Embryology: Detti: Female pelvic anatomy and mullerian anomalies

Question 1

What are the 7 branches of the anterior division of the internal iliac artery?

Answer 1

Umbilical
Superior vesicular
Inferior vesicular
Obturator
Pudendal
Uterine

Question 2

What is the first branch of the interior division of the internal iliac artery?

Answer 2

Umbilical

Question 3

What does the uterine artery divide into?

Answer 3

Descending: vaginal
Ascending: uteral

Question 4

What are the 3 divisions of the posterior division of the internal iliac artery?

Answer 4

Superior rectal
Inferior rectal
…?

Question 5

What is the connection between the superior 2/3 and inferior 1/3 of the vagina called?

Answer 5

Hymen (hymenal wing)

Question 6

What is the division point between the UG sinus and the Mullerian mesodermal tissues?

Answer 6

Hymen

Question 7

What direction does canalization of female tract occur?

Answer 7

Caudal to cephal (Backwards)

Question 8

What happens if canalization does not occur?

Answer 8

Vaginal septum

Cervical septum

Question 9

When is canalization complete?

Answer 9

20 weeks

Question 10

What promotes woofian duct?

Answer 10

Androgens: T and DHT
TDF
MIF

Question 11

What are other names for MIF?

Answer 11

AMH: anti-mullerian hormone
MIS: mullerian inhibiting substance

Question 12

EXAM: What is used to inflate the body cavity in laparoscopy?

Answer 12

CO2

NOT air… this could cause embolism

Question 13

What is another name for the suspensory ligaments of the ovary?

Answer 13

Infundibulopelvic ligament

Question 14

The right side ovarian artery comes from what? Left side?

Answer 14

Right: renal artery
Left: Aorta

Question 15

The right side ovarian vein drains to where? Left side?

Answer 15

Right: Inferior vena cava
Left: renal vein

Question 16

What does falciform ligament contain in embryo?

Answer 16

Umbilical vein (which has oxygenated blood)

Question 17

What does the umbilical vein become? Umbilical artery?

Answer 17

Vein: falciform ligament of liver
Artery: suspensory ligament of bladder

Question 18

Umbilical hernias are more common in what sex?

Answer 18

Females

Question 19

What is the most severe form of chlamydia infections?

Answer 19

Adhesions from liver to diaphragm: Kears-Sarne?

Question 20

What is endometriosis?

Answer 20

Endometrium that develops outside of uterus… rusty color all over pelvic organs

Question 21

What collects in abdomen with endometriosis?

Answer 21

Blood… becomes adhesions. Follows mentrual cycle.

Question 22

EXAM: All mullerian anomalies occur before what week of embryonic life?

Answer 22

20 wks.

Question 23

What are the seven types of mullein anomaly classes?

Answer 23

1. Hypoplasia/agenesis (nothing)
2. Unicornate (one duct.. two vaginas possible)
3. Diphelus
4. Bicornate
5. Septate
6. Arcuate
7. DES drug related

Question 24

If you have complete a genesis, where will vagina stop?

Answer 24

Hymen

Question 25

Do mullerian anomalies come from genetic karyotypes?

Answer 25

No... multifactorial

Question 26

TEST: Which direction does cavitaiton occur, and why is this important to bicornate uterus?

Answer 26

Cavitation goes from vagina to uterus. | Bicornate has normal lower uterus, bicornate upper uterus. Bicornate has normal vagina and cervix.

Question 27

TEST: What does the outer contour of the bicornate uterus follow?

Answer 27

The inner contour

Question 28

TEST: What is the outer appearance difference between the bicornate and septate uterus?

Answer 28

Bicornate: looks like two horns Septate: looks COMPLETELY normal: One cavity, with a septum, outer contour does not follow inner contour.

Question 29

What is the definition of a septate uterus?

Answer 29

Septa >7mm or longer. | Normal outer appearance

Question 30

What does DES (synthetic estogren used for morning sickness) do to the uterus?

Answer 30

Vaginal bleeding drug in US Morning sickness in england Uterus is unable to stretch to accommodate child

Question 31

What is MRKH?

Answer 31

No uterus or tubes Blind end vagina BUT normal ovaries that make estrogen. Normal looking woman.

Question 32

What is AI?

Answer 32

Androgen insensitivity: No receptors for androgen XY genotype, female phenotype

Question 33

What do you worry about in long term AI?

Answer 33

Testicular cancer

Question 34

When we see a genesis of tubes/uterus, what do we need to check for?

Answer 34

Karyotype: AI XY women will have higher risk of testicular cancer

Question 35

What allows AI to go through puberty?

Answer 35

Conversion of androgens to estrogens.

Question 36

What do you do to AI person's testicles?

Answer 36

Take them out after puberty. Cancer risk.

Question 37

The bicornate uterus has an increase in what?

Answer 37

Preterm delivery, not much infertility

Question 38

The septate uterus has and increase in what?

Answer 38

Infertility | Early pregnancy loss/miscarriage

Question 39

How do you differentiate bicornaute and septate uterus?

Answer 39

Bicorn: Heart shaped, more than 1 cm deep furrow Septate: less than 1 cm furrow, greater than 7-10cm septa

Question 40

What do you use to inflate the uterus in hysteroscopy?

Answer 40

Saline