Embryology: Detti: Female pelvic anatomy and mullerian anomalies Flashcards
What are the 7 branches of the anterior division of the internal iliac artery?
Umbilical Superior vesicular Inferior vesicular Obturator Pudendal Uterine
What is the first branch of the interior division of the internal iliac artery?
Umbilical
What does the uterine artery divide into?
Descending: vaginal
Ascending: uteral
What are the 3 divisions of the posterior division of the internal iliac artery?
Superior rectal
Inferior rectal
…?
What is the connection between the superior 2/3 and inferior 1/3 of the vagina called?
Hymen (hymenal wing)
What is the division point between the UG sinus and the Mullerian mesodermal tissues?
Hymen
What direction does canalization of female tract occur?
Caudal to cephal (Backwards)
What happens if canalization does not occur?
Vaginal septum
Cervical septum
When is canalization complete?
20 weeks
What promotes woofian duct?
Androgens: T and DHT
TDF
MIF
What are other names for MIF?
AMH: anti-mullerian hormone
MIS: mullerian inhibiting substance
EXAM: What is used to inflate the body cavity in laparoscopy?
CO2
NOT air… this could cause embolism
What is another name for the suspensory ligaments of the ovary?
Infundibulopelvic ligament
The right side ovarian artery comes from what? Left side?
Right: renal artery
Left: Aorta
The right side ovarian vein drains to where? Left side?
Right: Inferior vena cava
Left: renal vein
What does falciform ligament contain in embryo?
Umbilical vein (which has oxygenated blood)
What does the umbilical vein become? Umbilical artery?
Vein: falciform ligament of liver
Artery: suspensory ligament of bladder
Umbilical hernias are more common in what sex?
Females
What is the most severe form of chlamydia infections?
Adhesions from liver to diaphragm: Kears-Sarne?
What is endometriosis?
Endometrium that develops outside of uterus… rusty color all over pelvic organs
What collects in abdomen with endometriosis?
Blood… becomes adhesions. Follows mentrual cycle.
EXAM: All mullerian anomalies occur before what week of embryonic life?
20 wks.
What are the seven types of mullein anomaly classes?
- Hypoplasia/agenesis (nothing)
- Unicornate (one duct.. two vaginas possible)
- Diphelus
- Bicornate
- Septate
- Arcuate
- DES drug related
If you have complete a genesis, where will vagina stop?
Hymen
Do mullerian anomalies come from genetic karyotypes?
No… multifactorial
TEST: Which direction does cavitaiton occur, and why is this important to bicornate uterus?
Cavitation goes from vagina to uterus.
Bicornate has normal lower uterus, bicornate upper uterus. Bicornate has normal vagina and cervix.
TEST: What does the outer contour of the bicornate uterus follow?
The inner contour
TEST: What is the outer appearance difference between the bicornate and septate uterus?
Bicornate: looks like two horns
Septate: looks COMPLETELY normal: One cavity, with a septum, outer contour does not follow inner contour.
What is the definition of a septate uterus?
Septa >7mm or longer.
Normal outer appearance
What does DES (synthetic estogren used for morning sickness) do to the uterus?
Vaginal bleeding drug in US
Morning sickness in england
Uterus is unable to stretch to accommodate child
What is MRKH?
No uterus or tubes
Blind end vagina
BUT normal ovaries that make estrogen. Normal looking woman.
What is AI?
Androgen insensitivity:
No receptors for androgen
XY genotype, female phenotype
What do you worry about in long term AI?
Testicular cancer
When we see a genesis of tubes/uterus, what do we need to check for?
Karyotype: AI XY women will have higher risk of testicular cancer
What allows AI to go through puberty?
Conversion of androgens to estrogens.
What do you do to AI person’s testicles?
Take them out after puberty. Cancer risk.
The bicornate uterus has an increase in what?
Preterm delivery, not much infertility
The septate uterus has and increase in what?
Infertility
Early pregnancy loss/miscarriage
How do you differentiate bicornaute and septate uterus?
Bicorn: Heart shaped, more than 1 cm deep furrow
Septate: less than 1 cm furrow, greater than 7-10cm septa
What do you use to inflate the uterus in hysteroscopy?
Saline
