Female Anatomy & Histology

Question 0

What is the embryonic origin of Round Ligament? Describe its courses.

Answer 0

• Gubernaculum
• Attached to uterus
• Travel through Inguinal Canal
• Attached to Labium Major

Question 1

What are the two pouches around the uterus?

Answer 1

• Uterovesical pouch

- Rectouterine pouch (Pouch o Douglas)

Question 2

What structures does each of these ligaments attached to?

• Board Ligament
• Round Ligament
• Ovarian Ligament
• Suspensory Ligament
• Mesovarium

Answer 2

• Board: sides of uterine -> lateral pelvic walls
• Round: uterine -> inguinal canal -> labium major
• Ovarian: ovary -> uterine
• Suspensory: ovary -> peritoneum at level of L2
• Mesovarium: suspends ovary to board ligament

Question 3

What are the vascular supplies and venous drainages of the ovaries? Where do these vessels travel within?

Answer 3

• Abdominal Aorta -> Ovarian Artery
• Right Ovarian Vein -> IVC
• Left Ovarian Vein -> Left Renal Vein -> IVC
• All travel within the Suspensory ligaments of the Ovaries

Question 4

How is the female peritoneal cavity different from the male’s?

Answer 4

• Female’s opened via Ostium of the Fallopian Tube (only the ovaries are within the peritoneal cavity, all the rest of the reproductive system is outside of it).
• Male’s closed cavity, peritoneum covers on top of the reproductive system.

Question 5

What is the board ligament? What organs does it comprised of?

Answer 5

• Mensentery (double layers of ligament)
• Attached & anchor the uterine to lateral pelvic walls
• Comprised of mensenteries of the ovary, uterus, uterine tube

Question 6

Name the parts of the Fallopian Tube from the Ovaries to the Uterus. Where does fertilisation occur?

Answer 6

• Distal Ostium
• Fimbria
• Infundibulum
• Ampulla (site of fertilisation)
• Isthmus
• Proximal Ostium

Question 7

Describe the position of the uterus in respects of vagina and cervix.

Answer 7

• With respect to Vagina - anteVerted

- With respect to cerviX - antefleXed

Question 8

Describe the lymphatic drainages of the Uterus.

Answer 8

• Fundus: aortic nodes
• Body: External Iliac nodes
• Cervix: External & Internal Iliac nodes & Sacral nodes

Question 10

Describe the blood supplies to vagina?

Answer 10

• Superior: Vaginal A

Question 10

Describe the venous drainages from Uterine & Vagina.

Answer 10

• Uterine: Uterine V -> Internal Iliac V

- Vagina: Vaginal V -> Uterine V

Question 11

Describe the innervations to Vagina hence the pain perceived.

Answer 11

• Superior 4/5: Uterovaginal Plexus (Inferior S2-S4 ganglia), Visceral refer pain
• Inferior 1/5: Pudenal Nerve (S2-S4), Somatic local pain

Question 12

What is the blood supply to the Uterus? Why is this vessel’s anatomical position clinically important?

Answer 12

• Uterine A

Question 13

What’s a Bimanual Examination? When is it performed?

Answer 13

• Inserting 2 fingers into vagina to establish the position of the cervix
• Test of Cervical Motion Tenderness (a sign of Pelvic Inflammatory Disease)
• Palpate and locate the Uterus

Question 14

Draw a simple diagram showing the external genitalia of a female.

Answer 14

• Labia Majora: enclosing the pudenal cleft
• Labia Minora: enclosing the vestibule + consisting Clitoris
• Vestibule: consisting orifices of urethra & vagina + greater (Bartholin) & lesser vestibular glands

http://humansanatomy.org/2013/11/28/vagina-anatomy/vagina-anatomy-vulva-anatomy/

Question 15

What are the names given when the Greater Vestibular glands are inflamed and when they are blocked?

Answer 15

• Inflammation: Bartholinitis

- Blocked: Bartholin gland cyst

Question 16

Describe what can be found in each histological layer of the Ovary.

Answer 16

• Mesothelium: germinal epithelium derived from Mesoderm
• Cortex: follicles at different developmental stages
• Medulla: stromal cells + vasculatures + connective tissues

Question 17

Describe the epithelial lining of the Cervix.

Answer 17

• Endocervix: Mucus-secreting Columnar (as uterine cavity)

- Exocervix: Stratified Sqaumous Non-keratinised (as vagina)

Question 18

What are the three layers of the Uterus?

Answer 18

• Perimetrium
• Myometrium
• Endometrium

Question 19

What is the epithelium of the Vagina?

Answer 19

• Stratified Squamous Epithelium (not keratinised, only the external surface e.g. skin are)

Question 20

Vaginal Fornices?

Answer 20

The recesses of Vagina around the Cervix?

Question 21

What is Endometriosis?

Answer 21

• Ectopic endometrial tissue anywhere along the Peritoneal cavity
• Leads to Dysmenorrhoea and/or Infertility

Question 22

What happen to the Oogonia before birth?

