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OB/GYN 1 > Chapter 39 > Flashcards

Chapter 39 Flashcards

1
Q

Pelvic landmarks

A

mons pubis

labia majora

labia minora

clitoris

urethral opening

vestibule of vagina

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2
Q

Bony pelvis

A

2 coxal bones

sacrum

coccyx

true and flase pelvis

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3
Q

true pelvis

A

situated inferior to caudal portion of parietal peritoneum

condisered pelvic cavity

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4
Q

pelvic cavity

A

posterior wall formed by sacrum and coccyx

posterolateral wall formed by piriformis and coccygeus muscles

anteriolateral walls formed by hip bones and obturator internus muscles, which rim ischium and pubis

lower margin formed by levator ani and coccygeus muscles

known as pelvic diapraghm

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5
Q

perineum

A

area below pelvic floor

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6
Q

pelvic cavity

A

posterior: rectum, colon and ileum
anterior: bladder, ureters, ovaries, fallopian tubes, uterus, vagina

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7
Q

muscles of pelvis

A

psoas major: sidewall

iliacus: sidewall

Piriformis: posterolateral wall

Obturator internus: anterolateral pelvic sidewall

Levator ani: pelvic floor (diaphragm)

Coccygeus: posterior pelvic floor (diaphragm)

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8
Q

Abdominal wall

A

muscles extend superiorly from xyphoid process to symphysis pubis inferiorly

paried rectus abdominis anteriorly

external obliques

internal obliques

transvers abdominis anteriolaterally

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9
Q

muscles of false pelvis

A

Psoas major

iliacus muscles

psoas muscles join with iliacus muscles to form iliopsoas muscles

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10
Q

Muscles of true pelvis

A

Piriformis muscles

obturator internus muscles

muscles of the pelvic diaphragm

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11
Q

muscles of pelvic diaphragm

A

Levator ani (pubococcygeus, iliococcygeus and puborectalis muscles)

Coccygeus muscles

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12
Q

Bladder

A

apex: located posterior to pubic bones

Base: anterior to vagina, superior surface related to uterus

Neck: rests on upper surface of urogenital diaphragm; inferiolateral surfaces relate to retropubic fat, obturator internus, levator ani muscles, pubic bone

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13
Q

Ureters

A

cross pelvic inlet anterior to bifurcation of common iliac arteries

run anterior to internal iliac arteries and posterior to the ovaries

coarse anteriorly and medially under base of broad ligament where crossed by uterine artery

run anterior and lateral to upper vagina to ender posteroinferior bladder

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14
Q

Vagina physical description

A

collapsed musclular tube that extends from external genitalia to cervix of uterus

approx 9cm in length

l

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15
Q

Vagina landmarks

A

normally directed up and back fromning 90 with uterine cervix

extends up and back from vulva

upper half lies above pelvic floor

lower half lies within perineum

vaginal lumen surrounding cervix divided into 4 fornices

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16
Q

Vaginal blood supply

A

from vaginal and uterine arteries

drains into internal iliac vein

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17
Q

Cervix

A

projects into vaginal canal

endocervix

exocervix

protrudes into upper portion of vaginal canal forming 4 recess (fornices)

continuous ring shaped space with posterior fornix running deeper than ints anterior counterpart

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18
Q

Endocervix

A

cervical canal

communicates with uterine cavity by internal os

with vagina by external os

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19
Q

exocervix

A

continuous with vagina

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20
Q

Uterus

A

hollow pear shaped organ

fundus

body

cervix

usually anteflexed and anteverted

covered with peritoneum except anteriorly below os where peritoneum reflected onto bladder

supported by levator ani muscles, cardinal and uterosacral ligaments

round ligaments hold uterus in anteverted position

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21
Q

Uterine size

A

premenarchal: 1-3 cm long by .5-1 cm wide
menarchal: 6-8 cm long by 3-5 cm wide

w/multiparity: increases by 1-2 cm

postmenapausal: 3.5-5.5 cm long by 2-3 cm wide

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22
Q

uterine body

A

posterior to vesicouterine pouch and superior surface of bladder

anterior to rectouterine pouch (of Douglas), ilium, colon

medial to broad ligaments and uterine vessels

uterine cavity is funnel shaped in coronal plane, slitlike in sagital plane

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23
Q

layers of uterus

A

perimetrium

myometrium

endometrium

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24
Q

perimetrium

A

serous outer layer of uterous

serosa

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25
Q

myometrium

A

muscular middle layer of uterus composed of thick smooth muschle supported by connective tissue

