Anatomy of Lateral Pelvic Wall and Pelvic Mass Flashcards

1
Q

What three bones combine to make up the lateral pelvic wall?

A

Ilium
ischium
pubis

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2
Q

What membrane and ligaments are found on top of the lateral pelvic wall?

A

Sacrotuberous Ligament
Sacrospinous ligament
Obturator membrane

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3
Q

What muscles are found on the lateral pelvic wall?

A

Levator Ani
Coccygeus
Piriformis (covered by descending sacral plexus)
Obturator internus (partially covered by tendinous arch of levator ani)

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4
Q

The majority of arteries of pelvis and perineum arise from which artery?

A

internal iliac artery

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5
Q

What are the exceptions to the pelvic blood supply which do not come from the internal iliac artery?

A

Gonadal artery - from L2 level of abdominal aorta

Superior rectal artery - from inferior mesenteric (IMA)

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6
Q

The internal iliac goes on to divide into an anterior and posterior division. Explain what arteries are found in each division in male patients.

A

ANTERIOR

  • obturator artery
  • remnant of medial umbilical ligament
  • superior and inferior vesical (+ prostatic branch of IV)
  • Internal pudendal
  • middle rectal

POSTERIOR
- gluteal arteres

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7
Q

How does the internal pudendal artery terminate in the male?

A

End arteries are

  • dorsal artery of penis
  • posterior scrotal artery (previously perineal)
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8
Q

Where does the anterior scrotal artery originate from?

A

External iliac

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9
Q

The internal iliac goes on to divide into an anterior and posterior division. Explain what arteries are found in each division in female patients.

A
ANTERIOR
- obturator artery
- medial umbilical ligament
- superior vesical arteries
(women thought to not have inferior vesical artery - but this is not true)
- uterine artery
- vaginal artery (thought to supply territory of inferior vesical)
- internal pudendal
- middle rectal

POSTERIOR
- gluteal arteries

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10
Q

What important anastomoses occur between arteria supplies in the pelvis

A
  • uterine artery and the ovarian artery

- uterine artery and the vaginal artery

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11
Q

HOw does the female arterial supply to the pelvis terminate?

A
dorsal artery of clitoris
labial arteries (from perineal)
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12
Q

Explain how the venous drainage in the pelvis is arranged

A
  • follows arterial system (named as per arteries)
  • venous plexuses
  • Drain mainly to internal iliac vein
  • some drain via superior rectal into Hepatic Portal system
  • some will drain via lateral sacral veins into internal vertebral venous plexus
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13
Q

What is the disadvantage of the close communication between the lateral sacral veins and the internal vertebral venous plexus?

A
  • infection can track easily

- cancerous spread

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14
Q

What nerves are found on the lateral pelvic side wall?

A
  • Obturator (from lumbar plexus)
  • Sacral Plexus (combining to form sciatic)
  • Pudendal
  • Pelvic splanchnic nerves (for parasympathetics)
  • Nerve to levator ani
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15
Q

To which groups of lymph nodes do the superior parts of the pelvic organs drain?

A
  • external iliac nodes -> common iliac
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16
Q

To which groups of lymph nodes do the inferior parts of the pelvic organs drain?

A
  • internal iliac nodes first -> common iliac
17
Q

Where does the lymph from superficial parts of the perineum drain to and why is this?

A
  • superficial inguinal nodes

- Parietal (skin) not visceral structure

18
Q

Why is it difficult to map a direction of cancer spread in the pelvis?

A
  • lymphatics have high cross-over
    => cancer can spread in any direction
  • pattern not sufficiently predictable to anticipate spread
19
Q

What is meant by “trans-peritoneal spread”?

A
  • usually infections in abdomen and pelvis are kept seperate by layer of peritoneum
  • if thin peritoneum is invaded and infection passes through, then due to its draping nature across all pelvic organs, it acts as a means to spread infection
20
Q

What is the clinical importance of the pre-sacral venous plexus?

A

Can cause traumatic haemorrhage if injured during surgical procedure

21
Q

What structure should be avoided when ligating the uterine artery to perform a hysterectomy?

A

Ureter (in close proximity)