Anatomy Uterus, Vagina, ovaries and breast

Question 1

What are the attachments of the uterovesical fold (forming the vesicouterine pouch)

Answer 1

Upper surface of bladder to junction between cervix & uterine body.

Question 2

What are the attachments of the rectovaginal fold (forming the rectouterine pouch)

Answer 2

Surface of rectum to posterior fornix of vagina

Question 3

What are the 4 ligaments holding the uterus.

Answer 3

Uterosacral ligament
Broad Ligament
Transverse cervical ligament (Cardinal ligament)
Round ligament

Question 4

What are the attachments of the uterosacral ligament?

What does it consist off?

Answer 4

Cervix to anterior wall of sacrum

Folds of peritoneum contains smooth muscle and fibrous tissue.

Question 5

What are the attachment of the suspensory ligament?
What are its contents?
What vessel does it run over>

Answer 5

Infundibulum of uterine tube and upper pole of ovary to lateral wall of pelvis.
Contains ovarian vessels, nerves and lymphatics.
Runs over external iliac vessels.

Question 6

What are the subdivisions of the broad ligament

Answer 6

Mesomestrium
Mesovarium
Mesosalpinx

Question 7

Explain the terms
Mesomestrium
Mesovarium
Mesosalpinx

Answer 7

Mesovarium: Area of broad ligament that rises from pelvic floor upwards, covers most of uterus & runs laterally.
Mesovarium: Associated with ovaries, projects off the posterior wall of the broad ligament, holds neurovascular supply. Does not cover the ovary itself.
Mesosalpinx: Superior to mesovarium, contains fallopian tubes.

Question 8

Describe the course of the uterine artery

Answer 8

Anterior devision and the internal iliac artery, crosses above ureter, crossed medially and travels within the cardinal ligament towards cervix. Pass superiorly 1.5cm lateral to cervix within the broad ligament to anastomose with branches from the ovarian artery.

Question 9

What are the attachments of the transverse cervical ligament?
What are its contents

Answer 9

Lateral aspect of cervix to lateral wall of pelvis.
Uterine artery & vein
Very important hold structure of vagina and uterus

Question 10

What is the course and attachments of the round ligament?

Answer 10

Uterine horns (attachment of fallopian tubes), runs within broad ligament, passes through deep inguinal ring, passes in the inguinal canal alongside the ilioinguinal nerve and is then attached to tissue of labia majora.

Question 11

How does the cervix change in pregnancy?

Answer 11

Cervix increases in vascularity and is less rigid. Increases it mucous production (mechanical barrier to infection).

In late pregnancy the dense collagen loosens and allowing the lower section to shorten and upper section expand.

Question 12

What vessels supply the uterus, cervix and vagina

Answer 12

Ovarian vessels
Uterine vessels
Vaginal Artery
Internal pudendal artery

Question 13

Name the area of the fallopian tube from lateral to medial

Answer 13

Fibrae, infundibulum, ampulla, isthmus.

Question 14

What position is the ovary sit in a nulliparous woman?

Answer 14

It is vertical with a medial, lateral, tubal (superior), and uterine (inferior) extremities.
Sits within ovarian fossa of lateral wall of pelvis.

Question 15

What structures are found immediately posterior to the ovary?
What structures are found by the tubal extremity of the ovary?

Answer 15

Ureter and internal iliac artery

External iliac vein, fimbriae, suspensory ligament.

Question 16

Within the ovarian fossa, what separates the ovary from obturator vessels/nerves.

Answer 16

Parietal peritoneum.

Question 17

Where do sensory fibres from the uterine body and fundus travel

Answer 17

Travel with the sympathetic fibres via the inferior hypogastric plexus up the L/R hypogastric nerves to the superior hypogastric plexus to thoracic cords T11 & T12.

Question 18

Where do sensory fibres from the cervix and upper vagina travel?

Answer 18

Travel with the pelvic splanchnic nerves to S2-S4.

Question 19

Where do sensory fibres from the lower vagina & perineum travel?

Answer 19

Via pudendal nerve to S2-S4.

Question 20

Describes the motor fibres to

1) Uterine body & fundus
2) Lower uterus and upper vagina
3) Lower vagina and perineum

Answer 20

1) Sympathetics
2) Parasympathetic via pelvic splanchnic nerves
3) Somatic via pudenal nerve

Question 21

Where does the base of the breast extend?

Answer 21

From the 2nd rib to the 6th rib overlying th fascia of pectoralis fascia.

Question 22

Describe the breast lobules and the associated ducts.

Answer 22

The breast is roughly filled with 20 fat-filled lobules, each contains a lactiferous ducts.
The lactiferous ducts travel medial to open at nipple.

Question 23

What glands surround the nipple?

What do they secrete?

Answer 23

Areolar glands.

They secrete oily, protective lubricant.

Question 24

How are the breast lobules seperated from each other?

Answer 24

Suspensory ligaments, extending from deep fascia from pectoralis major to dermis of skin.

Question 25

What is the blood supply of the breast?

Answer 25

Mainly from lateral thoracic artery (branch axillary artery) forming lateral mammary branches.
Some lateral mammary branches come form posterior intercostal arteries.
Medial mammary branches arise from internal thoracic artery (branch of subclavian)

Question 26

75% of lymphatic drainage of the breast goes to which node?

Where does the rest drain?

Answer 26

Axillary node

Para-aortic nodes.