anatomy of the female pelvis Flashcards
what is mons pubis
pad of fatty tissues that overlies the pubis
What are some external landmarks?
vagina mons pubis labia clitoris urethral opening anus
What is the True Pelvis?
Below plevic brim to the pelvic diaphragm, contains pelvic organs
what is the false pelvis?
above the pelvic brim to the iliac crest - communicates with abdominal cavity superiorly
pelvic cavity
true pelvis, inferior to the caudal portion of the parietal peritoneum
what is in the posterior pelvic cavity
rectum, colon and ileum
what is in the anterior pelvic cavity
bladder, ureters, ovaries Fallopian tubes, uterus and vagina
what is the pouch of douglas
rectouterine space - lowest most posterior portion of the peritoneal cavity
what forms the posterior wall?
sacrum and coccyx
margin of post-lat wall formed by piriformis and coccygeus muscles
what forms the anterolateral walls?
formed by hip bones and obturator internus muscles
what forms the lower margin pelvic cavity?
(aka pelvic floor or pelvic diaphragm)
formed by levator ani and coccygeus muscles
muscles of the false pelvis
psoas major muscles - originate at the transverse process of lumbar vertebrae - descend inferiorly on pelvic side walls- join iliacus muscles in false pelvis (they do not enter the true pelvis)
lliopsoas muscle, iliacus and psoas major muscles: descend anterior to hip-insert into lesser trochanter, pass outside pelvic bones , do not enter true pelvis
what are the muscles of the true pelvis?
Piriformis muscles -
Obturator internus muscles -
pelvic diaphragm -
levator ani muscle (3 muscle groups) Puboccygeus muscles, lliococcygeus muscles, puborectalis (see the slide)
Bladder
location: anterior portion pelvic cavity - posterior to pubic symphysis
Function: Collect and store urine
remains in true pelvis when empty
when distended rises behind lower anterior abdominal wall pushes peritoneum away
vagina
extends postero-superiorly at a 45 degree angle from external genitalia to cervix, then forms a 90 degree angle to the cervix
average 9 cm long
anterior to rectum/anus - posterior to bladder/urethra
mucus membrane lining muscular walls
passageway for the products of menstruation
easily distended during sexual intercourse and childbirth
posterior wall is longer than the anterior wall
mucus membrane lining muscular walls
upper half above pelvic floor, lower hald within perineum
arterial supply - vaginal and uterine arteries drain into interal iliac veins
upper portion attaches to cervix -posterior portion attaches higher on cervix
what are the fornices?
4 arch like recesses formed by cervix protruding into upper portion of vaginal canal
blind pockets formed by inner surface of vagina and outer surface of cervix
continuous ring shaped space
uterus
Müllerian ducts enlogate and fuse to form uterus and vagina between 7th and 12th week of gestation
posterior to bladder/anterior to rectum
hollow, pear shaped
largest organ of female pelvis - allows for cyclic physiologic changes assoc with menstruation and after fertilization, serves to sustain, protect and deliver fetus
3 parts: fundus, body, cervix
usually antiflexed and antverted (held in place by round ligaments)
average size 6-8 cm long and 3-5 cm AP and transverse varies with age and parity
supported by levator ani muscles, cardinal ligaments and uter-sacral ligaments
portions of uterus
cervix isthmus body of uterus fundus of uterus cornua
what is the cervix?
"neck of uterus" lower cylindrical portion of uterus - projects into vaginal canal muscular divided into exocervix and endocervix only portion of uterus firmly supported
ithmus
ourter transition point between body of uterus and cervix
“waist” of uterus
point where uterus bends with empty bladder
anteversion bends anteriorly
retroversion bends posteriorly
uterine blood vessels enter at this point
body of uterus
aka corpus
between fundus and cervix
largest portion of the uterus
cavity funnel shaped coronal plane, slit-like sagittal plane
potential space for fluid accumulation-dynamic changes during menstrual cycle and pregancy
posterior to vesicouterine pouch and superior surface of bladder
anterior to rectouterine pouch ( pouch of douglas), ilium and colon
walls are together unless something is in there to separate them
fundus of uterus
widest portion of uterus
uppermost cephalic poriton of uterus
dome shaped
cornua - lateral borders of fundus, Fallopian tubes enter uterine cavity, interstitial portion of Fallopian tubes
layers of the uterine wall
3 histologic layers
perimetrium - serosa - outermost peritoneal covering (external layer)
myometrium - middle layer -muscular- thickest layer- primarily smooth muscle that is longitudinal and circular. contains main branches of uterine vessels and nerves
endometrium - inner layer - glandular tissue lining - mucous membrane - 2 layers which undergo monthly hormonal changes
endometrium
continuous with cervical canal - endocervical canal
changes dynamically responding to the cyclic hormonal changes. Appearance varies depedning on the patients menstrual status and period of life
two layers- zona funtionalis and zona basalis
zona funtionalis
superficial layer of glands and stroma (supporting tissue)
sheds with menses
zone basalis
basal layer
layer of endometrial glands which regenerate new endometrium after menses
uterine ligaments
anchor uterus in proper position in midline of pelvis
broad ligaments
round ligaments
uterosacral ligaments
cardinal ligaments
broad ligaments
double fold of peritoneum drapes over uterus, ovaries Fallopian tubes
lateral aspect of uterus to sidewalls of pelvis - provides lateral support for the uterus
covers both anterior and posterior surfaces of uterus
contain uterine vessels and nerves
3 separate areas: mesometrium, mesosalpinx and mesovarium
mesometrium
portion of broad ligament over the uterus
mesosalpinx
portion of broad ligament - upper fold encloses Fallopian tubes
mesovarium
posterior portion of the borad ligament that encloses the ovaries
round ligaments
hold fundus and body in forward position (anterior support)
attach to anterior lateral portion of fundus, extend to inguinal canal
insert into labia majora
holds uterine fundus in normal anteflexed position
uterosacral ligaments
attach posterior-lateral aspect of uterus at level of internal cervical os
extend posteriorly and inferiorly to sacrum
support cervix
with round ligaments hold uterus in normal anteflexed position
cardinal ligaments
aka: transverse cervical ligaments, mackenrodt ligaments or parametrium
provide lateral support of cervix and lower uterine segment
continuation of broad ligaments which extend across pelvic floor laterally from isthmus/cervix to pelvic sidewalls
with uterosacral ligaments hold cervix in fixed position
important landmarks for surgery - contain uterine vessels
explain the support system in the pelvis
explain which muscles and ligaments and where on the bone they attach
positions of the uterus
variable
most common anteverted/anteflexed
full bladder will tip average uterus backward
anteversion
anteflexion
retroversion
retroflexion
retroverted/retroflexed
dextroversion dextroflexion levoversion levoflexion uterine prolapse
anteversion
cervical canal forms 90 degree or smaller angle with vaginal canal anteriorly
anteflexion
fundas and body curved forward on cervix
approx 170 degree angle between uterine /cervical canal