8: Anatomy - female reproductive tract and breast Flashcards
In which cavity does the female reproductive system lie?
Pelvic cavity
Which space is found inferior to the levator ani muscle?
Perineum
What separates the pelvic cavity and the perineum?
Pelvic floor
levator ani, perineal muscles etc.
What type of peritoneum forms the floor of the peritoneal cavity and the roof of the pelvic cavity?
Parietal peritoneum
From anterior to posterior, which organs are found in the female pelvic cavity?
Bladder
Uterus
Rectum
In the female peritoneal cavity, which pouches are formed by the
a) bladder and uterus
b) uterus and rectum?
a) Vesico-uterine pouch
b) Recto-uterine pouch (of Douglas)
Which two pouches are found in the female peritoneal cavity?
Vesico-uterine pouch
Recto-uterine pouch
What is the most inferior part of the female peritoneal cavity?
Recto-uterine pouch
Which ligament connects the uterus to the walls and floor of the pelvis?
Broad ligament
What parts of the pelvic cavity are connected by the broad ligament?
Uterus
Pelvis walls and floor
What structures are contained within the broad ligament?
Uterine tubes
Proximal part of the round ligament
Which ligament, connecting the uterus to the walls and floor of the pelvis, contains the uterine tubes?
Broad ligament
What is the purpose of the broad ligament?
Keeps uterus in the midline
Which ligament’s proximal part is contained within the broad ligament?
Round ligament
Which structures are connected by the round ligament?
Uterus
Superficial perineum
Which structures does the round ligament pass through to connect the uterus and the superficial perineum?
Broad ligament
Deep inguinal ring
The (proximal / lateral) part of the round ligament is found in the broad ligament.
proximal part
What are the three layers of the uterus, from superficial to deep?
Endometrium
Myometrium
Perimetrium
What are the three layers of the uterus from deep to superficial?
Perimetrium
Myometrium
Endometrium
Which layer of the uterus is sloughed off during menstruation?
Endometrium
What are the two areas of the uterus?
Body
Cervix
The cervix is the space between which parts of the uterus?
Internal and external os
What area is found between the uterus and the perineum?
Vagina
Where in the uterus does implantation occur?
Body of uterus
Which ligaments attach the uterus to the sacrum?
Uterosacral ligaments
Which muscles form the floor of the pelvis?
Pelvic floor muscles
e.g levator ani
Inferior movement of the uterus is called uterine ___.
uterine prolapse
In which two positions can the uterus sit?
Anteversion
Retroversion
(Anteversion / Retroversion) is the most common uterine position in women.
Anteversion
What are the three important axes when determining whether the uterus is anterverted or retroverted?
Axis of the vagina
Axis of the cervix
Axis of the uterus
Is uterine retroversion normal?
Yes - normal variant
The walls of the vagina are usually (straight / collapsed).
collapsed
What device is used to hold the walls of the vagina apart during a gynae exam?
Speculum
What type of epithelium lines the vagina?
Squamous epithelium
What type of epithelium lines the cervix?
Columnar epithelium
At which point does the squamous epithelium of the vagina transition to the columnar epithelium of the cervix?
Squamocolumnar junction
Or ‘transformation zone’
At which structure is a smear inserted to sample the squamocolumnar junction?
External os of uterus
What is another name for the uterine tubes?
Fallopian tubes
Oviduct
What is another name for the Fallopian tubes?
Uterine tubes
Oviduct
Where in the uterine tubes does fertilisation occur?
Ampulla
Are the uterine tubes symmetrical?
No - length and curvature are different
What are the hairs of the uterine tube which collect the eggs from the ovaries?
Fimbriae
The fimbriae of the uterine tubes push the egg into which area?
Infundibulum (“funnel” - leads to the ampulla)
At their distal ends (nearest to the ovaries), what are the uterine tubes continuous with?
Peritoneal cavity
Why can infection pass between the female genital tract and the peritoneal cavity?
Uterine tubes are open-ended
What size are ovaries?
About the size of an almond
Similarly to the testes, where do the ovaries develop?
Posterior abdominal wall
Which ligaments are formed as the ovaries descend through the abdominal cavity to the pelvis?
Round ligaments
The walls of the vagina are made of ___ ___.
smooth muscle
At the superior end of the vagina, the cervix holds the vaginal walls apart in four places. What are these areas called?
Anterior, posterior and 2 lateral fornixes
What are the four parts of the vaginal fornix?
