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OB/GYN > Female Reproductive Anatomy > Flashcards

Female Reproductive Anatomy Flashcards

1
Q

What is the pelvic skeleton composed of?

A
  • sacrum and coccyx

- two innominate bones (os coxae)

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2
Q

What do the sacrum and coccyx form?

A

posterior wall

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3
Q

What do the two innominate bones form? What do the innominate bones consist of?

A
  • anterior and lateral walls

- consist of the fused ilium, ischium and pubis

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4
Q

What are the 3 functions of the female pelvis?

A
  1. provide a weight-bearing bridge between the spinal column and bones of the lower extremities
  2. direct the pathway of the fetal head during childbirth
  3. protect the organs of reproduction
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5
Q

What is the line terminalis?

A
  • imaginary line extending from the sacral promontory to the symphysis pubis
  • divides the pelvic cavity into 2 regions
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6
Q

Where is the false pelvis? What are it’s boundaries? What is another name for it?

A

AKA greater pelvis

  • located above linea terminalis

Boundaries:

  • abdominal wall
  • base of sacrum
  • iliac wings (lateral)
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7
Q

Where is the true pelvis? What are it’s boundaries? What is another name for it?

A

AKA lesser pelvis

  • located below the linea terminalis

Boundaries:

  • pubis and pubic rami (anterior)
  • sacrum and coccyx (posterior)
  • ilium and ischium (lateral)
  • muscles of pelvic diaphragm (inferior)
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8
Q

In a non-gravid patient, where are the uterus, ovaries and adnexa located?

A

true pelvis

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9
Q

The ______ ligaments connect the pelvic bones together and the ______ ligaments support the uterus and ovaries.

A
  • osseous

- suspensory

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10
Q

Name the 4 osseous ligaments and what they involve.

A
  1. sacroiliac – attach sacrum and iliac bones
  2. sacrosciatic – sacrum, iliac and coccyx
  3. sacrococcygeal – sacrum and coccyx
  4. pubic – the two pubic rami
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11
Q

Name the 7 suspensory ligaments.

A
  1. cardinal (lateral cervical)
  2. broad
  3. uterosacral
  4. round
  5. ovarian
  6. mesovarium
  7. infundibulopelvic (suspensory)
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12
Q

Pelvic ligaments are generally seen sonographically only in the presence of ______.

A

ascites

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13
Q

Describe the cardinal ligament and what it supports.

A
  • connects to uterus at the level of the cervix (lateral cervix)
  • supports the uterus and cervix
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14
Q

Describe the broad ligament.

A

extends from the lateral aspects of the uterus and attach to the lateral pelvic side wall

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15
Q

Which ligament is the only one we can see in the pelvis?

A

broad ligament

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16
Q

Which ligament provides posterior support?

A

uterosacral

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17
Q

Describe the round ligament.

A
  • situated anterior and inferior to the broad ligaments and fallopian tubes
  • attaches the uterine cornu to the anterior pelvic wall
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18
Q

Which ligament can cause low anterior pain in pregnancy?

A

round ligament

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19
Q

Describe the ovarian ligament.

A

attaches the inferior ovary to the uterine cornu

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20
Q

Describe the mesovarium ligament.

A

attaches the ovary to the posterior layer of the broad ligament on each side

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21
Q

Describe the infundibulopelvic ligament? What is another name for this?

A

AKA suspensory ligament

  • attaches the lateral ovary to the posterolateral pelvic wall and transmit the ovarian vessels and nerves
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22
Q

The rectus abdominus muscle forms much of the _________ body wall and extends from ______ to _________.

A

anterior

xiphoid to pubic symphysis

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23
Q

Which muscle is responsible for refraction/ghosting artifact sometime seen while imaging the midline pelvis transversely?

A

rectus abdominus

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24
Q

The psoas major muscle originates from __________ and ____________. It courses _______ and _______ through the abdomen.

A

lower thoracic and lumbar vertebrae

laterally and anteriorly

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25
Q

Which muscle is most likely to be mistaken for an ovary sonographically?

A

iliopsoas muscle

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26
Q

Below the level of the ________, fibers of the psoas major muscle begin to merge with fibers from the medial aspect of the _______ muscle. This forms the _________ muscle.

A
  • iliac crest
  • iliacus
  • iliopsoas
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27
Q

Which muscle inserts on the lesser trochanter of the femur?

A

iliopsoas muscle

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28
Q

The iliacus muscle arises at the _________ and extends _________ until it merges with the _________.

A
  • iliac crest
  • inferiorly
  • psoas major
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29
Q

Which muscle forms part of the lateral margins of the pelvic basin?

