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Female Pelvis > Anatomy and Physiology Ch 41 > Flashcards

Anatomy and Physiology Ch 41 Flashcards

1
Q

external pelvic landmarks

A
  • mons pubis
  • labia majora
  • labia minora
  • clitoris
  • urethral opening
  • vestibule of vagina
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2
Q

the bony pelvis consists four bones

A
  • Two innominate (coxal) bones
  • Sacrum
  • Coccyx
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3
Q

Divided into two continuous compartments by oblique plane that passes through pelvic brim

A
  • True Pelvis
  • False Pelvis
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4
Q

True Pelvis is considered

A

the pelvic cavity, and is situated inferior to the caudal portion of the parietal peritoneum

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5
Q

Posterior wall is formed by the

A

sacrum and coccyx

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6
Q

Posterolateral wall is formed by the

A

piriformis and coccygeus muscles.

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7
Q

Anterolateral walls formed by the

A

hip bones and obturator internus muscles.

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8
Q

Lower margin of pelvic cavity (the pelvic floor) formed by

A

levator ani and coccygeus muscles.

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9
Q

The pelvic floor is also known as the

A

pelvic diaphragm.

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10
Q

Area below the pelvic floor is the

A

perineum.

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11
Q

Posteriorly pelvic cavity occupied by the

A
  • rectum
  • colon
  • ileum
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12
Q

Anteriorly pelvic cavity occupied by the

A
  • bladder
  • ureters
  • ovaries
  • fallopian tubes
  • uterus
  • vagina
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13
Q

true pelvic musculature

A
  • Piriformis (posterolateral wall)
  • Obturator Internus (anterolateral pelvic sidewall)
  • Levator Ani (Pelvic Floor/Diaphragm)
  • Coccygeus (Posterior Pelvic Floor/ Diaphragm)
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14
Q

false pelvic musculature

A
  • Psoas Major (pelvic sidewall)
  • Iliacus (pelvic sidewall)
  • In the false pelvis, psoas muscles join with the iliacus muscles to form iliopsoas muscles.
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15
Q

Bladder Apex

A

posterior to pubic bones

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16
Q

Bladder Base

A

anterior to vagina

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17
Q

Ureters run

A

anterior to internal iliac arteries and posterior to the ovaries

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18
Q

Coarse anterior and lateral to

A

upper vagina where they then enter posteroinferior bladder

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19
Q

Location ureters enter bladder are also where

A

“ureteral jets” can be seen.

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20
Q

vagina

A

Collapsed muscular tube that extends from external genitalia to the cervix.

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21
Q
A
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21
Q

vagina is posterior

A

to bladder and urethra

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22
Q

Normal position of the vagina is

A

directed upward and backward, forming a 90 degree angle with cervix.

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23
Q

vagina is approximately

A

9cm in length

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24
Q

vagina is anterior

A

to rectum

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25
Q

cervix

A

protrudes into upper portion of vaginal canal forming four archlike recesses known as fornices.

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26
Q

The cervix is a continuous

A

ring-shaped space with posterior fornix running deeper than anterior counterpart.

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27
Q

The endocervix communicates with the

A

uterine cavity by the internal os and the vagina with the external os.

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28
Q

The exocervix is continuous

A

with the vagina

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29
Q

uterus

A

Hollow, pear-shaped organ

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30
Q

uterus divided into three main parts:

A

fundus, body, cervix

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31
Q

uterus usually in the

A

anteverted or anteflexed position, but can be retroverted or retroflexed

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32
Q

Round ligaments hold the uterus in

A

anteverted position.

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33
Q

Premenarchal

A

1-3cm in length by 0.5-1cm wide

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34
Q

Menarchal

A

6-8cm in length by 3-5cm wide

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35
Q

Multiparity

A

increase in size by 1-2cm

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36
Q

Postmenopausal

A

3.5-5.5cm in length by 2-3cm wide

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37
Q

uterine position usually in the

A

anteverted or anteflexed position, but can be retroverted or retroflexed

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38
Q

Flexion refers to

A

axis of uterine body relative to cervix

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39
Q

Version refers to

A

axis of cervix relative to vagina

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40
Q

layers of the uterus

A
  • perimetrium
  • myometrium
  • endometrium
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41
Q

Perimetrium

A

serous, outer layer of uterus

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42
Q

Myometrium

A

muscular middle layer of uterus composed of thick, smooth muscle

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43
Q

Endometrium

A

inner mucous membrane, glandular portion of uterine body

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44
Q

uterine ligaments

A
  • broad
  • round
  • cardinal
  • uterosacral
  • suspensory
  • ovarian
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45
Q

Broad

A

lateral aspect of uterus to pelvic sidewall

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46
Q

Round

A

fundus to anterior pelvic sidewalls, holds uterus forward

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47
Q

Cardinal

A

extend across pelvic floor laterally, supports cervix

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48
Q

Uterosacral

A

extend from uterine isthmus downward, along rectum to sacrum, also supports cervix

