anatomy of female reproductive tract Flashcards
what structures lie within the pelvic cavity?
- ovaries
- uterine tubes
- uterus
- sup part of vagina
what structures lie within the perineum?
- inf part of vagina
- perineal muscles
- bartholins glands
- clitoris
- labia
what is the pouch that sits between bladder and uterus?
- vesico-uterine
what is the pouch that sits between uterus and rectum?
- recto-uterine or pouch of douglas
what is the broad ligament of the uterus?
- double layer of peritoneum
- extends between uterus and lateral walls and floor of the pelvis
- helps maintain uterus in its correct midline position
what is the round ligament?
- it is an embryological remnant
- attaches to lateral aspect of uterus
- passes through deep inguinal ring to attach to superficial tissue of female perineum
- proximal part is contained within broad ligament
name the 3 layers of the uterus?
- perimetrium
- myometrium
- endometrium
what are two parts of uterus?
- body or fundus
- cervix
where does implantation of zygote occur?
- body of uterus
-> implantation anywhere else is considered as an ectopic pregnancy
what are the different positions of the uterus?
- anteverted and anteflexed (most common) - sits over bladder and transverse
common variation:
- retroverted and retroflexed
what are the 3 levels of support of uterus?
- uterosacral ligaments
- endopelvic fascia
- muscles of pelvis floor (levator ani)
weakness of these supports can result in uterine prolapse -> movement of uterus inferiorly
fertilisation occurs where?
- in the ampulla
what is a bilateral salpingo-oophrectomy?
- removal of both uterine tubes and ovaries
- salpinx is greek for tube
what is a unilateral salpingectomy?
- removal of one of the uterine tubes
where is the communication between genital tract and peritoneal cavity?
- the fimbriated end of the uterine tubes (open into peritoneal cavity)
where are ovaries located?
- almond sized and shaped, located laterally in the pelvic cavity
what do ovaries secrete?
- oestrogen and progesterone in respond to ant pit hormones FSH and LH
- develop on posterior abdom wall and move onto lateral wall of pelvis - round ligament of uterus
what is the vagina?
muscular tube whose walls are normally in contact
- except superiorly where cervix holds them apart
what are the 4 parts of the fornix?
- anterior
- posterior
- 2x lateral
where is the smear taken from in cervical screening?
- squamo columnar junction (transformation zone)
what is vaginal digital examation?
- position of uterus can be palpated here
- palpation of adnexae (uterine tubes and ovaries)
- ischial spines
-> can detect large masses or tenderness affecting structures in the uterine tubes and ovaries
-> head of fetus
-> pudendal nerve block
what is levator ani?
- skeletal muscle under voluntary control
- forms majority of pelvic diaphragm
- provides continual support for pelvis organs
what nerve supplies levator ani?
- S3, S4, 5 sacral plexus
- dual supply?
what is pernieum?
- shallow space between pelvic diaphragm
and skin - pelvic diaphragm forms floor of pelvis but roof of perineum
what is perineal body?
- bundle of collagenous and elastic tissue into which perineal muscles attach
- important for pelvic floor strength
-> can be disrupted during labour
-> located just deep to skin
what nerve supplies perineal muscles?
- pudendal nerve
- supplying both superficial and deep muscles
what do bartholins gland (greater vestibular gland) secrete?
- secrete lubricating fluid
-> an enlarged bartholins gland e.g. as a result of infection
where does bed of breast extend from?
- from ribs 2-6
- lateral border of sternum to mix-axillary line
- firmly attaches to skin via suspensory ligaments
where does breast tissue lie?
- lies on deep fascia covering pec major and serratus anterior
where is retromammary space?
- lies between fascia and breast
-> not being able to move the breast can indicate cancer has invaded this space
where is blood supply and drainage of breast?
internal thoracic (internal mammary) -> subclavian -> axillary
where does over 75% of lymph drain?
- drains to ipsilateral axillary lymph nodes and then to supraclavicular nodes
-> axillary lymh nodes also drain majority of upper limb
where can lymph from inner breast quadrants drain to?
- parasternal lymph nodes
where can lymph from lower inner breast quadrants drain to?
- abdominal lymph nodes
what are the 3 levels of axillary clearance?
- level I -> inferior and lateral to pec minor
- level II -> deep to pec minor
- level III -> sup and medial to pec minor
what is axillary clearance?
operation to remove most or all of lymph nodes under the arm
what is the 2 roles of the ovary?
- produce gametes (oogenesis in females)
- produce steroids, mainly oestrogens and progresterones (mainly progesterone)
the ovary is split into two structures what are these?
medulla and cortex
what does the medulla form?
