Chapter 39 reverse Flashcards
reverse
mons pubis
labia majora
labia minora
clitoris
urethral opening
vestibule of vagina
Pelvic landmarks
reverse
2 coxal bones
sacrum
coccyx
true and flase pelvis
Bony pelvis
reverse
situated inferior to caudal portion of parietal peritoneum
condisered pelvic cavity
true pelvis
reverse
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
pelvic cavity
reverse
area below pelvic floor
perineum
reverse
posterior: rectum, colon and ileum
anterior: bladder, ureters, ovaries, fallopian tubes, uterus, vagina
pelvic cavity
reverse
psoas major: sidewall
iliacus: sidewall
Piriformis: posterolateral wall
Obturator internus: anterolateral pelvic sidewall
Levator ani: pelvic floor (diaphragm)
Coccygeus: posterior pelvic floor (diaphragm)
muscles of pelvis
reverse
muscles extend superiorly from xyphoid process to symphysis pubis inferiorly
paried rectus abdominis anteriorly
external obliques
internal obliques
transvers abdominis anteriolaterally
Abdominal wall
reverse
Psoas major
iliacus muscles
psoas muscles join with iliacus muscles to form iliopsoas muscles
muscles of false pelvis
reverse
Piriformis muscles
obturator internus muscles
muscles of the pelvic diaphragm
Muscles of true pelvis
reverse
Levator ani (pubococcygeus, iliococcygeus and puborectalis muscles)
Coccygeus muscles
muscles of pelvic diaphragm
reverse
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
Bladder
reverse
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
Ureters
reverse
collapsed musclular tube that extends from external genitalia to cervix of uterus
approx 9cm in length
l
Vagina physical description
reverse
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
Vagina landmarks
reverse
from vaginal and uterine arteries
drains into internal iliac vein
Vaginal blood supply
reverse
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
Cervix
reverse
cervical canal
communicates with uterine cavity by internal os
with vagina by external os
Endocervix
reverse
continuous with vagina
exocervix
reverse
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
Uterus
reverse
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
Uterine size
reverse
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
uterine body
reverse
perimetrium
myometrium
endometrium
layers of uterus
reverse
serous outer layer of uterous
serosa
perimetrium
reverse
muscular middle layer of uterus composed of thick smooth muschle supported by connective tissue
myometrium
reverse
inner mucous membrane
glandular portion of uterine body
endometrium
reverse
broad
mesovarium
mesosalpinx
round
cardinal
uterosacral
suspensory
ovarian
uterine ligaments
reverse
lateral aspect of uterus to pelvic sidewall
broad uterine ligament
reverse
posterior fold of broad ligament
encloses ovary
mesovarium uterine ligament
reverse
upper fold of broad ligament
encloses fallopian tube
mesosalpinx uterine ligament
reverse
fundus to anterior pelvic sidewalls
holds uterus forward
Round uterine ligament
reverse
extend across pelvic floor laterally
firmly supporst cervix
cardinal uterine ligament
reverse
extend from uterine isthmus downward
along side rectum to sacrum
firmly supports cervix
uterosacral ligament
reverse
extends from lateral aspect of ovary to pelvic sidewall
suspensatory uterine ligament
reverse
extends medially from ovary to uterine cornua
ovarian uterine ligament
reverse
anteversion
dextroversion
retroversion
retroflexion
Uterine postions
reverse
most common position
fundus and body bent forward toward cervix
Anteversion uterus
reverse
normal variant in absence of pelvic masses
Dextroversion uterus
levoversion
reverse
entire uterus tilted posteriorly
retroversion uterus
reverse
fundus and body bent backward towards cervix
retroflexion uterus
reverse
infundibulum
ampulla
isthmus
interstitial portion
12 cm in length
blood supplied by ovarian arteries and veins
Fallopian tubes
reverse
funner shaped lateral tube projects beyond broad ligament to overlie ovaries
free edge of the funnel has fimbriae
fallopian infundibulum
reverse
widest part of tube where fertilization occurs
Ampulla of fallopian tube
reverse
hardest part
lies lateral to uterus
isthmus of fallopian tube
reverse
pierces uterine wall ar cornua
interstitial of fallopian tube
reverse
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
Ovaries
reverse
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
Variable postinos of ovaries
reverse
outer layer (cortex)
medulla
Ovaries normal anatomy
reverse
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
ovary cortex
reverse
composed of connective tissue containing blood, nerves, lymphatic vessels and some smooth muscle at region of hilum
medulla of ovary
reverse
ovum
two known hormones
estrogen: secreted by follicles
progesterone: secreted by corpus luteum
Ovarie reproductive cell
reverse
responsible for producing and maintaining secondary gender characteristics
preparing uterus for implantation of fertilized ovum
development of mammary glands in female
ovarian hormone responisibility
reverse
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
ovarian ligaments
reverse
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
Pelvic vasculature
reverse
arcuate arteriers
radial arteries
straight and spiral arteries
ovarian arteries
ovarian veins
Pelvic vasculature branches
reverse
arclike arteries that encircle uterus in outer third of myometrium
arcuate arteries
reverse
branches of arcuate arteries that extend from myometrium to base of endometrium
radial arteries
reverse
branches of radial arteries that supply zona basalis of endometrium
Straight and spiral arteries
reverse
branch laterally off aorta
run within suspensatory ligaments and anstomose with uterine arteries
ovarian arteries
reverse
right vein drains into IVC
left drains into left renal vein
ovarian veins
reverse
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
Mestrual cycle
reverse
mestrual cycle occurs less than 21 days
polymenorrheic
reverse
menstrual sycel occurs longer than 35 days
oligomenorrheic
reverse
premenarche: prepuberty
menarche: menstruating approx every 28 days
menopause: cessastion of menses
menstrual status
reverse
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
Ovulation
reverse
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
luteal phase
reverse
corpus luteum degenerates causing progesterone levels to decline
this decline causes menstration to occur and the cycle begins again
9-11 days after ovulation
reverse
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
conception and implantation
reverse
varying levels of estrogen/progesterone levels induce changes
changes correlate with ovulatory cycles of ovary
3 phases
menstrual phase
proliferative phase
secratory phase
endometrial changes
reverse
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
Endometrial menstrual phase
reverse
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
Endometrial proliferative phase
reverse
extends from approx day 15 to onset of menses (day 28)
secretory phase corresponds to luteal phase of ovarian cycle
Endometrial secretory phase
reverse
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
Proliferative phase summary
reverse
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
Secretory phase summary
reverse
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
Endometrial changes
reverse
hypoechoic
3 line sign
Zona basalis anteriorly and posteriorly
central line representing the cavity
endometrium sonogram appearance
reverse
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
Endometrium at ovulation
reverse
patients NOT on HRT thickness of
patients on HRT or taking tamoxifen may be up to 8 mm
postmenopausal endometrium
reverse
abnormally heavy or long periods
menorrhagia
reverse
painful periods
dysmenorrhea
reverse
absence of menstruation
amenorrhea
reverse
vesicouterine pouch
rectouterine pouch
\retropubic space
pelvic recess
reverse
anterior cul-de-sac
anterior to fundus between uterus and bladder
vesicouterine pouch
reverse
posterior cul-de-sac
posterior to uterine body and cervix
between uterus and rectum
rectouterine pouch
reverse
space of retzius
between bladder and symphysis pubis
retropubic space
