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Anatomy > Female Pelvic Viscera > Flashcards

Female Pelvic Viscera Flashcards

1
Q

Vesicouterine pouch

A

. Shallow recess btw ant. (Vesical) surface of uterus and sup. Surface of bladder

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2
Q

Rectouterine pouch of Douglas

A

. Deep recess btw ant. Surface of rectum and post. Surfaces of uterus and vagina
. Peritoneum lining inf. Pouch is anchored to perineal body by fascial condensation (rectovaginal septum)

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3
Q

Urethra in female

A

. Short membraneous tube homologous to prostatic and membraneous urethra of male
. External urethral orifice opens onto vestibule of vagina post. To clit, ant. To vaginal orifice
. Ducts of the paraurethral (skene’s) glands (make of G-spot) open into lat. urethra sup. To external urethral orifice

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4
Q

Vagina

A

. Inf. End birth canal
. Fibromuscular tube (8 cm long)
. Wall in contact except where they are separated by cervix

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5
Q

Vaginal mucosa

A

. Longitudinal (columns) and transverse ridges (rugae)
. Maintained by female reproductive hormones
. Luricated via transudation (similar to sweating)

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6
Q

Muscular walls of vagina

A

. Involuntary smooth muscles

. Striated mm. Of pelvic floor (levator ani, sphincter urethrovaginalis, bulbospongiosus mm.) are voluntary mm.

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7
Q

Vaginal hymen

A

. Endodermally-derived membrane

. Partially occluded vaginal orifice

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8
Q

Vagina anatomical relations

A

. Inf. To cervix
. Post. To bladder and urethra
. Ant. To rectum (separated from it by rectovaginal septum and rectouterine pouch)
. Urethra partially surrounded by ant. Vagina wall, pass together through pelvic floor, encircled. By fibers of sphincter urethrovaginalis mm.

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9
Q

Vagina blood supply

A

. Vaginal a. (Branch of uterine a.) anastomoses w. Descending branches of uterine aa.
. Vaginal venous plexus communicates w/ vesical, uterine, and rectal plexuses and drains to internal iliac vv.

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10
Q

Vagina lymph drainage

A

. Iliac (internal/external/common) nodes

. External orifice drains to superficial inguinal nodes

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11
Q

Chadwick’s sign

A

Inc. vascularity during pregnancy causes vagina to become violet-blue color

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12
Q

What issues allow urine or feces to drain uncontrolled from vagina?

A

. Vesicovaginal fistula
. Urethrovaginal fistula
. Rectovaginal fistula
. Developed from obstructed labor that leads to necrosis of the tissue causing fistula to form

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13
Q

Vagina innervation

A

. Superior 3/4 vagina innervated by uterovaginal division of inf. Hypogastric plexus (insensitive to touch and temp)
. Inf. 1/4 receives somatic innervation (efferent and afferent) via deep perineal branch of pudendal n. (Sensitive to touch and temp)

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14
Q

Uterus layers

A

. Perimetrium: peritoneum and CT
. Myometrium: intermediate muscular layer
. Endometrium: inner mucosal layer

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15
Q

Uterine fibroid tumors

A

. Benign tumors of myometrium
. Most common in African Americans
. Can cause pelvic pain, menstrual problems, and infertility

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16
Q

Body of uterus

A

. Sup. 2/3 of uterus
. Fundus: dome-shaped portion sup. To uterine tubes
. Cornua (horns): superolat. Body at junction w/ uterine tubes
. Uterine cavity: triangular in coronal, slit-like in sagittal

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17
Q

Cervix

A

. Separated from uterus body by isthmus of uterus
. Cylindrical inf. 1/3 of uterus
. Vagina attaches to outer walls midway along vertical descent, divides cervix into supravaginal and intravaginal portions
. Intravaginal lies w/in sup. Vagina (vaginal vault)

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18
Q

Goodell’s Sign

A

. Hormonal changes that lead to softening of cervix when pregnant

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19
Q

Hegar’s sign

A

. Softening of isthmus during pregnancy

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20
Q

Cervical canal

A

. Short, narrow passage approx. 2.5 cm long
. Internal os: sup. Opening of cervical canal at level of uterine isthmus, continuous w/ uterine cavity
. External os: inf. Opening into vagina, has ant. And post. Lips