Anterior
Posterior
Left and right lateral
What bony features can be palpated on internal examination?
Ischial spines
What areas of the uterine tubes are closest to the uterus?
Adnexae
The adnexae are found at the (proximal / distal) ends of the uterine tubes.
proximal
The levator ani is a ___ muscle.
skeletal muscle
under voluntary control
Which muscle forms the majority of the pelvic floor?
Levator ani
Which specific nerves supply the
a) superior
b) inferior
aspects of levator ani? What are their nerve roots?
a) Superior - nerve to levator ani (S3-5)
b) Inferior - pudendal nerve (S2-4)
What does the levator ani do?
Relaxes in defaecation
Reflex contraction when intra-abdominal pressure increases
Physical barrier
The levator ani prevents ___ of the pelvic organs.
prolapse
Apart from the levator ani, which other muscles make up the pelvic floor?
Perineal muscles
Which nerve supplies the perineal muscles?
Pudendal nerve (S2,3,4)
Where do all the perineal muscles originate from?
Perineal body
The perineal body acts as the origin of which muscles?
Perineal muscles
When can the perineal body be damaged?
What happens as a result?
Childbirth
Incontinence / prolapse
Which glands are found in the perineum, just inferior and lateral to the vaginal orifice?
Bartholins glands
What is the other name for the Bartholins glands?
Greater vestibular glands
What is the function of the Bartholins glands?
Produce lubrication
What is the difference between the vestibule and vaginal orifice?
Vaginal orifice surrounds vagina only
Vestibule surrounds vaginal orifice and external urethral orifice
Which ribs do the breasts cover?
Ribs 2 - 6
Which space exists between the breast and the pectoralis muscles?
Retromammary space
Where does 75% of lymph from the breast drain to?
Axillary nodes on the same side
Where does lymph from the inner breast quadrants (upper inner and lower inner) drain?
Parasternal nodes on the same or contralateral sides
Where can lymph from the lower inner breast drain?
Parasternal nodes
OR
Abdnominal nodes
Where does lymph from the axillary and parasternal nodes drain to?
Supraclavicular nodes
Axillary lymph nodes supply both the breasts and upper limbs. They are surgically cleared out for some types of breast cancer.
What muscle are the different levels of axillary nodes described in relation to?
Pectoralis minor
Which branches of the subclavian artery supply the breast?
Axillary artery
Internal thoracic/mammary artery
Which specific branches of the subclavian artery supply the breast?
Axillary artery
Internal thoracic artery
Which branches of the subclavian artery supply the
a) upper and lower INNER
b) upper and lower OUTER
quadrants of the breast?
a) Internal thoracic artery supplies inner quadrants
b) Axillary artery supplies outer quadrants
Via which vaginal structure can fluid be drained from the rectouterine pouch?
What is this procedure called?
Posterior fornix
Culdocentesis
The broad ligament is made of which material?
Peritoneum
The broad ligament can be divided into different sections depending on the structures it envelops.
What are these three sections?
Mesosalpinx - surrounding uterine tubes
Mesovarium - surrounding ovary
Mesometrium - surrounding uterus
The broad ligament (is / isn’t) a peritoneal formation.
IS a peritoneal formation
The round ligament (is / isn’t) a peritoneal formation.
ISN’T a peritoneal formation
Embryological remnant (of the gubernaculum, which the ovaries descended through from the posterio abdominal wall)
Which embryological structure allows the testes and ovaries to descend from the posterior abdominal wall to the pelvis?
Gubernaculum
Which ligament is thought to contribute to the anterverted, anteflexed position of the uterus in most women?
Round ligament
Which infection can be mimicked by infection tracking through the right uterine tube?
Appendicitis
Which part of the vagina is culdocentesis performed via?
Posterior fornix
Which triangle is made by the right and left ischial spines and the pubic symphysis?
Urogenital triangle
What is the central focus of most of the pelvic floor muscles called?
Perineal body
The vaginal and external urethral orifices are found in which area of the perineum?
Vestibule
Which breast quadrant is the axillary tail found in?
Upper outer quadrant
Which hormones are responsible for
a) production of breast milk
b) ejection of breast milk?
a) Prolactin
b) Oxytocin
If pathology is found in one breast, what should you do first?
Examine the other breast
As parasternal lymph node pathology can track to contralateral breast
Check both axillae for lumps (axillary node invasion)
What is the clinically significant venous drainage of the breast?
Why?
Intercostal veins
Drain posteriorly, allowing breast cancer to spread to the thoracic spine
