Clinical Anatomy of the Lateral Pelvic Wall and a Pelvic Mass

Question 1

what structures are associated with the obturator foramen?

Answer 1

foramen covered by obturator membrane

gap in obturator membrane forms obturator canal which obturator nerve passes through

Question 2

function of obturator internus?

Answer 2

lateral rotation of the hip

Question 3

name the muscles of the lateral pelvic wall?

Answer 3

levator ani
obturator internus
coccygeus
piriformis
tendinous arch of levator ani

Question 4

where do most arteries of lateral pelvic wall originate?

Answer 4

internal iliac artery

Question 5

2 exceptions to the general origin of lateral pelvic wall arteries?

Answer 5

gondal artery
- branches from abdominal aorta at L2

superior rectal artery (continuation of inferior mesenteric)

Question 6

feature of lateral pelvic wall arterial supply?

Answer 6

extensive anastamoses

Question 7

what are the 2 divisions of the internal iliac artery which forms the male pelvic arterial supply?

Answer 7

anterior division (visceral)
posterior division (parietal)

Question 8

branches of anterior division?

Answer 8

obturator artery

superior and inferior vesical arteries

Question 9

branches of posterior division?

Answer 9

gluteal arteries
internal pudendal artery
middle rectal artery
prostatic branch of inferior vesical artery

Question 10

male perineum arterial supply?

Answer 10

internal pudendal artery > perineal artery > posterior scrotal artery

continuation of internal pudendal artery after perineal splits off > dorsal artery of the penis + deep artery of the penis

anterior scrotal artery comes from external iliac

Question 11

which artery has to be ligated in hysterectomy?

Answer 11

uterine artery

Question 12

uterine artery in females is equivalent to which artery in male?

Answer 12

artery to vas defrens

Question 13

which artery in female is classes as the same as the inferior vesical artery in male?

Answer 13

vaginal artery

- but have often found branches from vaginal artery to bladder

Question 14

where does vaginal artery originate 60-70% of the time?

Answer 14

uterine

- but can come from pudendal etc

Question 15

…

Answer 15

…

Question 16

…

Answer 16

…

Question 17

what are the 2 main arterial anastamoses in female?

Answer 17

between uterine artery and ovarian artery

between uterine artery and vaginal artery
- vaginal comes off uterine then splits into 2 branches (1 goes up and anastamoses with uterine, the other goes down and anastamoses with internal pudendal)

Question 18

what passes right underneath the uterine artery and should therefore be protected when the artery is ligated in hysterectomy?

Answer 18

ureter

Question 19

what aretry supplies the female erectile tissue?

Answer 19

dorsal artery of the clitoris

- comes from internal pudendal

Question 20

branches of internal pudendal artery which supply female perineum?

Answer 20

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Question 21

general rule for venous drainage?

Answer 21

follows arterial system

drain mainly to internal iliac vein

Question 22

exceptions to general rule to venous drainage?

Answer 22

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Question 23

clinical relevance of /…

Answer 23

…

Question 24

main nerves of lateral pelvic wall?

Answer 24

obturator nerve
sacral plexus
pelvic splanchnic nerves
nerve to levator ani

Question 25

nerves of sacral plexus?

Answer 25

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Question 26

superior pelvic viscera generally drain lymph where?

Answer 26

external iliac nodes > common iliac > aortic > thoracic duct > venous system

Question 27

inferior pelvic viscera generally drain lymph where?

Answer 27

deep perineal nodes > internal iliac > common iliac > aortic > thoracic duct < venous system

Question 28

superficial perineum generally drains lymph where?

Answer 28

superficial inguinal nodes

Question 29

where do ovaries and testes drain and why?

Answer 29

lumbar nodes

- as they both originate on the abdominal wall

Question 30

where do glans penis and clitoris drain?

Answer 30

deep inguinal

Question 31

lymphatic drainage is very variable, what does this mean?

Answer 31

implications for spread of infection or cancers

Question 32

how does trans-peritoneal spread of cancer etc occur?

Answer 32

peritoneal membrane usually forms a roof over the pelvic organs and acts as a barrier to prevent spread into abdominal area
can be penetrated by an aggressive cancer as very thing allowing the cancer to disseminate