30. Applied Anatomy of the Female Reproductive System Flashcards
What artery supplies the pelvic viscera?
What 3 arteries exit the pelvis?
Describe the course of the brancehes of the abdominal aorta.
What are the branches of the pudendal artery?
Internal iliac. (Not obturator).
Superior and inferior gluteal, internal pudendal.
Abdominal aorta bifurcation at L4 to internal and external iliac. Internal iliac bifurcates to superior and inferior gluteal, obturator, pudendal (and umbilical (obliterates - becomes medial umbilical folds in anterior abdominal wall), inferior vesical and middle rectal). External iliac becomes femoral.
Arteries of perineum, inferior rectal, perineal, dorsal clitoris/penis.
NB: ‘vesicle’ = bladder
Where is the most common location of an extopic pregnancy?
List some symptoms of an ectopic pregnancy.
Where can a metastasis from ovarian cancer go?
Ampulla of fallopian tubes. Other places incl. isthmic (most likely to rupture), cervical, cornual.
Light vagainal bleeding, nausea and vomiting + pain, lower abdo pain/cramps, pain on one side of body, dizziness/weakness, shoulder/neck/rectum pain.
Peritoneal cavity -> liver.
Label A-E of the female reproductive tract.
A) uterine artery
B) ovarian artery
C) vaginal artery
D) spiral arteries
E) suspensory ligament
List the 4 ligaments of the uterus.
What is the assocaition of the ureter to the uterine artery?
Broad ligament (wide fold of peritoneum, connects sides of uterus to walls and floor of pelvis), ovarian ligament (connects ovary to lateral surface of uterus), round ligament (originates at uterine horns, enters pelvis via deep inguinal ring, passes through inguinal canal and continues on to labia majora), suspensory ligament (houses the ovarian vessels).
Ureter passes under the uterine artery (water passes under bridge). Sometimes damaged in surgical proceedures.
Label A-F
A) ureter
B) ligament of ovary
C) round ligament of uterus
D) ovarian artery and vein
E) suspensory ligament of ovary
F) broad ligament of uterus
Label 1-7 in this laproscopic view of the uterus.
1) uterus
2) round ligament
3) ovarian ligament
4) uterosacral ligament
5) ovary
6) suspensory ligament of the ovary
7) ureter
* 6 accompanied by 7*
Label A-D
A) uterine artery
B) inferior gluteal artery
C) vaginal artery
D) internal pudendal artery
Label A-F on the posterior view of the uterus.
A) suspensory ligament
B) ovarian/round ligament
C) broad ligament
D) isthmus
E) ampulla
F) infundibulum
What are the supports of the uterus?
What is the space behind the uterus called? And in front?
How does the round ligament assist the uterus?
What does the pelvic floor seperate?
What forms the pelvic floor?
Transverse cervical (cardinal) ligaments (largest), pubocervical ligaments x2, sacrocervical ligaments. Also levator ani and perineal body.
Rectouterine pouch/pouch of Douglas behind. Vesicouterine pouch infront.
Holds it in anteverted (leaning) and anteflexed (bending) position.
Main pelvic cavity (above) and perineum (below).
Levator ani muscles, coccygeus muscles and their covering fascia. Incomplete anteriorly in females - urethra and vagina.
What is the levator ani composed of?
Sphincter vaginae/levator prostatae (sling around vagina/prostate and insert into perineal body). Puborectalis (maintains anal canal angle), pubococcygeus, iliococcygeus. JOIN AT MIDLINE RAPHE.
Label A-D.
A) piriformis
B) ischial spine
C) coccygeus
D) levator ani
Label A-C.
A) lumbosacral trunk
B) obturator nerve
C) pudendal nerve
PSN: pelvic cplanchnic nerves (cut), parasympathetic to inferior hypogastric plexus
Label A-E of this female pelvic floor.
A and B) puborectalis, pubococcyygeus
C) Iliococcygeus
D) Coccygeus
E) piriformis
When do retroverted and retroflexed uteruses commonly occur?
Where does the speculum go in a smear test?
How might the pelvic floor get injured, and what might this cause?
Women who have had >1 pregnancy. Cause more painful intercourse and mestruation.
Into fornices so smear taken from around external os.
Difficult childbirth - levator ani muscles fail to recoil and take up previous position: uterine and vaginal prolapse, bladder herniation (cytocele), alteration of bladder neck position (stress incontinence), rectal prolapse. Antenal classes and pelvic floor exercises.
NB: ONE OF MAIN CAUSES of uterine prolapse = DAMAGE TO CARDINAL LIGAMENTS rather than levator ani.
What does the female superficial pouch contain?
What passes through the pudendal canal?
Describe the course of the pudendal nerve. What branches does it give off?
3 masses of erectile tissue: bulb of vestibule, crura of clitoris. 3 muscles: bulbospongiosus, ischiocavernosus, superficial transverse perineal muscle. Bartholin’s gland. Perineal body.
Pudendal nerve (off sacral plexus), internal pudendal artery/vein (from internal iliac artery).
Exits pelvis through greater sciatic foramen, passes over sacrospinous ligament, and reenters the pelvis through lesser sciatic foramen. Gives off inferior rectal nerve, dorsal nerve of penis/clitoris and perineal nerve.
Label the following.
1) superficial pouch (erectile tissue + associated muscles)
2) deep pouch (deep perineal muscles and EUS (and Cowper’s glands in male))
A) levator ani
B) Colles’ fascia
C) round ligament
D) perineal membrane
E) urogenital diaphragm
F) obturator internus
Label A-E. What do A and B do?
A) bulbospongiosus - reduces size of vaginal orifice, compresses dorsal vein of clitoris
B) ischiocavernosis - assists in clitoral erection
C) superficial transverse perineal
D) Bartholin’s gland
E) bulb of vestibule
What do general visceral afferents do? Can they detect pain?
What 3 types of anaesthesia can be given during birth?
Conduct impulses from organs, glands and BV which travel via sympathetic and parasympthetic neurons. Unconscious of most of these impulses (visceral pain). Nocioception in viscera can cause pain if GVA travels with sympathetic nerves - impulses reach SC through sympathetic path via T1-5 from thoracic viscera and T5-L2 for abdomen. GVA impulses travel with parasympathetic splanchnic nerves in the pelvis S2-4.
1. Spinal anaesthesia: Subarachnoid space L4-5. Complete anaethesia below waist.
2. Pudendal nerve block: Peripheral nerve block S2-4 - perineum and lower 1/4 vagina - mum can feel/assist contractions.
3. Caudal epidural block: anaesthetic administered to catheter in sacral canal.
