Anatomy of Pelvic Lateral Wall and Pelvic Mass Flashcards
What are the ligaments of the lateral pelvic wall?
Sacrospinous ligament
Sacrotuberous ligament
What are the muscles of the lateral pelvic wall?
Obturator internus
Coccygeus
Piriformis
Levator ani
What is the name of the canal which passes through the obturator internus?
Obturator canal (for the obturator nerve)
Where do the majority of arteries of pelvis and perineum arise from?
Abdominal aorta –> Common iliac artery –> Internal iliac artery
Which lateral pelvic wall arteries do not arise from the lateral pelvic wall?
Gonadal/ovarian artery- from L2 abdominal aorta
Superior rectal artery- continuation of inferior mesenteric
Approximately where does the common iliac artery bifurcate?
L5/S1
Where does the internal iliac artery divide into the anterior and posterior trunks?
At the superior border of the greater sciatic foramen
What are some of the anterior trunk branches from the internal Iliac artery in males?
Obturator artery Inferior vesical artery Middle rectal artery Internal pudendal artery Inferior gluteal artery
What are some of the anterior trunk branches from the internal Iliac artery in females?
Obturator artery Umbilical artery Vaginal artery Uterine artery Middle rectal artery Internal pudendal artery Inferior gluteal artery
What are some of the posterior trunk branches from the internal Iliac artery?
PILS Posterior Iliolumbar Lateral sacral arteries Superior gluteal artery
Which artery is found exclusively in males, and replaced in females by the vaginal artery?
Inferior vesical artery
Describe the blood supply to the male perineum
Most from the internal pudendal –> terminates as deep and dorsal arteries of penis
Internal pudenal –> perineal –> posterior scrotal artery
External iliac –> anterior scrotal artery
What are the 3 folds in the internal aspect of the abdominal wall?
Lateral umbilical fold (inferior umbilical fold)
Medial umbilical fold (remnant of umbilical artery)
Median umbilical fold (Urachus)
Which artery in females is homolog of artery to vas deferens?
Uterine artery
Where are there anastomoses in the female gonadal arteries?
Uterine -> ovarian artery
Uterine -> vaginal artery
Which structures in the female have the potential to be damaged during pelvic surgery?
Ovarian artery
Uterine artery
Ureter (passes under uterine artery)
Describe the blood supply to the female perineum
Most from the internal pudenal artery –> terminates as dorsal artery of clitoris
Internal pudenal –> inferior rectal artery
Internal pudenal –> perineal –> labial arteries
What is the pattern of venous drainage of the pelvis?
Mainly to the internal iliac vein.
Some via superior rectal into hepatic portal system
Some via lateral sacral veins into internal vertebral venous plexus
In the pelvis the veins form a number of _________
In the pelvis the veins form a number of venous plexuses
What are some of the nerves of the lateral wall?
Obturator nerve Sciatic nerve Pudendal nerve Sacral plexus Pelvic splanchnic nerves Nerve to levator ani
Obturator nerve arises from…
Anterior rami of spinal nerves L2-L4
The sciatic nerve arises from…and supplies…
L4-S3
Flexors of knee, and all muscles in the lower leg and foot
The pudendal nerve arises from…. and supplies…
S2-S4
Sensory and motor functions to structures of the perineum
The pelvis/perineum derives parasympathetic innervation via…
Pelvic splanchnic nerves arising from S2-S4
Lymphatics: where does the superior pelvic viscera drain?
External iliac nodes
Common iliac nodes, aortic thoracic duct, venous system
Lymphatics: where does the inferior pelvic viscera drain?
Deep perineum
Internal iliac nodes
Common iliac, aortic, thoracic duct, venous system
Lymphatics: where does the superficial perineum drain?
Superficial inguinal nodes
Lymphatics: where do the gonads drain?
Usually to the aortic/caval nodes (lumbar)
There is high crossover of lymphatic drainage from pelvic organs. What is the clinical consequence of this?
Transperitoneal spread
Disease or cancer can spread through peritoneal layer and disseminate into peritoneal cavity
