Anatomy of Lateral Pelvic Wall and Pelvic Mass

Question 1

what runs through the obturator canal and where is it

Answer 1

obturator nerve

canal is located just above the obturator membrane

Question 2

what ligaments are on the lateral pelvic wall

Answer 2

sacrospinous
sacrotuberous
obturator membrane

Question 3

what is the tendinous arch of the elevator ani

Answer 3

which fascia lying over obturator interns which the elevator ani attaches to

Question 4

where does the sacral plexus sit

Answer 4

on the inside of the piriformis

Question 5

where do most arteries in the pelvis arise from

Answer 5

internal iliac artery

Question 6

what arteries in the pelvis do not come off the internal iliac

Answer 6

gonadal artery - from abdominal aorta

superior rectal artery - comes from inferior mesenteric

Question 7

what is the first split that the internal iliac artery makes

Answer 7

into posterior (parietal) and anterior (visceral) division

Question 8

what comes from the posterior division of the internal iliac

Answer 8

gluteal arteries

Question 9

what comes from the anterior division of the internal iliac (males)

Answer 9

obturator artery (goes through obturator canal)

superior and inferior vesical arteries

internal pudendal artery

prostatic branch of inferior vesicle artery

Question 10

what is the medial umbilical ligament

Answer 10

remnant of the umbilical artery in the fetus which connects the placenta to the internal iliac artery

Question 11

which pelvic artery do males have that females done have

Answer 11

inferior vesicel artery (although some females can have them)

Question 12

what is the blood supply to the male perineum

Answer 12

internal pudenal artery

gives off the:

• perineal artery
• posterior scortal artery
• deep artery of the penis
• dorsal artery of the penis

the anterior scrotal artery comes off the external iliac

Question 13

what is the blood supply to the female pelvis coming from the anterior division of the internal iliac

Answer 13

uterine artery (vas deferens artery in male)

vaginal artery (comes down off the uterine artery but can vary, same as inferior vesicle artery, gives branches to the bladder)

superior vesicle arteries

obturator artery

middle rectal artery

internal pudenal artery

Question 14

where do anastomoses occur in the female reproductive system

Answer 14

the uterine artery and ovarian arteries (the ureter travels under the uterine artery)

the uterine and the vaginal artery anastomose around the superior aspect of the vagina

Question 15

what are the arteries to the female perineum

Answer 15

internal pudendal artery gives off the inferior rectal, perineal artery and dorsal artery of clitoris

labial arteries come off the perineal artery

Question 16

where to venous plexuses in the pelvis drain to

Answer 16

mainly to internal iliac vein

some drain via superior rectal into hepatic portal system

some drain via lateral sacral veins into internal vertebral venous plexus

Question 17

what the clinically important issue about drainage of pelvic plexuses into the lateral sacral veins into the internal vertebral venous plexus

Answer 17

any infection/cancer can spread around the whole body via the vertebral canal

likely to haemorrhage badly if rectal surgery?

Question 18

where does the obturator nerve come from

Answer 18

lumbar plexus

Question 19

what nerves are on the lateral wall of the pelvis

Answer 19

sacral plexus

pelvic splanchnic nerves 
pudendal nerve 
sciatic nerve 
nerve to levator ani 
obturator nerve

Question 20

what lymphatics lie either side of the rectum

Answer 20

pararectal

Question 21

what lymphatics lie above the rectum by the sacrum

Answer 21

sacral

Question 22

what lymphatics lie on the common iliac

Answer 22

common iliac

Question 23

what lymphatics lie on the external iliac and internal iliac

Answer 23

external and internal iliac nodes

Question 24

what lymphatics lie on the inguinal artery

Answer 24

superficial and deep inguinal

Question 25

where does superior pelvic viscera drain to

Answer 25

external iliac nodes - then to

common iliac, aortic, thoracic duct, venous system

Question 26

where does the inferior pelvic viscera drain to

Answer 26

deep perineum

then internal iliac nodes, common iliac, aortic, thoracic duct, venous system

Question 27

where does the superficial perineum drain to

Answer 27

superficial inguinal nodes

Question 28

where do ovaries and testes drain into (lymph)

Answer 28

lumbar nodes

because they originated from the abdominal wall

Question 29

where do cliterus and glans of penis drain

Answer 29

inguinal nodes

Question 30

what is trans-peritoneal spread

Answer 30

when infection/cancer etc manages to penetrate the peritoneum and the peritoneum then helps spread the cancer eg. along to other organs it touches

or can get inside the peritoneum and spread to abdominal viscera eg. underside of the liver mets from uterine cancer