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HD2 > Applied Anatomy of the Female Reproductive System > Flashcards

Applied Anatomy of the Female Reproductive System Flashcards

1
Q

What are the 4 main ligaments?

A

Broad
Suspensory
Ovarian
Round

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2
Q

What is the broad ligament?

A

Peritoneal fold suspending uterus and uterine tubes

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3
Q

What are the 3 parts of the broad ligament?

A
  • mesovarium (suspends ovaries)
  • mesosalpinx (extends from ovaries to uterine tube)
  • mesometrium (majority of broad ligament)
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4
Q

What is the suspensory ligament?

A

Extends out from ovary to wall of pelvis

Contains ovarian vessels and nerves

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5
Q

What is the ovarian ligament?

A

Holds ovaries to uterus

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6
Q

What is the round ligament?

A

Remnant of gubernaculum

  • reflects uterus keeping it anteverted and anteflexed
  • passes into inguinal canal ending in labia majora
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7
Q

What are the 4 parts of the uterine tube?

A
  • isthmus (most narrow part)
  • ampulla (middle part of tube)
  • infundibulum (uterine tube opens towards ovaries)
  • fimbriae(collects ovules)
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8
Q

What is the most common site of fertilisation?

A

Ampulla of the uterine tube

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9
Q

What is the internal and external os?

A

Internal and external orifice of the uterus

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10
Q

What is the cervix?

A

Lower part of uterus angling towards vagina

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11
Q

What is the position of the uterus?

A

Anteverted and anteflexed

  • can also be retroverted/retroflexed
  • anteverted = angle between cervix and vagina = 90 degrees
  • anteflexed = angle between cervix and uterine body = 170 degrees
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12
Q

What is the vesicouterine pouch?

A

Angle between bladder/uterus

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13
Q

What is the pouch of douglas?

A

Rectum/uterus

- fluid can accumulate here in pathologies

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14
Q

When does an ectopic pregnancy occur?

A

When fertilised egg implants outside of intra-uterine cavity

- most commonly fallopian tube

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15
Q

What happens an ectopic pregnancy occurs in the fallopian tube?

A
  • growing foetus stretches
  • ruptures wall of tube = bleeding
  • life threatening
  • symptoms: abdominal cramps, bleeding, dizziness, pain in shoulder/neck/rectum, vomiting
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16
Q

What are the 4 main supports of the uterus?

A
  • levator ani muscles and perineal body
  • transverse cervical ligaments (fibromuscular from lateral pelvic walls to cervix and upper vagina)
  • pubocervical ligaments (firm bands CT from pubis to cervix on either side of bladder)
  • uterocervical ligaments (fibromuscular bands cervix to sacrum)
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17
Q

What main vessels supply blood to pelvic viscera?

A

Internal iliac -> anterior and posterior divisions

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18
Q

What arteries make up the anterior division?

A

Obturator
Uterine
Vaginal

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19
Q

What arteries make up the posterior division?

A 
Superior gluteal (GSF)
Inferior Pudendal (LSF)
Inferior Gluteal (GSF)
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20
Q

What is the path of the uterine artery?

A

Internal iliac -> uterine -> with ovarian artery coming of abdominal aorta goes into circuit -> gives off vaginal branch (Upper 1/3 of vagina and cervix) and ascending branch (uterus)

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21
Q

What arteries supply the vagina?

A

Lower 2/3 vaginal artery off internal iliac

Upper 1/3 branch off uterine artery

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22
Q

What is the pelvic floor?

A

Group of muscles dividing the main pelvic cavity from peritoneum below
- pelvic diaphragm

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23
Q

What makes up the pelvic floor?

A

Coccygeal
Levator ani group
Covering fascia

24
Q

What makes up the levator ani?

A

(anterior to posterior)

  • levator sphincter vaginae/prostate (sling around inserting into perineal body)
  • puborectalis (sling from pubic bone around rectoanal junction)
  • pubococcygeus (pubic to anococcygeal body)
  • iliococcygeus (ilium to anococcygeal body and coccyx)
25
Q

What is the anococcygeal body?

A

Fibrous mass between tip of coccyx and anal canal

26
Q

What are the external rotators of the hip?