- forms core of the organ and contains loose connective tissue, contorted by arteries, veins and lymphatics and is continuous w hilum of organ
what is cortex made up of?
- scattered ovarian follicles in a highly cellylar tissue stroma
- outer ‘shell’ of cortex is dense connective tissue called tunina albuginea
what is the outer layer of cortex in ovary covered by?
- single layer of cuboidal cells - called germinal epithelium
what group of arteries enter the hilum from the broad ligament to supply blood to the ovary?
- helicine arteries
name two separate layers of cortex of ovary
- germinal epithelium - top layer
- tunina albuginea
what is oogenesis
- development of oocytes, female germ cells, from oogonia
what is folliculogenesis
- growth of follicle which consists of the oocyte and any associated support cells
what is atresia?
- loss of oogonia and oocytes by an apoptosis-based process
- cell is resorbed following cell death
- squamous (once united w the follicle it becomes cuboidal)
- cuboidal
- mul
what is primordial follicle?
- most immature stage of an ovarian’s follicle devlopment
- oocyte surrounded by a single layer of flat, supporting granulosa cells
if the oocyte fails to associate with the pregranulosa cell (follicle cell) what will happen
- the cell will die
what are the cells found in between follicle cells and oocytes in this image?
- stromal cells - surround follicles
primary follicle is made up of what kind of cells?
- cuboidal cells
what is the zona pellucida?
- layer of extracellular matrix, which forms a thin layer between the oocyte and granulosa cells (follicle cells on the periphery of the oocyte)
the stromal cells form what initially?
- theca folliculi
- they then transform to form a layer called theca interna
what does theca interna secrete?
- oestrogen precursors - which will be converted to oestrogen by GC
what is the antrum
- as follicle enlarged, antrum - filled w follicular fluid - begins to form and enlarge in granulosa cell layer, forming a secondary follicle
- now termed secondary follicle
study
- cover
after ovulation, follicle transforms into what?
- corpus luteum with theca and GC secreting oestrogen and progesterone, help preparing uterus for implntation
if implantation does not occur, what does cell transform into?
- white coloured connective tissue called corpus albicans
if implantation does occur, placenta secretes what substance to prevent the degeneration of the corpus luteum
- HCG
- in turn maintains progesterone levels - thus maintaining pregnancy
how does the ovum move down uterine tube?
- by gentle peristalisis
- and currents created by ciliated epithelium
where does fertilisation occur?
- occurs in ampulla and fertilized ovum is then transported to the uterus for implantation
ampulla of the uterine tube is made up of what?
- mucosa is highly folled and lined by simple columnar epithelium w ciliated and secretory cells
- this is surrounded by SM
how many laters of SM in ampulla?
- 2
how many layers in isthmus?
- 3
what is the innner secretory mucosa of the uterus called? (inner wall)
- endometrium
- shed during menstruation - made up of tubular secretory glands - embedded in connective tissue stroma
what is the middle layer of uterine wall made up of?
- coat of 3 SM layers - combined w collagen and elastic tissue
- called myometrium
what is outer wall of uterus called and what is it made up of?
- loose connective tissue covered by mesothelium
- called perimetrium
uterus is divided into what two layers?
- stratum functionalis - undergoes monthly growth degeneration and loss
- stratum basalis - reserve tissue that regenerates the functionalis
during proliferative phase occurs at what days
- around day 5 - day 14 (until about 1 day after ovulation)
what occurs during the proliferative phase?
- stratum basalis proliferates and glands, stroma and vasculature grow -> increasing the thickness of the endometrium by reconstituting the stratum functionalis
what occurs during the proliferative phase?
- stratum basalis proliferates and glands, stroma and vasculature grow -> increasing the thickness of the endometrium by reconstituting the stratum functionalis
the secretory phase occurs during which days
- around day 14 to day 28
what happens to endometrium during the secretory phase?
- the glands become coiled w a corkscrew appearance and secrete glycogen
what occurs in the endometrium during the menstrual phase?
- the arterioles in the stratum functionalis undergo constriction, depriving the tissue of blood causing ischaemia
- resultant tissue breakdown, leakage of blood and tissue sloughing
what is the cervix and what is it composed of?
- short cylinder w a small lumen that projects into the upper vagina
- composed of mostly fibrous CT covered by stratified squamous epithelium on its vaginal surface. transitions to mucous secreting simple columnar epithelium
what is the transition zone of the cervix?
- common site of dysplasia
- neoplastic changes leading to cervical cancer, most frequently occur in this transition zone
the mucous secreting epthelium of the cervix forms glands called?
