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Clinical Anatomy > Female pelvis > Flashcards

Female pelvis Flashcards

1
Q

What does the upper genital tract consist of?

A

Endocervix
Uterus
Fallopian tubes
Ovaries

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2
Q

What causes the differentiation of male and female reproductive systems?

A

Initially they are indifferent, the SRY gene of the Y chromosome initiates male differentiation

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3
Q

What is the origin of the female genital tract?

A

Mesodermal in origin

Mainly arising from paramesonephric (Mullerian) ducts

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4
Q

Where may remnants of the mesonephric ducts be retained?

A

May be retained in the leaves of the broad ligament between uterus, fallopian tube and ovary

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5
Q

What are the remnants of the mesonephric ducts?

A

Gartner’s ducts - paired remnants that can become cystic, located laterally to the vaginal wall in broad ligament

Epoophoron (paraovarium) - analogous to epididymis
Found cranially in broad ligament + may communicate with Gartner’s ducts

Paraoophoron - analogous to paradidymis, usually located medially w/in broad ligament

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6
Q

What is the genital tract closely related to?

A

Closely related to urinary tract
Anomalies in one system can be associated with anomalies in other system

Trigone of bladder derives from mesonephric ducts in both sexes

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7
Q

What does the genital septum separate?

A

Genital tract forms a genital septum between GI + GU tracts

Anterior to genital septum is vesicouterine pouch
Posteriorly rectouterine pouch

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8
Q

How many systems are in the female pelvis?

A

3 systems pass through

Normal size pelvic organs not palpable per abdomen ˙.˙ deep to pelvic bones
Must be examined per rectum or per vaginum

Close relationship can lead to potential surgical problems eg. rupture bowel in gynaecological surgery or urethral + pelvic floor muscle damage -> incontinence
Ureters are at risk in surgery

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9
Q

At what stage does the uterus receive the developing foetus?

A

Morula stage receives foetus, allows its implantation (blastocyst stage) + provides environment for development before expelling foetus through lower genital tract

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10
Q

How would one define the orientation of uterus?

A

Anteverted + anteflexed
Flexion = angle between cervix + upper vagina
Version = angle between long axis of uterus + cervix

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11
Q

What is the issue with retroverted uterus?

A

Positioned directly above the vagina .˙. prone to prolapse into vagina when intra-abdominal pressure increases

Significant as don’t want to puncture uterus if putting instruments inside

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12
Q

What is the uterus subdivided by?

A

2 sub-divisions delineated by entry point of uterine tubes:
Superior - fundus
Inferior - body

Fundus is top of uterus, above entry point of uterine tubes

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13
Q

What arises from junction of the fundus w/ uterine tubes?

A

Anteriorly - round ligament

Posteriorly - ovarian ligament

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14
Q

What are the 3 components of the uterus?

A

Peritoneum - double layered membrane continuous with abdominal peritoneum

Myometrium - thick smooth muscle layer
cells undergo hypertrophy + hyperplasia in pregnancy to prepare to expel foetus in parturition

Endometrium - inner mucous membrane that’s further sub-divided
i. deep stratum basalis - changes little through menstrual cycle + is not shed in menstruation

ii. superficial stratum functionalis - proliferated in response to oestrogen + becomes secretory in response to progesterone shed during menstruation + regenerates from stratum basalis

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15
Q

What is the broad ligament?

A

Peritoneal fold that attaches to uterus, anterior surface of ovary + fallopian tubes
Developmentally it forms when 2 Mullerian ducts fuse, bringing 2 peritoneal folds together

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16
Q

What are the 3 divisions of the broad ligament?

A

Mesometrium - surrounds uterus + forms fold over internal iliac vessels

Mesovarium - part associated with ovaries

Mesosalpinx - originates superiorly to mesovarium + encloses fallopian tubes

Surrounds the intra-vaginal part of cervix

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17
Q

What is the ovarian ligament?

A

Attaches to ovary inferiorly, connecting to side of uterus

A fibrous band w/in broad ligament

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18
Q

What is the suspensory ligament of ovary?

A

Extends out from ovary to lateral abdominal wall (attaches it to it)
Contains ovarian artery, vein, nerve plexus + lymphatic vessels

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19
Q

What is the round ligament?

A

Remnant of gubernaculum (along with ovarian ligament), attaching to anterior surface of uterus + labia majora via deep inguinal ring

Can cause pain in pregnancy due to increased force on it form expanding uterus

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20
Q

What is the cardinal (transverse cervical) ligaments?

A

Houses uterine artery + veins + often removed in hysterectomy to treat cancer as they can house cancerous cells

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21
Q

What are 2 other ligaments?

A

Uterosacral ligaments

Pubocervical ligaments

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22
Q

What are the 2 portions of the cervix?

A

Supra + intravaginal portions

Intravaginal portion surrounded by broad ligament

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23
Q

What is the external os?

A

The opening of the cervix into vagina

24
Q

What is the arterial supply of the uterus?

A

Comes from uterine artery off internal iliac artery

Ovarian artery from abdominal aorta at L2

25
Q

What structure is passes over the internal iliac artery?

