2. Anatomy & histology of the female reproductive system Flashcards
Where is the tunica albuginea located in the ovaries??
Forms part of the fibrous outer structure
What encloses the ovaries?
Parietal peritoneum
What are the follicles within the ovaries stimulated by?
Stimulated by FSH to produce a primary follicle, which will mature to release an ovum
What do ovarian cysts develop from?
From follicles within the ovaries
What are 2 complications of ovarian cysts?
Torsion, rupture.
Where do ovarian tumours most commonly arise from?
Epithelial component or from germ cells
Why do women get sharp pains during ovulation?
Mature follicle must rupture through the peritoneum covering, causes disruption of sensory nerves
Why do nuns tend to get ovarian cancer?
every time a follicle ruptures the capsule, Damage to the capsule, mitosis for repair gives chance for carcinogenesis. Nuns never get pregnant, ovulation never interrupted - pregnancy stops ovulation for a period of time
What structure allows passage of ovarian vessels and what are they?
suspensory ligament of the ovary allows passage of the ovarian artery and vein to the ovary
Where do the ovarian vessels originate and drain?
Same as testicular vessels. Arteries directly from the abdominal aorta, below renal arteries. Right ovarian vein drains into IVC, left drains into left renal vein
What is the top of the uterus called?
fundus
What are the 2 parts of the uterus?
body and cervix
how might a patient with an ovarian cyst present?
bloating
pain - could rupture or twist - can occlude blood vessel
dyspareunia
What are the 2 pouches?
Vesicouterine pouch, rectouterine pouch
What is the external and internal opening of the cervix called?
External and internal os
What type of epithelium lines the cervix and what does it produce?
Simple columnar, produces cervical mucus, which changes in consistency and pH depending on the menstrual cycle to help facilitate or prevent entry of sperm
What is the transitional zone close to the external os?
Zone where epithelium changes from simple columnar to vaginal epithelium (stratified squamous).
What is the clinical significance of the transitional zone?
Most risk of malignant changes`What are the vaginal fornices?
What are the vaginal fornices?
Arches created by the cervix projecting into the vaginal canal.
What is cervical ectropion?
Cervical ectropion (or cervical erosion) is a condition in which the central (endocervical) columnnar epithelium protrudes out through the external os of the cervix and onto the vaginal portion of cervix, undergoes squamous metaplasia, and transforms to stratified squamous epithelium. * (it's indistinguishable from cervical cancer, so further testing is required for differential diagnosis!!!!!)
What compression effects can expansion of the uterus during pregnancy cause?
Constipation, urinary frequency, gastro-oesophageal reflux, pain
What are the different parts of the fallopian tube?
Fibrae, infundibulum, ampulla, isthmus
What is the most common site of fertilisation?
Ampulla
What is the function of the fimbrae and what feature do they have to help?
Have large surface area to catch the ovum in the peritoneal cavity and channel it to the infundibulum
why does the fimbrae need to catch the ovum?
the ovaries and uterine tubes are open to the peritoneal cavity so the egg is released into the peritoneal cavity before being picked up by fimbrae
What enables transport of the ovum in the fallopian tube?
Cells are lines with cilia.
What is an ectopic pregnancy and where is the most common place for it to occur?
implantation Occurs outside the uterine wall, most commonly in the fallopian tube (97%). Other places: interstitial, cervical, fimbral, ovarian, peritoneal
why can ectopic pregnancy lead to haemorrage?
the embryo will try to get nourishment for itself by invading surrounding tissues and eroding blood vessels.
Ectopic pregnancy is a medical emergency. The fallopian tubes are not adapted for implantation, and therefore the pregnancy is not viable
when can the fallopian tubes get blocked and what does uit lead to?
due to scarring in chronic infection, leading to infertility.
What is pneumoperitoneum and can it occur in women?
Free air in the peritoneum, air enters through the vagina and enters the fallopian tubes which open directly into the peritoneal cavity.
what part of the uterus expands during pregnancy?
fundus
what is the fundus covered by?
parietal peritoneum.
what are the ligaments around the uterus?
