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Reproduction and Child health > Female reproductive anatomy, pelvis and peritoneum > Flashcards

Female reproductive anatomy, pelvis and peritoneum Flashcards

1
Q

What two halves does the pelvic inlet (brim) divide the pelvis into?

A
  1. False (greater) pelvis

2. True (lesser) pelvis - pelvic cavity

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2
Q

What two regions can the perineum be divided into? What are its boundaries?

A

Urogenital triangle and Anal triangle

Pubic symphysis, Ischial tuberosities, coccyx

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3
Q

Complete the sentence:

When standing upright, the plane of the pelvic inlet lies at … to the …

A

When standing upright, the plane of the pelvic inlet lies at 60 degrees to the horizontal

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4
Q

What are the differences in pelvic girdle shapes between males and females?

A

Males (android): Narrower, thicker boned, wedge-shaped, acute pubic arch
Females (gynaecoid): Wider, thinner bones, cylindrical cavity, broad pubic arch

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5
Q

What muscles makes up the pelvic floor?

A

Levator ani group (iliococcygeus, pubococcygeus and puborectalis)
Coccygeus

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6
Q

What are the functions of the pelvic floor muscles?

A

Supporting and pulling pelvic organs UP and FORWARDS
Preventing prolapse
Puborectalis - mainting anorectal angle and helps keep you continent

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7
Q

What is the urogenital hiatus covered by?

A

Perineal membrane (urogenital diaphragm) - tough fibrous sheet - has openings for urethra and vagina - space above it DPP and below it SPP

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8
Q

What are the functions of the perineal body?

A

Strong union between pelvic floor muscles and perineal membrane
Pelvic floor integrity
Supports posterior vaginal wall in females
Attachment point for anal sphincters

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9
Q

What are the boundaries of the DPP and what does it contain? mention innervation

A

Pelvic floor and perineal membrane
Contains voluntary (skeletal) muscles - innervated by the Pudendal nerve (S2-4)
Males: Bulbourethral glands/Cowper’s glands

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10
Q

What do the bulbourethral glands/cowper’s glands do and what happens if they become infected?

A

Secrete lubricating mucus
Can become infected/develop stones
Intense pain exacerbated by defecation/rectal exam

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11
Q

What are the boundaries of the SPP and what does it contain?

A

Between perineal membrane and fascia bound surrounding genitalia
Bulb of vestibule + Paired corpora cavernosa = crura of clitoris
Bulbosponiosis + ishiocavernosus muscles = cover erectile bodies
Greater vestibular glands/Bartholin’s glands

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12
Q

What are the vulva?

A

Folds of tissue guarding the urethral opening, vagina and clitoris

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13
Q

Describe the function of the greater vestibular (bartholin’s) glands and what happens if they are infected?

A

Drain into the vestibule at 5 and 7 o’clock position relative to vaginal opening
Can become inflamed, infected and form cysts or abscesses

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14
Q

What positions are episiotomies usually carried out?

A

Mediolateral position

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15
Q

Where can you find the ischioanal (ischiorectal) fossae?

A

In the Anal triangle (posterior)
Contains fat
Anterior extensions into the urogenital triangle

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16
Q

In the female, the peritoneum drapes over the pelvic organs, what two pouches does it form? Which pouch is more likely to get an infection?

A
  1. Vesicouterine pouch
  2. Rectouterine pouch/ Pouch of Douglas
    Rectouterine is the most GRAVITY dependent - intraperitoneal fluid/blood/pus will accumulate - infection
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17
Q

Describe the vagina, mention its innervation.

A

Distensible fibromuscular tube - between bladder and rectum
Connects vestibule (space between labia minora) to the external os of the uterine cervix
Runs posterosuperiorly
Prox vag - pelvic splanchnic n - parasymp - S2-4
Dist vag - pudendal n - somatic - S2-4

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18
Q

What is the name of a prolapsed bladder and rectum through the vagina?

A

Cystocele

Rectocele

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19
Q

What can you use the posterior fornix of the uterus for?

A

Posterior fornix is DEEPEST, lying adjacent to rectouterine pouch - can pass a needle through the posterior fornix to access this

20
Q

What are the thick smooth muscle layer and outer serosal layer of the uterus called?

A

Thick smooth muscle layer - myometrium

Outer serosal layer - perimetrium

21
Q

What is the bimanual palpation procedure used for?

A

Check approx size and position of the uterus:

2 digits in vagina, one hand on abdo - check if uterus is anterverted and anteflexed

22
Q

Describe the normal position of the uterus (mention angles).

