Anatomy of Pelvic Lateral Wall and Pelvic Mass

Question 1

What are the ligaments of the lateral pelvic wall?

Answer 1

Sacrospinous ligament

Sacrotuberous ligament

Question 2

What are the muscles of the lateral pelvic wall?

Answer 2

Obturator internus
Coccygeus
Piriformis
Levator ani

Question 3

What is the name of the canal which passes through the obturator internus?

Answer 3

Obturator canal (for the obturator nerve)

Question 4

Where do the majority of arteries of pelvis and perineum arise from?

Answer 4

Abdominal aorta –> Common iliac artery –> Internal iliac artery

Question 5

Which lateral pelvic wall arteries do not arise from the lateral pelvic wall?

Answer 5

Gonadal/ovarian artery- from L2 abdominal aorta

Superior rectal artery- continuation of inferior mesenteric

Question 6

Approximately where does the common iliac artery bifurcate?

Answer 6

L5/S1

Question 7

Where does the internal iliac artery divide into the anterior and posterior trunks?

Answer 7

At the superior border of the greater sciatic foramen

Question 8

What are some of the anterior trunk branches from the internal Iliac artery in males?

Answer 8

Obturator artery
Inferior vesical artery
Middle rectal artery
Internal pudendal artery
Inferior gluteal artery

Question 9

What are some of the anterior trunk branches from the internal Iliac artery in females?

Answer 9

Obturator artery
Umbilical artery
Vaginal artery
Uterine artery
Middle rectal artery
Internal pudendal artery
Inferior gluteal artery

Question 10

What are some of the posterior trunk branches from the internal Iliac artery?

Answer 10

PILS
Posterior
Iliolumbar
Lateral sacral arteries
Superior gluteal artery

Question 11

Which artery is found exclusively in males, and replaced in females by the vaginal artery?

Answer 11

Inferior vesical artery

Question 12

Describe the blood supply to the male perineum

Answer 12

Most from the internal pudendal –> terminates as deep and dorsal arteries of penis
Internal pudenal –> perineal –> posterior scrotal artery
External iliac –> anterior scrotal artery

Question 13

What are the 3 folds in the internal aspect of the abdominal wall?

Answer 13

Lateral umbilical fold (inferior umbilical fold)
Medial umbilical fold (remnant of umbilical artery)
Median umbilical fold (Urachus)

Question 14

Which artery in females is homolog of artery to vas deferens?

Answer 14

Uterine artery

Question 15

Where are there anastomoses in the female gonadal arteries?

Answer 15

Uterine -> ovarian artery

Uterine -> vaginal artery

Question 16

Which structures in the female have the potential to be damaged during pelvic surgery?

Answer 16

Ovarian artery
Uterine artery
Ureter (passes under uterine artery)

Question 17

Describe the blood supply to the female perineum

Answer 17

Most from the internal pudenal artery –> terminates as dorsal artery of clitoris
Internal pudenal –> inferior rectal artery
Internal pudenal –> perineal –> labial arteries

Question 18

What is the pattern of venous drainage of the pelvis?

Answer 18

Mainly to the internal iliac vein.
Some via superior rectal into hepatic portal system
Some via lateral sacral veins into internal vertebral venous plexus

Question 19

In the pelvis the veins form a number of _________

Answer 19

In the pelvis the veins form a number of venous plexuses

Question 20

What are some of the nerves of the lateral wall?

Answer 20

Obturator nerve
Sciatic nerve
Pudendal nerve
Sacral plexus
Pelvic splanchnic nerves
Nerve to levator ani

Question 21

Obturator nerve arises from…

Answer 21

Anterior rami of spinal nerves L2-L4

Question 22

The sciatic nerve arises from…and supplies…

Answer 22

L4-S3

Flexors of knee, and all muscles in the lower leg and foot

Question 23

The pudendal nerve arises from…. and supplies…

Answer 23

S2-S4

Sensory and motor functions to structures of the perineum

Question 24

The pelvis/perineum derives parasympathetic innervation via…

Answer 24

Pelvic splanchnic nerves arising from S2-S4

Question 25

Lymphatics: where does the superior pelvic viscera drain?

Answer 25

External iliac nodes

Common iliac nodes, aortic thoracic duct, venous system

Question 26

Lymphatics: where does the inferior pelvic viscera drain?

Answer 26

Deep perineum
Internal iliac nodes
Common iliac, aortic, thoracic duct, venous system

Question 27

Lymphatics: where does the superficial perineum drain?

Answer 27

Superficial inguinal nodes

Question 28

Lymphatics: where do the gonads drain?

Answer 28

Usually to the aortic/caval nodes (lumbar)

Question 29

There is high crossover of lymphatic drainage from pelvic organs. What is the clinical consequence of this?

Answer 29

Transperitoneal spread

Disease or cancer can spread through peritoneal layer and disseminate into peritoneal cavity