- endocervical glands
- secretions vary from thin and watery in proliferative phase i.e. for passage of sperm to thick following ovulation
- outlets of glands can become blocked forming a nabothian cyst
the vagina forms 4 layers what are these?
- non-keratinized stratified squamous epithelum
- lamina propria
- fibromuscular layer
- adventitia
what is lamina propria layer of vagina made up of?
- CT rich in elastic fibres and thin walled blood vessels
what is fibromuscular layer of vagina made up of?
- inner circular and outer longitudinal SM
stratified squamous epthelium of the vagina accumulated what substance?
- glycogen
- commensal bacteria metabolizes the glycogen to lactic acid - inhibiting the growth of pathogenic bacteria
stratified squamous epithelium of the vagina accumulated what substance?
- glycogen
- commensal bacteria metabolizes the glycogen to lactic acid - inhibiting the growth of pathogenic bacteria
what is the mons pubis?
- structure that overlies the pubic symphysis
- contains highly oblique hair follicles
what is the labia majora?
- extensions of the mons pubis, rich in apocrine sweat glands and sebaceous glands and has small bundles of SM
- hair follicles on the outer surface, but not the inner
what is the labia minora?
- skin folds that lack subcutaneous fat and hair follicles, but are rich in vasculature and sebaceous glands secreting directly onto the surface of the skin
what is clitoris composed of?
- two tubes of erectile vascular tissue (corpora cavernosa), covered by a fibrocollagenous sheath covered by skin with rich innervation and a thin epidermis
what kind of gland is the breast?
- it is a subcutaenous gland
- secretory tissue of the breast is made up of 15-25 lobes
what kind of gland do the lobes of the breast contain?
- a compound tubulo-acinar gland
- drains via a series of ducts leading to the nipple
adjacent to the secretory lobules is dense fibrous tissue - which in turn is surrounded by adipose tissue
amongst the fibrous connective tissue, what else is the breast composed of?
- suspensory ligaments - extend from the dermis of the skin to the deep fascia overlying the muscle of the anterior chest wall.
- often most pronounced in the upper breast and thought to support the breast tissue
amongst the fibrous connective tissue, what else is the breast composed of?
- suspensory ligaments - extend from the dermis of the skin to the deep fascia overlying the muscle of the anterior chest wall.
- often most pronounced in the upper breast and thought to support the breast tissue
describe the duct system of the breast?
the terminal duct lobular unit (TDLU) is a basic functional secretory unit of the breast
- in the non-lactating breast, terminal ductules(or acini) lead into an intralobular collecting duct which leads into the lactiferious duct for that lobe
- the lactiferous duct leads to the nipple, passing through an expanded duct region near the nipple termed the lactiferous sinus
what kind of connective tissue surrounds the lobule?
- dense fibrocollagenous connective tissue
-> looser connective tissue surrounds the acini within the lobule - allowing the rapid expansion in pregnancy - adipose tissue is also between lobules
what structures line the acini?
- secretory epithelial cells line the acini - vary from cuboidal to columnar
- secretory cells of the acinus are surrounded by myoepithelial cells (MEp)
- pink on histology
what are larger ducts e.g. lactiferous duct lined by?
- lined by an epithelium that varies from a thin stratified squamous to stratified cuboidal
the nipple is covered by what kind of epithelium?
- thin, highly pigmented, keratinized stratified squamous epithelium
what is the core of the nipple composed of?
- it has a core of dense irregular connective tissue mixed w bundles of smooth muscle
what changes occur in the breast during menstrual cycle even in the absence of pregnancy?
- during the luteal phase the epithelial cells increase in height
- the lumina of the ducts become enlarged and small amounts of secretions appear in the ducts
what occurs to breast in first trimester of pregnancy?
- in the first trimester there is elongation and branching of the smaller ducts, combined with proliferation of the epithelial cells of the glands and the myoepithelial cells
what occurs to breast in second trimester of pregnancy?
- in the second trimester - glandular tissue continues to develop w differentiation of secretory alveoli
- plasma cells and lymphocytes infiltrate the nearby connective tissue
what occurs to the breast in the third trimester of pregnancy?
- in the third trimester secretory alveoli continue to mature, with development of extensive rER (rough endoplasmic reticulum)
-> these changes are also accompanied by a reduction in CT and adipose tissue present
during pregnancy what hormones stimulate the proliferation of secretory tissue in the breast?
- oestrogen
- progesterone
what is S and D in this image?
- S = septa of connective tissue
- D - interlobular duct
what is TDLU and P in this image?
- TDLU = total duct lobular unit
- P = plasma cell
what is M and Ly in this image?
- myoepithelial cell
- lymphocyte
