Clinical Anatomy of the Lateral Pelvic Wall and a Pelvic Mass Flashcards
what structures are associated with the obturator foramen?
foramen covered by obturator membrane
gap in obturator membrane forms obturator canal which obturator nerve passes through
function of obturator internus?
lateral rotation of the hip
name the muscles of the lateral pelvic wall?
levator ani obturator internus coccygeus piriformis tendinous arch of levator ani
where do most arteries of lateral pelvic wall originate?
internal iliac artery
2 exceptions to the general origin of lateral pelvic wall arteries?
gondal artery
- branches from abdominal aorta at L2
superior rectal artery (continuation of inferior mesenteric)
feature of lateral pelvic wall arterial supply?
extensive anastamoses
what are the 2 divisions of the internal iliac artery which forms the male pelvic arterial supply?
anterior division (visceral) posterior division (parietal)
branches of anterior division?
obturator artery
superior and inferior vesical arteries
branches of posterior division?
gluteal arteries
internal pudendal artery
middle rectal artery
prostatic branch of inferior vesical artery
male perineum arterial supply?
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
which artery has to be ligated in hysterectomy?
uterine artery
uterine artery in females is equivalent to which artery in male?
artery to vas defrens
which artery in female is classes as the same as the inferior vesical artery in male?
vaginal artery
- but have often found branches from vaginal artery to bladder
where does vaginal artery originate 60-70% of the time?
uterine
- but can come from pudendal etc
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what are the 2 main arterial anastamoses in female?
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)
what passes right underneath the uterine artery and should therefore be protected when the artery is ligated in hysterectomy?
ureter
what aretry supplies the female erectile tissue?
dorsal artery of the clitoris
- comes from internal pudendal
branches of internal pudendal artery which supply female perineum?
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general rule for venous drainage?
follows arterial system
drain mainly to internal iliac vein
exceptions to general rule to venous drainage?
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clinical relevance of /…
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main nerves of lateral pelvic wall?
obturator nerve
sacral plexus
pelvic splanchnic nerves
nerve to levator ani
nerves of sacral plexus?
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superior pelvic viscera generally drain lymph where?
external iliac nodes > common iliac > aortic > thoracic duct > venous system
inferior pelvic viscera generally drain lymph where?
deep perineal nodes > internal iliac > common iliac > aortic > thoracic duct < venous system
superficial perineum generally drains lymph where?
superficial inguinal nodes
where do ovaries and testes drain and why?
lumbar nodes
- as they both originate on the abdominal wall
where do glans penis and clitoris drain?
deep inguinal
lymphatic drainage is very variable, what does this mean?
implications for spread of infection or cancers
how does trans-peritoneal spread of cancer etc occur?
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
