Anatomy of pelvic lateral wall and pelvic mass Flashcards
Generally, what is seen in the lateral pelvic wall?
Vessels Nerves Lymphatics Ureter Muscle Peritoneum Vas deferens/ round ligament of uterus
What ligaments make up the 2 sciatic foramen of the pelvis?
Sacrospinous
Sacrotuberous
What is the tendinous arch of the levator ani?
Origin point of levator ani
Thickened fascia over obturator internus
What is the function of the obturator internus?
Separates the superior and inferior gemellus
Lateral rotator
Underneath which muscle does the sciatic nerve pass?
Piriformis
What do the majority of the arteries of the pelvis and perineum arise from?
Internal iliac artery
What are the 2 exceptions to the arteries of the lateral pelvic wall (not internal iliac)?
Gonadal arteries; L2
Superior rectal; continuation of inferior mesenteric artery
What are the 2 divisions of the internal iliac artery in the pelvis?
Anterior; visceral
Posterior; parietal
What are the divisions of the posterior internal iliac artery within the lateral pelvis?
Sup and inf gluteal arteries
What are the divisions of the anterior internal iliac artery within the lateral pelvis?
Internal pudendal
Vesical arteries
Obturator artery
What are the branches of the internal pudendal artery in men?
Middle rectal Inferior vesical Prostatic branch Perineal artery Posterior scrotal artery Deep artery of penis Dorsal artery of penis
What is the route of the internal pudendal artery?
Leaves pelvis via greater sciatic foramen
Re-enters via lesser sciatic foramen
What is the origin of the anterior scrotal artery?
External iliac artery
What do the dorsal artery of penic and deep artery of penis supply respectively?
Dorsal artery = corpus spongiosum
Deep artery = corpus cavernosum
What is the difference between the arteries of pelvic wall in males and females?
Female; no inferior vesical artery
Equivalent is vaginal artery
What is the importance of the uterine artery?
Ligated in a hysterectomy
What are the 2 important anastomoses in the female genital system?
Uterine artery and ovarian artery
Uterine artery and vaginal artery
Where does the ureter run in terms of the uterine artery?
Ureter runs underneath the uterine artery; need to be sure not to ligate in hysterectomy
What are the branches of the internal pudendal artery in females?
Uterine artery Middle rectal Vaginal artery Inferior rectal artery Perineal artery Dorsal artery of malignancy
What is the origin of the labial arteries?
External iliac
What is important about the venous system in the pelvis?
Forms large plexuses which can be easily torn and will bleed lots
Where will venous blood from the pelvis drain?
Internal iliac
Into common iliac
IVC
What is the drainage of the superior rectal vein?
Hepatic portal system via splenic vein
Where will the lateral sacral plexus drain into?
Internal vertebral venous plexus; important for cancerous and infection spread
What plexuses are associated with the sacrum in the plexus?
Lateral sacral
Presacral
What are the nerves of the lateral pelvic wall?
Sacral plexus Pelvic splanchnic nerves Nerve to levator ani Pudendal Sciatic Obturator nerve
Via which canal does the obturator nerve and vessel pass through?
Obturator canal
What are the lymphatics present in the pelvis?
Pararectal Deep and superficial inguinal Internal and external iliac Common iliac Sacral Inferior mesenteric Lumbar
Where will superior pelvic viscera lymph drain to?
External iliac Common iliac Aortic Thoracic duct Venous system
Where will inferior pelvic viscera lymph drain to?
Deep perineum Internal iliac Common iliac Aortic Thoracic duct Venous system
Where will lymph from the superficial perineum drain to?
Superficial inguinal nodes
Where will lymph from ovaries and testes drain to?
Lumbar nodes
Where will lymph from the clitoris and glans of penis drain to?
Deep inguinal nodes first
What is trans-peritoneal spread?
Disease can penetrate through the peritoneal layer and disseminate into the peritoneal cavity
