Anatomy Flashcards
The female reproductive system lies both within the _____ and the ______
pelvic cavity and the perineum
What parts of the female reproductive system are in the pelvic cavity?
ovaries, uterine tubes, uterus, superior part of vagina
What parts of the female reproductive system are in the perineum?
inferior part of vagina, perineal muscles, bartholin’s glands (greater vestibular glands), clitoris, labia
What is the perineum?
the area below the pelvic floor, it is a shallow space between the pelvic diaphragm and the skin
What is the only true female reproductive organ?
the ovaries (everything else is secondary/ accessory)
The peritoneum forms the __1__ of the abdominal cavity but ___2___ of pelvic cavity
1) floor
2) roof
As the peritoneum drapes over the reproductive organs it forms two pouches which are?
vesicouterine and rectouterine
What is the clinical significance of the rectouterine pouch? Why is this not quite true?
it is the lowest point of the peritoneal cavity in the upright female patient therefore any excess fluid will collect here, however there are often little lateral extensions that lie either side of the rectum (lateral para-rectal fossa) which are usually slightly deeper and can also collect fluid
The broad ligament of the uterus is a _____1_______ that extends between the ______2_______ and it helps ______3________ and it contains within it the ______4_________
1) double layer of peritoneum
2) sides of the uterus to the lateral walls and floors of the pelvis
3) maintain the uterus in its correct midline position
4) uterine tubes and the proximal part of the round ligament
The round ligament of the uterus is an _____1____ that attaches to the ___2_____ and passes through ____3___ to attach to ____4_____ the proximal part is contained within the _____5_______
1) embryological remnant
2) lateral aspect of the uterus
3) the deep inguinal ring
4) superficial tissue of the female perineum
5) broad ligament
What are the three layers of the uterine body?
perimetrium, myometrium, endometrium
The uterus is generally found in ______ unless _______
pelvic cavity unless pregnant will move up into abdominal cavity at about 12 weeks
Most common position of the uterus is?
anteverted and anteflexed
anteverted: the cervix is tipped anteriorly relative to the axis of the vagina
ante flexed: the uterus is tipped anteriorly relative to the axis of the cervix (the mass of the uterus lies over the bladder)
everything is tipped anteriorly to the next thing
A common normal variation of uterus position?
retroverted and retroflexed
Retroverted: cervix tipped posteriorly relative to the axis of the vagina
Retroflexed: uterus tipped posteriorly relative to the axis of the cervix
The vagina is essentially a ______ and the walls are usually ______
muscular tube
collapsed
the vagina is usually ___ long and extends from _______
7-9cm
superior most aspect of the vaginal part of the cervix of the uterus to the vaginal orifice the opening at the inferior end of the vagina
Fertilisation occurs in the _____ of the uterine tubes
ampulla of the uterine tubes
Parts of the uterine tubes from lateral to medial?
infundibulum, ampulla, isthmus, uterine part
Describe the ampulla of the uterine tubes?
this is the widest and longest part of the tube which begins at the medial end of the infundibulum
this is where fertilisation occurs
Describe the infundibulum of the uterine tubes?
the funnel-shaped distal end of the tube that opens into the peritoneal cavity through the abdominal osmium, the finger like processes of the fimbriated ends of the infundibulum (fimbriae) spread over the medial surface of the ovary
Describe the isthmus of the uterine tubes?
the thick walled part of the tube which enters the uterine horn
What is the ideal position of the uterine tubes? What is the reality?
tubes extend symmetrically posterolaterally to the lateral pelvic walls where they arch anterior and superior to the ovaries in the horizontally disposed broad ligament
in reality the tubes are commonly asymmetrically arranged with one or the other often lying superior and even posterior to the uterus
Explain how the oocyte expelled at ovulation passes into the peritoneal cavity?
