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Block II > Female ext genitalia > Flashcards

Female ext genitalia Flashcards

1
Q

Ovaries descent

A

from posterior abdominal wall into perineum, but does not go through inguinal canal

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2
Q

Ovaries are suspended by which ligaments?

A

Suspensory ligament - It holds all the ovarian vessels

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3
Q

Parts of the uterus

A

Fundus

Body

Isthmus

Cervix

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4
Q

Parts of the fallopian tube

A

Ampulla

Isthmus

Infundiubulum

Fimbriae

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5
Q

Parts of uterine tube

A

Infundibulum

Fimbriae (exposed to peritoneal cavity, so infections)

Ampulla

Isthmus

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6
Q

Ligaments associated with uterus

A

Suspensory ligament of ovary: contains vessels, nerve, lymphatics

Ovarian ligament: connects ovary to uterus

Broad ligament of uterus (mesovarium+mesosalpinx+mesometrium)

Round ligament of uterus

Uterosacral ligament

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7
Q

What ligaments stabilize the uterus?

A

Pubocervical ligament

Transverse cervical/cardinal ligament

Uterosacral ligament

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8
Q

What ligament contains ovarian vessels, nerves, and lymphatics?

A

Suspensory ligament of the ovary.

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9
Q

Where do ovarian arteries originate?

A

Aorta

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10
Q

Where does the uterine artery originate?

A

Internal iliac artery

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11
Q

Where does the vaginal artery originate?

A

Internal iliac artery

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12
Q

Collaterals in the uterus

A

The ovarian, uterine, and vaginal arteries all anastomose, but the main anastomosis is between the ovarian & uterine arteries.

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13
Q

Subdivisions of the broad ligament

A

Broad ligament: double layer of peritoneum below the uterine tubes and lateral to the uterus.

  • Mesosalpinx: is right under the fallopian tubes
  • Mesovarium is right under the ovary
  • Everything else is mesometrium

Connects to the round ligament.

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14
Q

Angle of anteflexion of uterus

A

Angle between axis of cervix and axis of uterine body

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15
Q

Angle of anteversion

A

Angle between the axis of the cervix and the axis of the vagina

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16
Q

What space is behind the posterior fornix?

A

Pouch of douglas

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17
Q

What organ is in anterior to the anterior fornix?

A

Bladder

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18
Q

Normal, retroverted, anteverted, and reroflexed uterus positions

A
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19
Q

Blood supply to vagina

A

Uterine artery & vaginal artery

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20
Q

Lymphatics of upper vagina

Lymphatics of lower vagina

A

Upper vagina drains into internal iliac nodes

Lower vagina drains into superficial inguinal nodes

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21
Q

What structure in a female is directly in front of the rectum in the midline adn is palpated through teh anterior wall of the rectum?

  • Bladder
  • Body of uterus
  • Cervix of uterus
  • Pubic symphysis
  • Vagina
A

Cervix of uterus.

(The body of the uterus lies upon of the bladder, so it’s too far in front of the anterior rectal wall to be palpated.)

22
Q

If you ligate the uterine vessels, what can provide collateral blood supply to the uterus?

A

Ovarian arteries.

23
Q

Where are the uterine and ovarian vessels found?

  • Broad and ovarian
  • Broad and suspensory
  • Suspensory and round
  • Round and suspensory
  • Suspensory and ovarian
A

Broad and suspensory ligaments hold the uterine and ovarian vessels.

(Round ligament has no vessels in it)

24
Q

The most inferior extent of the peritoneal cavity in the female is the:

  • Pararectal fossa
  • Paravesical fossa
  • Rectouterine pouch
  • Rectovesical pouch
  • Vesicouterine pouch
A

Rectouterine pouch

25
Q

Which of these structures courses inferiorly into the pelvic cavity by passing over the pelvic brim, then courses posterior to the uterine artery in the female?

  • Urethra
  • Ovarian artery
  • Ureter
  • Median sacral artery
  • Round ligament of uterus
A

Ureter

26
Q

Implantation occurs where?

A

Body of uterus

27
Q

Rectovaginal septum - clinical significance if it’s torn?

A

Separates the posterior surface of the vagina from the rectum.

Tearing it could mean feces in the vagina.

28
Q

what is uterine prolapse?

A

Uterus descends into the vagina

Caused by weakness in the ligaments that support the uterus: transverse cervical, the pubocervial, and the uterosacral.

