1 - Pelvic Viscera II (Female) Flashcards
What is the anterior-inferior border of uterus?
Posterior?
Bladder
Rectum
What are the internal os and extern os of the uterine cervical canal?
Internal leads to uterine cavity
External leads to lumen of vagina
What is the normal position of the uterus?
Horizontal, fundus pointing anterior
Anterversion - long axis of cervix bent anterior to long acis of vagina and 90 degrees
Anteflexion - Log axis of body of uterus bent anterior relative to long axis of cervix
What can be associated with abnormal position of uterus?
Retroverted Uterus
Retroflexed Uterus
Dyspareunia (pain during intercourse)
Dysmenorrhea (pain during menstruation)
Retroverted = Long axis of cervix in line with long axis of vagina (vertical w/vagina)
Retroflexed = Posterior bend, lies in rectouterine pouch
What is the anterior peritoneal covering of the uterus?
What is the Vesicouterine Pouch?
Covers w/exception of cervix (reflected onto bladder)
Part of peritoneal cavity
Floor of the peritoneal refelction from the cervix to the bladder
What is the posterior peritoneal covering of the uterus?
Peritoneal reflection from rectum to upper part of vagina and uterus forms floor of Rectouterine Pouch (of Douglas) of peritoneal cavity
What are the four parts of the Broad Ligament of Uterus (lateral peritoneum)
Mesometrium - Majority of ligament lateral to uterus and inferior to mesovarium
Mesovarium - From posterior layer of broad ligament associated with ovary
Mesoalpinx - Inferior to uterine tube
Suspensory Ligament of Ovary - Upper lateral part of broad ligament; suspends ovary from lateral pelvic wall; contains neurovascular supply to ovary
What are the contents of the broad ligament?
What make up the Distal Part of Gubernaculum? (remnants)
What makes up the Proximal Part of the Gubernaculum? (remnants)
Uterine Tube - free upper border of ligament
Round Ligament of Uterus - Remnant of distal part of gubernaculum attached to lateral side of uterus; passes through inguinal canal to labium majora (UTERUS TO INGUINAL CANAL - LABIUM MAJORA)
Round Ligament of Ovary (Ligament of Ovary) - Remnant of proximal gubernaculum attached to lateral uterus; attached to ovary (UTERUS TO OVARY)
Uteran Artery and Vein and Ovarian Artery and Vein, lymphatics, nerves; all anastomose
What level does the uterine artery pass superior to the ureter?
Clnical: Hyserectomy?
What branch comes off this?
Cervix
During hysterectomy (removal of uterus) Ligate the arter, NOT ureter
Has vaginal branch
What is the lymphatic drainage from the fundus?
What is the lymphatic drainage from body/cervix?
Lumbar (para aortic) Lymph nodes (UPPER = LUMBAR)
Iliac Lymph Nodes (LOWER = ILIAC)
What can contribute to the prolaps of uterus into vagina or protruding of urinary bladder or rectum against vaginal wall?
What are the named structures and locations for the above?
Stretching of ligaments of Cervix of Uterus
- Cardinal Ligaments - Lateral Vagina/Cervix to Lateral Pelvis; located at base of broad ligament
- Vesicouterine Ligament - Bladder to Uterus
- Uterosacral Ligament - Sacrum to Cervix (beneath pouch of douglas); CAN BE PALPATED during rectal exam
Cystocele?
Rectocele?
Bladder bulges against anterior wall of vagina
Rectum bulges against posterior wall of vagina
Childbirth can cause weakening of pelvic diaphragm by stretching pelvic diaphragm and ligaments of uterus
Uterine Tube parts
Infundibulum
Ampulla
Isthmus
Uterine Part
Infundibulum - Location of fimbria
Ampulla - Fertilization
Isthmus - Short narrow, medial to ampulla
Uterine - short intramural sgement entering within wall of uterus
What is blood supply and lymphatics of uterine tube?
Blood = Uterine and Ovarian Arteries
Lymph - Lumbar, Internal Iliac nodes
(Fundus = Lumbar, Body/Cervix = Internal Iliac)
What peritoneal covers the uterine tubes?
Mesosalpinx
What can lead to spread of infection form uterus/vagina to peritoneal cavity?
What can a blockage of uterine tube cause?
What is a Hysterosalpingography?
What is a second form of ectopic pregnancy?
Opening of uterine tube to peritoneal cavity
Blockage of Uterine Tube can cause infertility; result of adhesions from healed infections; can result in Ectopic Tubal Pregnancy; leading to rupture and hemorrage
Hysterosalpingography - Radiography of uterus and uterine tubes following injection of radiopaque material to determine patency of tubes
Opening of uterine tube to peritoneal cavity can result in oocytes passing into cavity and impanting in peritoneum
What is the fibrous capsul of the ovary?
Normal location of ovary? Boundaries?
Why can ovary disease cause thigh pain?
Tunica Albuginea
Ovarian Fossa on lateral wall of pelvis
Superior - External Iliac Vessels
Inferior - Internal Iliac Vessels and Ureter
Passes righ over Obturator Nerve
What two ligaments contain ovarian neurovascular bundles?
Suspensory Ligment
Mesovarium
Where doe Ovarian Arteries arise form?
What do they cross over and enter?
Anastomose with?
Aorta at L2
Cross over External Iliac Vessels to enter Suspensory Ligament of Ovary
Anastomose with Uterine Artery
What is an Ovariectomy?
Ovarian Vessels ligated as they cross pelvis brim and external iliac vessels; do not ligate ureter at this location
What is the venous drainage of the ovaries?
What are the lymphatics of the ovary?
Right - IVC
Left - Left renal vein
W/Fundus to Lumbar Lymph Nodes
Where does the superior half of the vagina lie?
Inferior?
What is the inferior end of vagina originally covered by?
Superior = Above Pelvic Diaphragm
Inferior = Below Pelvic Diaphragm
Hymen
What can be examined during manual vaginal exam:
Anterior
Posterior
Lateral
Anterior: Cervix, Posterior Bladder, Urethra
Posterior: Rectouterine Pouch, Amulla of Rectum, Perineal body
Lateral: Uterine Artery, Ureter, levator Ani, Ovary (if abnormal), urogenital diaphragm, bulbs of vestibule
What is important about the Posterior Fornix in relation ot the Rectouterine Pouch?
Access for drainage of infected peritoneal fluid, Culdocentesis is removal of fluid from rectouterine pouch by intentional puncture
Bad abortion can easily puncture the posterior vaginal wall w/sharp instrument
What is the blood supply to the vagina?
Lymphatics?
Vaginal Artery forms vagina venous plexus and vaginal branch of uterine artery
Upper 1/3 = External/internal Iliac Nodes
Middle 1/3 = Internal Iliac Nodes
Lower 1/3 = Superficial Inguinal Nodes