A

Anterversion, Anteflexed
Angle of version = Vagina and Cervix
Angle of flexion = Cervix and Uterus

23
Q

What can be the associated pathology with a retroverted and/or retroflexed uterus?

A

Subfertility problems

Endometriosis

24
Q

What is the function of the fimbriae?

A

From the infundibulum lie over the ovary, ready to receive/collect the ovum at ovulation

25
Q

Where does fertilisation usually occue?

A

Ampulla of the uterine tubes

26
Q

What method can you use to view the shape and patency of the uterine cavity and tubes?

A

Hysterosalpingogram - inject dye into vagina - travels up uterus, through uterine tubes and into peritoneal cavity

27
Q

Where do the paired uterine (fallopian) tubes open into?

A

Open into the peritoneal cavity

28
Q

What might happen if there is an undetected ectopic pregnancy?

A

Rupture and cause haemoperitoneum

29
Q

How might pelvic inflammatory disease (PID) be a risk for ectopic pregnancies and subfertility?

A

Uterine tubes may present a route of spread for infections from the vagina - PID
Salpingitis to tubal or tuboovarian abscesses

30
Q

Embryologically, where and from what do the ovaries develop from?

A

Intermediate mesoderm
Posterior abdominal wall (L2 vertebral level)
Descend to lateral pelvic wall and drag blood supply and lymphatics with them to final position

31
Q

Which ligament of the ovary contains the blood supply and lymphatics?

A

Suspensory ligament of the ovary

32
Q

Why can you get medial thigh pain with ovarian pathology?

A

The ovaries are close to the obturator nerve - supplies the medial thigh. Can become impinged with ovarian pathology

33
Q

Where do ovaries drain lymph to?

A

Para-aortic nodes

34
Q

What do the ovarian and round ligaments connect? What are they a remnant of?

A

Both are remnant of the gubernaculum
Ovarian lig - connects ovary to uterus
Round lig - connect uterus to labia majora (runs via inguinal canal)

35
Q

What might be a route of metastatic spread from the uterus to the inguinal lymph nodes?

A

Round ligament of the uterus

36
Q

What three regions is the broad ligament separated into?

A
  1. Mesosalpinx (uterine tube)
  2. Mesovarium (ovaries)
  3. Mesometrium (endometrium)
37
Q

What is the point where pelvic fascia come together?

A

Tendinous arch

38
Q

What are the three parametrial ligaments that support the uterus?

A
  1. Uterosacral
  2. Cardinal ligament
  3. Pubocervical
39
Q

What is the name of the fascia which surrounds the vagina and connects it to the tendinous arch?

A

Paracolpium

40
Q

What is the golden rule for blood supply to the pelvic organs and perineum?

A

From branches of the internal iliac artery
Internal pudendal artery supplies perineum
Rich anastomoses between all organs - inc flow/demand during pregnancy

41
Q

What passes below the uterine artery? Hint: Water flow under the bridge

A

Ureter passes below uterine artery (lateral to cervix)

42
Q

What is at damage during a hysterectomy?

A

Ureter

43
Q

Where do the following structures drain to?

Ovary, fallopian tubes, fundus of uterus, body of uterus, cervix, prox vagina, distal vagina, external genitalia

A

Ovary, fallopian tubes, fundus of uterus - paraortic nodes
Body of uterus, cervix, prox vagina - internal and external iliac nodes
distal vagina, external genitalia - superficial and deep inguinal nodes
P.S. round lig of uterus drains part of uterus to superficial inguinal nodes

44
Q

What is the pelvic pain line?

A

The lowest point of peritoneal reflection over the pelvic organs. Determines the route visceral pain fibres takes from pelvic structures back into the CNS

45
Q

Describe the innervation in the pelvic cavity below and above pelvic pain lines…

A

Above - pelvic organs covered in peritoneum, visceral sensory nerves travel alongside sympathetic nerves (refer pain T11-L2)
Below - not covered, visceral sensory n. - alongside parasymp nerves (refer pain S2-4)
External genitalia/distal vagina, perineal pouch muscles, sphincters - somatic innervation - pudendal nerve (S2-4)

46
Q

How does the pudendal nerve pass in/out of the pelvic cavity?

A

Via the greater sciatic foramen and back in towards the perineum via lesser sciatic foramen.
Runs close to the ischial spine and sacrospinous ligament

47
Q

How do you access the pudendal nerve when doing a nerve block?

A

Runs close to ischial spine, palpate through vagina - estimate location - anaesthesia for perineum, distal vagina and anal canal

Reproduction and Child health (21 decks)

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