- The round ligament
- The ligament of the ovary (continuous with the round ligament)
- The broad ligament
What is the broad ligament?
Double fold of the peritoneum that attaches the uterus, fallopian tubes, and ovaries to the pelvis
What are the different parts of the broad ligament?
- Mesovarium - surrounding the ovary
- Mesometrium - between the pelvic wall and the uterus
- Mesosalpinx - surrounding the fallopian tube
What is the suspensory ligament?
Extends outwards from the ovary to the lateral abdominal wall. Fold of the peritoneum, contains ovarian vessels, and nerves.
Anchors ovary to lateral abdominal wall.
What is the ovarian ligament?
Attaches to the ovary inferiorly. It connects the ovary to the side of the uterus.
What are the ovarian ligament and Round ligament remnants of?
Gubernaculum
What is the round ligament?
Remnant of gubernaculum, originates at the uterine horns (point where fallopian tube enters uterus)and attaches to the labia majora, passing through the inguinal canal.
Function of broad ligament?
attaches uterus to pelvic side walls.
Function of suspensory ligament?
akes ovarian vessels (artery/vein) to and from ovaries. Comes from broad ligament.
What is the blood supply to the uterus and vagina?
Uterine artery, vaginal artery
Where does the uterine and vaginal artery originate from?
Anterior branch of the internal iliac artery.
What is the relationship between the uterine artery and ureter?
Ureter passes under the uterine artery
water under the bridge
What is the normal angle between the uterus and cervic and vagina called?
Between uterus and cervix is anteflexion, between cervix and vagina is called anteversion (if angle <180, if more then its retro)
What is the uterus comprised of?
Smooth muscle (myometrium) and epithelial layer (endometrium)
What epithelial cells line the endometrium?
qSimple columnar epithelium
where does the uterine artery pass?
between the layers of the broad ligament
What is endometriosis?
Growth of endometrial tissue in sites other than the uterine cavity
Where may endometriosis occur?
Pelvic cavity (most common), uterosacral ligaments, pouch of douglas, rectosigmoid colon, bladder, distal ureter
What are common symptoms of endometriosis?
Dysmenorrhoea, Dyspareunia, Cyclical or chronic pelvic pain, Subfertility.
Define Dysmenorrhoea and Dyspareunia
Painful period pain, painful sex
What is the clinical significance of the rectouterine pouch (pouch of Douglas)?
Btwn the rectum and uterus posteriorly. Can be site of fluid collection (infection or haemorrhage). Can also be used for peritoneal dialysis through pouch, in end stage kidney failure patient.
Keep eye on fluid by doing digital examination of vagina and have one hand on her stomach.
What clinical test can you do for ectopic pregnancy?
Blood SERUM beta hcg test (bit different to normal pregnancy test). Also used for HPV testing in men.
Explain why pain may be felt at the shoulder tip following rupture of an ectopic pregnancy?
Internal bleeding irritates phrenic nerve (that innervates diaphragm). Radiates to shoulder tip/blade.
Why must you watch out for bleeding during a hysterectomy?
Uterus close to the anastomoses if the uterine artery and vaginal artery and surgeon could cut this and cause bleeding.
Explain why the ureter is in danger of being damaged during `hysterectomy?
Ureter is very close to uterus. Ureter passes through parametrium of vagina.
What is the epithelial lining of the vagina?
Stratified squamous epithelium
How does the vagina regulate its pH?
contains lactobacilli which metabolise glycogen to produce lactic acid, keep the environment acidic to prevent infections such as candida
What contributes the external genitalia?
Labia majora and labia minora
What structures contribute to the vulva?
Labia majora, labia minora, clitoris, vestibule, external urethral opening, paraurethral gland, vaginal opening, greater vestibular glands
What structure is the clitoris under and what tissue is it formed from?
Clitoral hood, corpora cavernosa.