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26
Q

endometrium

A

inner mucous membrane

glandular portion of uterine body

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27
Q

uterine ligaments

A

broad

mesovarium

mesosalpinx

round

cardinal

uterosacral

suspensory

ovarian

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28
Q

broad uterine ligament

A

lateral aspect of uterus to pelvic sidewall

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29
Q

mesovarium uterine ligament

A

posterior fold of broad ligament

encloses ovary

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30
Q

mesosalpinx uterine ligament

A

upper fold of broad ligament

encloses fallopian tube

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31
Q

Round uterine ligament

A

fundus to anterior pelvic sidewalls

holds uterus forward

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32
Q

cardinal uterine ligament

A

extend across pelvic floor laterally

firmly supporst cervix

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33
Q

uterosacral ligament

A

extend from uterine isthmus downward

along side rectum to sacrum

firmly supports cervix

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34
Q

suspensatory uterine ligament

A

extends from lateral aspect of ovary to pelvic sidewall

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35
Q

ovarian uterine ligament

A

extends medially from ovary to uterine cornua

36
Q

Uterine postions

A

anteversion

dextroversion

retroversion

retroflexion

37
Q

Anteversion uterus

A

most common position

fundus and body bent forward toward cervix

38
Q

Dextroversion uterus

levoversion

A

normal variant in absence of pelvic masses

39
Q

retroversion uterus

A

entire uterus tilted posteriorly

40
Q

retroflexion uterus

A

fundus and body bent backward towards cervix

41
Q

Fallopian tubes

A

infundibulum

ampulla

isthmus

interstitial portion

12 cm in length

blood supplied by ovarian arteries and veins

42
Q

fallopian infundibulum

A

funner shaped lateral tube projects beyond broad ligament to overlie ovaries

free edge of the funnel has fimbriae

43
Q

Ampulla of fallopian tube

A

widest part of tube where fertilization occurs

44
Q

isthmus of fallopian tube

A

hardest part

lies lateral to uterus

45
Q

interstitial of fallopian tube

A

pierces uterine wall ar cornua

46
Q

Ovaries

A

almond shaped

attached at posterior aspect of broad ligament by mesovarium

lie in ovarian fossa

fossa bounded by ext iliacs, ureter obturator nerve

dual blood supply ovarian and uterine artery

blood drained by ovarian vein into IVC on right and renal vein on left

47
Q

Variable postinos of ovaries

A

anterior to internal iliac artery and vein

medial to external iliac artery and vein

ellipsoid shape with long azis oriented vertically

location highly variable as ligaments loosen, especially after pregnancy

48
Q

Ovaries normal anatomy

A

outer layer (cortex)

medulla

49
Q

ovary cortex

A

primarily follicles in varying stages of development

covered by layer of dense connective tissue

tunica albuginea

tunica albuginea surrounded by single layer of cells germinal epithelium

50
Q

medulla of ovary

A

composed of connective tissue containing blood, nerves, lymphatic vessels and some smooth muscle at region of hilum

51
Q

Ovarie reproductive cell

A

ovum

two known hormones

estrogen: secreted by follicles
progesterone: secreted by corpus luteum

52
Q

ovarian hormone responisibility

A

responsible for producing and maintaining secondary gender characteristics

preparing uterus for implantation of fertilized ovum

development of mammary glands in female

53
Q

ovarian ligaments

A

supported medially by ovarian ligaments originating bilaterally at cornua of uterus

laterally by suspensory (infundibulopelvic) ligament extending from infundibulim of fallopian tubke and ovary to sidewall of pelvis

Ovary also attached to posterior aspect of broad ligament via mesovarium

54
Q

Pelvic vasculature

A

ext iliacs arteries: medial psoas border

ext iliac veins: medial and posterior to arteries

Int iliac arteries: posterior to ureters and ovaries

Int iliac veins: posterior to arteries

uterine arteries and veins: between layers of broad ligaments, lateral to uterus

55
Q

Pelvic vasculature branches

A

arcuate arteriers

radial arteries

straight and spiral arteries

ovarian arteries

ovarian veins

56
Q

arcuate arteries

A

arclike arteries that encircle uterus in outer third of myometrium

57
Q

radial arteries

A

branches of arcuate arteries that extend from myometrium to base of endometrium

58
Q

Straight and spiral arteries

A

branches of radial arteries that supply zona basalis of endometrium

59
Q

ovarian arteries

A

branch laterally off aorta

run within suspensatory ligaments and anstomose with uterine arteries

60
Q

ovarian veins

A

right vein drains into IVC

left drains into left renal vein

61
Q

Mestrual cycle

A

reproductive years begin around 11-13 at onset of menses

end around age 50 whn menses ceases

cycle approx 28 days in length

begins with first day of menstrual bleeding

62
Q

polymenorrheic

A

mestrual cycle occurs less than 21 days

63
Q

oligomenorrheic

A

menstrual sycel occurs longer than 35 days

64
Q

menstrual status

A

premenarche: prepuberty
menarche: menstruating approx every 28 days
menopause: cessastion of menses

