Page 157 - Clinical Anatomy

ECA2 7/18/06 6:43 PM Page 142

142 The abdomen and pelvis

The ureter is readily infiltrated by lateral extension of a carcinoma of the
uterus; bilateral hydronephrosis with uraemia is a frequent mode of termi-
nation of this disease.
The close relationship of ureter to the lateral fornix is best appreciated
by realizing that a ureteric stone at this site can be palpated on vaginal
examination. (This is the answer to the examination question: ‘When can a
stone in the ureter be felt?’)

Blood supply
The uterine artery (from the internal iliac) runs in the base of the broad liga-
ment and crosses above and at right angles to the ureter to reach the uterus
at the level of the internal os. The artery then ascends in a tortuous manner
alongside the uterus, supplying the corpus, and then anastomoses with the
ovarian artery. The uterine artery also gives off a descending branch to the
cervix and branches to the upper vagina. The veins accompany the arteries
and drain into the internal iliac veins, but they also communicate via the
pelvic plexus with the veins of the vagina and bladder.

Lymph drainage (Fig. 105)
1◊◊The fundus (together with the ovary and Fallopian tube) drains along
the ovarian vessels to the aortic nodes, apart from some lymphatics which
pass along the round ligament to the inguinal nodes.
2◊◊The body drains via the broad ligament to nodes lying alongside the
external iliac vessels.

Fig. 105◊Lymph drainage
of the uterus and vagina.