Female Pelvic Viscera Flashcards
Vesicouterine pouch
. Shallow recess btw ant. (Vesical) surface of uterus and sup. Surface of bladder
Rectouterine pouch of Douglas
. 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)
Urethra in female
. 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
Vagina
. Inf. End birth canal
. Fibromuscular tube (8 cm long)
. Wall in contact except where they are separated by cervix
Vaginal mucosa
. Longitudinal (columns) and transverse ridges (rugae)
. Maintained by female reproductive hormones
. Luricated via transudation (similar to sweating)
Muscular walls of vagina
. Involuntary smooth muscles
. Striated mm. Of pelvic floor (levator ani, sphincter urethrovaginalis, bulbospongiosus mm.) are voluntary mm.
Vaginal hymen
. Endodermally-derived membrane
. Partially occluded vaginal orifice
Vagina anatomical relations
. 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.
Vagina blood supply
. 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.
Vagina lymph drainage
. Iliac (internal/external/common) nodes
. External orifice drains to superficial inguinal nodes
Chadwick’s sign
Inc. vascularity during pregnancy causes vagina to become violet-blue color
What issues allow urine or feces to drain uncontrolled from vagina?
. Vesicovaginal fistula
. Urethrovaginal fistula
. Rectovaginal fistula
. Developed from obstructed labor that leads to necrosis of the tissue causing fistula to form
Vagina innervation
. 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)
Uterus layers
. Perimetrium: peritoneum and CT
. Myometrium: intermediate muscular layer
. Endometrium: inner mucosal layer
Uterine fibroid tumors
. Benign tumors of myometrium
. Most common in African Americans
. Can cause pelvic pain, menstrual problems, and infertility
Body of uterus
. 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
Cervix
. 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)
Goodell’s Sign
. Hormonal changes that lead to softening of cervix when pregnant
Hegar’s sign
. Softening of isthmus during pregnancy
Cervical canal
. 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
Fornices
. 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)
Normal position of uterus
. Anteverted and anteflexed
. Can be retroverted or retroflexed, but gives heavier cramps, doesn’t necessarily impede fertility
Anteversion of uterus
. Ant. Angulation of uterus relative to vagina
. Uterus enters ant. Vaginal wall at 90 degree angle
Anteflexion
. Ant. Flexion of uterine body relative to cervix at level of isthmus
Uterus location when anteverted and anteflexed
. Uterine body sup. To bladder
. Fundus palpated through ant. Abdominal wall
. As bladder fills, uterus is displaced sup.
Uterine ligaments
. Primary support fo uterus provided by muscles of pelvic and UG diaphragms (w/ help from peritoneal folds and visceral pelvic ligaments)
Broad ligament of uterus and components
. 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
Round ligament of uterus (ligamentum teres uteri)
. 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
Transverse cervical ligaments
. 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
Sacrouterine ligaments
. 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
Pubocervical lineaments
. Paired fibromuscular sheets extending from pubic bodies to cervix
. Encloses bladder neck, urethra, vagina, and cervix
Uterus artery blood supply
. 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
Uterus venous blood supply
. Uterine venous plexus surrounds cervix and isthmus of uterus and coalesces to form definitive uterine vv.
. Uterine vv. Drain to internal iliac vv.
Uterus lymphatic drainage
. 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
Uterine (fallopian) tubes
. 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
Pelvic inflammatory disease
. Infection
. Female reproductive tract provides indirect conduit btw pelvic peritoneal cavity and external environment so it makes incidence high
Regions of uterine tube
. 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
Fimbriae
. 20-30 finger-like projections
. Grasp ovary and guide ovum into infundibulum
. Single, enlarges ovarian fimbria is attached directly to ovary
Uterine tube blood supply
. Anastomosing tubal branches of uterine and ovarian aa.
. Venous drainage follows arterial pathways
Lymph drainage of uterine tube
. Lumbar lymph nodes
Ovary
. Source of oocytes and reproductive hormones
. Almond shaped, 3 cm long
. Surface starts smooth then becomes lumpy and scarred w/ ovulation
.
How ovary is secured
. 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
Artery blood supply to ovary
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.
Venous bloody supply to ovary
. Ovarian v. Arises as pampiniform plexus surrounding ovarian a.
. R ovarian vv. Drains to IVC
. L ovarian vv. Drain to L renal v.
Lymph drainage of ovary
. Follows ovarian blood vessels
. Drains to lumbar lymph nodes
Uterus, cervix, and upper 3/4s vagina receive autonomic innervation from ____
. Uterovaginal division of inf. Hypogastric plexus
Pathway of visceral afferents carrying pain sensation for proximal uterine tubes and fundus and body of uterus
. Follow sympathetic pathways
. Ascend via hypogastric nn., sup. Hypogastric plexus, and lumbar splanchnic nn. To enter spinal cord at T11-L2
Visceral afferents carrying pain sensation from cervix and sup. 3/4 of vagina follow ____
. Parasympathetic pathways
. Travel via pelvic splanchnic nn. (S2-4)
Pathway for fibers conveying non-pain sensations from uterus, cervix, and upper vagina
Follow parasympathetic pathway
Inf. 1/4 vagina innervation
. Somatic innervation (efferent and afferent) via deep perineal branch of pudendal n.
Ovary innervation
. 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
Mittleschmerz
. Abdominal pain in 10th dermatome from ovarian pain during ovulation
Uterine tube innervation
. 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
Tubal pregnancies
. 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
