Clinical anatomy of female repro tract Flashcards
Name two major purposes of the ovary
- produce mature ova for fertilization
2. Generate steroid hormones
Name the four parts of the uterus from superior-inferior
- Fundus
- Uterine tubes
- Body
- Cervix
Where is the vesicouterine and rectouterine pouch?
The vesicouterine pouch is anterior to the uterus
The rectouterine pouch/pouch of Douglas is a posterior extension of the peritoneum; between the posterior wall of the uterus and rectum in females
What is the normal position for the uterus to be in?
Name the two terms that would describe an abnormally placed uterus
- Anteverted (inclined forward, with respects to the vagina)
- Anteflexed forward with respect to the cervix
Abnormal: retroverted (points upwards at the head), retroflexed (flexes backwards at the cervix so the body and fundus are pointing towards the back)
Where is the cervix? What two gutters does it form?
Cervix: the inferior part of the uterus, forms the posterior and anterior fornix
*it’s a broad cylinder with a narrow central channel that produces a dome-shaped bulge into the vaginal canal
Which age group is there a higher prevalence of cervical carcinomas and which disease does it have a strong link with?
Strong link with HPV and more common in younger women
If the cervical carcinoma tumour were to spread into the lymphatic system which lymph nodes would be immediately affected?
The internal and common iliac nodes
What is the function of the fallopian tubes? Where is the usual site of fertilization?
Conduct the oocyte into the uterine cavity, fertilization is usually in the ampulla
How do the fallopian tubes communicate with the peritoneal cavity?
Via an opening in the infundibulum
Compare a tubal ligation procedure and a salpingo-oophorectomy
Tubal ligation: severing and tying the fallopian tubes for female sterilization
Salpingo-oophorectomy: Removing the uterine tubes + ovaries (e.g; cancer risk, reproductive disorders)
What is the primary job of the uterine ligaments?
Name the four major sets
To anchor/support the uterus and ovaries in the pelvis via CT
- Broad ligament
- Round ligament
- Cardinal (transverse cervical ligament)
- Uterosacral ligament
What is the broad ligament? Name and briefly describe each of its three parts
A double fold of peritoneum that extends laterally to the sidewalls of the pelvis
Mesovarium: a portion of the broad ligament that suspends the ovaries
Mesosalpinx: part of the broad ligament between the fallopian tube and the mesovarium
Mesometrium: Surrounds the uterus and is the largest subsection of the broad ligament. It covers the external iliac vessels and encloses the proximal part of the round ligament of the uterus.
Where did the round ligament originate from embryologically? What are its attachment points?
Derived from the caudal end of the gubernaculum.
Attaches from the ovary, through the inguinal canal and splays out on labia majora
What and where is the cardinal (transverse cervical) ligament?
Fascia that extends from the cervix to the lateral pelvis walls
What and where is the uterosacral ligament?
Fascia (bilateral) extending from the cervix to the posterior pelvic walls/sacrum
What is the job of the ovarian ligament and the suspensory ligament of the ovary?
Ovarian: connects the ovary to the lateral surface of the uterus
The suspensory ligament extends from the ovary in the other direction and carries blood vessels and nerves from the abdomen into the pelvis!
What do the pubocervical ligaments do?
Bilateral structures that attach the cervix to the posterior surface of the pubic symphysis, they support the uterus in the pelvic cavity
What generally happens when the uterine ligaments fail?
Vaginal and/or uterine prolapse
Which arteries supply the female repro tract and where do they branch off from?
The ovarian arteries, arising just below the renal arteries (L1) on the abdominal aorta
Which veins supply the female repro tract? Where do they drain into?
Ovarian veins:
L ovarian vein -> drains into L renal vein
R ovarian vein -> drains into IVC
Name the lymph nodes involved in drainage from the
a) ovary
b) the uterus’ fundus + upper body
c) the uterus’ body + Cervix
a) Lumbar para-aortic nodes
b) para-aortic nodes and superficial inguinal nodes
c) external + internal iliac nodes and sacral nodes
What is the pudendal cleft and what does it come together to form?
The opening between the labia majora which comes together to form mons pubis
What does the labia minora enclose?
Encloses the opening of the vagina, the vestibular bulbs/clitoral bulbs
*vestibular bulbs are two masses of erectile tissue on either side of the vaginal opening and the clitoris
What are the major and lesser vestibular bulbs and what do they secrete?
Major: bartholin’s, slightly posterior and to the L and R of the vaginal opening, they secrete mucus to lubricate the vagina (homologous to bulbourethral glands in males)
Lesser: skene’s, secretes fluid that helps lubricate the urethral opening
What are the four roles of the bulbospongiosus muscle?
Clitoral erection, orgasm contraction, closes the vagina, expels remaining urine from the urethra
What is the role of the ischiocavernosus muscle in males and females
Stabilizes the erect penis, tenses the vagina during orgasm
Where is the perineal body?
Between the junction of the urogenital triangle and anal triangle
What is culdocentesis/how is it performed? When is it used?
When peritoneal fluid is aspirated from the pouch of Douglas (rectouterine pouch) through the posterior vaginal fornix. It is used to evaluate women with pain in the lower abdomen/pelvis to determine whether intraabdominal fluid is present
What is the pelvic pain line? Which structures are above and below and how does it determine the course of visceral pain sensation?
It is a ‘threshold’ in the inferior peritoneum, a pelvic structure is “above” the pelvic pain line if it’s in contact with the peritoneum
Above the line: uterine fundus, body; visceral afferent fibres conducting pain follow sympathetic fibres
Below: uterine cervix, vagina; visceral afferent fibres conducting pain impulses follow parasympathetic fibres
Describe the innervation to the vagina
Inferior 1/5: somatic innervation from the pudendal nerve
Superior 4/5: visceral innervation from uterovaginal plexus
Describe the pathway of the pudendal nerve, what does it innervate?
- Exits pelvis via the greater sciatic foramen (S2-4)
- Crosses ischial spine (close to sacrospinous ligament)
- Enters perineum via lesser sciatic foramen (with internal pudendal artery)
- Travels through pudendal canal/Alcock’s canal (along the wall of the ischioanal fossa)
Gives off branches
Innervates the perineum (between anus and scrotum/vulva) and the pelvic floor
What two muscles is the greater sciatic foramen in between?
Piriformis and coccygeus muscle
What three major branches does the pudendal nerve give off?
- Perineal N: innervates perineum
- Inferior rectal nerve
- Dorsal nerve of penis/clitoris; purely sensory
What forms the lowest point in the peritoneal cavity?
The rectouterine pouch
Name three ways to diagnose a cervical carcinoma and a treatment option
Diagnosis: inspection, imaging, biopsy
Treatment: can include removal of cervix/uterus
