AN48.1-8 | Pelvic wall and viscera — Summary & Reflection

REFLECT

KEY TAKEAWAYS

Pelvic Wall and Viscera — Key Points:

1. Pelvic diaphragm: levator ani (pubococcygeus, puborectalis, iliococcygeus) + coccygeus; supports pelvic viscera; puborectalis maintains the anorectal angle
2. Internal iliac artery: posterior division (iliolumbar, lateral sacral, superior gluteal); anterior division (obturator, inferior gluteal, superior + inferior vesical, uterine, internal pudendal, middle rectal)
3. Uterine artery crosses ureter 2 cm lateral to cervix ("water under the bridge")
4. Sacral plexus: L4–S4; gives sciatic, pudendal, superior + inferior gluteal; pelvic splanchnics (S2–S4) = parasympathetic to pelvic viscera
5. BPH: transition zone → compresses urethra; PCa: peripheral zone → hard nodule on DRE
6. Automatic bladder: lesion above S2 → spastic/reflex bladder; autonomous bladder: lesion at/below S2 → atonic/overflow
7. Suprapubic cystostomy: full bladder rises extraperitoneally above pubis → safe midline entry
8. Haemorrhoids: internal (above pectinate line = painless); external (below = painful)
9. Ectopic pregnancy: blood in pouch of Douglas → posterior fornix tenderness
10. Structures on DRE: prostate, seminal vesicles (male); cervix, pouch of Douglas (female)