A

iliacus muscle

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30
Q

The obturator internus muscle is a _______ sheet of muscle anchored along the brim of the _____ pelvis.

A
  • triangular

- brim

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31
Q

The obturator internus muscle extends ________ and _______ along the side wall of the ____ pelvis. It passes beneath the ________ to exit through the ______________.

A
  • posteriorly and medially
  • true pelvis
  • levator ani
  • lesser sciatic foramen
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32
Q

The obturator internus is a ________ muscle.

A

hypoechoic

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33
Q

Piriformis muscle is located __________ in the _______ pelvis.

A

deeply posterior, true pelvis

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34
Q

Which muscle is not well seen due to it’s deep location?

A

piriformis muscle

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35
Q

What muscles is the pelvic diaphragm composed of?

A
  • coccygeus

- levator ani

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36
Q

Name the pelvic diaphragms 2 functions.

A
  1. resist increased intra-abdominal pressure (coughs, sneezes, Valsalva)
  2. resist gravity (standing up)

(supports urethra, rectum and vagina like a sling)

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37
Q

Which orifices pass through the levator ani? Name them from anterior to posterior.

A
  • urethra
  • vagina
  • rectum
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38
Q

The levator ani muscle group is located between the ______ and ______. It forms the ____________________.

A
  • pubis and coccyx

- anterior/middle pelvic floor

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39
Q

Which muscles are located in the true pelvis and which in the false pelvis?

A

True:

  • obturator internus
  • piriformis
  • coccygeus
  • levator ani

False:
- iliacus

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40
Q

Name the following muscle’s locations:

  • rectus abdominus
  • psoas major
  • iliacus
  • obturator internus
  • piriformis
  • coccygeus
  • levator ani
A
  • rectus abdominus: anterior wall
  • psoas major: posterior wall
  • iliacus: iliac fossa
  • obturator internus: lateral wall
  • piriformis: posterior wall
  • coccygeus: posterior floor
  • levator ani: middle and anterior floor
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41
Q

The urinary bladder is a hollow _____________ organ that is located between the ________ and _________.

A
  • musculomembranous

- symphysis pubis and vagina

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42
Q

Where do the ureters insert on the bladder?

A

trigone: the inferior/posterior portion of the bladder

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43
Q

Name the 3 layers of the bladder wall

A
  • outer epithelial layer
  • middle muscular layer
  • inner mucosal layer
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44
Q

The empty bladder has mucosal folds known as ______, and the walls are _____ so they can be demonstrated sonographically.

A
  • rugae

- thick

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45
Q

When the bladder is distended, the _______ is stretched and no longer recognized as a distinct layer.

A

mucosa

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46
Q

When is the bladder considered adequately full?

A

when the dome (superior portion) of the bladder extends above the uterine fundus

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47
Q

How long is the vagina?

A

7-10cm

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48
Q

The vagina is a canal of _____ muscle that extends from the __________ to the _________.

A
  • smooth

- external vaginal introitus to the uterine cervix

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49
Q

The ______ vaginal fornix is smaller than the ________ vaginal fornix.

A

anterior, posterior

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50
Q

Which fornix is a frequent site of vaginal fluid collections? What is this due to?

A

posterior, gravity dependence

51
Q

What are the lateral fornices?

A

They surround the lateral aspect of the external cervix on either side

52
Q

The uterus is located between the _______ and _______.

A

urinary bladder and rectum

53
Q

The isthmus is also referred to as the ______________.

A

lower uterine segment

54
Q

Which portion of the uterus is the most flexible portion and grows at the most rapid rate during pregnancy?

A

isthmus

55
Q

What is the function of the cervix?

A
  • provides an alkaline secretion favorable for sperm penetration
  • acts as a sphincter during pregnancy
56
Q

What is the endocervical canal?

A

the continuation of the endometrial cavity into the cervix

57
Q

The cervix has an ________ os opening from the cervix into the uterus and an ________ os opening from the cervix into the vagina.

A
  • internal

- external

58
Q

A newborn uterus is ______ cervix, ______ body and fundus.

A

2/3 cervix, 1/3 body and fundus

59
Q

A pediatric uterus is ______ cervix, ______ body and fundus.

A

1/2 cervix, 1/2 body and fundus

60
Q

A postmenopausal uterus has ___________ proportions, which is ______ cervix, ______ body and fundus.

A
  • normal adult proportions

- 1/3 cervix, 2/3 body and fundus.

61
Q

What is the length and AP measurement of the uterus for the ages 2-8?

A

length: 33, AP: 7.5 (mm)

62
Q

What is the length and AP measurement of the uterus for the ages 9-menarche?