because the ovary is suspended in the peritoneal cavity and its surface is not covered by peritoneum the oocyte expelled passes into the peritoneal cavity however its intraperitoneal life is short because it is normally trapped by the fimbriae of the infundibulum of the uterine tube and carried into the ampulla where it may be fertilised
The ovaries are ______ shaped and sized
They are gonads (primary reproductive organs) but also _________
almond
endocrine glands as they secrete oestrogen and progesterone in response to FSH and LH from the anterior pituitary gland
The vagina is a muscular tube whose walls are normally in contact except ____________
superiorly where the cervix holds them apart forming a fornix
Describe the vaginal fornix?
this is the recess around the cervix and contains anterior, posterior and lateral parts
What is the mons pubis?
this is the rounded fatty eminence anterior to the pubic symphysis, pubic tubercles and superior pubic rami, the eminence is formed by a mass of fatty subcutaneous tissue, the amount of fat increases at puberty and decreases after menopause, the surface of the mons is continuous with anterior abdominal wall and after puberty the mons pubis is covered with coarse pubic hairs
What is the vestibule of the vagina?
the space surrounded by the labia minora into which the orifices of the urethra and vagina and the ducts of the greater and lesser vestibular glands open
The roughly circular body of the female breast rests on a bed of the breast which extends from _______
ribs 2-6
lateral border of sternum to the mid-axillary line
Two thirds of the bed of the breast are formed by the ___1________ and the other third by ______2_____
1) pectoral fascia overlying the pectoralis major
2) fascia covering the serratus anterior
What lies between the fascia and the breast?
the retromammary space
The breasts are attached to the skin via _______
suspensory ligaments
Most lymph (>75%) from the breast drains to the ________________1______________
Lymph from inner breast quadrants can drain to the _______2_________
Lymph from the lower inner breast quadrant can drain to _______3_________
1) ipsilateral axillary lymph nodes and then to the supraclavicular nodes
2) parasternal lymph nodes
3) abdominal lymph nodes
Apart from lymph from the breast, lymph from where else drains to the axillary lymph nodes… why is this relevant?
from the upper lymph
if taking out these nodes due to a cancer then could cause upper limb lymphedema
What are the three surgical levels of axillary nodes?
Level I – inferior and lateral to pectoralis minor
Level II – deep to pectoralis minor
Level III – superior and medial to pectoralis minor
Describe blood supply to the breasts?
branches from the internal thoracic artery from the subclavian
branches from the axillary artery
What is the cervix?
the cylindrical, relatively narrow inferior third of the uterus
Describe the two parts of the cervix?
the supravaginal part which is between the isthmus (isthmus of uterus is the inferior narrow part of uterus) and the vagina
vaginal part which protrudes into the superior most anterior vaginal wall
What is the external and internal cervical os?
The internal os of the cervix is the opening of the cervix that joins the uterus, while the external os of the cervix is the junction between the cervix and the vagina
The pelvic floor is made up of 3 layers which are?
the pelvic diaphragm, the muscles of perineal pouches, the perineal membrane
The pelvic diaphragm is the ______ of the pelvic floor and consists of ___________
deepest (most internal)
two muscles: levator ani and coccygeus
3 parts of levator ani?
iliococcygeus, pubococcygeus, puborectalis
What forms most of the pelvic diaphragm?
levator ani
Levator ani is tonically contracted ___1___ it actively contracts when ___2____
1) most of time
2) coughing, sneezing or vomiting (basically anything that is increasing intrabdominal pressure)
Innervation of levator ani?
pudendal nerve and nerve to levator ani
note there is debate over whether there is a dual nerve supply
What provides additional support to the pelvic diaphragm?
endo-pelvic fascia:
some loose areolar tissue
some fibrous
collagen and elastic fibres
pelvic ligaments: fibrous endo-pelvic fascia uterosacral transverse cervical (cardinal) lateral ligament of bladder lateral rectal ligaments
The deep perineal pouch lies below ____1______ but above the ______2_________
1) the fascia covering the inferior aspect of the pelvic diaphragm
2) above the perineal membrane
What does the deep perineal pouch contain?
