Anatomy of Female Reproductive Tract and Breast Flashcards
the female reproductive system lies within which cavity?
both the pelvic cavity and perineum
what aspects of the female reproductive system are found within the pelvic cavity?
ovaries
uterine tubes
uterus
superior part of vagina
what aspects of the female reproductive tract are found within the perineum?
inferior part of vagina perineal muscles bartholin's glands clitoris labia
what forms a roof over pelvic organs?
inferior part of parietal peritoneum (floor of peritoneal cavity)
what pouches are formed by the peritoneum overlying the pelvic organs?
vesico-uterine pouch
recto-uterine pouch (pouch of douglas)
- most inferior part of peritoneal cavity in anatomical position so any excess fluid tends to collect here
how is fluid removed from the pouch of douglas?
drained via needle passed through the posterior fornix of vagina
what is the broad ligament of the uterus?
double layer of peritoneum which extends between the uterus and lateral walls and the floor of the pelvis
what is the function of the broad ligament of the uterus?
contains the uterine tubes and the proximal part of the round ligament
helps maintain the uterus in its correct midline position
what is the round ligament and what path does it take?
embryological remnant which attaches to the lateral aspect of the uterus, then passes through the deep inguinal ring to attach to the superficial tissue of the female perineum
(proximal part contained within broad ligament)
3 layers of the uterus and which is shed during menstruation?
perimetrium
myometrium
endometrium (shed)
where in the uterus does the zygote implant?
thickened endometrium of body of uterus
what holds the uterus in place and prevents prolapse?
3 levels of support
- number of strong ligaments (e.g uterosacral ligament)
- endopelvic fascia
- pelvic floor muscles (e.g levator ani)
most common position for the uterus to be found in?
anteverted and antiflexed
anteverted
- cervix tipped anteriorly relative to the axis of the vagina
anteflexed
- uterus tipped anteriorly relative to the axis of the cervix (mass of uterus lies over bladder)
other normal variations in 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
uterus is basically tipped backwards against the rectum
how is a cervical smear performed?
must use a speculum as walls of vagina are normally collapsed
sample the squamo-columnar junction (transformation zone)
how do the uterine tubes usually lie?
asymmetrically
what is a bilateral salpingo-oophrectomy?
removal of both uterine tubes and ovaries
how do the genital tract and peritoneal cavity communicate?
what is the impact of this?
the fimbrae at the ends of the uterine tubes open into the peritoneal cavity
therefore infection could pass between the 2 areas
(i.e PID can cause peritonitis and ectopic pregnancy can develop in peritoneal cavity)
location of the ovaries?
develop on posterior abdominal wall and move onto the lateral wall of the pelvis in the pelvic cavity (round ligament of uterus)
function of ovaries?
secrete oestrogen and progesterone in response to anterior pituitary hormones FSH and LH
every month releases an ovum into the peritoneal cavity which is picked up by the fimbrae of uterine tube
what is the fornix?
the space around the cervix
where cervix holds walls of vagina apart at the superior aspect of the vagina
what are the 4 parts of the fornix?
anterior
posterior
2 X lateral
what can be palpated on digital vaginal examination?
ischial spines (laterally and at 4 and 8 o'clock position) position of uterus (assessed by bimanual palpation) palpation of adnexae (uterine tubes and ovaries - can detect large masses or tenderness affecting these structures)
what is the perineum and what forms the boundaries of it?
shallow space between pelvic diaphragm and the skin
what forms the pelvic diaphragm?
levator ani and coccygei muscles
what openings are found in pelvic diaphragm?
openings for passage of distal parts of alimentary, renal and reproductive tracts from pelvis to perineum
describe levator ani muscle?
made up of a number of smaller muscles
skeletal muscle (voluntary)
forms majority of pelvic diaphragm (including its fascial coverings)
function of levator ani muscle?
support of pelvic organs
- tonic contraction
- reflexively contracts further during situation of increased intra-abdominal pressure
- weakness can cause prolapse of pelvic organs
what innervated levator ani muscle?
S3, S4, S5
potentially has dual supply
divisions of perineal muscles and what supplies them?
superficial and deep perineal muscles
both supplied by pudenal nerve
what is the perineal body?
bundle of collagenous and elastic tissue located just deep to skin into which the perineal muscles attach
important to pelvic floor strength and can be disrupted during labour
what are the bartholins glands?
(same as bulbourethral glands in males)
two small pea sized alveolar glands which sit either side of posterior vagina and secrete mucous to lubricate vagina
where is the bed of breasts located?
between ribs 2-6
between lateral border of sternum and mid-axillary line
what do the breasts sit on top of?
deep fascia covering pec major and serratus anterior
what lies between fascia and the breast?
retromammary space
what attaches the breast tissue to the skin?
suspensory ligaments
what is the name of the tapering end of breast tissue towards the axilla?
axillary tail (of spence)
how is the position of an abnormality (e.g lump) described in the breast?
clock face (e.g 3 o'clock position) or in 4 quadrants (upper outer/inner, lower outer/inner)
how else is a lump in the breast described?
asses whether fixed to any underlying tissue (e.g pectoral fascia)
- ask patient to stand with hands on hips causing contraction of pectoral muscles)
lymphatic drainage in the breast?
75% of lymph from breast drains to ipsilateral axillary lymph nodes and then to supraclavicular nodes
lymph from inner quadrants can drain to parasternal nodes
lymph from lower quadrants can drain to abdominal nodes
what are the implications of removing axillary nodes for other body areas?
can cause lymphoedema in upper limb as lymph from upper limb also drains to axillary nodes
axilla forms a pyramidal passageway between arms and chest, what is found within this area?
brachial plexus and branches
axillary artery/vein and branches
axillary lymph nodes
all embedded in axillary fat
surgeons use levels to describe extent of axillary node clearence in breast cancer surgery, what are these levels and how are they determined?
level 1 = inferior and lateral to pectoralis minor
level 2 = deep to pectoralis minor
level 3 = superior and medial to pectoralis minor
blood supply and drainage of breast?
axillary artery and internal thoracic (internal mammary) = supply
lateral thoracic vein (mostly) and internal thoracic vein (and some from internal intercostal vein) = drainage
