Basics Flashcards
1
Q
Female Upper Genital Tract
A
uterus, fallopian tubes, ovaries, and cervix
2
Q
Cervix Histology
A
-
Endocervix: proximal to the uterine external os
- simple columnar epithelium with mucous-producing cells
-
Cervical transformation zone
- squamocolumnar junction
- Cervical cancer most commonly occurs in this zone.
-
Ectocervix: distal to the uterine external os
- stratified squamous epithelium (nonkeratinized)
3
Q
Female Lower Genital Tract
A
vagina and vulva
4
Q
Function of the Uterus
A
- Site of implantation of the fertilized ovum
- Protects and supports the growth of the fetus
- Site of menstruation
5
Q
Function of the cervix
A
- Promotes entry of sperm into the uterus for fertilization
- Allows menstrual blood to flow from the uterus into the vagina
- The endocervix secretes a clear, alkaline fluid to facilitate the passage of sperm.
6
Q
Location and position of the uterus
A
- located posterior to the bladder and anterior to the rectum
- commonly anteverted by 90° and anteflexed by 120
- retroflexion may impair conception
7
Q
Anteverted vs Anteflexed
A
- Flexion: angle between the axis of the uterine body and the axis of the cervix
- Version: angle between the axis of the cervix and the axis of the vagina.
8
Q
Location of the cervix
A
- most distal aspect of the uterus and protrudes into the fundus of the vagina
*
9
Q
Pouch of Douglas
Recto[uterine/vesicle] space
A
- Intraperitoneal space that lies between the uterus and the rectum (bladder and rectum in males)
- lowest point of the peritoneal cavity
- common site of fluid collection and/or intraperitoneal metastases.
10
Q
Uterine Vein:
Location/ Function
A
- Venous plexus in the uterine wall (broad ligament) → uterine veins
- → internal iliac veins
- Crosses the ureter anteriorly in the broad ligament
Function
- Drains the uterus
11
Q
Uterine Artery:
Location/ Function
A
- Branch of the internal iliac artery
- Crosses the ureter anteriorly in the broad ligament
- Ligation of the uterine arteries (e.g., during hysterectomy) → risk of ureter injury!
Function
- Supplies the distal portion of the uterus and the cervix
12
Q
Uterus Histology
A
- Endometrium: mucosal layer
- Simple columnar epithelium with tubular glands
- Connective tissue (stroma)
- Myometrium: smooth muscle layer
- Serosa/adventitia:
- Uterine body: peritoneal serosa
- Anterior cervix and lateral uterine body: adventitia (not covered by peritoneum)
13
Q
Paramesonephric Duct ( Mullarian duct)
A
- uterus,
- cervix,
- fallopian tubes
- proximal part of the vagina
14
Q
Location and Structure of Fallopian Tubes
A
Contained in the proximal part of the broad ligaments
- Fimbria: Ciliated end of the fallopian tube
- Infundibulum: funnel-shaped opening with attached fimbriae
- Ampulla: widest part; most common site of fertilization
- Isthmus: narrowest part
- Intramural: located in the myometrium of the uterus
15
Q
Fallopian tube vasculature
A
Lateral 2/3
- Ovarian artery and vein
Medial 1/3
- Uterin artery and vein
16
Q
Fallopian Tubes Histology
A
-
Mucosa:
- simple ciliated columnar epithelium and secretory Peg cells
-
Muscular layer:
- smooth muscle(Inner circular and outer longitudinal layer)
- Serosa: highly vascular layer
17
Q
Location of Ovaraies
A
- Lateral to the uterus
- close to the lateral pelvic wall
- Suspended in the mesovarium
- (attached to the posterior part of the broad ligament)
18
Q
Ovarian Vein:
Location/ Function
A
- Pampiniform plexus → ovarian veins →
- renal vein (left) and inferior vena cava (right)
- Located in the mesovarium and infundibulopelvic ligament
Function
- Drains the ovaries and lateral two-thirds of the fallopian tubes
19
Q
Ovarian Artery:
Location/ Function
A
- Located in the infundibulopelvic ligament
- Anastomosis with ovarian branches from the uterine artery
Function
- Supplies the ovaries and lateral two-thirds of the fallopian tubes
- Supplies the proximal portion of the uterine body
20
Q
Lymphatic Drainage of the Vulva
A
- The superficial inguinal nodes
- → deep inguinal → pelvic and external iliac lymph nodes → paraaortic lymph nodes
21
Q
Lymphatic Drainage of the Vagina
A
- Upper third: external iliac nodes
- Middle third: common and internal iliac nodes
- Distal third: superficial inguinal nodes
22
Q
Sensory Inervation of the Vagina
A
Pudendal Nerve (S2-4)
Pudendal nerve block is often used for anesthesia prior to vaginal procedures, childbirth, or episiotomy.