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49
Q

Suspensory

A

extends from lateral aspect of ovary to pelvic sidewall

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50
Q

Ovarian

A

extends medially from ovary to uterine cornua

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51
Q

parts of the fallopian tubes projections that overlie ovary

A
  • interstitial
  • isthmus
  • ampulla
  • infundibulum
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52
Q

Interstitial

A

pierces uterine wall at cornua

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53
Q

Isthmus

A

hardest part, lateral to uterus

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54
Q

Ampulla

A

widest part of tube, location of fertilization

55
Q

Infundibulum

A

funnel-shaped tube, free edge of the funnel has fimbriae (finger-like projections that overlie ovary

56
Q

ovaries

A

Almond shaped

57
Q

ovaries attached to

A

broad ligament by mesovarium

58
Q

ovaries supported medially by

A

ovarian ligaments and laterally by suspensory (infundibulopelvic) ligament

59
Q

Ovarian fossa bounded by

A

external iliac vessels, ureter, and obturator nerve

60
Q

ovarian blood Supply

A

ovarian artery and uterine artery

61
Q

ovaries blood drained by

A

ovarian vein into IVC on right and into renal vein on left

62
Q

ovaries vary in

A

pelvic location

63
Q

ovaries made up of

A

outer layer (cortex), which surrounds the central medulla

64
Q

ovaries cortex covered by

A

layer of dense connective tissue known as the tunica albuginea

65
Q

ovaries medulla composed of

A

connective tissue containing blood, nerves, lymphatic vessels and smooth muscle at hilum

66
Q

ovaries produce

A

reproductive cell- ovum

67
Q

ovaries secretes two hormones

A
  • estrogen (secreted by follicles)
  • progesterone (secreted by corpus luteum)
68
Q

ovarian hormones are responsible for

A

producing and maintaining gender characteristics (mammary glands in females, etc.), and preparing uterus for pregnancy

69
Q

pelvic vasculature

A

-External Iliac Arteries- medial to psoas border
- External Iliac Veins- medial and posterior to arteries
- Internal Iliac Arteries- posterior to ureters and ovaries
- Internal Iliac Veins- posterior to arteries
- Uterine Arteries and Veins- between layers of broad ligaments, lateral to uterus

70
Q

pelvic vasculature continued

A
  • Arcuate arteries: arc-like arteries that encircle uterus in outer third of myometrium
  • Radial arteries: branches of arcuate arteries that extend from myometrium to base of endometrium
  • Straight and spiral arteries: branches of radial arteries that supply zona basalis of endometrium
  • Ovarian arteries: branch laterally off aorta, run within suspensory ligaments and anastomose with uterine arteries
71
Q

Female reproductive years begin around

A

11 to 13 years of age at onset of menses

72
Q

menstrual cycle ends around age

A

50, when menses ceases

73
Q

menstrual cycle is approximately

A

28 days in length

74
Q

Premenarche

A

prepubescent

75
Q

Menarche

A

menstruating approximately once a month

76
Q

Menopause

A

cessation of menses

77
Q

approximately 28 days

A

beginning with first day of menstrual bleeding

78
Q

polymenorrheic

A

Cycle occurs at intervals of less than 21 days-

79
Q

oligomenorrhic

A

Cycle prolonged for more than 35 day

80
Q

Menorrhagia

A

abnormally heavy or long periods

81
Q

Dysmenorrhea

A

painful periods

82
Q

Amenorrhea

A

absence of menstruation

83
Q

Proliferative Phase

A
  • Days 1 to 14
  • Corresponds to follicular phase of ovarian cycle
  • Menstruation occurs on days 1 to 4
  • Thin endometrium
  • Estrogen level increases as ovarian follicles develop.
  • Increasing estrogen levels cause uterine lining to regenerate and thicken.
  • Ovulation occurs on day 14
84
Q

Secretory Phase

A
  • Days 15 to 28
  • Corresponds to luteal phase of ovarian cycle
  • Ruptured follicle becomes corpus luteum.
  • Corpus luteum secretes progesterone.
  • Endometrium thickens.
  • If no pregnancy, estrogen and progesterone decrease.
  • Menses on day 28
85
Q

Ovulation

A

ovum released once a month by one of two ovaries (during menarchal years)

86
Q

Ovulation usually occurs

A

about mid cycle around day 14 of a 28 day cycle

87
Q

All ova begin to develop during

A

embryonic life, and remain within preantral follicle as an immature oocyte until menses begins.

88
Q

Each female ovary contains

A

around 200,000 oocytes at time of birth.

89
Q

Process of ovulation regulated by

A

hypothalamus

90
Q

At puberty, hypothalamus begins releasing

A

gonadotropin-releasing hormones (GnRHs)

91
Q

GnRHs stimulate

A

anterior pituitary gland to secrete varying levels of gonadotropins.

92
Q

Secretion of follicle-stimulating hormone
(FSH) by

A

anterior pituitary gland causes
follicles to develop during the first half of the
menstrual cycle.