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21
Q

Fornices

A

. Recesses btw intravaginal portion of cervix and walls of vagina
. Continuous around cervix w/ 4 subdivision
. Ant. Fornix: shallow
. Lat. fornices (R/L)
. Post. Fornix: deepest, immediately adjacent to rectouterine pouch of Douglas (proximity allows for diagnostic exams or drain fluid accumulation)

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22
Q

Normal position of uterus

A

. Anteverted and anteflexed

. Can be retroverted or retroflexed, but gives heavier cramps, doesn’t necessarily impede fertility

23
Q

Anteversion of uterus

A

. Ant. Angulation of uterus relative to vagina

. Uterus enters ant. Vaginal wall at 90 degree angle

24
Q

Anteflexion

A

. Ant. Flexion of uterine body relative to cervix at level of isthmus

25
Q

Uterus location when anteverted and anteflexed

A

. Uterine body sup. To bladder
. Fundus palpated through ant. Abdominal wall
. As bladder fills, uterus is displaced sup.

26
Q

Uterine ligaments

A

. Primary support fo uterus provided by muscles of pelvic and UG diaphragms (w/ help from peritoneal folds and visceral pelvic ligaments)

27
Q

Broad ligament of uterus and components

A

. Transverse peritoneal fold enclosing uterus, uterine tubes, and ovaries
. Mesovarium: transverse fold in post. Layer (encloses and supports ovary)
. Mesosalpinx: encloses uterine tue, sup. To ovary and proper ovarian ligament
. Mesometrium: portion inf. To ovary and proper ovarian ligament

28
Q

Round ligament of uterus (ligamentum teres uteri)

A

. Remnant fetal gubernaculum
. Courses anterolaterally btw layers of broad ligament to reach deep inguinal ring
. Traverses inguinal canal, exits at superficial inguinal ring, blends w/ superficial fascia of Latium majus

29
Q

Transverse cervical ligaments

A

. Paired fibromuscular sheets extending from cervix laterally to blend w/ tendinous arch of levator ani at lat. pelvic wall
. Known as cardinal ligaments of Mackenrodt

30
Q

Sacrouterine ligaments

A

. Paired fibromuscular bands extending from cervix to sacrum on either side of rectum
. Raises edges of peritoneum makes sacrouterine folds
. Blend w/ serosa of rectum
. Can be palpated on rectal exam

31
Q

Pubocervical lineaments

A

. Paired fibromuscular sheets extending from pubic bodies to cervix
. Encloses bladder neck, urethra, vagina, and cervix

32
Q

Uterus artery blood supply

A

. Uterine a.: branch of ant. Division of internal iliac a.
. Courses medially btw broad ligament layers at level of isthmus of uterus before branching
. Ascending branch: uterine body and tube
. Descending branch: cervix, vagina, urethra
. Uterine a. Lies immediately sup. To ureter

33
Q

Uterus venous blood supply

A

. Uterine venous plexus surrounds cervix and isthmus of uterus and coalesces to form definitive uterine vv.
. Uterine vv. Drain to internal iliac vv.

34
Q

Uterus lymphatic drainage

A

. Fundus drains to lumbar nodes
. Lymph vessels from body of uterus pass btw layers of broad ligament and drain in external iliac nodes
. Cervix drains to internal iliac and sacral nodes

35
Q

Uterine (fallopian) tubes

A

. Muscular ducts extending lat. from uterine cornua
. Lumen of tube is continuous w/ uterine cavity medially via uterine ostium
. Opens to peritoneal cavity laterally via abdominal ostium
. Receives oocyte
. Normal site of fertilization
. Oocyte/conceptus transported to uterine cavity via peristalsis and ciliary action

36
Q

Pelvic inflammatory disease

A

. Infection
. Female reproductive tract provides indirect conduit btw pelvic peritoneal cavity and external environment so it makes incidence high

37
Q

Regions of uterine tube

A

. Intramural: w/in uterine wall
. Isthmus: narrow region adjacent to uterus
. Ampulla: widest, site of fertilization
. Infundibulum: funnel-shaped, communicates w/ peritoneal cavity via abdominal ostium

38
Q

Fimbriae

A

. 20-30 finger-like projections
. Grasp ovary and guide ovum into infundibulum
. Single, enlarges ovarian fimbria is attached directly to ovary

39
Q

Uterine tube blood supply

A

. Anastomosing tubal branches of uterine and ovarian aa.

