Vessels, Nerves and Lymphatics of the Pelvis

Question 1

branches of which arteries distribute blood to most of the pelvic organs, perineum and gluteal region except the testis, ovary and upper part of rectum?

Answer 1

right and left internal iliac artery

Question 2

Answer 2

Question 3

what is the distribution of the superior and inferior vesical arteries?

Answer 3

• bladder
• seminal gland and prostate in males

Question 4

what is the origin of the superior vesical artery?

Answer 4

patent part of umbilical artery

Question 5

what is the origin of the inferior vesical artery?

Answer 5

anterior division of internal iliac artery

Question 6

what is the distribution of the uterine artery?

Answer 6

• pelvic part of ureter
• uterus
• ligament of uterus
• uterine tube
• vagina

Question 7

what is the origin of the uterine artery?

Answer 7

anterior division of internal iliac artery

Question 8

what is the distribution of the gonadal (testicular or ovarian) arteries?

Answer 8

testis and ovary

Question 9

what is the origin of the gonadal (testicular and ovarian) arteries?

Answer 9

abdominal aorta

Question 10

what is the distribution of the superior rectal artery?

Answer 10

• upper 2/3rds of the rectum, down to the level of levator ani

Question 11

what is the origin of the superior rectal artery?

Answer 11

inferior mesenteric artery

Question 12

what is the distribution of the middle and inferior rectal arteries?

Answer 12

• seminal gland, prostate and rectum (lower 1/3).

Question 13

what is the origin of the middle and inferior rectal arteries?

Answer 13

internal iliac artery

Question 14

what is the origin of the vaginal artery?

Answer 14

anterior division of internal iliac artery (uterine artery)

Question 15

what is the distribution of the vaginal artery?

Answer 15

vagina and branches to inferior part of urinary bladder

Question 16

what is the distribution of the internal pudendal artery?

Answer 16

main branch to perineum

Question 17

what is the origin of the internal pudenal artery?

Answer 17

anterior division of internal iliac artery

Question 18

what is the distribution of the obturator artery?

Answer 18

• pelvic muscles
• nutrient artery to ilium and head of femur

Question 19

what is the origin of the obturator artery?

Answer 19

internal iliac artery

Question 20

which part of the rectum drains into the portal circulation?

Answer 20

superior 2/3rds

Question 21

which part of the rectum drains into the systemic circulation?

Answer 21

lower 1/3rd

Question 22

what is the significance of understanding the venous drainage of the rectum?

Answer 22

As there is a portocaval anastomosis, there is an alternative route of circulation whhen there is a blockage in the liver or portal vein.
This is a means to reduce portal venous pressure.

Question 23

why might haemorrhoids be associated with cirrhosis of the liver?

Answer 23

increased portal venous pressure due to poor liver function can result in varices (abnormally dilated veins) at sites of anastomoses, such as haemorrhoids

Question 24

with which venous plexus does the prostatic venous plexus communicate with on its posterior side?

Answer 24

Batson venous plexus, to the internal vertebral venous plexus (significant in prostate cancer spread to the spine)

Question 25

what does the ilioinguinal nerve originate from and what is its distribution?

Answer 25

- L1 and enters the inguinal canal at the superficial inguinal ring - supplies skin at the root of the penis in males and labia in the female.

Question 26

where does the genitofemoral nerve originate from and where does it enter?

Answer 26

L1-2 and enters at the deep inguinal ring

Question 27

what structures in the male are supplied by the genital branch of the genitofemoral nerve? what is the clinical significance of this?

Answer 27

- cremaster muscle - sensation to lateral aspect of scrotum - It is responsible for efferent limb of the cremasteric reflex – contraction of cremaster muscle and resulting elevation of testis upon sensory stimulation of the ilioinguinal nerve.

Question 28

The pudendal nerve arises from which plexus?

Answer 28

sacral plexus

Question 29

from which segmental level does the pudendal nerve arise?

Answer 29

anterior rami of spinal nerves S2-4

Question 30

what bony landmarks are used when performing a pudendal nerve block during labour?

Answer 30

ischial spine, palpated transvaginally

Question 31

the autonomic nerve supply to the pelvis originates from which plexus?

Answer 31

pelvic plexus (or inferior hypogastric)

Question 32

the sympathetic nerve fibres supplying the pelvis originate from

Answer 32

L1-2 via the hypogastric nerve and terminal aspect of the sympathetic trunk.

Question 33

The autonomic nerve supply to the pelvis originates from the pelvic plexus (or inferior hypogastric) The sympathetic fibres originate from L1 and L2 via the hypogastric nerve and terminal aspect of the sympathetic trunk. They provide sympathetic supply to all internal pelvic organs. In a male they supply the?

Answer 33

vas deferens seminal vesicles prostate epididymis

Question 34

The autonomic nerve supply to the pelvis originates from the pelvic plexus (or inferior hypogastric) The sympathetic fibres originate from L1 and L2 via the hypogastric nerve and terminal aspect of the sympathetic trunk. They provide sympathetic supply to all internal pelvic organs. In a female they supply the?

Answer 34

ovaries uterus fallopian tubes vagina

Question 35

parasympathetic fibres in the pelvis originate from?

Answer 35

pelvic splanchnic nerves (S2 to S4). In addition to providing parasympathetic supply to all the internal pelvic organs, they innervate erectile tissues in both male and female.

Question 36

after rectal surgery, why are some men unable to ejaculate?

Answer 36

because the surgery can damage the nerves in the pelvic region that are responsible for controlling ejaculation, particularly the sympathetic nerves, which can lead to a condition called retrograde ejaculation where semen travels backwards into the bladder instead of being expelled during orgasm

Question 37

what are the four primary groups of lymph nodes present in the pelvis?

Answer 37

- external iliac - internal iliac - sacral - common iliac

Question 38

external iliac lymph nodes drain which area of the pelvis?

Answer 38

- mainly from inguinal lymph nodes - also recieve lymph from pelvic viscera, especially superior parts of anterior pelvic organs. - drain into common iliac nodes.

Question 39

internal iliac lymph nodes drain which pelvic area?

Answer 39

- gluteal region - deep perineum - inferior pelvic viscera

Question 40

sacral lymoph nodes drain which pelvic area?

Answer 40

posteroinferior pelvic viscera and drain to either internal or common iliac nodes

Question 41

common iliac lymph nodes drain which pelvic areas?

Answer 41

- drainage from external, internal and sacral lymph nodes