Answer 22

Oogonium -> Meiosis I -> Primary Oocyte -> Oocyte Maturation Inhibitor -> Primary Oocyte arrested at Phase I = all the future ova

Question 23

Describe the constitutions involved in the Primary Follicle.

Answer 23

• Granulosa cells secrete glycogen to surround the Oocyte = Zona Pellucida
• Stromal cells surround -> Theca Folliculi

Question 24

Describe the constitutions involved in the Secondary Follicle.

Answer 24

- Fluid appears between Granulosa cells | - Theca Folliculi -> Theca Externa & Interna

Question 25

What is the next phase of the Secondary Follicle? Describe its constitutions.

Answer 25

- Graafian Follicle - Antrum pushes Oocyte to periphery - LH -> Theca Folliculi -> secrete Androgen - FSH -> Granulosa cells -> turn Androgen into Oestrogen

Question 26

What happens to the Follicle before ovulation?

Answer 26

- LH receptors appear on Granulosa cells - LH Surge -> restart Meiosis I -> Primary Oocyte -> haploid Secondary Oocyte + haploid Polar Body - Secondary Oocyte -> Meiosis II -> arrested -> Ovum

Question 27

What happens during ovulation?

Answer 27

- Rapture of follicle -> Release Ovum | - Remnant follicle -> Corpus Luteum

Question 28

What are the cells made up of Corpus Luteum? What are their secretion?

Answer 28

- Granulosa Lutein Cells: Progesterone | - Thecal Lutein Cells: Oestrogen

Question 29

What stimulates the oogonia enter Meiosis I?

Answer 29

Mesonephric (Follicular) cells

Question 30

What arrests Oogonia at Prophase I? Where is it produced from?

Answer 30

Oocyte Maturation Inhibitor from Mesonephric (Follicular) cells

Question 31

What type of cells will the Follicular (Mesonephric) cells become? Suggest some of their functions.

Answer 31

- Granulosa cells - Secrete glycogen to surround Oocyte within Zona Pellucida - Respond to FSH to turn Androgen from Thecal cells into Oestrogen

Question 32

Describe the appearances of the Ovarian mesothelium, and why is it?

Answer 32

- Dull, grey, scarred, distorted | - Rapid raptures of follicles

Question 33

True or false? Ovarian mesothelium = Peritoneum.

Answer 33

False, Ovarian mesothelium = continuous with Peritoneum, but different epithelial linings

Question 34

What structures of the Uterine (Fallopian) Tube aid the transport of developed follicles?

Answer 34

- Pseudostratified columnar ciliated epithelium - Cilia more predominate at Ampulla - Muscular layer thicker towards Isthmus

Question 35

Describe the epithelium of the Cervix.

Answer 35

- Endocervix (continuous as Uterine): Simple columnar, mucus secreting - Exocervix (continuous as Vagina): Stratified squamous non-keratinised

Question 36

What keeps the Vagina at its normal pH?

Answer 36

- Normal secretion of Glycogen from Stratified Squamous Epithelium - Lactobacilli turns Glycogen -> Lactate -> acidic

Question 37

Describe the embryonic derivation of the Vagina.

Answer 37

- Superior portion: Intermediate Mesoderm | - Inferior portion: Endoderm

Question 38

How is the Vagina lubricated?

Answer 38

- Secretions from Cervical/Vestibular glands

Question 39

Describe the hormonal controls of the changes in uterine linings throughout the Menstrual cycle.

Answer 39

- Proliferative: Oestrogen -> Stratum Functionalis regrows from Stratum Basalis from its blood supplies, straight arteries - Secretory: Progesterone -> glands enlarge in endometrium - Menses: sudden drop in Progesterone -> spasm of spiral A in Stratum Functionalis of Endometrium causing its necrosis

Question 40

What is it called when the Cervix become infected and blocked? What complication could it cause?

Answer 40

- Nabothian Cyst | - Infertility

Question 41

What are the anatomical relations of the vagina?

Answer 41

- Anteriorly – base of bladder and urethra (embedded in anterior vaginal wall) - Posteriorly – anal canal, rectum and most superiorly pouch of Douglas - Laterally – levator ani and ureters (lying just superior to lateral fornices)

Question 42

Which structures may be palpated in a vaginal examination?

Answer 42

- Anteriorly – bladder, urethra and pubic symphysis - Posteriorly – rectum (prolapsed uterine tubes and ovary) - Laterally – ovary and uterine tube, sidewall of pelvis (ischial spines) - Apex – cervix (ante or retro-verted)

Question 43

In bimanual / pelvic examination, which of the cervical fornices is the usually largest and why? What structures can be palpated from each fornix?

Answer 43

- Since the uterus is usually anteverted and anteflexed, the posterior fornix is the deepest - Palpation of the posterior fornix is used to assess posterior fundus, uterosacral ligaments, posterior broad ligaments/ovaries and Pouch of Douglas. - Palpation of the anterior fornix might address bladder, recto-pubic space - Palpation of the lateral fornices might address broad ligaments and associated structures. The Fallopian tubes and ovaries cannot normally be felt.