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Endo Exam 2 > Female pelvis and perineum > Flashcards

Female pelvis and perineum Flashcards

1
Q

Female ureter relationship

A

the ureter courses directly inferior to the uterine a. This relationship is important to remember during hysterectomies when the uterine a is clamped and ligated; (the water runs under the bridge).

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2
Q

anatomical relationships of female urinary bladder

A

a. Anterior - pubic bones and symphysis
b. Posterior - vagina and cervix
c. Lateral - muscles of pelvic wall and pelvic diaphragm
d. Inferior – UG diaphragm

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3
Q

Urinary bladder: peritoneum and supporting ligaments

A

a. Peritonealized only on superior surface.
b. Lateral ligament of bladder (thickening of endopelvic fascia)
c. Pubovesicle ligament – attaches neck to pubic bone

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4
Q

Cystocele

A

a. A cystocele (fallen bladder) can result from a weakening of the pelvic diaphragm and/or fascias which support the bladder. Most common cause of a cystocele is childbirth; can also result from obesity, chronic constipation, or heavy lifting.
b. Can cause urinary incontinence as well as incomplete emptying of the bladder.

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5
Q

Supropubic cystotomy

A

a. The full bladder extends superior to pubic symphysis, but remains deep to peritoneum. This provides access to bladder for inserting catheters.
b. Because the bladder is subperitoneal, this allows for access without compromising the peritoneal cavity.

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6
Q

Female Urethra: function and glands

A
  1. Function: passage of urine; 4 cm long
  2. Superior (pelvic) portion and inferior (perineal) portion
  3. Sphincter urethrae
  4. Paraurethral (Skene’s) glands; open near external urethral orifice; these glands are the homologue of the male prostate.
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7
Q

GI organs relationships

A

A. Rectum
1. See male pelvis

  1. Anatomical relationships:
    a. Anterior (female) – uterus, cervix, vagina
    b. Posterior – sacrum, coccyx

B. Anal Triangle
1. See male perineum

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8
Q

Ovaries: function and location

A
  1. Function: produce gamete cells; produce and secrete hormones (estrogen and progesterone).
  2. Location:
    a. Lie on lateral wall of pelvis in the ovarian fossa.
    b. Boundaries of ovarian fossa:
  3. Superior and anterior – external iliac vessels
  4. Posterior – ureter
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9
Q

Ovaries: supporting ligaments and mesenteries, vascular supply

A

a. Mesovarium – part of broad ligament

b. Suspensory ligament (infundibulopelvic ligament)
1. Attaches superolateral portion of ovary to lateral pelvic wall.
2. Ovarian vessels, nerves, and lymphatics travel in suspensory ligament

c. Ovarian ligament – attaches medial portion of ovary to lateral uterus.

Vascular Supply (see uterine tube vascular supply)

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10
Q

Ovaries lymphatic drainage

A

lumbar lymph nodes

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11
Q

Uterine tube: function, location, structure, supporting ligaments and mesenteries

A
  1. Function: transport oocyte (or zygote) to uterine cavity; provides normal site of fertilization.
  2. Location
    a. Extend from ovary (abdominal ostium) to uterus (uterine ostium).
    b. Typically arch anterior and superior to the ovaries.
  3. Structure
    a. Ciliated epithelium (helps propel oocyte along uterine tube)
    b. Smooth muscle
  4. Supporting ligaments and mesenteries – mesosalpinx (part of broad ligament)
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12
Q

Uterine tube features

A

a. Infundibulum
1. Lateral, funnel-shaped portion with fimbriae
2. Opens into peritoneal cavity (abdominal ostium)

b. Ampulla
1. Dilated region, medial to infundibulum
2. Normal site of fertilization

c. Isthmus
1. Medial 1-2 cm of uterine tube
2. Constricted lumen

d. Uterine portion
1. Passes through muscular wall of uterus
2. Opens into uterine cavity (uterine ostium)

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13
Q

Uterine tube vascular supply

A

a. Arterial
1. Ovarian a
a. Branch of abdominal aorta
b. Travels within suspensory ligament to reach lateral ovary
2. Uterine a
a. Branch of internal iliac a
b. Ascending branch supplies uterine tube and ovary
b. Venous
1. Ovarian v
a. Right ovarian vein drains to the inferior vena cava
b. Left ovarian vein drains to the left renal v.
2. Tubal v – drain to ovarian veins and uterine plexus

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14
Q

Uterine tube lymphatic drainage

A

lumbar lymph nodes

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15
Q

ectopic tubal pregnancy

A

: Ectopic tubal pregnancy can occur when implantation occurs in uterine tube; most common cause is structural or functional defects of uterine tubes.

