior scrotum
via anterior scrotal artery
the rest is internal pudendal artery
From which vertebral levels are the testicular and ovarian arteries derived?
L2
They’re both gonadal arteries
In females, which three arteries anastomose to supply the ovaries, uterus and vagina?
Ovarian artery (L2)
Uterine artery
Vaginal artery (both derived from posterior division of internal iliac artery)
Which ligament does the ovary hang off?
Suspensory ligament
Which vein is mostly responsible for draining the pelvis?
Internal iliac vein
Which veins are responsible for draining the pelvis apart from the internal iliac vein?
What is the clinical significance of this?
Internal vertebral plexus
Infection / cancer can track up the valveless veins, through the spinal cord to the brain
What is the main venous drainage of the pelvis?
Internal iliac veins
Which artery is usually found superior to the S1 ramus of the lumbosacral plexus?
Superior gluteal artery
What is the lymphatic drainage of the superior pelvic viscera?
External iliac nodes
What is the lymphatic drainage of the inferior pelvic viscera?
Internal iliac nodes
What is the lymphatic drainage of the superficial perineum?
Superficial inguinal nodes
What is the lymphatic drainage of the
a) superior pelvic viscera
b) inferior pelvic viscera?
a) External iliac nodes
b) Internal iliac nodes
What is the lymphatic drainage of the
a) perineum
b) superior pelvic viscera
c) inferior pelvic viscera?
a) Superficial inguinal nodes
b) External iliac nodes
c) Internal iliac nodes
Which nerves (and roots) supply the
a) inferior aspect
b) superior aspect
of levator ani?
a) Pudendal nerve (S2,3,4)
b) Nerve to levator ani (S3,4,5)
From the external iliac nodes, describe the lymphatic drainage of the superior pelvic viscera.
External iliac nodes
Common iliac ““
Para-aortic ““
Thoracic duct
=> Left venous angle
From the internal iliac nodes, describe the lymphatic drainage of the inferior pelvic viscera.
Internal iliac
Common iliac
Para-aortic
Thoracic duct
Right venous angle
Which muscle are the gluteal arteries closely related to?
Piriformis
Which blood vessels are closely related to piriformis?
Superior and inferior gluteal arteries
