applied anatomy

Question 1

Uterus - The uterus is divided into ___ main parts:

•The body of the uterus superior ___

• ________
• _______
• The uterine _____

•The cervix lower ___

Answer 1

two

2/3

Fundus

Isthmus

horns

1/3

Question 2

the cervix is Divided by the vaginal attachment into what two parts?

Answer 2

• Supra vaginal part (between the isthmus and vagina) which is only separated from the bladder anteriorly only by loose connective tissue and from the rectum posteriorly by recto-uterine pouch. (Pouch of Douglas)
• Vaginal part (which protrudes to the vagina):that is visible during speculum examination

Question 3

what si the Relationships of the supra vaginal Cx?

Answer 3

• Anteriorly: Urinary bladder
• Posteriorly: Forms the anterior wall of Douglas pouch (separates it from the rectum)
• Laterally: 1/2 an inch lateral to the internal os the ureter is crossed by the uterine artery (i.e. ureter below the uterine artery)(Water under the bridge)

The uterosacral, cardinal, and pubo-cervical ligaments are attached to its posterior, lateral, and anterior surfaces respectively

Question 4

Post view (water _______ the bridge)

Answer 4

under

Question 5

what is the vasculature?

Answer 5

• Shared between the uterine and the vaginal artery = anterior division of internal iliac artery
• Ovarian artery: enclosed in the infundibulo-pelvis ligaments; direct branch from Aorta
• Ovarian Vein: right side drains into IVC
• Left Ovarian vein: drains into left renal vein.
• Lymphatic drainage = along the uterine vessels within the transverse cervical ligament to the internal and external iliac lymph nodes and along uterosacral to the sacral lymph nodes
• Along the ovarian vessels to the para-aortic nodes.

Question 6

what is the innervation of the female reproductive tract?

Answer 6

• Superior hypogastric plexus: In front of sacral promontory; Contains sympathetic nerve fibres; divides into right and left hypogastric nerves
• Inferior hypogastric plexus: the right and left hypogastric nerves + preganglionic parasympathetic fibres from the pelvic splanchnic nerves. Located on each side of rectum and base of the bladder; contains both sympathetic and parasympathetic fibres.
• Pelvic splanchnic nerves: S2/3/4; preganglionic parasympathetic fibers that originate from the 2nd, 3rd, and 4th sacral spinal segments. They join the hypogastric nerves to form the inferior hypogastric plexuses.

Question 7

what ar ethe functions of the nerves in the pelvis?

Answer 7

• Sympathetic: inhibits peristalsis and stimulates muscle contraction of genital organs during orgasm.
• Parasympathetic: increases peristalsis and contraction of the bladder and rectum for urination and defecation.
• Nerve sparing surgery in pelvis

Question 8

what are the ligaments? (3 true ligaments)

Answer 8

• Transverse cervical ligaments (cardinal) àFrom the Cx and lateral part of the vagina to the lateral wall of the pelvis
• Uterosacral ligaments pass superioly and posterioly from the side of the Cx to the middle of the sacrum.
• Pubocervical ligament/ fascia

Question 9

what are the different types of hysterectomy?

Answer 9

Different kinds of hysterectomy

Hysterectomy is removal of uterus

Subtotal – when only uterus alone if removed and leaving the cervix behind

Total – when uterus and cervix is removed

Radical – slightly more tissue, uterus, cervix, upper vagina and parametrium box with soft tissue

Question 10

where is a pudendal block done?

Answer 10

Episiotomy (a surgical incision of the perineum and the posterior vaginal wall generally done by a midwife or obstetrician)

Pudendal nerve goes around the ischial spine

Question 11

what are the different types of episiotomies?

Answer 11

After pudendal block, or analgesia or whatever

Can be a midline or a mediolateral episiotomy

Normally done in oblique fashion in the UK

Need to know what structure we are cutting

Don’t want to cut external anal sphincter in the medial one

Question 12

what are the muscels of the perineum?

Answer 12