1. Female pelvic viscera Flashcards
List the female pelvic viscera?
Reproductive tract: Ovary, uterine tube, uterus, cervix and vagina
+ Bladder, Rectum and anal canal
Muscles are are found in the lateral pelvic floor and wall
Pelvic floor:
- Levator ani S 3,4. Divided into…
1. Iliococcygeus
2. Pubococcygeus
Lateral wall:
- Puborectalis: Sling around recto-anal junction to aid rectal continence
- Pubovaginalis: Spincter around vagina, for close and general support of the urogenital organs
Position of the ovary?
On lateral pelvic wall in an ovarian fossa in the angle between the internal and external iliac vessels.
Medial to the obturator nerve and the thin wall of the acetabulum**
*Central dislocation of the hip may injure the ovary
Role of ovary?
Produces an ovum monthly is response to FSH and LH from the pituitary gland.
Produces oestrogen and progesterone to maintain uterine cycle
Relation of ovary to peritoneum?
The peritoneum is absorbed into the ovarian wall, therefore the ovary is truly intraperitoneal i.e. it actually lies inside the peritoneal cavity
Support of the ovary?
Hangs off the posterior aspect of the broad ligament on the mesovarium
Is supported by the ovarian ligament and suspensory ligament
What is the suspensory ligament of the ovary?
In the broad ligament and carrying the ovarian blood vessels
Relations of the ovarian ligament?
In the broad ligament and between the ovary and uterus
Relations of the round ligament?
Remnant of..
Is a continuation of the ligament of the ovary. Passes from the uterus and to the labia (through inguinal canal)
Remnant of GUBERNACULUM
Where is the ovum secreted into from the ovary?
Risk?
Ovulation into the peritoneal cavity, where the ovum is “picked up” by the fimbriated end of the uterine (Fallopian) tube.
Risk: As the ovum is secreted into the peritoneal cavity, ectopic pregnancy may occur in the peritoneal cavity or in the uterine tube
Position of the ureter in relation to the ovary? Risk?
The ureter lies posteriorly and is at risk during surgical procedures on the ovary
Position of the obturator nerve in relation of the ovary? Risk?
The obturator nerve lies laterally
Risk: Ovarian disease may cause referred pain to the medial thigh
Vascular supply of the ovary?
Ovarian artery from the aorta at L1/2
Ovarian vein: Form a plexus that coalesces into the ovarian vein. The left drains to the left renal vein. The right ovarian vein drains to the IVC
Nerve supply of the ovary?
Referred pain?
By symphatic nerves derived from T10/11
Referred pain is to the peri-umbilical region
Ovary lymph drainage?
To the para-aortic nodes
Sections of the uterine tube?
- Ostium surrounded by fimbriae (within peritoneal cavity)
- Infundibulum
- Ampulla (where fertilisation occurs)
- Isthmus
- Intramural part through uterine wall
Uterine tube: Ligament attachments Blood supply? Referred pain? Function?
Ligaments: In the upper, free edge of the broad ligament (mesosalpinx)
Blood supply: From anastomosis between the uterine and ovarian arteries
Referred pain: Lower abdomen
Function: Ovum fertilisation and transport
Uterus structural features?
Pear shaped
Thick walled
Muscular
Function of uterus?
Central pelvic organ for implantation of the fertilised ovum and growth of the foetus and placenta
Muscular support of the uterus from..
- Levator ani
- Perineal body
- Perineal membrane
The visceral and parietal fasciae meet and fuse as the organs pierce the pelvic floor, forming the….
Tendinous arch of the pelvic fascia
Facial thickenings on the pelvic floor that form uterine ligaments..
Tendinous arch of PF \+ Lateral ligament of the bladder \+ Paracolpium, divided into... - Uterosacral posteriorly - Transverse cervical / Cardinal ligament (carries uterine artery) laterally - Pubocervical anteriorly
Weakness of the ligaments and of the pelvic floor muscles may lead to ….
PROLAPSE
Which ligaments hold the uterus anteverted and anteflexed over the bladder?
Broad and round ligaments
Parts of the uterus?
Fundus, body and cervix
What are the fornices of the vagina?
Clinical importance?
The cervix pushes into the vagina forming the fornices
The posterior fornix is related to the peritoneal recto-uterine pouch of douglas
Clinical:
- Distensible
- Foreign bodies may get “lost”
- Peritoneal cavity may be accessed via the posterior fornix
The cervix:
The isthmus of the uterus leads to the _____ os and the narrow _____ of the cervix – about 2.5 cms long, with supravaginal and vaginal parts
The latter opens into the vagina as the external os and has the vaginal _____ around it
The isthmus of the uterus leads to the internal os and the narrow cylinder of the cervix – about 2.5 cms long, with supravaginal and vaginal parts
The latter opens into the vagina as the external os and has the vaginal fornices around it
Angulation of the:
- Cervix and body?
- Uterine cervix to vagina?
- Cervix and body = Anteflexed
- Uterine cervix to Vagina = AnteVerted
Retroversion and/or retroflexion may cause back-ache and difficulty in conception
Why is the vagina wall distensible?
For intercourse and childbirth
Vagina blood supply?
Anastomosing uterine and vaginal arteries (vesical arteries involved too)
Structure of vagina?
Angled upwards and backwards
Passes from cervix to vestibule, between labia minora
It’s anterior and posterior walls are in contact with each other, so it takes on an H-shape
Urethra embedded in anterior wall
When the vagina passing through levator ani and into the perineum, where it is surrounded by the…
Urethral or urethrovaginal sphincter
The ureter passes ______ to the uterine artery adjacent to the lateral fornices
The ureter passes inferior to the uterine artery adjacent to the lateral fornices
Vagina blood supply?
Superior vesical
Vaginal
Internal pudendal
Uterine arteri
Urethra blood supply?
Vaginal
Internal pudental
Structural features of females urethra:
Glands?
Journey?
External sphincter?
Many small mucous glands and lacunae, para-urethral glands and ducts near orifice
Passes through deep perineal pouch with external sphincter and then perineal membrane
Ext. sph. signet ring, marked anteriorly; other muscle is longitudinal to make shorter, wider urethra during micturition
Epithelium of the urethra:
Urinary but quickly becomes stratified squamous
Bladder and Urethra lymph driange to…
external and internal iliac nodes
Ovary lymph drainage?
Para-aortic nodes
Uterus and proximal vagina lymph drainage?
Internal iliac nodes
Uterine tubes lymph drainage?
Para-aortic (also to sup inguinal)
Distal vagina and urethra lymph drainage to..
Deep and superficial inguinal nodes
Sympathetic pre-aortic plexus, boosted by lumbar splanchnics from the sympathetic trunk continues as…
sup. hypogastric plexus, which becomes left and right pelvic plexuses, boosted by sacral splanchnics Essentially T12 to L2
Nerve supply of ovary and distal uterine tube?
Mainly via pre-aortic sympathetic from T10 and 11.
Pain to peri-umbilical region
Uterine body and proximal uterine tubes nerve supply?
Via branches of the pelvic plexus with the sympathetics mainly from T12 and L1.
Pain= Suprapubic
Pain from the uterine cervix and proximal vagina (i.e. structures inferior to the peritoneum, the “Pain Line”) is via ….
the parasympathetic pelvic splanchnics (and pelvic plexuses), therefore felt deeply in the pelvis
Distal vagina nerve supply?
Pudendal nerve
