Vessels, nerves & lymph nodes of the Pelvis

Question 1

Which major vessel supplies most of the pelvic organs, perineum and gluteal region except testis, ovaries and upper part of rectum?

Answer 1

Right and Left Internal Iliac Arteries

Question 2

From where do the internal iliac arteries originate?

Answer 2

Common Iliac arteries, which bifurcate into internal and external iliac arteries at around L5,S1 vertebral level

Question 3

At what structure do the internal iliac arteries split into anterior and posterior trunks?

Answer 3

Greater sciatic foramen

Question 4

What are the branches of anterior trunk of the internal iliac artery?

Answer 4

Obturator

Superior Vesical

Inferior Vesical

Middle Rectal

Inferior Gluteal

Question 5

What are the branches of the posterior trunk of the internal iliac artery?

Answer 5

Superior gluteal artery

Lateral sacral artery

Question 6

Which part of the rectum drains into the portal circulation?

Answer 6

Superior

Question 7

Which part of the rectum drains into the systemic circulation?

Answer 7

Inferior

Question 8

Why might haemorrhoids be associated with liver cirrhosis?

Answer 8

Portal Hypertension

Question 9

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

Answer 9

Batson venous plexus

Question 10

What is the clinical significance of knowing about the venous drainage of the prostate?

Answer 10

Prostate cancer can spread via the Batson venous plexus

Question 11

What are the two broad categories of nerve supply to the reproductive organs?

Answer 11

Somatic

Autonomic

Question 12

What nerves form the somatic nerve supply to the reporductive organs and at what vertebral level do they originate?

Answer 12

Ilioinguinal (L1)

Genitofemoral (L1,L2)

Pudendal (S2,S3,S4)

Question 13

What nerve innervates the scortum?

Answer 13

Genitofemoral nerve

Question 14

Where does the pudendal nerve arise from, what course does it take and what does it innervate?

Answer 14

Origin - Sacral plexus

Course - Follows pudendal artery

Innervates - Skin & muscles of perineum

Question 15

In what clinical scenario is the course of the pudendal nerve important to understand?

Answer 15

A difficult childbirth using an instrument (e.g. forceps delivery)

Question 16

What procedre is carried out on the pudendal nerve to assist with a difficult birth?

Answer 16

A bilateral pudendal nerve block will provide pain relief during an instrument assisted childbirth

Question 17

What bony landmarks are used for guidance during a pudendal nerve block procedure?

Answer 17

Ischial spine

Question 18

Which nerves innervate the vas deferens, seminal vesicles, prostate and epiddidymis in males?

Answer 18

Sympathetic fibres from L1,2 via hypogastric plexus

Question 19

Which nerves supply the female genital tract?

Answer 19

Sympathetic nerves from the ovarian plexus

Parasympathetic nerves from the pelvic splanchnic nerves

Question 20

Which nerves innervate the erectile tissues in both males and females?

Answer 20

Parasympathetic fibres from hypogastric plexus

Question 21

What structures drain lymph into the external iliac lymph nodes?

Answer 21

Glans of the Penis

Clitoris

Prostate

Cervix

Question 22

Into which lymph nodes does the gluteal region, deep perineum and inferior pelvic viscera drain?

Answer 22

Internal iliac lymph nodes

Question 23

Which group of lymph nodes drain the rectum and posterior wall of the pelvis?

Answer 23

Sacral lymph nodes

Question 24

Into which group of lymph nodes does the lymph from the external, internal iliac and sacral lymph nodes drain into?

Answer 24

Common Iliac lymph nodes