Anatomy of pelvic lateral wall and pelvic mass

Question 1

Generally, what is seen in the lateral pelvic wall?

Answer 1

Vessels
Nerves
Lymphatics
Ureter
Muscle 
Peritoneum 
Vas deferens/ round ligament of uterus

Question 2

What ligaments make up the 2 sciatic foramen of the pelvis?

Answer 2

Sacrospinous

Sacrotuberous

Question 3

What is the tendinous arch of the levator ani?

Answer 3

Origin point of levator ani

Thickened fascia over obturator internus

Question 4

What is the function of the obturator internus?

Answer 4

Separates the superior and inferior gemellus

Lateral rotator

Question 5

Underneath which muscle does the sciatic nerve pass?

Answer 5

Piriformis

Question 6

What do the majority of the arteries of the pelvis and perineum arise from?

Answer 6

Internal iliac artery

Question 7

What are the 2 exceptions to the arteries of the lateral pelvic wall (not internal iliac)?

Answer 7

Gonadal arteries; L2

Superior rectal; continuation of inferior mesenteric artery

Question 8

What are the 2 divisions of the internal iliac artery in the pelvis?

Answer 8

Anterior; visceral

Posterior; parietal

Question 9

What are the divisions of the posterior internal iliac artery within the lateral pelvis?

Answer 9

Sup and inf gluteal arteries

Question 10

What are the divisions of the anterior internal iliac artery within the lateral pelvis?

Answer 10

Internal pudendal
Vesical arteries
Obturator artery

Question 11

What are the branches of the internal pudendal artery in men?

Answer 11

Middle rectal 
Inferior vesical 
Prostatic branch
Perineal artery 
Posterior scrotal artery 
Deep artery of penis
Dorsal artery of penis

Question 12

What is the route of the internal pudendal artery?

Answer 12

Leaves pelvis via greater sciatic foramen

Re-enters via lesser sciatic foramen

Question 13

What is the origin of the anterior scrotal artery?

Answer 13

External iliac artery

Question 14

What do the dorsal artery of penic and deep artery of penis supply respectively?

Answer 14

Dorsal artery = corpus spongiosum

Deep artery = corpus cavernosum

Question 15

What is the difference between the arteries of pelvic wall in males and females?

Answer 15

Female; no inferior vesical artery

Equivalent is vaginal artery

Question 16

What is the importance of the uterine artery?

Answer 16

Ligated in a hysterectomy

Question 17

What are the 2 important anastomoses in the female genital system?

Answer 17

Uterine artery and ovarian artery

Uterine artery and vaginal artery

Question 18

Where does the ureter run in terms of the uterine artery?

Answer 18

Ureter runs underneath the uterine artery; need to be sure not to ligate in hysterectomy

Question 19

What are the branches of the internal pudendal artery in females?

Answer 19

Uterine artery 
Middle rectal 
Vaginal artery 
Inferior rectal artery 
Perineal artery 
Dorsal artery of malignancy

Question 20

What is the origin of the labial arteries?

Answer 20

External iliac

Question 21

What is important about the venous system in the pelvis?

Answer 21

Forms large plexuses which can be easily torn and will bleed lots

Question 22

Where will venous blood from the pelvis drain?

Answer 22

Internal iliac
Into common iliac
IVC

Question 23

What is the drainage of the superior rectal vein?

Answer 23

Hepatic portal system via splenic vein

Question 24

Where will the lateral sacral plexus drain into?

Answer 24

Internal vertebral venous plexus; important for cancerous and infection spread

Question 25

What plexuses are associated with the sacrum in the plexus?

Answer 25

Lateral sacral | Presacral

Question 26

What are the nerves of the lateral pelvic wall?

Answer 26

``` Sacral plexus Pelvic splanchnic nerves Nerve to levator ani Pudendal Sciatic Obturator nerve ```

Question 27

Via which canal does the obturator nerve and vessel pass through?

Answer 27

Obturator canal

Question 28

What are the lymphatics present in the pelvis?

Answer 28

``` Pararectal Deep and superficial inguinal Internal and external iliac Common iliac Sacral Inferior mesenteric Lumbar ```

Question 29

Where will superior pelvic viscera lymph drain to?

Answer 29

``` External iliac Common iliac Aortic Thoracic duct Venous system ```

Question 30

Where will inferior pelvic viscera lymph drain to?

Answer 30

``` Deep perineum Internal iliac Common iliac Aortic Thoracic duct Venous system ```

Question 31

Where will lymph from the superficial perineum drain to?

Answer 31

Superficial inguinal nodes

Question 32

Where will lymph from ovaries and testes drain to?

Answer 32

Lumbar nodes

Question 33

Where will lymph from the clitoris and glans of penis drain to?

Answer 33

Deep inguinal nodes first

Question 34

What is trans-peritoneal spread?

Answer 34

Disease can penetrate through the peritoneal layer and disseminate into the peritoneal cavity