Anatomy of Female Reproductive System and Breast Flashcards
Where does the female reproductive system lie?
Within the bony pelvis and perineum
What are the parts of the female reproductive system found in the pelvic cavity?
Ovaries, uterine tubes, uterus, superior vagina
What are the parts of the female reproductive system found in the perineum?
Inferior vagina, perineal muscles, Bartholin’s glands, clitoris, labia
What does the inferior part of the parietal peritoneum form?
Floor of peritoneal cavity and roof over pelvic organs
What does the peritoneum cover?
Superior aspect organs
What pouches are formed by the peritoneum?
Vesico-uterine pouch and recto-uterine pouch (of Douglas)
Why does excess fluid within the peritoneal cavity tend to collect within the pouch of Douglas?
It’s the most inferior part of the peritoneal cavity in the anatomical position
How can fluid collection in the pouch of Douglas be drained?
Via a needle passed though the posterior fornix of the vagina
What is the broad ligament of the uterus?
Double layer of peritoneum = extends between uterus and lateral walls and floor of pelvis
What is the purpose of the broad ligament of the uterus?
Helps maintain uterus in its correct midline position
Contains uterine tubes and proximal part of round ligament
What is the round ligament of the uterus?
Embryological remnant = attaches to lateral aspect of uterus
What does the round ligament of the uterus pass through?
Passes through deep inguinal ring to attach to superficial tissue of the female perineum
What are the three layers of the uterus?
Perimetrium, myometrium, endometrium
Where does implantation of the zygote occur?
In the body of the uterus
What are the three levels of support that hold the uterus in place?
Number of strong ligaments (e.g uterosacral ligament)
Endopelvic fascia
Muscles of pelvic floor
What can weakness of the uterine supports cause?
Uterine prolapse = movement of the uterus inferiorly
What is the most common position for the uterus to be in?
Anteverted and anteflexed
What is an anteverted uterine position?
Cervix tipped anteriorly relative to the axis of the vagina
What is anteflexed uterine position?
Uterus tipped anteriorly relative to the axis of the cervix
What is a normal variation of the position of the uterus?
Retroverted and retroflexed
What is a retroverted uterine position?
Cervix tipped posteriorly relative to the axis of the vagina
What is a retroflexed uterine position?
Uterus tipped posteriorly relative to the axis of cervix
What are some features of a cervical screening?
Walls of the vagina are usually collapsed
Clinician must be able to see cervix
Must sample the squamocolumnar junction
Where does fertilisation occur?
In the ampulla of the uterine tubes
Do the uterine tubes lie symmetrically?
No, not usually
What is a bilateral salpingo-oophrectomy?
Removal of the uterine tubes and ovaries
Where do the fimbriated ends of the uterine tubes open into?
The peritoneal cavity = allows communication between genital tract and peritoneal cavity
What does the communication between the uterine tubes and the peritoneal cavity mean?
Infection can pass between the two areas = pelvic inflammatory disease can cause peritonitis, ectopic pregnancy can develop into peritoneal cavity
What size are the ovaries?
Almond sized and shaped = located laterally in pelvic cavity
What do the ovaries secrete?
Oestrogen and progesterone = occurs in response to LH and FSH
Where do the ovaries develop?
On posterior abdominal wall = move onto lateral wall of the pelvis
What do the ovaries do in post-pubertal women?
Release an ovum once a month directly into the peritoneal cavity to be picked up by the fimbriae of the uterine tube
What is the vagina?
Muscular tube = walls are normally in contact
Where are the walls of the vagina always held apart?
In the superior aspect = held apart by cervix to form fornix
What are the parts of the fornix?
Anterior, posterior, lateral x2
Where can the ischial spines be palpated during a vaginal digital examination?
Laterally and in the 4 and 8 o’clock positions
How is the position of the uterus palpated during a vaginal digital examination?
Assessed by bimanual palpation
What is palpated in a palpation of the adnexae during a vaginal digital examination?
Uterine tubes and ovaries = can detect large masses or tenderness affecting these structures
How are the adnexae palpated?
Place examining fingers into lateral fornix and press deeply with other hand in iliac fossa on same side = repeat on other side
What is the perineum?
Shallow space between pelvic diaphragm and skin = divided into superficial and deep pouches
What does the pelvic diaphragm form?
The floor of the pelvis but the roof of the perineum
Where are the openings of the perineum located?
In the pelvic floor
What structures make up the urogenital triangle?
Ischial spine x2 and pubic symphysis
What structures make up the anal triangle?
Ischial spine x2 and the coccyx
What is the levator ani?
Skeletal muscle = made up of smaller muscles, under voluntary control
What does the levator ani form?
Majority of the pelvic floor
What is the function of the levator ani?
Provides continual support for pelvic organs = tonic contraction, reflexively contracts further during situations of increased intra-abdominal pressure
What nerve innervates the levator ani?
Nerve to levator ani = consists of S3-5 and sacral plexus fibres
What are some features of the perineal muscles?
Superficial and deep
Supplied by pudendal nerve
What is the perineal body?
Bundle of collagenous and elastic tissue into which perineal muscles attach = located just deep to skin
What is the function of the perineal body?
Important to pelvic floor strength = can be disrupted during labour
Where is the Bartholin’s gland located?
Under the labia minus on either side
Where does the bed of the breast extend?
From ribs 2-6
Lateral border of sternum to mid-axillary line
Where do the breasts lie?
On deep fascia covering pectoralis major and serratus anterior
Where is the retromammary space located?
Between fascia and breast
What attaches the breast to the skin?
Suspensory ligaments
What are the quadrants of the breast?
Upper outer, upper inner, lower outer, lower inner
How is the position of a lump on the breast described?
In relation to the 4 quadrants or a clock face
How do you assess whether a lump on the breast is fixed to underlying tissue?
Ask the patient to place hands firmly on hips = contracts the pectoral muscles
What areas should be assessed of you find a lump on the breast?
Both the axilla and supraclavicular areas
Where does most lymph from the breast drain to?
> 75% drains to ipsilateral axillary lymph nodes then to the supraclavicular nodes
Where can lymph from the inner breast quadrants drain to?
Parasternal lymph nodes
Where can lymph from the lower inner breast drain to?
Abdominal lymph nodes
What other body parts drain their lymph into the axillary nodes?
The upper limbs
What is the axilla?
Pyramidal passageway between arm and chest
What does the axilla contain?
Brachial plexus branches, axillary artery and vein, axillary lymph nodes
What do breast surgeons use levels of axillary node clearance to describe?
The extent of axillary node clearance
What is the position of each level of axillary node clearance described in relation to?
Pectoralis minor
What are the levels of axillary node clearance?
Level I = inferior and lateral to pectoralis minor
Level II = deep to pectoralis minor
Level III = superior and medial to pectoralis minor
