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3002 > 72 Female pelvic viscera > Flashcards

72 Female pelvic viscera Flashcards

1
Q

What are the 2 layers of subcutaneous fascia/ subcutaneous tissue of the perineum?

A
  1. Superficial fatty layer - Camper’s fascia

2. Deep membranous layer - Colles’/ perineal fascia

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2
Q

What are Scarpa’s fascia and Camper’s fascia continuous with?

A
  • Scarpa’s fascia continuous with Colles’/ perineal fascia

* Camper’s fascia continuous with superficial fatty layer of the superficial fascia/ subcutaneous tissue of the perineum

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3
Q

What does the superficial fatty layer of the superficial fascia/ subcutaneous tissue of the perineum (Camper’s fascia) make up in female pelvis?

A

Makes up the substance of the mons pubis and labia majora

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4
Q

What does the deep membranous layer of the superficial fascia/ subcutaneous tissue of the perineum (Colles’/perineal fascia) contribute to in the female pelvis?

A

Contributes to the formation of the labia majora

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5
Q

What are the other names for uterine tube?

A
  • Fallopian tubes

* Salpinges

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6
Q

What structure does the vagina and urethra pass through?

A

Pelvic floor/ diaphragm and urogenital triangle of perineum

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7
Q

Where does obturator nerve lie in the female pelvis?

A

Lateral wall of pelvis (ovary lies just medial to it)

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8
Q

What does obturator fascia overlie and give rise to?

A
  • Overlying obturator internus

* Give origin to levator ani

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9
Q

What muscles are found in female pelvis?

A
  1. Pelvic floor/ diaphragm muscle:
    • Levator ani
    - S3, S4
    - Divided into iliococcygeus and pubococcygeus
  2. Lateral wall:
    • Puborectalis - sling around rectoanal junction to aid rectal continence
    • Pubovaginalis - “sphincter” around vagina for closure and general support of the urogenital organs
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10
Q

How is the broad ligament formed

A

• Peritoneum (2 layers) drapes over the bladder and then like a sheet over the uterus, uterine tube and ovarian ligaments to form the broad ligament from the uterus –> lateral pelvic wall

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11
Q

What structures hold the uterus anteverted and anterflexed over the bladder

A

Broad and round ligaments

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12
Q

What is the uterine tube contained within?

A

Uterine tube is contained within the superior margin of the broad ligament

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13
Q

What are the parts of the broad ligament?

A
  1. Mesosalpinx - part of broad ligament surrounding the uterine tube
  2. Mesovarium - part of broad ligament suspending the ovaries
  3. Mesometrium - part of broad ligament adjacent to the body of the uterus
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14
Q

What is the round ligament of the uterus a continuation of? What does it pass through?

A
  • Continuation of the ovarian ligament (both remnants of the gubernaculum)
  • Passes within the broad ligament from the uterus through inguinal canal –> labia majora
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15
Q

Position of ovary and its relations?

A

One on each side on lateral pelvic wall in an ovarian fossa in the angle between the internal and external iliac vessels immediately medial to the obturator nerve and the thin wall of the acetabulum

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16
Q

What may central dislocation of the hip injure?

A

Ovary

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17
Q

What is the function of the ovary?

A
  • Produces an ovum monthly in response to LH and FSH from the pituitary gland
  • Produces oestrogen and progesteron to maintain uterine cycle
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18
Q

Relation of ovary to peritoneum?

A

Peritoneum is absorbed into the ovarian wall

=> ovary = truly intraperitoneal (lies inside peritoneal cavity)

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19
Q

What does the ovary hang off of and supported by?

A

• Hangs off the posterior aspect of the broad ligament on the mesovarium • Supported by the ovarian ligament and suspensory ligaments

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20
Q

What is the suspensory ligament of ovary?

A

In the broad ligament and carrying the ovarian blood vessels

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21
Q

Relations of the ovarian ligament?

A

In the broad ligament and between the ovary and uterus

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22
Q

Where is the ovum secreted into from the ovary?

Risk?

A
  • Ovary on lateral pelvic wall with ovulation into the peritoneal cavity,
  • Ovum is “picked” up by the fimbriated end of the uterine tube

• Risk - as ovum is secreted into the peritoneal cavity, ectopic pregnancy may occur in the peritoneal cavity or in the uterine tube

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23
Q

Position of the ureter in relation to the ovary?

Risk?

A
  • Ureter lies posteriorly

* At risk during surgical procedures on the ovary

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24
Q

Position of the obturator nerve in relation of the ovary?

Risk?

A
  • Obturator nerve lies laterally

* Ovarian disease may cause referred pain to the medial thigh

25
Q

Blood supply of ovary?

A

Ovarian arteries (arise from aorta at L2)

26
Q

Nerve supply of ovary? Referred pain?

A
  • Sympathetic nerves derived from T10 and T11

* Referred pain - periumbilical region

27
Q

Venous drainage of ovary?

A

• Plexus of veins coalesces into the ovarian vein:

  1. Left ovarian vein drains –> left renal vein
  2. Right ovarian vein –> IVC
28
Q

Lymphatic drainage of ovary?

A

Para-aortic (lumbar) lymph nodes

29
Q

Sections of the uterine tube?

A
  1. Ostium (opening of uterine tube in infundibulum) surrounded by fimbriae (within the peritoneal cavity)
  2. Infundibulum
  3. Ampulla (where fertilisation occurs)
  4. Isthmus
  5. Intra-mural part through uterine wall
30
Q

Function of uterine tube?

A

Fertilisation of ovum and transport to uterus

31
Q

Uterus structural features?

