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INTRODUCTION

Test Taking Tips

  • GYN: Remember to review the differential diagnosis and management of abdominal/pelvic masses, including ectopic pregnancy, ovarian mass, ruptured ovarian cyst, and tubo-ovarian abscess/PID.

  • OB: Review the physiologic changes of the pregnant patient during each of the trimesters.

ANATOMY

What are the branches of the internal iliac artery (hypogastric)?

  • Posterior division: Iliolumbar, Lateral sacral, Superior gluteal

  • Mnemonic: I Love Sex

  • Anterior division: inferior Gluteal, internal Pudendal, Inferior vesical, superior vesical, Middle rectal, Vaginal, Obturator, Umbilical, Uterine

  • Mnemonic: I Love Going Places In My Very Own Underwear (anterior and posterior)

What is the arterial supply to the uterus?

  • Uterine artery from the hypogastric and ovarian arteries directly from the aorta

Right ovarian vein originates from:

  • Inferior vena cava

FIGURE 30-1

The muscles and vasculature of the pelvis. (Reproduced with permission from Brunicardi FC, Andersen DK, Billiar TR, et al. Schwartz’s Principles of Surgery, 11th ed. New York, NY: McGraw Hill; 2019.)

Left ovarian vein originates from:

  • Left renal vein

Vaginal arterial supply:

  • Upper: cervical branch of the uterine artery, vaginal branch of the hypogastric

  • Lower: internal pudendal, middle, and inferior hemorrhoidal

The major arterial supply to the cervix is located:

  • In the lateral cervical walls at the 3 and 9 o’clock positions

The internal pudendal artery supply:

  • The rectum, labia, clitoris, perineum

Artery that supplies the round ligament:

  • Sampson

Inferior epigastric artery and vein originate from:

  • External iliac artery and external iliac vein, respectively

What is the levator ani complex?

  • Iliococcygeus, pubococcygeus, puborectalis

What are the boundaries of the femoral triangle?

  • Sartorius muscle (lateral), adductor longus muscle (medial), and inguinal ligament (superior)

The floor of the femoral triangle is formed by:

  • Iliopsoas, pectineus, and adductor longus

What is the space of Retzius (retropubic space)?

  • The area between the bladder and the symphysis pubis, bounded laterally by the arcus tendinous fascia pelvis and ischial spines

What is the cul-de-sac of Douglas?

  • Also known as the rectouterine pouch or fold, this is located anterior to the rectum, separating the posterior wall of the vagina from the rectum. Bounded laterally by the uterosacral ligaments.

FIGURE 30-2

The avascular spaces of the female pelvis. (Reproduced with permission from Brunicardi FC, Andersen DK, Billiar TR, et ...

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