93
Q

The follicular phase begins on cycle day

A

one of menstrual bleeding and continues
until ovulation around day 14.

94
Q

As follicles grow, they fill with

A

fluid and secrete estrogen.

95
Q

Typically, 5 to 8 preantral follicles begin to
develop, but

A

only one reaches full maturity.

96
Q

Mature follicle is known as the

A

graafian follicle- around 2cm right before ovulation

97
Q

As estrogen level in the blood rises,

A

pituitary gland inhibited from further
production of FSH, and then starts secreting luteinizing hormone (LH)

98
Q

LH level will normally increase rapidly

A

24-36 hours before ovulation, this
process is known as LH surge (used to predict release of ovum)

99
Q

LH level usually peaks

A

10–12 hours prior to ovulation

100
Q

Ovulation is the explosive release of the

A

ovum from the ruptured dominant follicle
(graafian follicle)

101
Q

Can be associated with

A

small amount of fluid in the posterior cul-de-sac

102
Q

Midcycle dull ache on either side

A

of lower abdomen (pelvic area) lasting a few hours
is known as “mittelschmerz” (from German origin meaning “middle pain”)

103
Q

After ovulation,

A

ovary enters luteal phase, which lasts about 14 days

104
Q

Menstruation usually occurs

A

14 days after ovulation

105
Q

During luteal phase,

A

cells in lining of ruptured ovarian follicle begin to multiply and create the corpus luteum (this process is known as luteinization, stimulated by LH surge)

106
Q

Corpus luteum immediately begins

A

secreting progesterone

107
Q

9 to 11 days after ovulation,

A

the corpus luteum degenerates, causing progesterone levels to decline

108
Q

As those levels decline,

A

menstruation occurs and cycle begins again

109
Q

If conception and implantation has occurred,

A

the human chorionic gonadotropin (hCG) produced by the zygote will cause the corpus luteum to persist

110
Q

Will continue to secrete

A

progesterone for 3 more months until placenta takes over

111
Q

Varying levels of

A

estrogen and progesterone throughout menstrual cycle induce changes in
endometrium, changes correlate with ovulatory cycles of ovary

112
Q

Typical endometrial cycle identified and described in

A

three phases, beginning with menstrual
phase.

113
Q

Menstrual phase lasts approximately

A

1 to 5 days and begins with declining progesterone levels, causing spiral arterioles to constrict.

114
Q

Causes decreased

A

blood flow to endometrium, resulting in ischemia and shedding of zona functionalis.

115
Q

First 5 days coincide with

A

follicular phase of ovarian cycle.

116
Q

As follicles produce estrogen,

.

A

estrogen stimulates superficial layer of endometrium to regenerate and grow.

117
Q

Phase of endometrial regeneration called

A

proliferative phase and will last until luteinization of graafian follicle
around ovulation.

118
Q

With ovulation and luteinization of graafian follicle,

A

progesterone secreted by ovary causes spiral arteries and
endometrial glands to enlarge.

119
Q

Prepares endometrium for

A

implantation, should conception occur.

120
Q

Endometrial phase after ovulation referred to as

A

secretory phase.

121
Q

Extends from approximately

A

day 15 to onset of menses (day 28).

122
Q

Secretory phase of endometrial cycle corresponds to

A

luteal phase of ovarian cycle

123
Q

Sonographic appearance of endometrium changes

A

dramatically
among the three phases of endometrial cycle.

124
Q

endometrium changes should be

A

correlated to patient’s menstrual status.

125
Q

Thickness of endometrium will

A

decrease with menstruation,
becoming thin echogenic line during early proliferative phase.

126
Q

As regeneration of endometrium occurs,

A

endo will thicken to an average of 4 to 8 mm in proliferative phase, when measured as double layer from anterior to posterior. (“three-line” sign)

127
Q

Three echogenic lines seen in

A

proliferative endometrium represent zona basalis anteriorly and posteriorly, with central line representing uterine cavity.

128
Q

Right before ovulation, endometrium measures

A

6 to 10 mm and becomes
isoechoic with myometrium.

129
Q

After ovulation, during secretory phase,

A

endometrium reaches thickest
dimension, averaging 7 to 14 mm.

130
Q

Becomes echogenic,

A

blurring “three-line” appearance

131
Q

Postmenopausal patients who are not on HRT should have endometrial thickness of

A

<5 mm.

132
Q

Postmenopausal patients on HRT or taking
tamoxifen may demonstrate

A

normal endometrial thicknesses up to 8 mm.

133
Q

Vesicouterine pouch:

A

anterior cul-de-sac; anterior to fundus between uterus and bladder

134
Q

Rectouterine pouch (Pouch of Douglas):

A

posterior cul-de-sac; posterior to uterine body
and cervix, between uterus and rectum

135
Q

Retropubic space:

A

space of Retzius; between bladder and symphysis pubis

Female Pelvis (5 decks)

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