. Venous drainage follows arterial pathways

40
Q

Lymph drainage of uterine tube

A

. Lumbar lymph nodes

41
Q

Ovary

A

. Source of oocytes and reproductive hormones
. Almond shaped, 3 cm long
. Surface starts smooth then becomes lumpy and scarred w/ ovulation
.

42
Q

How ovary is secured

A

. In shallow ovarian fossa against lat. pelvic wall
. Mesovarium: fold in post. Layer of broad ligament
. Proper ovarian ligament: from fetal gubernaculum, attaches ovary to uterus body, continuous w/ round ligament of uterus
. Suspensory ligament: peritoneal fold running from lat. pelvic wall to ovary, transmits ovarian vessels and n. Fibers supplying ovary

43
Q

Artery blood supply to ovary

A

Ovarian a. Arises from abdominal aorta inf. To renal a.
. Descends ant. To ureter
. Crosses pelvic brim ant. To external iliac vessels and enters suspensory ligament
. Ends in ovarian branch and tubal branch to uterine tube
. Tubal branch anastomoses w/ tubal branch of uterine a.

44
Q

Venous bloody supply to ovary

A

. Ovarian v. Arises as pampiniform plexus surrounding ovarian a.
. R ovarian vv. Drains to IVC
. L ovarian vv. Drain to L renal v.

45
Q

Lymph drainage of ovary

A

. Follows ovarian blood vessels

. Drains to lumbar lymph nodes

46
Q

Uterus, cervix, and upper 3/4s vagina receive autonomic innervation from ____

A

. Uterovaginal division of inf. Hypogastric plexus

47
Q

Pathway of visceral afferents carrying pain sensation for proximal uterine tubes and fundus and body of uterus

A

. Follow sympathetic pathways

. Ascend via hypogastric nn., sup. Hypogastric plexus, and lumbar splanchnic nn. To enter spinal cord at T11-L2

48
Q

Visceral afferents carrying pain sensation from cervix and sup. 3/4 of vagina follow ____

A

. Parasympathetic pathways

. Travel via pelvic splanchnic nn. (S2-4)

49
Q

Pathway for fibers conveying non-pain sensations from uterus, cervix, and upper vagina

A

Follow parasympathetic pathway

50
Q

Inf. 1/4 vagina innervation

A

. Somatic innervation (efferent and afferent) via deep perineal branch of pudendal n.

51
Q

Ovary innervation

A

. Nn. Course along vessels to form ovarian plexus (overlaps uterine plexus)
. Presynaptic sympathetic: arise in lower thoracic segments, postsynaptic cell bodies in ovarian plexus
. Presynaptic parasympathetic: vagus n.
. Visceral afferent: follow sympathetic pathway, enter at T10-12

52
Q

Mittleschmerz

A

. Abdominal pain in 10th dermatome from ovarian pain during ovulation

53
Q

Uterine tube innervation

A

. Derived from uterovaginal and ovarian plexuses
. Visceral afferents follow sympathetic pathways
. Afferents from prox. Uterine tubes ascend via hypogastric nn., sup. Hypogastric plexus, and lumbar splanchnic nn. To enter at T 11-L2
. Afferents from distal tubes ascend via ovarian plexus to enter cord at T10-12

54
Q

Tubal pregnancies

A

. Pain referred to T10-12 dermatomes
. Often confused w/ appendicitis
. Medical or surgical remedy
. Prior to rupture, tube sparing surgery possible, but salpingectomy (surgical excision) preferred

Anatomy (49 decks)

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