A

Obturator Internus

Piriformis

27
Q

Where is the obturator internus?

A

Through lesser sciatic foramen

Inserts into greater trochanter of femur

28
Q

Where is the piriformis?

A

Originates from anterior aspect of sacrum
Passes out pelvis through GSF
To greater trochanter of femur
External rotator of hip

29
Q

What are the 2 main disorders of the pelvic floor?

A
  • prolapse of uterus

- damage during childbirth

30
Q

What is prolapse of the uterus dependent on?

A

Tone of levator ani

- if damage = downwards displacement of uterus

31
Q

When does uterus prolapse most commonly occur?

A

After menopause as viscera atrophy

32
Q

What is uterus prolapsed always accompanied by?

A

Vagina prolapse

  • first degree: no external signs, urgency symptoms
  • second degree: cervix down into vagina opening
33
Q

How can there be damage to the pelvic floor during childbirth?

A
  • pelvic floor supports foetal head while cervix dilates permitting delivery
  • injury = tearing levator ani
    = incontinence
  • controlled episiotomy
34
Q

Which part of the levator ani normally tears in childbirth?

A

Puborectalis

Pubococcygeus

35
Q

What structures make up the female superficial pouch?

A
  • masses of erectile tissue
  • 3 muscles
  • greater vestibular gland
  • perineal body
36
Q

What are the erectile tissue masses in the superficial pouch?

A
  • crus of clitoris (attached to urogenital diaphragm)

- bulb of vestibule (erectile tissue of vestibule)

37
Q

What are the 3 muscles of the superficial pouch?

A
  • bulbospongiosis
  • ischiocavernous
  • superficial transverse perineal muscle (fixed perineal body)

attached to perineal body

38
Q

What is the greater vestibular gland?

A

Bartholin’s cyst - small fluid filled sac

- inside opening of woman’s vagina

39
Q

What is the perineal body?

A
  • posterior border of urogenital triangle

- structure in muscles of pelvic floor/perineum attach

40
Q

Where do the nerves supplying the pelvic floor come from?

A

Lumbar and sacral levels

- enter lumbar sacral plexi

41
Q

Where is the lumbar plexis?

A

Situated behind psoas major

42
Q

What are the important branches of the lumbar plexis?

A
  • L2,3,4 femoral (anterior compartment of thigh)
  • L2,3,4 obturator (medial compartment of thigh)
  • L1,2, genitofemoral (skin of scrotum/cremaster muscle/labium majorum)
43
Q

What is the lumbosacral trunk?

A

Fibres from L4 and L5 join

  • emerges medial to psoas major
  • inferiorly over pelvic brim
  • joins sacral plexus
44
Q

What is the sacral plexus?

A
  • posterior in pelvis
  • branches immediately
  • exits pelvis via GSF
  • sciatic and gluteal branches
45
Q

What is the course of the pudendal nerve?

A

S2,3,4
Leaves pelvis via GSF
- enters perineum through LSF around sacrospinous ligament
- through pudendal canal with pudendal artery and vein

46
Q

Course of pelvic parasympathetic pelvic viscera?

A

S2,3,4

47
Q

Function of pelvic parasympathetic nerve?

A

Micturition, defecation, genital erection

48
Q

What is the function of the sympathetic supply?

A 
Bladder filling
IUS contraction (hypogastric)
Contraction of seminal vesicles and vas deferens
49
Q

What are the 3 obstetric anaesthetic options?

A
  • spinal anaesthesia
  • pudendal nerve block
  • caudal epidural block
50
Q

How is spinal aesthesia done?

A
  • subarachnoid space L4-L5

- complete below waist monitoring uterine contractions

51
Q

How is pudendal nerve block done?

A
  • peripheral nerve block S2-S4
  • perineurium and lower 1/4 vagina
  • mother feels contractions
52
Q

How is caudal epidural block done?

A

Administer to catheter in sacral canal (S1-S5)

- limbs unaffected

53
Q

What is the penis drained by?

A

Deeper inguinal lymph nodes

54
Q

What are the ovaries/testes drained by?

A

Preaortic lymph nodes

55
Q

What does horizontal/superficial lymph node swelling indicate?

A

Vulva/scrotal cancer

HD2 (22 decks)

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