A

length: 43, AP: 13 (mm)

63
Q

What is the length and AP measurement of the uterus for the nulliparous?

A

length: 80, AP: 30 (mm)

64
Q

What is the length and AP measurement of the uterus for the multiparous?

A

length: 90, AP: 40 (mm)

65
Q

What is the length and AP measurement of the uterus for the postmenopausal?

A

varied, based on parity and years since menopause

66
Q

Which layer of the uterus is the outer serosal layer, which is part of the visceral peritoneum?

A

perimetrium

67
Q

Laterally, the perimetrium becomes the _________, anteriorly it forms the ___________ and posteriorly forms the ______________.

A
  • broad ligament
  • vesicouterine pouch (anterior cul-de-sac)
  • rectouterine pouch (pouch of Douglas/posterior cul-de-sac)
68
Q

What is the most dependent recess in the body?

A

rectouterine pouch

69
Q

The _________ is the middle muscular uterine layer.

A

myometrium

70
Q

The myometrium is composed of ___ layers of ______ muscle that contract during parturition. How does the myometrium appear sonographically?

A
  • 3 layers of smooth muscle

- homogeneous

71
Q

The inner portion of the myometrium sometimes looks hypoechoic, this is referred to as the __________.

A

junctional zone

72
Q

What is the parametrium?

A

refers to the tissues surrounding the uterus (not a uterine layer!)

73
Q

The endometrium is the _________ layer, which consists of the _________ layer and _________________ layer.

A
  • inner mucosal
  • superficial functional layer (stratum functionalis)
  • deeper permanent basal layer (stratum basalis)
74
Q

Measurements of the endometrium should be obtained in a _______ view and are taken in the _______ dimension.

A

sagittal, AP

75
Q

Order the uterine layers from outer to inner.

A

perimetrium > myometrium > basal layer of endometrium > functional layer of endometrium

76
Q

Describe anteversion.

A

Forward placement of the uterus at the cervix

- forms 90 degree angle with the vagina

77
Q

Describe retroversion.

A

Tilting backward of the uterus at the cervix

- oriented more linearly in relationship to the vagina

78
Q

Describe anteflexion.

A

bending forward of the uterus at the body

79
Q

Describe retroflexion.

A

bending backward of the uterus at the body

- may become incarcerated during pregnancy

80
Q

What is a symptom of incarceration with pregnancy?

A

urinary retention

81
Q

What is the most common uterine position?

A

anteverted/anteflexed

82
Q

What type of transducer is used for TV?

A
  • higher frequency (>7.5 MHz)

- convex or phased array

83
Q

How should a transvaginal transducer be cleaned?

A

high level disinfectant — NO autoclaving! (will lose PZT potential)

84
Q

How do you decide if the uterus is flexed or verted?

A

x axis = flex

y axis = vert

85
Q

What is the size and mean volume of an ovary before menopause? (varies with ovulatory stage)

A

size = 3.5 x 2.0 x 1.5 cm (up to 5cm in any one place is normal)

mean volume = less than or equal to 9.8 cm cubed

86
Q

What is the size and mean volume of an ovary postmenopause? (varies with number of years since menopause)

A

size = 2.0 x 1.0 x 0.5 cm

mean volume = less than or equal to 5.8 cm cubed

87
Q

What is the equation for ovarian volume in cm cubed?

A

length x width x AP x 0.523

88
Q

What are the two layers of the ovary?

A
  • cortex - outer functional layer

- medulla - inner ovary

89
Q

The _______ of the ovary contains blood vessels and connective tissue/stroma.

A

medulla

90
Q

The ______ of the ovary constitutes the bulk of the ovary and contains a large number of primordial and developing follicles.

A

cortex

91
Q

Where is the hilum of the ovary located? What does this do?

A
  • anterior surface

- channels the ovarian vessels and nerves

92
Q

Where to the suspensory ligaments and fimbraiae of the Fallopian tube attach to the ovary?

A

superior surface

93
Q

How long are the fallopian tubes? What is their function?

A
  • 7-14cm

- transport fertilized ovum to the uterus by means of peristaltic contractions

94
Q

Which region of the fallopian tube is narrow and relatively straight, located within the uterine wall (cornu)?

A

interstitial/intramural

95
Q

Which region of the fallopian tube is the medial portion closest to the uterus (medial 1/3)?

A

isthmus

96
Q

Which region of the fallopian tube is the longest portion?

A

ampulla

97
Q

Which region of the fallopian tube is the outer portion with a trumpet shaped end?

A

infundibulum

98
Q

Which region of the fallopian tube curves around the ovary and is thin walled and distendable?