23
Q
Vagina Histology
A
Inner mucosal layer
- Nonkeratinized stratified squamous epithelium rich in glycogen.
External muscular layer
- Outer longitudinal and Inner circular smooth muscle layer
Hymen:
- nonkeratinized stratified squamous epithelium
24
Q
Vulva Histology
A
- Labia minora
- Nonkeratinized stratified squamous epithelium (sebaceous glands)
- Labia majora
- Keratinized stratified squamous epithelium
- Eccrine, apocrine, and sebaceous glands
- Vestibule:
- nonkeratinized squamous epithelium (vestibular glands)
- Urethra:
- columnar epithelium (vestibular glands)
25
Vagina and Vulva Embryology
1. Paramesonephric ducts (Müllerian ducts) → upper third of the vagina
2. **Urogenital sinus** → lower two-thirds of the vagina, vaginal vestibule, vestibular glands
3. Urogenital folds → labia minora
4. Labioscrotal swelling → labia majora
5. Genital tubercle → clitoris
26
Broad Ligament and Ureter relation
the ureter is located directly posterior to the infundibulopelvic ligament, close to the medial leaf of the broad ligament.
27
Speculum Examination
* Insertion of a speculum device facilitates the inspection of the vaginal wall and ectocervix
* Evaluate the quality of vaginal discharge to determine whether a smear should be acquired
28
Signs and Symptoms of pathologic discharge
* Malodorous
* consistency (e.g., frothy, curd-like)
* Pruritic and/or erythematous vagina
* Cervical tenderness
29
Physiologic leukorrhea (normal discharge)
* Profuse white or yellow and non-malodorous vaginal discharge can be physiological if none of the features mentioned above are present.
* In newborns, vaginal discharge may occur due to in-utero exposure to maternal estrogen (no treatment is necessary).
30
Colposcopy
* a type of microscope used to acquire a magnified view of the ectocervix or vaginal wall
* Application of acetic acid or iodine facilitates the colposcopic detection of precancerous and cancerous lesions
* Colposcopy-directed cervical smears and biopsies
31
Cervical Ectopy
* squamous cell epithelium of the ectocervix is replaced by columnar cell epithelium of the endocervix
* physiological influence of estrogen (e.g., pregnancy, certain oral contraceptives).
* Cervical ectopy is seen on colposcopy as a sharply demarcated bright red area with papillarystructures.
* Malignant transformation may occur in cases of HPV-16 and/or HPV-18 infections
32
Abnormal findings in Colposcopy
1. White lesions under acetic acid application: **condylomata acuminata**
2. White membrane that cannot be scraped off: **cervical leukoplakia**
3. Punctate lesions or coarse mosaic pattern: **cervical intraepithelial neoplasia**
4. Atypical vessels: **cervical cancer**
33
Normal Vaginal Smear
cylindrical Lactobacilli (Doderlein's bacilli)
34
Trichomoniasis Vagnial Smear
Motile flagellated protozoa
35
Gonorrhea Vagnial Smear
Gram staining when gonorrhea is suspected → gram-negative, intracellular diplococci
36
Bacterial Vaginosis Vagnial Smear
Clue cells and whiff test (adding KOH to vaginal smear elicits a fishy odor)
pH \> 4.5
37
Vaginal Candidiasis Vagnial Smear
Pseudomycelia and/or yeast cells
pH \<4
38
39
M
40
Pulmonary contusion
Lung penchymal
41
42
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