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16
Q

peritonitis clinical correlation

A

Because of the continuity from peritoneal cavity to uterine tube, infections in the peritoneal cavity (peritonitis) may spread to the female reproductive organs (and vice versa).

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17
Q

Salpingitis =

A

infection of the uterine tubes; can potentially lead to a blocked uterine tube and infertility

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18
Q

Tubal ligation

A

is a surgical method of birth control in which a small segment of the uterine tube is ligated or a clamp is placed around the uterine tube.

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19
Q

Uterus: function, anatomical relationships

A
  1. Function: Receive, retain, nourish embryo and fetus.
  2. Anatomical relationships:
    a. Anterior/inferior – urinary bladder
    b. Posterior – rectum
20
Q

Uterus: features

A

a. Fundus –superior to openings of uterine tube.
b. Body – contains openings of uterine tubes; attachments of round and ovarian ligaments.
c. Isthmus – constricted inferior portion leading to cervix
d. Cervix
1. Supravaginal portion (contains internal os)
2. Vaginal portion (contains external os)

21
Q

Supporting Ligaments/Mesenteries of Female Reproductive Viscera

A

a. Suspensory ligament (infundibulopelvic ligament)
1. Attaches superolateral portion of ovary to lateral pelvic wall.
2. Ovarian vessels, nerves, lymphatics - in suspensory ligament

b. Ovarian ligament – attaches medial portion of ovary to uterus.
c. Round ligament – attaches uterus to labia majorum; courses through deep inguinal ring and inguinal canal.

d. Broad ligament – mesentery of ovaries, uterine tube, uterus
1. Mesometrium – uterine portion
2. Mesovarium – ovarian portion
3. Mesosalpinx – tubal portion
e. Cardinal ligament – cervix to pelvic wall; contains uterine vessel.

22
Q

Uterus: orientation

A

a. Anteverted – forward angulation of uterus relative to axis of vagina
b. Anteflexed – forward angulation of uterus relative to axis of cervix

23
Q

Uterus: vascular supply

A

a. Arterial (Uterine aa)

b. Venous (Uterine venous plexus→Uterine vv)

24
Q

Uterus: lymphatic drainage

A

a. Fundus – lumbar lymph nodes via ovarian lymph vessels
b. Body and isthmus – external/internal iliac/superficial inguinal nodes.
c. Cervix – sacral, internal iliac lymph nodes

25
Q

Uterus positioning (clinical correlation)

A

: Abnormal positioning of uterus can occur; retroflexion and retroversion. In some cases, can predispose uterus to prolapse.

26
Q

Pap smear

A

The Pap (Papanicolaou) smear is a technique used to analyze cervical mucosa for diagnosing cervical cancer.

27
Q

hysterectomy

A

A hysterectomy is a surgery to remove the uterus and cervix. In some cases the ovaries will also be surgically removed.

28
Q

Vagina: functions and anatomical relationships

A
  1. Functions as organ of copulation and inferior portion of birth canal.
  2. Anatomical relationships:
    a. Anterior – bladder/urethra
    b. Posterior – rectum and anal canal
29
Q

Vagina: features

A

a. Fornix
1. Recess around vaginal portion of cervix (anterior, posterior, lateral)
2. Posterior recess is deepest, located anterior to rectum
b. Vaginal orifice; opens into vestibule of vagina

30
Q

Vagina: Structure

A

a. Thin-walled, distensible tube of CT and muscle extending from cervix to vaginal orifice.
b. Vaginal walls are normally collapsed upon one another.

31
Q

Vagina: vascular supply

A

a. Arterial
1. Uterine aa. supply superior portion of vagina
2. Vaginal aa. supply inferior portion of vagina
b. Venous - Uterine venous plexus → Uterine and vaginal vv

32
Q

Vagina: lymphatic drainage

A

a. Upper portion to internal/external iliac nodes (and some to sacral)
b. Perineal portion to superficial inguinal nodes

33
Q

Colpotomy

A

A colpotomy is a procedure by which an incision is made in the vagina. The procedure can be used to enter the rectouterine pouch via the posterior fornix of the vagina (culdocentesis); can also be used to examine ovaries/uterine tube.