Contains part of the urethra (and vagina in females), bulbourethral glands in male, neurovascular bundle for penis/clitoris, extensions of the ischioanal fat pads and muscles (deep transverse perineal muscle in males or smooth muscle in females, both have the external urethral sphincter, compressor urethrae)
What muscles are contained within the deep perineal pouch?
external urethral sphincter, compressor urethrae
in males the deep transverse perineal muscle and in females a smooth muscle (debate around this)
The perineal membrane is ___1______ to deep perineal pouch. It is a ______2__________
It attaches _______3_______
It has openings for ________4________
Together with the perineal body, it is the ___________5___________
1) Superficial
2) Thin sheet of tough, deep fascia
3) laterally to the sides of the pubic arch, closing the urogenital triangle
4) the urethra (and vagina in females)
5) last passive support of the pelvic organs
The superficial perineal pouch lies __1___ the perineal membrane. In females it contains ____2_______
1) below
2) Contains female erectile tissue and associated muscle:
Clitoris and crura – corpus cavernosum
Bulbs of vestibule – paired
Associated muscles – bulbospongiosus and ischiocavernosus
Also contains greater vestibular glands, superficial transverse perineal muscle and branches of internal pudendal vessels and pudendal nerve
What does the superficial perineal pouch contains in males?
Contains root of penis:
Bulb – corpus spongiosum, crura paired – corpus cavernosum
Associated muscles – bulbospongiosus and ischiocavernosus
Also contains proximal spongy (penile) urethra, superficial transverse perineal muscle and branches of internal pudendal vessels and pudendal nerve
List the layers of the pelvic floor from deep to superficial?
pelvic diaphragm, deep perineal pouch, perineal membrane, superficial perineal pouch (first with erectile tissue then with the muscles of the superficial perineal pouch lying over them)
Injury to the pelvic floor related to obstetrics and gynaecology can occur because of?
pregnancy (increased pressure)
childbirth (stretching or tearing of the actual muscles or alternatively the pudendal nerve is damaged so muscles can’t be supplied properly)
What is the perineal body?
this is an important structure in support of the pelvic floor
its is where all the layers of the pelvic floor are linked and a number of muscles converge so provides a lot of support
Urinary continence depends on?
external urethral sphincter, compressor urethrae, levator ani
Faecal continence depends on?
Contraction of puborectalis muscle (part of levator ani) decreases the anorectal angle, acting like a sphincter. When the rectal ampulla is relaxed & filled with faeces, voluntary contraction of this muscle will help to maintain continence.
Describe how urinary continence is achieved?
As the bladder fills, this is sensed by stretch receptors at the end of visceral afferent nerve fibres
This information is relayed to the CNS via S2,S3,S4 spinal cord levels
There is a reflex at this point to empty the bladder by stimulation of the detrusor muscle and inhibition of the internal sphincter muscle
However in those infants who have been “potty trained” along with children and adults, the brain overrides this reflex; action potentials within inhibitory nerve fibres from the cortex pass inferiorly and inhibit this reflex. We can also voluntarily contract the external sphincter and levator ani muscles.
Describe what happens when it is appropriate to micturate?
Once it is appropriate to micturate:
The cerebral inhibition of this reflex is lifted and there is a co-ordinated contraction/relaxation of various muscles:
The detrusor muscle contracts (parasympathetic)
The internal urethral sphincter (parasympathetic), external urethral sphincter and levator ani muscles relax (somatic motor)
The anterolateral abdominal wall muscles contract to increase intra-abdominal pressure and force urine out of the external urethral orifice (somatic motor nerve fibres)
The external urethral sphincter and the levator muscles are supplied by?
branches of the pudendal nerve S2,3 and 4
and nerve to levator ani
Describe the prostatic urethra, the membranous urethra and the spongy urethra?
The prostatic urethra is the part that passes through the prostate and runs to the membranous urethra. The membranous urethra is the part passing through the perineal membrane that contains the striated muscle of the external urethral sphincter, which surrounds the urethra and is supplied by perineal branches of the pudendal nerve S2,3,4. The spongy urethra passes through the bulb of the penis and then into its corpus spongiosum.
What is the longest part of the male urethra?
the spongy urethra