29
Q

Borders of the perineum

A

Perineum: diamond-shaped region between pubic symphysis and the coccyx; most inferior part of the pelvic outlet

Roof- pelvic floor

Base - skin & fascia

Boundaries: pubic symphysis, tip of conccyx, inferior pubic rami, inferior ischial rami

30
Q

Urogenital triangle and anal triangle in the perineum

A

Anteriorly, urogenital triangle: roots of ext genitalia and the openings of the urethra and vagina

Posteriorly, the anal triangle contains the anal aperture

31
Q

Contents of the deep perineal space vs superficial perineal space

A

Deep perineal space: between the superior and inferior fascia of the urogenital diaphragm; contains

  • external urethral sphincter
  • nerve & vessels of the penis/clitoris
  • In men, bulbourethral gland lateral to the membranous part of urethra
  • deep perineal transversii muscle

Superficial perineal space between the external perineal fascia of Gallaudet and Colles’ fascia contains

  • ischiocavernosus muscle
  • bulbospongiosus muscle
  • In women, vestibular gland
  • crura of penis/clitoris
  • bulb of vestibule/penis
  • Posterior scrotal arteries and nerves/ Labiel arteries and posterior labial nerves
  • artery to bulb
  • superficial transverse perineal muscle

Separated by perineal membrane.

32
Q

Perineal body- where is it and what attaches to it?

A

Fibromuscular mass at the center of the perineum between anus and vagina

Attachment for the superficial and deep perineal muscles and the bulbosponiosus, levator ani, and external anal sphincter muscles

33
Q

Episiotomy

A

Surgically incision of the perineum during labor to prevent tears and allow for better healing in stead of poor healing of a torn pelvic floor; can also increase birth canal diamater.

34
Q

What makes up the pelvic diaphragm and what is its function?

A

Pelvic diaphragm: levator ani + coccygeus; separates the true pelvis from perineum

  • Resists changes in abdominal pressure
  • Assists in rectal & vaginal sphincter actions
  • Supports pelvic viscera
35
Q

Course of the pelvic diaphragm

A

Posteriorly, it connects around the anus (and vagina in women) and attaches to teh coccyx via midline raphe/anococcygeal ligament.

Anteriorly, the pelvic diaphragm muscles are separated by the UG diaphragm: 3 layers; fits into levator ani

36
Q

Levator ani muscles - what are they and what do they form?

A

Pubococcygeus (contains puborectalis), and ilioccygeus converge around the anal aperture to form the median raphe/anococcygeal ligament.

Together, they support pelvic viscera and resist increases in intra-abdominal pressure.

37
Q

Water under the bridge

A

The ureter is posterior to the uterine artery (and ductus deferens in men), so in a hysterectomy, make sure you don’t clamp the ureter.

38
Q

Blood supply to distal bowel

A
  • Superior rectal artery from IMA
  • Middle rectal artery from internal iliac
  • Inferior rectal artery from internal pudendal artery
39
Q

Differences above and below pectinate line in distal bowel

A

Above

  • superior rectal artery
  • Columnar epithelia
  • GVA
  • Veins drain into portal system

Below

  • Inferior rectal artery
  • Squamous epithelia
  • GSA
  • Veins drain into caval system
40
Q

Anal fissures usually occur where in relation to the pectinate line?

A

Below it, in the squamous portions

41
Q

Which hurts and why - internal vs external hemorrhoids?

A

External hemorrhoids hurt more because they’re below the pectinate line, so they have GSA

Whereas, internal hemorrhoids are above the pectinate line adn only have GVA

42
Q

What pouch in the female is more prone to infection (abscesses)?

A

Rectouterine pouch is deeper; it can aspirate fluids through the external sphincter into rectm

43
Q

You want to drain blood from the pelvis from a ruptured ectopic pregnancy. What procedure do you do?

A

Colpocentesis: insert needle through teh posterior fornix of the vagina into the rectouterine pouch.

44
Q

What muscle is responsible for fecal continence?

A

Puborectalis (the medial & inferior portion of the pubococcygeus) wraps around the anorectal junction to maintain fecal continence.

45
Q

The typical uterus is _flexed and _verted

A

Anteflexed at the junction of the cervix and the body

Anteverted at the junction of the vagina and cervical canal

46
Q

Tendinous arch of fascia pelvis is important to..

A

Tendinous arch of fascia pelvis: Dense band of connective tissue connecting levator ani fascia to the pubocervical fascia (covers anterior wall of vagina).

Important to urinary continence.

Tearing this causes the ipsilateral side of the vagina to fall, carrying the bladder and urethra with it -> cystocele (bladder prolapse)

47
Q

What ligament is a remnant of the gubernaculum? What is its function?

A

Round ligament of uterus: just maintains anteversion of the uterus (fundus turned forward at the junction of the cervix and vagina)

48
Q

In an episiotomy ( incision of perineum), the surgeon cuts 45 degrees away from the midline in order to avoid damaging what?

A

The perineal body. If this is damaged, it destabilizes the muscles attached to it -> urinary and fecal incontinence

49
Q

Boundaries of the superficial perineal pouch

A

Inferiorly - Colles’ fascia

Posteriorly - perineal body

Superiorly- perineal membrane

50
Q

Course of the ureter down from renal pelvis

A
  • Runs down, crossing pelvic brim close to where the common iliac artery bifurcates
  • Medial to gonadal vessels as it enters pelvis
  • In the pelvis, it’s lateral to the iliac artery

Block II (17 decks)

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