Blood vessels Flashcards
Where do the lymphatics of the vulva drain?
Superficial inguinal nodes
What is the femoral triangle?
Subfascial space of the upper one third of the thigh.
- Bounded by the inguinal ligament, sartorius muscle, and adductor longus muscle
- Floor formed by the pectineal,
adductor longus, and iliopsoas muscles
- Femoral artery bisects the same, vein medial to artery, nerve lateral (VAN)
What is the path of the uterine artery?
Arcuate (along the sides of the uterus)
Crosses over the ureter in the cardinal ligament and gives off cervical and vaginal branches
before ascending adjacent to the wall of the uterus and anastomosing with the medial end of the ovarian artery
What supports the ovary?
Lateral: Pelvic wall by the infundibulopelvic ligament (contains ovarian artery and vein)
Medial: Utero-ovarian ligament, mesoovarium (broad ligament)
What is the path of the round ligament?
Anterior corpus > retroperitoneal tissue (pass lateral to the deep inferior epigastric vessels) > internal inguinal ring > labia majora
Where do the ovarian vessels come from?
Directly from the aorta below the renal vessels
Where do the ovarian veins drain?
Right: Vena cava
Left: Renal vein
“right to ivc”
What is the blood supply of the fallopian tube?
Branches of the ovarian vessels through the mesosalpinx. Watch out for a prominent fimbrial branch at the lateral end of the tube!
What is the blood supply of the vagina?
Uterine vessels, pudendal vessels (distal vagina), and middle and inferior hemorrhoidal vessels (posterior wall)
What is the fascia of Denonvilliers?
Between the vaginal wall and rectum (cul-de-sac of Douglas to the top of the perineal body)
What is the anterior cul-de-sac?
Recess between the dome of the bladder and the anterior surface of the uterus
- Its loose peritoneum forms the vesicouterine fold (e.g., your bladder flap), but also is several cm away when you enter vaginally
What is the posterior cul-de-sac?
Anterior: Vagina
Posterior: Rectosigmoid
Lateral: Uterosacral ligaments
What is the prevescical space or the space of Retzius?
Lateral: Bony pelvis, attachment of bladder to cardinal ligament), attachment of pubocervical fascia to obturator internus
Cranial: Abdominal wall.
Important structures: Dorsal clitoral vessels, obturator nerve and vessels, bladder nerves
What is the rectovaginal space?
Apex of the perineal body upward to the cul-de-sac Laterally around the sides of the rectum to the attachment of the rectovaginal septum
What lies near the sacrospinous ligament?
Sacral plexus
Pudenal nerve
Venous plexus of internal iliac vein
Middle rectal vessels
What side is the aorta on relative to the vena cava?
The left
Where does the aorta bifurcate?
At the level of the fourth lumbar vertebra (just below the umbilicus)
What drains into the para-aortic nodes?
Drainage from the common iliac nodes (final drainage of the pelvic viscera) and ovaries
What is the presacral space?
Below the bifurcation of the aorta
Lateral: internal iliac arteries
Important structures: Middle sacral vessels, lateral sacral vessels, presacral nerve (superior hypogastric plexus - involved in orgasm)
What are the posterior branches of the internal iliac artery?
Iliolumbar artery
Lateral sacral artery
Superior gluteal artery
What are the anterior branches of the internal iliac artery?
Obturator artery Internal pudendal artery Inferior gluteal artery Uterine artery Superior vesical artery Vaginal (inferior vesical) artery Middle rectal artery
What are the branches of the aorta before bifurcation?
Renal
Ovary
Inferior Mesenteric
Lumbar
Where are the inferior and superior epigastric vessels?
Just above the pubic symphysis, the vessels lie approximately 5.5 cm from the midline, whereas at the level of the umbilicus, they are 4.5 cm from the
midline.
Location of inferior mesenteric artery (IMA)
3-6 cm above aortic bifurcation
Location of renal veins
Reflect 3rd part of duodenum to see
- Left renal vein: 4-5 cm above IMA
- Right renal vein (usually not exposed): Inferior and lateral insertion into IVC
Lumbar veins are most at risk during which side of para-aortic lymphadenectomy?
Left
- Left ascending lumbar vein parallel to aorta
- Otherwise, lumbar veins behind aorta