A
  • Pear shaped, thick walled, muscular, central pelvic organ
  • Support of the uterus is hugely important (levator ani, perineal body, perineal membrane)
  • Fascial thickenings on the pelvic floor/ diaphragm (supportive uterine ligaments) that pass from the uterus + cervix –> sacrum, pubis + lateral pelvic walls
  • Anteverted and ante flexed to lie over the bladder
32
Q

Function of uterus?

A

Implantation of fertilised ovum and growth of foetus along with the placenta

33
Q

Uterine supportive ligaments

A
  • “Ligaments” derived from the membranous fascia that covers the organs (visceral) and pelvic floor/ diaphragm (parietal) as well as any intervening connective tissue
  • Visceral and parietal fasciae meet and fuse as the organs pierce the pelvic floor/ diaphragm forming the tendinous arch of pelvic fascia adjacent to the organs and running from pubis to sacrum
34
Q

What does weakness of uterine supportive ligaments and pelvic floor muscles lead to?

A

Prolapse

35
Q

How are the vaginal fornices formed?

A

Cervix pushes into the vagina forming the fornices (anterior and posterior)

36
Q

What is the posterior fornix related to?

A

Rectouterine pouch (of Douglas)

37
Q

Clinical importance of the vaginal fornices?

A
  • Fornices are distensible and foreign bodies may get “lost” there
  • Peritoneal cavity may be accessed via the posterior fronix
38
Q

Structure of cervix?

A
  • Internal os
  • Cervical canal
  • External os (with vaginal fornices around it)
39
Q

What does anteversion of uterus mean?

A

Refers to the angle (open anteriorly) between the vagina and cervix of uterus

40
Q

What does anteflexion of uterus mean?

A

Refers to the angle (open anteriorly) between cervix and uterus (body and fundus)

41
Q

What may retroversion and/ or retroflexion cause?

A

Backache and difficulty in conception

42
Q

Structure of vagina?

A
  • ~10cm in length
  • Angled upwards and backwards
  • Passing from cervix –> vulval vestibule between the labia minor
  • Anterior and posterior walls are in contact with each other
  • Lies anterior to the rectum but posterior to bladder
  • Urethra embedded in its anterior wall
43
Q

What structures does the vagina pass through?

A
  • Structures: Pass through levator ani (pelvic floor/ diaphragm)
  • Spaces: Pass through perineum (deep and superficial pouches of perineum) where it is surrounded by urethral sphincter and urethrovaginal sphincter (component of urethral sphincter next to the vagina)
44
Q

Ureter passes _____ to the uterine artery and _____ to the lateral fornices

A

Ureter passes inferior to the uterine artery and lateral to the lateral fornices

45
Q

Vagina blood supply?

A
  1. Uterine artery (ureter inferiorly)
  2. Superior vesical
  3. Vaginal
  4. Internal pudendal
46
Q

Female urethra blood supply?

A
  1. Vaginal

2. Internal pudendal

47
Q

Ovary blood supply?

A

Ovarian artery (from aorta at L2)

48
Q

Lymphatic drainage of uterus and proximal vagina?

A

Drain into internal iliac nodes

49
Q

Lymphatic drainage of uterine tube?

A

Drains into paraaortic (lumbar) but also pass to superficial ligament

50
Q

Structure of female urethra?

A
  • Pelvic ~4cm long and 6mm wide
  • Embedded in anterior wall of vagina
  • Many small mucous glands particularly in proximal urethra
  • Paraurethral glands and ducts in distal urethra are homologous to the prostate
  • Passes through deep compartment/ pouch of perineum with external urethral sphincter —> perineal membrane —> superficial compartment / such or perineum
  • External urethral sphincter - a ring with the other muscles being longitudinal to make the urethra short and wide during micturition
51
Q

Epithelium of female urethra?

A

Urinary but becomes stratified squamous

52
Q

Lymphatic drainage of female urethra?

A

Drains into external and internal iliac nodes

53
Q

Lymphatic drainage of distal vagina and female urethra?

A

Drains into deep and superficial inguinal nodes

54
Q

Nerve supply of pelvis?

A
  • Sympathetic trunk
  • Parasympathetic pelvic splanchnics (S2, S3, S4) —> pelvic plexus (aka inferior hypogastric)
  • Superior hypogastric plexus becomes left and right pelvic plexuses (aka inferior hypogastric) augmented by sympathetic sacral splanchnics
  • Somatic pudendal nerve (S2, S3, S4)
  • Sympathetic preaortic (prevertebral) plexus
  • Sympathetic and parasympathetic uterovaginal branched of the pelvic plexus
55
Q

Nerve supply of ovary and distal uterine tube?

Referred pain?

A
  • Mainly supplied via preaortic sympathetics derived from T10 and T11
  • Pain referred to the peri-umbilical region
56
Q

Pain from uterine body + fundus, and proximal uterine tube passes via what?
Referred pain?

A
  • Pain passes via branches of the pelvic plexus with the sympathetics mainly from T12 + L2
  • Pain referred to the suprapubic region
57
Q

What structures are above and below the pelvic pain line?

A
  • Intraperitoneal structures are above (sympathetic)

* Subperitoneal structures are below (PS)

58
Q

Pain from uterine cervix and proximal vagina is via what?

A
  • Pain via the parasympathetic pelvic splanchnics from S2, S3, S4 (and pelvic plexus)
  • Felt deeply in the pelvis
59
Q

Nerve supply of distal vagina?

A

Supplied by somatic pudendal nerve (S2, S3, S4)

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