Clinically Relevant Anatomy - Female reproductive system and Breasts Flashcards
Which female reproductive organs are located in the true pelvic cavity?
Above the levator ani muscle: Ovaries Uterine tubes Uterus Superior part of vagina
Which organs in the female reproductive system are located in the perineum?
Inferior part of vagina Perineal muscles Bartholin's glands Clitoris Labia
What is the primary organ of female reproduction?
Ovaries
Everything else is accessory
What is the pelvic floor muscle?
Levator ani
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
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
What is the location of recto uterine pouch?
B/w rectum and posterior wall of uterus
Name another peritoneal pouch
Vesico-uterine pouch
What are para rectal pouches?
Technically the most inferior portion where fluid drains
How to drain fluid from pouch of douglas?
Via a needle passed through the posterior fornix of the vagina
Which are the only true intra-peritoneal organs of the pelvic cavity?
Uterine tubes
Completely covered by the peritoneum
Fimbriated end is open
Name the ligament formed from double layer of peritoneum
Broad ligament
Describe the borders of the broad ligament
Extends between the uterus and the lateral walls & floor of the pelvis
What is the function of broad ligament?
helps maintain the uterus in its correct midline position
What are the contents of the broad ligament
uterine tubes and (the proximal part of) the round ligament
Name the ligament that is an embryological remnant on the lateral aspect of the uterus
Round ligament/teres ligament
Describe the course of round ligament
From uterus, through anterior abdo wall and inguinal canal and down into labia in the perineum.
Which ligament contains the gubernaculum?
Round ligament
What are the 3 layers of the uterine body
perimetrium
myometrium
endometrium
Where does implantation occur?
Body of the uterus
Ectopic pregnancy if it implants anywhere else
What is the most common location of ectopic pregnancy?
Uterine tubes
What are the less common sites of ectopic pregnancy?
Ovary
Abdomen: due to connection b/w uterine tube and peritoneum
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
How does uterine prolapse occur?
Weaking of the levels of support of the uterus causes posterior movement of the uterus
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