A

ampulla

99
Q

Which region of the fallopian tube has numerous finger-like projections that maintain a close relationship between the tube and ovary?

A

fimbriae

100
Q

Which region of the fallopian tube is normally the fertilization?

A

ampulla

101
Q

The space of retzius is also known as what? Where is it located?

A

AKA retropubic or prevesical space

- between the pubic bone and anterior urinary bladder wall

102
Q

The vesicouterine space is also known as what? Where is it located? This space is usually ______, but may contain ______.

A

AKA anterior cul-de-sac

  • anterior to the uterus and posterior to the bladder
  • empty, may contain loops of bowel
103
Q

The rectouterine space is also known as what? Where is it located?

A

AKA posterior cul-de-sac, pouch of Douglas

- posterior to the cervix, anterior to the rectum

104
Q

Complex free fluid in the peritoneal recesses is associated with ________ or _______.

A

hemorrhage or infection/pus

105
Q

Where does the abdominal aorta bifurcate?

A

L4

106
Q

The external iliac arteries course through the ______ pelvis, adjacent to the ______ muscles and exit the pelvis through the femoral canals to supply the lower extremities.

A
  • false

- psoas

107
Q

The internal iliac (or ________) arteries dive deep into the pelvis and divide into ______ and ______ trunks. The anterior branches give rise to several arteries, including the _______ and ______ arteries.

A
  • hypogastric
  • anterior and posterior trunks
  • uterine and vaginal arteries
108
Q

The uterine arteries cross the _______ on each side and at the _____ ascend the lateral portion of the uterus within the _____ ligament. At the ______, they course laterally to reach the ______, where they end by joining each ________.

A
  • ureters
  • cervix
  • broad
  • cornu
  • ovary
  • ovarian artery
109
Q

Name the branches of the uterine arteries from outer to inner (superficial to deep).

A

uterine > arcuate > radial > spiral

U are really smart

110
Q

Which arteries supply the myometrium? Which arteries supply the deeper layers of the myometrium and endometrium? Which arteries supply just the endometrium?

A

myometrium = arcuate arteries
deep myometrium and endometrium = radial arteries
endometrium = spiral arteries

111
Q

The uterine artery comes from the ________.

A

internal iliac artery

112
Q

The ovarian arteries are lateral branches of the ______ and arise just below the level of the _______. They course to the pelvis and reach the ovarian ______ via the ________ ligament.

A
  • aorta
  • renal arteries
  • hilum
  • infundibulopelvic
113
Q

In what region do the ovarian and uterine arteries anastomose and give rise to numerous branches?

A

uterine cornua

114
Q

The venous anatomy of the pelvis _______ the arterial anatomy.

A

parallels

115
Q

The right gonadal/ovarian vein empties into the ______ just below the level of the _______, wheel the left gonadal vein empties into the _______.

A
  • IVC
  • right renal vein
  • left renal vein
116
Q

The uterine venous plexus is ______ than the associated arterial channels and is seen sonographically.

A

larger

117
Q

What veins may be associated with pelvic congestion syndrome?

A

dilated tortuous veins (>4-5mm) near the uterus and/or in the adnexa

118
Q

What is a treatable cause of pelvic pain?

A

pelvic congestion syndrome

- veins can be embolized to reduce pain for pt

119
Q

If the arterials don’t need much blood supply, they _______ or become ____ resistance.

A

clamp down, high resistance

120
Q

Describe the Doppler characteristics of the uterine arteries in a non-gravid patient in regards to velocity and resistance. What is the difference in resistance between proliferative and secretory phase and in postmenopausal women vs women of reproductive age?

A
  • moderate to high velocity
  • high resistance flow
  • higher resistance flow in proliferative than in secretory
  • higher resistance flow in postmenopausal than in women of reproductive age
121
Q

The radial arteries will have ______ resistance flow in proliferative phase than in secretory phase. These arteries are _______ to visualize in _________ women.

A
  • higher

- difficult, postmenopausal

122
Q

In the ovarian arteries during the follicular phase, flow is often _____ velocity and _____ resistance. In the periovulatory period and luteal phase, resistance _______ dramatically on the side with the ____________ (_____ PI and RI).

A
  • low velocity
  • high resistance
  • drops
  • dominant follicle
  • lower PI and RI (low resistance flow)
123
Q

In postmenopausal women, the RI’s of the ovarian arteries approaches ____ (_____ resistance) with increasing age.

A

1.0, high resistance

124
Q

Any organ that is _______ to life will have high resistance and any organ that is ______ to life will have low resistance.

A

non-vital to life = high resistance

vital to life = low resistance

OB/GYN (6 decks)

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