34
Q

Vaginal fistulae

A

Vaginal fistulae (vesicovaginal, urethrovaginal, rectovaginal) can sometimes occur as a result of traumatic vaginal deliveries. Trauma to the vaginal wall can cause inflammation and necrosis.

35
Q

Female External Genitalia: Mons pubis

A

Mons pubis – rounded, fatty pad over the pubic symphysis

36
Q

Female External Genitalia: Labia Majora

A

a. Fatty skins folds; contain hair, sebaceous glands.
b. Form the boundaries of the pudendal cleft.
c. Contain the termination of the round ligament of the uterus.

37
Q

Female External Genitalia: Labia minora

A

a. Smaller (fat-free), hairless folds inside labia majora.
b. Form boundaries of vestibule of vagina.
c. Anteriorly, unite to form the prepuce and frenulum of the clitoris.

38
Q

Female External Genitalia: Vestibule of the vagina

A

a. Contains openings for urethra and vagina

b. The hymen is a thin mucus membrane which partially occludes vaginal lumen.

39
Q

Female External Genitalia: Clitoris

A

a. Composed of erectile tissue
b. Attached to the pubic symphysis by the suspensory ligament of the clitoris.
c. Components:
1. Crura – composed of corpora cavernosa; covered by ishiocavernosus muscle
2. Body and glans

40
Q

Female External Genitalia: Bulbs of the vestibule

A

erectile tissue, covered by bulbospongiosus muscle.

41
Q

Female External Genitalia: Greater vestibular glands (Bartholini)

A

a. Located in superficial perineal space along posterolateral wall of vagina.
b. Mucus-secreting glands
c. CLINICAL CORRELATION – the Bartholin glands are common sites of origin for vulvar adenocarcinomas.
d. CLINICAL CORRELATION – Bartholinitis – inflammation of the Bartholin glands. These glands can become so enlarged that they impinge on the wall of the vagina and rectum.

42
Q

Urogenital Triangle Muscles

A
  1. Superficial perineal space
    a. Superficial transverse perineal
    b. Bulbospongiosus – surround bulb of vestibule
    c. Ishiocavernosus – surround crura of clitoris
  2. Deep perineal space
    a. Deep transverse perineal
    b. Sphincter urethrae (urethrovaginal sphincter).
  3. Perineal body – ligamentous structure in middle of perineum; provides support for pelvic and perineal viscera.
43
Q

CLINICAL CORRELATION: Child birth and the perineal body

A
  1. The perineal body can tear during vaginal delivery.
  2. As a result, the perineal body is no longer able to support pelvic viscera
  3. Prolapse of the bladder, uterus, or vagina may occur.
44
Q

CLINICAL CORRELATION: Episiotomy

A
  1. Incision of perineum (through posterior wall of vagina) during delivery in order to prevent tearing.
  2. Midline (median) episiotomy
  3. Mediolateral episiotomies – less risk of tearing external anal sphincter.
45
Q

Blood Supply to Female Genitalia - Internal genitalia

A
  1. Internal Genitalia
    a. Ovarian artery – branch of aorta; descends through suspensory ligament.
    b. Uterine artery – branch of internal iliac artery; travels through cardinal ligament.
    c. Vaginal artery – branch of internal iliac artery.
    d. Veins are venae comitantes
46
Q

Blood supply to female external genitalia

A

a. Arteries
1. Internal pudendal aa.
a. Perineal a. – posterior labial a.
b. Arteries to the vestibule
c. Deep aa. of the clitoris (courses through corpus cavernosum)
d. Dorsal aa. of the clitoris
2. External pudendal a. (anterior labial branches)
b. Veins
1. Venae comitantes to internal pudendal vein
2. Superficial dorsal v. of clitoris (drains to external pudendal v.)
3. Deep dorsal v. of the clitoris (drains to vesicle venous plexus)

47
Q

Innervation to female Genitalia

A
  1. Internal Genitalia – autonomic (see later lecture)
  2. External genitalia
    a. Sensory:
  3. Ilioinguinal n (L1) provides anterior labial n
  4. Pudendal nerve (S2,S3,S4) provides perineal (posterior labial n.) and dorsal n. of clitoris.
  5. Note: There is also a perineal branch of the posterior cutaneous nerve of the thigh (S1,S2,S3)
    b. Motor (to muscles of UG triangle) – all from perineal branch of the pudendal n.

Endo Exam 2 (14 decks)

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