65
Q

Ovulation

A

explosive release of ovum from ruptured graafian follicle

rupture associated with small amounts of fliud in posterior cul-de-sac midcycle

midcycle dull ache on either side of lower ab lasting a few hrs

“mittelschmerz” middle pain

66
Q

luteal phase

A

begins with ovulatoin and about 14 days in length

menstruation almost always occurs 14 days aftern ovulation

cells in lining of ruptured ovarian follicle begin to multiply and create corpus luteum (yellow body)

luteinization and is stimulated by LH surge

corpus luteum begins secreting progesterone

67
Q

9-11 days after ovulation

A

corpus luteum degenerates causing progesterone levels to decline

this decline causes menstration to occur and the cycle begins again

68
Q

conception and implantation

A

human chorionic gonadotropin (HCG) produced by the zygote causes corpus luteum to persist

it will continue to secrete progesterone for 3 more months until placenta takes over

69
Q

endometrial changes

A

varying levels of estrogen/progesterone levels induce changes

changes correlate with ovulatory cycles of ovary

3 phases

menstrual phase

proliferative phase

secratory phase

70
Q

Endometrial menstrual phase

A

lasta approx 1-5 dyas and begins with declining progesterone levels

causes spiral arterioles to constrict

decreased blood flow to endometrium resulting in ischemia and shedding of zona functionalis

first 5 days coincide with follicular phase of ovarian cycle

as follicles produce estrogen they stimulate the superficial layer of endometrium to regenerate and grow

71
Q

Endometrial proliferative phase

A

lasts until luteiniation of graafian follicle around ovulation

with ovulation and luteinization of graafian follicle progesterone secreted by ovary causes spiral arteries and endometrial glands to enlarge

prepares endometrium for implanation should conception occur

72
Q

Endometrial secretory phase

A

extends from approx day 15 to onset of menses (day 28)

secretory phase corresponds to luteal phase of ovarian cycle

73
Q

Proliferative phase summary

A

days 1-14

corresponds to follicular phase of ovarina cycle

mestruation occurs on days 1-4

thin endometrium

estrogen level increases as ovarian follicles develope

‘increasing estrogen causes uterine lining to regenerate and thicken

ovulation occurs on day 14

74
Q

Secretory phase summary

A

days 15-28

corresponds to uteal phase of ovarian cycle

ruptured follicle becomes corpus luteum

corpus luteum secretes progesterone

endometrium thickens

no pregnancy, estrogne/progesterone decrease

menses day 28

75
Q

Endometrial changes

A

during menses not uncommon to see varying levels of fluid and debris with uterine cavity

with menstruation endometrium becomes thin echogenic line during early proliferative phase

as regeneration occurs endometrium will thicken to 4-8mm in proliferative phase

76
Q

endometrium sonogram appearance

A

hypoechoic

3 line sign

Zona basalis anteriorly and posteriorly

central line representing the cavity

77
Q

Endometrium at ovulation

A

measures 6-10 mm and becomes isoechoic with myometrium just before ovulation

after ovulation thickest dimension avg 7-14 mm

becomes echogenic blurring 3 line appearance

78
Q

postmenopausal endometrium

A

patients NOT on HRT thickness of

patients on HRT or taking tamoxifen may be up to 8 mm

79
Q

menorrhagia

A

abnormally heavy or long periods

80
Q

dysmenorrhea

A

painful periods

81
Q

amenorrhea

A

absence of menstruation

82
Q

pelvic recess

A

vesicouterine pouch

rectouterine pouch

\retropubic space

83
Q

vesicouterine pouch

A

anterior cul-de-sac

anterior to fundus between uterus and bladder

84
Q

rectouterine pouch

A

posterior cul-de-sac

posterior to uterine body and cervix

between uterus and rectum

85
Q

retropubic space

A

space of retzius

between bladder and symphysis pubis

OB/GYN 1 (31 decks)

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