2 - Female Reproductive System Flashcards
Label the parts of the female reproductive system.
What is the blood supply to the female reproductive system?
- Ovarian artery from abdominal aorta below renal artery.
- Anastomoses between uterine and vaginal so could be issues with bleeding in hysterectomy
- Also internal pudendal artery
Why are nuns more likely to get ovarian cancer?
- Capsule of peritoneum that is damaged at ovulation by rupturing follicle
- Scarring and causes chance for mutation as proliferating
- Nuns don’t take OC pill so have more ovulations
How might someone with an ovarian cyst present?
- Discomfort on intercourse
- Pain
- Bloating
- More likely to lead to torsion and occlusion of blood supply
Label the different parts of the uterus and the uterine tubes?
What can you feel in the fornices when doing a vaginal exam?
Lateral: levator ani
What does a cervix look like if you were to put a camera up the vagina?
- Looks like glans penis, external os is like the wee hole. Os bigger if had a child.
- Os may be inside out due to pregnancy and OC pill
- Cervical cancer will look red and nasty on cervix
Why might a pregnant woman feel pain?
Round ligament (remnant of gubernaculum) is being stretched and this attaches from the uterine horns to the labia majora
What is the issue with the uterine tubes being open into the peritoneal cavity?
Bacteria can track up the vagina and uterine tubes and end up with peritonitis
Explain the attachments of the main ligaments of the female reproductive system?
- Broad: Flat sheet of peritoneum, from lateral walls and folds over the internal female genitalia, covering their surface anteriorly and posteriorly. Split into three
- Round: Uterine horns to labia majora. Remnant of gubernaculum
- Suspensory: from ovary to wall. Neurovascular pathway and tents peritoneum
- Ligament of ovary: ovary to uterus
How is the broad ligament split into three?
Mesometrium: mesentry of uterus
Mesovarium: mesentry of ovaries
Mesosalpinx: mesentry of tubes
How can the bladder move up if it is constricted by the peritoneum?
Peritoneum does not cover the anterior bladder so it can move up
What is the normal angle of the cervix with the vagina and the uterus?
- Anteverted, Anteflexed
- Round ligament pulls fundus forward
When giving birth and a mother has a tear, what part of the vagina is tearing?
Fourchette
What are the four types of femal genital mutilation?
Type 4 is things like piercings
What are the health risks with FGM?
Female genital mutilation (FGM) is a procedure where the female genitals are deliberately cut, injured or changed, but there’s no medical reason for this to be done.
Complete the following table.
What is the general pathogenesis behind polycystic ovaries?
Ovarian cysts derived from follicles form. Can be asymptomatic or can cause torsion/rupture. To be polycystic have to have over 10 - common cause of infertility
What is the common origin of tumours of the ovary?
From germinal epithelium (modified mesothelium cuboidal)
How does the ova travel down the uterine tube and what are some causes of infertility due to dysfunction of this?
- Cilia and mucus secreting Peg cells
- Scarring from ectopic pregnancy or a chronic infection like chlamydia
- Adhesions from endometriosis
What are some risk factors for an ectopic pregnancy?
- IUD
- Endometriosis
- PID
- Blocked fallopian tube
- Immotile cilia
What is the clinical significance of the vesicouterine and the rectouterine pouch?
Fluid collection can occur here, e.g in haemorraghe or infection
What are the layers of the uterus? And what is the type of cell in the innermost layer?
Endometrium is simple columnar, same as the cervix
What is endometriosis?
Ectopic endometrial tissue is dispersed to different sites in peritoneal cavity.
Can attach to ovaries and uterus and associated with severe dysmennorhea and infertility
What do the epithelia in the cervix do?
- Simple columnar
- Secrete cervical mucus, changes in consistency and pH depending on menstraul cycle to help or hinder entry of sperm
What is the purpose of the epithelia in the vagina?
- Stratified squamous containing lots of glycogen
- Lactobacilli regulate pH and keep environment acidic so no thrush
- Adapted to expand and resist friction but cannot lubricate so depends on cervix
What are the common sites of ectopic implantation, with most common first?
- Ampulla
- Isthmus
- Fimbrae
- Cornual
Where would you mainly feel pain with ectopic pregnancy in ampulla?
- Iliac fossa - compression of structures
- Shoulder tip (on rupture): irritation of phrenic nerve, referred pain
Why is ectopic pregnancy a gynaelogical emergency?
Lots of anastomoses between vaginal and uterine arteries
Why are the ureters at risk during a hysterectomy?
Ureters cross the uterine arteries which need to be ligated so may clamp them
How might a retroverted retroflexed uterus present?
Painful sex or asymptomatic
What is the innervation of the different parts of the female genitalia?
What would the histology of the vagina be like?
- Mucosa, submucosa and muscular layer
- Non-keratinised stratified squamous
- Lots of glycogen (bright pink) for metabolism by lactobaccili to maintain acid pH
- No glands as lubrication from cervix
What would the histology of the cervix be like?
- Simple columanr with sharp change to vaginal epithelium at entrance to external os
- Lots of mucosal glands
- Transformation zone changes location in life
What is the histology of the uterus?
Simple columnar
How can the endometrium be split up into different areas?
- Stratum Basalis
- Stratum Functionalis: outer compact and deeper spongy layers
- Functional layer stripped away in menstruation and replaced by basal layer (cells next to the glands)
Identify where in the menstrual cycle each of these histological slides are (endometrium).
1 - Proliferative stage under influence of oestrogen. Stratum functionalis ncrease in length as cells grown from the glands in basalis
2 - Secretory phase where glands grow bigger and more coiled into the lamina propria. Saw tooth appearance. Empty spaces due to stromal oedema. Decidual cells where can only see nucleus
3 - Menstraul phase where progesterone levels drop so endometrium breaks down. Spasm of coiled arteries in stratum functionalis so lack of nutrients so these cells die. Coiled arteries don;t go into the basalis
What is the histology of the fallopian tubes?
- Inner mucosa and a serosal layer. Folding in the lumen
- Ampulla has two muscle layers, isthmus has three and is bigger
- Ampulla has lots of cilliated cells, increase in peg cells towards uterus
What is a peg cell?
- Non-ciliated epithelial cell within the uterine tube.
- Capacitate sperm
- Give nutrients to the oocyte
- Inhibits microorgansms getting into peritoneum
What are the layers of the urogenital triangle?
