G27 28 Pelvis I II

Question 1

obturator nerve

Answer 1

L2-L4

medial to psoas

branch of lumbar plexus

innervates medial thigh

exits obturator foramen (one of two ways to exit pelvis (other GSF)

Question 2

lubmosacral trunk

Answer 2

inf 1/2 of anterior ramus L4 and ant ramus of L5

srosses sacral ala to join sacral plexus

Question 3

compression of sacral plexus

Answer 3

pelvic tumors or childbirth

Question 4

superior gluteal nerve

inferior gluteal nerve

Answer 4

L4-S1

goes to lesser gluteal muscle

exits superior to piriformis

exits greater sciatic foramen

Inferior: L5-S2
-supllies gluteus maximus
also exits greater sciatic
but inferior to piriformis

Question 5

posterior cutaneous nerves of the thigh

Answer 5

S1-S3

cutaneous inn to post thigh

Question 6

sciatic nerve:

Answer 6

L4-S3

two nerves wrapped : tibial and fibular

bound but do not share fibers

exits inf ro piriformis?

Question 7

pudendal nerve

Answer 7

perineum blocks exit

must exit GSF
enter LSF

wraps around ischial spine,

(coccygeous on deep side of sacrospinus ligament)

Question 8

arteries of pelvis

Answer 8

ovarian/testicular (L2/L3)

superior rectal artery

iliolumbar (up)

common iliacs…when external iliac crosses the inguinal ligament it changes to femoral artery

Question 9

portal caval anastimosis

Answer 9

if branch of IMA: vein will drain to the portal system

4 in total

• rectum (superior rectal from IMA)
• umbilicus: caput madusa
• esophagus
• retropertoneal

Question 10

internal iliac

Answer 10

posterior division-

• iliolumbar artery
• superior gluteal : largest and exits greater sciatic foramen, passes between lumbosacral trunk S1
• lateral sacral

anterior division

• Obturator (out obturator canal)(loose)
• umbilical (medial umb ligament)
• superior vesical artery (bladder) (branch from umbilical)
• inferior gluteal (exit)*
• internal pudendal (exit/enter)* (inferior rectal branches off)
• middle rectal (drains to caval)
• inferior vesical (male) uterine with a vaginal branch (female)

Question 11

obturator artery

Answer 11

Aberrant Accessory
DOES NOT COME OFF INTERNAL ILIAC

20% off inferior epigastric artery -over pubic ramus (pelvic brim)

requires caution during hernia repairs

Question 12

uterine and vaginal arteries

Answer 12

ovarian artery (aorta) gonadal

internal iliac branches and single uterine artery with vaginal branch (more inferior)
-vag posterior to ureter, uterine artery passes anterior to ureter in broad ligament.

DO NOT LIGATE URETER DURING HISTORECTOMY

Question 13

inferior vesical artery

uterin artery

Answer 13

male: inferior vesicle: suplies bladder, ductus def, seminal vesicle and prostate
w: uterine: bladder and vagine

Question 14

lymphatic drainage

Answer 14

follows venus supply

internal iliac, common ilian, lumbar, lumbar lymph trunks, cisterna chyle, thoracic duct

GONADS: directly to lumbar nodes, sometimes up higher

Question 15

rectum

Answer 15

rectosigmoid junction

-no tenia coli, haustra or omental appendices
transferse folds : folds within rectu : valves of houston (smooth internally)

pubococcygeous muscle: (puborectalis portion)

• defacation puborectalis ALONE relaxes
• the rest contracts to prevents pelvic herniation

superior rectal V-portal system
middle rectal V- IVC
inferior rectal V- IVC
(internal rectal plexus)

internal hemmaroids: portal hypertension
external : bad luck

arteries
-inferiore rectal arteries branch off internal pudendal

Question 16

ureters (water under the bridge)

Answer 16

primary retroperitoneal

• no valve, enter at angle as kind of valve
• WATER UNDER THE BRIDGE

male bladder: extra sexual organs

womenL posterior to uterine artery
-important when ligating uterine artery during hysterectomy

malesL inferiore to ductus deferens

Question 17

pre puberty blasdder

Answer 17

above pubis where it can be injured

Question 18

bladder parts

Answer 18

apex: at pubic symphysis

fundusL obbosite of apex

neckL where funndus and inferolateral spaces meet

trigone: triangle shaped structure on teh posterior surface of the bladder

sphincter: external urethra: VOLUNTARY (striated)
- in men is below prostate circular
- in woman from bladder to BS

internal urethral sphincter: INVOLULNTARY (ANS):(detrusor/smooth) expell urine, external , prevents retrograde ejaculation of semen in males, less robust in females

RUGAE

femaile sits on perineal membrane
male: sits on prostate, then muscle then perineal mem

both sexes have superior vesicle (can be off umb or int iliac)

Question 19

surgical access

Answer 19

distended bladder extends into abdomen (esp in men), superpubic incision can gain access to bladder just without getting into peritoneal sac

Question 20

BROAD LIGAMENT

Answer 20

all over, the mesentary of the uterus
mesosappinx (by fimbrae)
mesoovarium
mesometrium

suspensory ligaments (homologous contents to spermatic chord) (carry ovarian artery and vein)

proper ovarian ligament: obliterated gubernaculum)

round ligament of uterusL goes forward (more obliterated gubernaculum)
-going to inguinal canal

Question 21

uterine tube and uterus

Answer 21

fimbrae, infundibulum, ampulla, isthmus

pathwaty for infection into peritoneal vacity. pelvic inflammatory disease is much more common in females!

uterus:
fundus
body
isthmus
cervix

internal and external os
external os site of pap smear

uterine prolapse (falling uterus into vagina)

uterus stays big for a while

vaginal (current) or abdominal hysterectomy

• no longer have to go through peritoneal sac)
• used to leave cervix intact

Question 22

uterine ligaments

Answer 22

thickenings of endopelvic fascia beneatch parietal peritoneaom of broad ligament from cervix to pelvic walls

supports the uterus and prevents from descentind thoruhg vagina

uterosacral (ant)

cardinal ligaments (transverse cervical lig)- where the uterine artery and vein)