Clinically Relevant Anatomy - Female reproductive system and Breasts Flashcards by Arya Nedungadi

Which female reproductive organs are located in the true pelvic cavity?

Above the levator ani muscle: 
Ovaries
Uterine tubes
Uterus
Superior part of vagina

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Which organs in the female reproductive system are located in the perineum?

Inferior part of vagina
Perineal muscles
Bartholin's glands
Clitoris
Labia

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What is the primary organ of female reproduction?

Ovaries

Everything else is accessory

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What is the pelvic floor muscle?

Levator ani

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What is the peritoneum?

Very thin serous membrane layer

Completely covers the superior aspect of viscera

Drapes itself over the pelvic organs and forms little pouches

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What is the most important peritoneal pouch?

Recto-uterine pouch/Pouch of Douglas

Most inferior part of the peritoneum in anatomic position - excess fluid collets here

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What is the location of recto uterine pouch?

B/w rectum and posterior wall of uterus

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Name another peritoneal pouch

Vesico-uterine pouch

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What are para rectal pouches?

Technically the most inferior portion where fluid drains

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How to drain fluid from pouch of douglas?

Via a needle passed through the posterior fornix of the vagina

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Which are the only true intra-peritoneal organs of the pelvic cavity?

Uterine tubes

Completely covered by the peritoneum

Fimbriated end is open

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Name the ligament formed from double layer of peritoneum

Broad ligament

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Describe the borders of the broad ligament

Extends between the uterus and the lateral walls & floor of the pelvis

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What is the function of broad ligament?

helps maintain the uterus in its correct midline position

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What are the contents of the broad ligament

uterine tubes and (the proximal part of) the round ligament

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Name the ligament that is an embryological remnant on the lateral aspect of the uterus

Round ligament/teres ligament

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Describe the course of round ligament

From uterus, through anterior abdo wall and inguinal canal and down into labia in the perineum.

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Which ligament contains the gubernaculum?

Round ligament

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What are the 3 layers of the uterine body

perimetrium
myometrium
endometrium

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Where does implantation occur?

Body of the uterus

Ectopic pregnancy if it implants anywhere else

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What is the most common location of ectopic pregnancy?

Uterine tubes

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What are the less common sites of ectopic pregnancy?

Ovary

Abdomen: due to connection b/w uterine tube and peritoneum

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What are the 3 levels of support for the uterus

uterosacral ligament: runs from cervix to sacrum (not uterus)
Endopelvic Fascia
Muscles of the pelvic floor

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How does uterine prolapse occur?

Weaking of the levels of support of the uterus causes posterior movement of the uterus

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What is the most common position of the uterus

Anteverted and Anteflexed

Define anteverted

Cervix tipped anteriorly relative to the axis of the vagina

Define anteflexed

Uterus tipped anteriorly relative to the axis of the cervix (the mass of the uterus lies over the bladder)

Normal variation of the position of uterus

Retroverted and retroflexed

Why is a speculum used during cervical smear?

Vaginal walls are usually collapsed, hence speculum needed to spread it apart to get a good view of cervix

Which area of cervix is to be sampled during smear?

Squamo columnar junction

Which factors affect appearance of cervix?

Age Stage of menstrual cycle Parity

What is the significance of uterine tubes?

Fertilisation occurs here | Specific location: Ampulla

Name the process of removing both uterine tubes and ovaries

bilateral salpingo-oophrectomy

What is the clinical significance of fimbriated ends of uterine tubes opening into peritoneal cavity?

Communication between the genital tract and the peritoneal cavity Infection could pass between the two areas. Pelvic Inflammatory Disease can cause peritonitis Ectopic pregnancy can develop in peritoneal cavity

What is the appearance of a hysterosapingogram (HSG) when tubes are patent and not blocked?

Radiopaque dye spills out of the end of the uterine tube and into the peritoneal cavity

Name the fossa located on lateral wall of the uterus

Ovarian fossa - location of the ovaries

What structures of the ovaries develop on the posterior abdominal wall

Arterial supply, venous and lymphatic drainage

Lateral vaginal fornices are used to palpate which structures?

Ischial spines can be palpated - laterally - 4 and 8 o’clock positions

Bimanual palpation during vaginal exam assesses what?

Position of uterus

Hormones secreted by ovaries

oestrogen | progesterone

Ovum is released into peritoneal cavity- true or false?

True

List fornices of vagina

anterior posterior lateral - 2X

How to palpate adnenxae in vaginal exam

adnexae: uterine tubes and ovaries place examining fingers into lateral fornix press deeply with other hand in the iliac fossa of the same side repeat on other side can detect large masses or tenderness affecting these structures.

Which part of the levator ani muscle is made of skeletal muscle and under voluntary control?

Lateral aspect (majority)

Which aspect of levator ani is under autonomic control and is made of SM

Medial aspect

Weakened levator ani leads to ____?

uterine (& other organs) prolapse urinary incontinence Fecal incontinence

Function of levator ani

provides continual support for the pelvic organs. tonic contraction reflexively contracts further during situations of increased intra-abdominal pressure

Nerve supply of levator ani

"nerve to levator ani" - S3,4,5 | Pudendal nerve - S2,3,4

Perineal body ***

bundle of collagenous and elastic tissue into which the perineal muscles attach important to pelvic floor strength can be disrupted during labour located just deep to skin

What are the contents of the perinuem

Perineal muscles | Perineal body

Nerve supply to perineal muscles

Pudendal nerve

Other name for bartholin glands

Greater vestibular glands | Secrete lubrication into vagina

What is the perineum?

shallow space between pelvic diaphragm and the skin pelvic diaphragm forms floor of pelvis, but roof of perineum

What are the openings of the pelvic floor?

passage of distal parts of alimentary, renal and reproductive tracts from pelvis to perineum

Borders of the bed of breast tissue

from ribs 2-6 | lateral border of sternum to mid-axillary line

Name the fatty tissue of the breast that extends to axilla?

Axillary tail of spence

Name the muscles on which the breast lies

lies on deep fascia covering pec major and serratus anterior

What is the retromammary space?

Potential space b/w breast and pectoral fascia | Contains small amount of fat - allows movement between breast and muscles

What attaches breast to skin?

suspensory ligaments

There is only one opening on nipple for lactation - T or F

F. | Multiple openings

What is the significance of a "fixed" lump?

Lump has invaded the deep fascia and has attached to muscle

Lymphatic drainage of the breast

lateral parts of the breast (75-80% - ipsilateral) - axillary lymph node Medial quadrants - parasternal lymph node - can easily cross to contralateral side to parasaternal lymph node Inferior quadrant - abdominal lymph node From upper limb: axillary lymph nodes - lymphedema if axillary nodes are removed

Function of axilla

pyramidal passageway between arm and chest

Contents of axilla

brachial plexus branches axillary artery (& branches) and axillary vein (& tributaries) axillary lymph nodes all embedded in axillary fat

Significance of levels of axillary nodes

Breast surgeons use “levels” of axillary nodes to describe the extent of “axillary node clearance”. The position of each level can be described in relation to pectoralis minor

Level I axillary nodes

inferior and lateral to pectoralis minor

Level II axillary nodes

Deep to pec minor

Level III axillary nodes

Superior and medial to pec minor

Blood supply to breast

axillary artery | Internal thoracic/internal mammary

Function of Levator Ani

provides continual support for the pelvic organs. - tonic contraction - reflexively contracts further during situations of increased intra-abdominal pressure - weakness can be a factor in the development of prolapse of the pelvic organs