Anatomy Flashcards
Key components of a gynae history
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Define mammary glands
Modified sweat glands
- consist of ducts and secretory lobules
- each lobule consists of many alveoli drained by a single lactiferous duct
- ducts converge at the nipple
Blood supply to breasts
Medial aspect = internal thoracic artery
Lateral aspect
- lateral thoracic and thoracoacromial branches
- lateral mammary branches
- mammary branchesLymphatic drainage of the breast
Axillary - 75%
Parasternal - 20%
Posterior intercostal - 5%
Structures of the vulva
Mons pubis Labia majora Labia minora Vestible Batholin's glands Clitoris
Define mons pubis
Subcut fat pad located anterior to pubic symphysis
- formed by fusion of labia majora
Define labia majora
- hair-bearing external skin folds
- extend from mons pubis to posterior commissure
- embryologically derived from labioscrotal swellings
Define labia minora
- hairless skin folds which lie within the labia majora
- fuse anteriorly to form hood of clitoris, fuse posteriorly to form fourchette
- embryologically derived from urethral folds
Define vestible
- area enclosed by labia minora
- contains opening of vagina and urethra
Define Bartholin’s glands
- secrete lubricating mucus from small ducts during sexual arousal
- located either side of vaginal opening
Define clitoris
- located under clitoral hood
- formed of erectile corpora cavernosa tissue
- engorges with blood during sexual stimulation
- embryologically derived from genital tubercle
Vascular supply and lymphatics of vulva
Internal and external pudendal arteries
Drainage via pudendal veins
Lymph drainage to superficial inguinal lymph nodes
Innervation of vulva
Anterior - ilioinguinal nerve - genital branch of genitofemoral nerve Posterior - pudendal nerve - posterior cutaneous nerve of thigh
Histology of the vagina (internal to external)
Stratified squamous epithelium
- provides protect
- lubricated by cervical mucus
Elastic lamina propria
- dense connective tissue layer
- projects papillae into overlying epithelium
- location of large veins
Fibromuscular layer
- two layers of smooth muscle
- inner circular and outer longitudinal layer
Adventitia
- fibrous layer
- provides additional strength to vagina
- binds to surrounding structuresAnatomical position of vagina
Anterior - bladder and urethra
Posterior - rectouterine pouch, rectum and anal canal
Lateral - ureters and levator ani muscle
Anatomical structure of vagina
Fibromuscular tube
- anterior and posterior walls normally collapsed and in contact with each other
Posterior fornix
- acts as reservoir for sperm - liquefies in 20-30 mins allowing for easier permeation through cervical canal
Vascular and lymphatics for vagina
Uterine and vaginal arteries - branches of internal iliac artery Venous return via vaginal venous plexus - drains into internal iliac vein Lymphatic drainage - superior -> external iliac nodes - middle -> internal iliac nodes - inferior -> superficial inguinal lymph nodes
Anatomy of cervix
Ectocervix - projects into vagina
- lined by stratified squamous non-keratinised epithelium
- opening is external os
Endocervical canal - proximal
- lined by mucus-secreting simple columnar epithelium
- uterine cavity begins at internal os
Functions of the cervix
Facilitate passage of sperm Maintains sterility of upper reproductive tract - frequent shedding of endometrium - thick cervical mucus - narrow external os
Venous and lymphatics of cervix
Uterine artery
Venous drainage by plexus in broad ligament -> uterine veins
Lymphatic drainage via iliac, sacral, aortic and inguinal lymph nodes
Anatomy of the uterus
Fundus - top of uterus above entry point of uterine tubes
Body - usual site for implantation of blastocyst
Cervix - lower part of uterus linking to vagina
Anatomical position of uterus
Anteverted - angle of cervix compared to vagina
- uterine fundus anterior and cervix posterior
Retroverted
- backwards tipping of uterus
Anteflexed - angle of body of uterus and cervix
- forward/downward bending of body of uterus
Retroflexed
- bending backward of the body of the uterus upon the cervix
Histological structure of uterus
Peritoneum - double layered membrane continuous with abdominal peritoneum
Myometrium - thick smooth muscle layer
- cells undergo hypertrophy and hyperplasia during pregnancy in preparation to expel fetus at birth
Endometrium - inner mucous membrane lining uterus
- deep stratum basalis - changes little throughout menstrual cycle and not shed
- superfical stratum functionalis - proliferates in response to oestrogens and becomes secretory in response to progesterone
- shed during menstruation and regenerates from cells in stratum basalis layer
Ligaments of the uterus
Broad ligament - double layer of peritoneum attaching sides of uterus to pelvis
- acts as mesentery and contributes to maintenance of position
Round ligament - remnant of gubernaculum
- functions to maintain anteverted position of uterus
Ovarian ligament - joins ovaries to uterus
Cardinal ligament - located at base of broad ligament, extends from cervix to lateral pelvic walls
- contains uterine artery and vein and provides support to uterus
Uterosacral ligament - extends from cervix to sacrum
- provides support
Histology of fallopean tubes
Main function is to assist transfer and transport of ovum from ovary to uterus
Inner mucosa layer
- lined with ciliated columnar epithelial cells and peg cells (non-ciliated secretory cells)
Smooth muscle layer - contracts to assist with transportation of ova and sperm
- sensitive to sex steroids - peristalsis greatest when oestrogen high
Anatomical structure of fallopian tubes
Fimbriae - finger-like, ciliated projections which capture ovum from surface of ovary
Infundibulum - funnel-shaped opening near the ovary to which fimbriae are attached
Ampulla - widest section
- fertilisation usually occurs here
Isthmus - narrow section of uterine tubes connecting ampulla to uterine cavity
Functions of ovaries
Produce oocytes
Produce steroid sex hormones - oestrogen and progesterone
Components of the ovary
Surface
- formed by simple cuboidal epithelium and dense connective tissue capsule
Cortex
- comprised of connective tissue stoma and numerus ovarian follicles
Medulla
- formed by loose connective tissue
- rich neurovascular network which enters via the hilum of ovary
Ligaments of ovaries
Suspensory ligament
- fold in peritoneum extending from mesovarium to pelvic wall
- contains neurovascular structures
Ligament of ovary
- extends from ovary to fundus of uterus
- continues to labium majus as round ligament
Venous supply and lymphatics of ovaries
Ovarian arteries - arise from abdominal aorta
Drains via ovarian veins into inferior vena cava
Lymphatic drain into para-aortic nodes
Subdivisions of broad ligament
Mesometrium
- surrounds uterus
- laterally covers external iliac vessels
- encloses proximal part of round ligament
Mesovarium
- associated with ovaries
- projects from posterior surface of broach ligament and attaches to hilum of ovary
- enclosed neurovascular supply but not ovary itself
Mesosalpinx
- originates superiorly to mesovarium
- encloses fallopian tubes