A

Ureters - susceptible to damage during surgery

26
Q

What is the nerve supply of the uterus?

A

SNS - uterovaginal plexus (from ant + intermediate hypogastric plexus)

PS - pelvic splanchnic nerves (S2-S4)

Afferent fibres enter spinal cord @ T10-L1 via inferior hypogastric plexus

Cervix innervated by inferior fibres uterovaginal plexus

27
Q

What is the clinical importance of the nerve supply of the uterus?

A

When administrating nerve block for labour, must span T10-L2

28
Q

Describe the course of the round ligament

A

Attaches to the anterio surface of uterus @ junction with the uterine tubes
Then descends through the deep inguinal ring to labium majus

29
Q

Describe where the uterus reaches week by week?

A

12 weeks - uterus becomes palpable above pubis
20-22 weeks - reaches. umbilicus
36-38 weeks - reaches xiphisternum

30
Q

What are the changes that the uterus undergoes?

A

Uterus expands
Endometrium (decidua during pregnancy) expands across as foetus grows
Cervix softens
Uterine wall thickens

31
Q

List some clinical conditions associated with the uterus

A

Menstrual disorders - menorrhagia, metrorrhagia, dysmenorrhoea, amenorrhea

Uterine prolapse - caused by weakened pelvic floor, varying degrees of prolapse

Uterine fibroids - benign growth in uterus, symptoms include heavy periods, longer periods, polyuria, difficulty voiding, backache/leg pains

Endometriosis - where endometrial tissue ends up outside uterus, symptoms include dysmenorrhoea, menorrhagia, pain

Endometrial carcinoma - incidence increasing because longer lifespans, obesity, fewer pregnancies + later pregnancies

32
Q

What is the adnexa?

A

The structures between the uterus + pelvic side wall are referred to as the adnexa

33
Q

Where do the uterine tubes develop from?

A

The Mullerian ducts

34
Q

How are the uterine tubes attached to the broad ligament?

A

By the mesosalpinx

35
Q

How long are uterine tubes and what are the 4 parts?

A

12cm in length

Fimbriae, infundibulum, ampulla, isthmus

36
Q

Describe parts of the uterine tubes

A 
Isthmus = narrowest part
Ampulla = place fertilisation
37
Q

What cells line the uterine tubes?

A

Ciliated cells
Glandular cells
Help move the oocyte/ embryo along tube by mucociliary system
During ovulation, ovum moves along oviduct

38
Q

Where is the most common region for ectopic pregnancies?

A

Ampulla

Medical emergencies associated with the oviduct

39
Q

What is the blood supply of the oviduct?

A

Ovarian + uterine arteries

40
Q

What is salpingitis?

A

Inflammation of uterine tubes
Can be caused by STD’s - gonorrhoea + chlamydia
Consequences - hydro-salpinx (tube fills w/water) or pyosalpinx (fills w/pus)

41
Q

What is cervical excitation?

A

Tenderness elicited by moving cervix from side to side

42
Q

Where do ovaries arise from?

A

Mesoderm

43
Q

Approximately how many oocytes are produced?

A 
20wks gestation - 5 million oocytes 
500,000 at birth 
By puberty - 50,000
Fewer than 500 are ovulated
Males produce 300 million sperm per day
44
Q

What is the blood supply of the ovaries?

A

Gonads take their blood supply as they descend

Arise from abdominal aorta @ L2

45
Q

Where do the ovarian vessels run?

A

Run within suspensory ligament, then enter mesovarium of broad ligament
Run anterior to ureter
Artery anterior to vein

46
Q

What is at risk when ligating ovarian vessels?

A

Ureters are at risk

47
Q

Where do the ovarian veins drain into?

A

Left drains into the left renal vein -> IVC

Right drains directly into IVC

48
Q

What is the lymphatic drainage of the ovaries and the uterine tubes?

A

Ovaries drain to para-aortic nodes

Uterine tubes drain to iliac, sacral + aortic nodes

49
Q

Why is the lymphatic drainage clinically important?

A

When carrying out biopsy to stage ovarian cancers

50
Q

What occurs to the ovaries after menopause?

A

Become smaller + less white in appearance

51
Q

Describe what occurs during the menstrual cycle

A

Follicles develop up to point of ovulation (14 days from end of cycle)
At this point the corpus luteum begins to develop, then regress again

52
Q

What is the significance of ovarian pathologies?

A

May cause symptoms in medial aspects of thigh as obturator nerve runs past the ovaries

53
Q

Which cells may become cancerous in the ovary?

A

3 ovarian cells:

  1. epithelial cells
  2. germ cells
  3. Granulosa cells

90% malignant tumours derived from epithelial tissue (adenocarcinoma)

Germ cell tumours are benign teratomas - they comprise of all 3 germ layers + often contain teeth + hair etc

54
Q

What is the prognosis of ovarian cancer?

A

Very poor as often asymptomatic until later stages

55
Q

Describe ovarian cysts + the complications

A

Can reach a huge size, causing bleeding + pain

Complications - cause acute pain:
Ovarian torsion
Rupture
Infection

Clinical Anatomy (10 decks)

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