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Pelvic Anatomy
James Cook, 3rd year GEM
Aim

Review muscles, ligaments, arteries, veins,
lymphatics and nerves

Clinical context: Hysterectomy

Give you confidence in your knowledge
Top Tip!

Learn how to draw basic anatomical
diagrams from grays

Reproduce these in your exam = easy marks!

Surgeons use drawings to teach (and learn)
Hysterectomy

Definition?

Indications?
Hysterectomy
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Definition: removal of the uterus


Most common major gynaecological operation
Indications:

Fibroids
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Endometriosis
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Pelvic malignancy
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Chronic pelvic inflammatory disease
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Prolapse
Prolapse



The descent of the uterus and/or vaginal walls
within the vagina
Aetiology:
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Weakened support of pelvic organs
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Increased strains on the support
What are the pelvic supports?
Uterus
Levator Ani supports everything else
Levator Ani supports everything else
Do the round ligament and the broad ligament
provide pelvic support?
Incision
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Laparotomy
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Vaginal
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Laparoscopic
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What layers are cut?
Layers
Ligation of Arteries and Veins
Anterior branch

Easy way to remember:

Belly button

Thigh

Clitoris

Bladder

Uterus

Vagina

Rectum

Bum
Anterior branch

Easy way to remember:

Belly button: umbilical
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Thigh: Obturator
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Clitoris: Internal pudendal

Bladder: Superior vesicle
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Uterus: Uterine
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Vagina: Vaginal

Rectum: Middle Rectal
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Bum: Inferior gluteal
“Bridge over water”
Posterior Branch
PILS

Posterior branch

I

L

S
Posterior Branch
PILS

Posterior branch
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Ileolumbar
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Lateral Sacral

Superior Gluteal
Bilateral salpingo-oophorectomy
Venous drainage
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Right Ovary drains to?
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Left Ovary drains to?
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Pelvic viscera drainage generally follows the
course of the arterial branches.
Dissect the uterus
Suture

What were the layers?
Send to ward 209



Infection!
Why would a vaginal examination be
performed?
What lymph nodes would be palpable?
Pouch of Douglas
Inguinal nodes are palpable
Exam Question

Superficial & Deep Inguinal = palpable
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External & internal = not palpable
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Para-aortic?
Lymphatic drainage
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Superficial drain the external genitalia / deep
perineal pouch
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Deep inguinal drain the glans clitoris/penis
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External iliac drains the superior pelvis
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Internal iliac drains the inferior pelvis
Catheter is removed

What nerve relaxes contracts the bladder and
relaxes the sphincter?
S2, 3, 4 keeps...
Hypogastric nerve
Thank you