Lecture 24 DA

Question 1

What are the two divisions of the external iliac artery?

Answer 1

Posterior branch - to the parietal body wall.

Anterior branch - To the body wall and viscera (to viscera is variable).

Question 2

What are the arteries of the posterior branch of the external iliac artery (3 of them)?

Answer 2

Iliolumbar, lateral sacral and superior gluteal arteries.

Question 3

What are the arteries of the antterior branch of the external iliac artery (3 of them)?

Answer 3

Obturator, inferior gluteal and internal pudendal arteries.

Question 4

What is a feature of the uterine and vaginal artery in regards to pregnancy?

Answer 4

The two anastamose, and are convoluted and tortuous so that when the uterus expands when pregnant, the two can expand with it.
Facial arteries are similar.

Question 5

What is meant by end organs? Where can they be found?

Answer 5

Means arteries will end there, and dnt anastamose. Occurs in the extremities.

Question 6

Why shouldn’t vasoconstrictors be injected into end organs?

Answer 6

It can cause avascularity and possibly gangrene due to the lack of anastamoses.

Question 7

Do veins within the pelvic cavity have valves?

Answer 7

No.

Question 8

Where do the vesical, prostatic and uterovaginal veins drain?

Answer 8

To the internal iliac vein.

Question 9

Where does the prostate venous plexus drain to? What is the clinical significance of this?

Answer 9

Normally to tributaries of the IVC. Cancer can spread due to this, forming secondary metastasis in bone, liver, brain and neural tissue.

Question 10

Where can the prostate drain to aside from tributaries to the IVC?

Answer 10

Retrogradely to the vertebral canal via anterior sacral veins.

Question 11

What happens to cavernous vessels during erection?

Answer 11

They are constricted during erection, filling them with blood.

Question 12

What is a possible complication of prostatectomy?

Answer 12

Damage of the erectile nerves is possible, as well as blood vessels.

Question 13

Where does the superior rectal vein drain to?

Answer 13

To the inferior mesenteric vein, at the common iliac vein bifurcation level.

Question 14

How does the superior rectal vein communicate with the internal iliac vein below?

Answer 14

Via the inferior and middle rectal veins.

Question 15

What system is the superior rectal vein part of?

Answer 15

Portal system.

Question 16

What system are the inferior and middle rectal veins part of?

Answer 16

Systemic.

Question 17

What happens to the rectal veins during portal hypertension?

Answer 17

They will distend, forming varices, and can distend out of the anal canal, called haemorrhoids.

Question 18

What is the difference between visceral and somatic haemorrhoids?

Answer 18

Visceral haemorrhoids are found in the upper anal canal, and cause some discomfort.
Somatic haemorrhoids are found much lower down and are extremely painful.

Question 19

What can be said of the lymph drainage of the pelvis?

Answer 19

Accompanies the veins.

Question 20

What does the superficial inguinal node drain?

Answer 20

Skin of the perineum.

Question 21

Where does pelvic vicera lymph drain to?

Answer 21

Deep inguinal node.

Question 22

Where does the superficial inguinal node drain to?

Answer 22

To the deep inguinal node.

Question 23

Where does scrotum lymph drain to?

Answer 23

To inguinal nodes.

Question 24

Where does testes lymph drain to? What is a consequence of this?

Answer 24

To para aortic abdominal wall nodes. Cancer is difficult to observe, but can be palpated by checking the left superior clavicular node, a sentinel node. Swollen if cancer is present.

Question 25

What are the spinal nerves of the sacral plexus, and what does it supply?

Answer 25

S2-4

Supplies pelvic muscles and gluteal region.

Question 26

What are the main branches of the sacral plexus?

Answer 26

Obturator and pudendal nerve.

Question 27

What does the pudendal nerve supply, and how does it avoid compression?

Answer 27

Supplies the perineum and external genitalia, supplying them from below, to prevent compression from viscera above.

Question 28

What is a pudendal nerve block procedure?

Answer 28

Done during pregnancy, the needle is inserted into the pudendal canal. The ischial spine is palpated through the vagina. Pudendal vessels are endangered.

Question 29

What nerves do viscera have?

Answer 29

A single sensory pathway - afferent

Dual motor - sympathetic and parasympathetic

Question 30

What pathway is the inferior hypogastric nerve composed of?

Answer 30

Mixed (both sympathetic and parasympathetic).

Question 31

What pathway is the superior hypogastric nerve composed of?

Answer 31

Sympathetic.

Question 32

What pathway are the pelvic splachnic nerves composed of?

Answer 32

Parasympathetic.

Question 33

What do sympathetic nerves do within the pelvis?

Answer 33

Contract the sphincters and arteries.

Question 34

What happens to the neurovascular supply at the junction between endoderm and ectoderm derived structures? Name a site.

Answer 34

They overlap. The rectum is one site. Epidermis, dermis and skeletal muscle is another. Epithelium, lamina propria and smooth muscle.

Question 35

What is the rectum supplied by above and below the pectinate line?

Answer 35

Above - from unpaired

Below - from paired

Question 36

Name three pelvic reflex arcs and the spinal nerves involved.

Answer 36

Micturition
Defaecation
Erection
S2-4

Question 37

What is the pelvic pain line?

Answer 37

Passes from the inferior pubic bone to the upper coccyx.

Question 38

How is pain referred above the pelvic pain line?

Answer 38

Referred to the anterior abdominal wall via sympathetics, as visceral afferents pass with sympathetics.

Question 39

How is pain referred below the pelvic pain line?

Answer 39

Visceral afferents pass with parasympathetics, and so pain is referred to the perineum.