Part 16: Pelvic Peritoneum, Vessels and Nerves Flashcards
Describe the arrangement of pelvic peritoneum in the male
Draped over pelvic viscera. Anteriorly roofs retropubic space, behind forms the rectovesical pouch with the retroperitoneal tissue forming rectovesical fascia (of Denonvilliers) betwen bladder and rectum. Laterally peritoneum is continuous with that of the side walls
How does the pelvic peritoneum differ in the female compared with male?
Largely the same but altered due to presence of uterus and broad ligaments. Thus has vesicouterine pouch and rectouterine pouch (of Douglas).
Where does the common iliac artery bifurcate?
At SI joint, IIA passes down and EIA passes more lateral
How many branches to anterior division of internal iliac artery?
3 associated with bladder: Superior vesical, inferior vesical, obliterated umbilical
3 associated with other viscera: Middle rectal, uterine artery, vaginal artery
3 parietal: Obturator artery, internal pudendal artery, inferior gluteal artery
What are the branches to the posterior division of the internal iliac artery?
Iliolumbar
Lateral sacral artery
Superior gluteal
Where does iliolumbar artery arise and where does it supply?
From posterior branch IIA.
Has lumbar branch (essentially the 5th lumbar artery) which supplies psoas, QL, spinal L5 branch
Iliac branch supplies iliac fossa and anastomoses around ASIS
Where does lateral sacral artery artery arise and where does it supply?
Arises from posterior branch IIA.
Runs lateral to anterior sacral foramina supplying roots and piriformis. Spinal branches to meninges.
Where does superior gluteal artery arise and where does it supply?
Largest branch of IIA - from posterior division.
Exits through greater sciatic foramen above piriformis to supply gluteals
Where does superior vesical artery arise and where does it supply?
Highest branch of anterior division of IIA.
Persistent patent proximal part of foetal umbilical artery (distal part becomes medial umbilical ligament). Runs along wall of pelvis, turns medially to reach upper bladder, supplies adjacent ureter and ductus deferens
Where does inferior vesical artery arise and where does it supply?
Branch of anterior division of IIA.
Supplies trigone and lower bladder, ureter, ductus deferens and seminal vesicles
Where does middle rectal artery arise and where does it supply?
Branch of anterior division if IIA. Maybe absent in females where uterine artery replaces its supply. Supplies lower rectal wall. May give off prostatic artery.
Where does uterine artery arise and where does it supply?
Anterior division if IIA.
Crosses pelvis at base of broad ligament superficial to ureter turing up at cervix. Anastomoses with ovarian artery
Where does vaginal artery arise and where does it supply?
Anterior division of IIA but often as branch of uterine. Supplies upper vaginal walls.
Where does obturator artery arise and where does it supply?
Anterior division of IIA. Passes along side wal of pelvis. Enters OF, branch to pubic symphysis
Where does internal pudendal artery arise and where does it supply?
Anterior division of IIA. Lies in front of inferior gluteal, piercing parietal pelvic fascia. Exist through greater sciatic foramen, below piriformis. Supplies perineum and external genitalia.