Female Reproductive System Flashcards
What makes up the ‘upper genital tract’?
uterus
fallopian tubes
ovary
What is the fundus?
anything above where the uterine tubes enter
What is the body?
anything below where the uterine tubes enter
Where does the female reproductive system arise from?
paramesonephric ducts
What remnant of mesonephric duct persists?
gartner’s gland/cyst
on lateral vagina wall
Which 3 germ layers give rise to the genital tract?
ectoderm
mesoderm
endoderm
Can normal sized pelvic organs be palpated over the abdomen?
no- they need to be examined ‘per vagina’ or ‘per rectum’
What are the 3 tissue layers?
perimetrium
myometrium
endometrium
What is a ‘genital septum?’
genital tract forms genital septum between GI and GU tract
What are the 3 tracts that go through a female pelvis?
Genital tract
GI
GU
What can cause pelvic adhesions?
inflammation
scar tissue
infection
endometriosis
What is a pelvic adhesion?
adhesion is a band of scar tissue that binds 2 parts of your tissue that aren’t normally joined together.
Pelvic adhesions may involve any organ within the pelvis, such as the uterus, ovaries, fallopian tubes, or bladder, and usually occur after surgery.
When does the uterus receive the developing human?
at morula stage
allows implantation
prove environment for development before expelling foetus
What is the size and shape of the uterus?
pear
What does version mean?
angle between vagina and cervix
What does flexion mean?
angle between uterus and cervix
What is the normal position of the uterus in relation to vagina and cervix?
anteversion & anteflexion
When is it clinically important to establish the version and flexion of the uterus?
to determine risk of prolapse
before inserting IUD
What is uterine prolapse?
A uterine prolapse is when the uterus descends toward or into the vagina. It happens when the pelvic floor muscles and ligaments become weak and are no longer able to support the uterus. In some cases, the uterus can protrude from the vaginal opening.
What are the parts of the uterus?
fundus, body, cervix
What are the 2 subdivisions of the uterus and what separates them?
corpus uterus
(SEPARATED BY INTERNAL OS)
cervix uterus
What can cause uterine prolapse?
multiple vaginal pregnancies
connective tissue disease (Marfan’s, Ehlers Danos)
What are round ligaments and ovarian ligaments remnants of?
gubernaculum remnant
What does the gubernaculum do?
Function during development.
As the scrotum and labia majora form in males and females respectively, the gubernaculum aids in the descent of the gonads (both testes and ovaries). The testes descend to a greater degree than the ovaries and ultimately pass through the inguinal canal.
What does the round ligament do?
Connect: uterine fundus to labia majorai.
Travel in roundinguinal canal, above artery of Samspon
What does the ovarian ligament do?
Connect: ovary to lateral uterus
How does the broad ligament form?
broad ligament forms after the Mullerian ducts join together during development.
During this process, 2 layers of peritoneum join together enveloping the pelvic organs, which is then known as the broad ligament.
What does the broad ligament connect?
lateral pelvic walls to the uterus, fallopian tube, ovaries etc.
What is the broad ligament?
double layered peritoneum (made of mesothelial cells)
What are the 3 parts of the broad ligament?
mesometrium (largest)- pelvic wall to uterus body
mesosalpinx- suspend uterine tubes in pelvic cavity
mesovarium- attach to ovary
What is the cardinal ligament?
cervix to pelvic side wall
What does the cardinal ligament contain?
uterine vessels (from anterior branch of internal iliac) -> supply uterus
What happens if you do hysterectomy and you affect the cardinal ligament?
ligate uterine vessels -> ureter at risk (damaged = hydronephrosis)
What is the uterosacral ligament?
connect uterus to sacrum
What does the infundibulopelvic ligament connect?
ovary to lateral pelvic wall
What does the infundibulopelvic ligament contain?
. Contain: ovarian vessels
i. In oophorectomy -> ligate vessels -> prevent bleeding i. Ligate ovarian vessels -> ureter courses retroperitoneally -> injury risk
What parts does the cervix have?
supra vaginal and intra vaginal
What is the external OS clinically used for?
smear test
What is the cervical opening into the vagina and why is a doctor familiar with it?
ectocervix (proximal to external Os)
Smear test
What is the blood supply of the uterus and where does it arise?
uterine artery
arises from anterior division of internal iliac artery
What structure links closely to the uterine artery?
ureter
uterine artery crosses over ureter from lateral to medial
What is the clinical significance between ureter and uterine artery crossing?
Important in hysterectomy
in the operation, uterine artery needs to be ligated to prevent excess blood loss
be careful not to ligate ureter too
What is the nerve supply of the uterus and at which spinal level do the afferent nerves enter?
sympathetic nerve fibres of the uterus = arise from the uterovaginal plexus.
Parasympathetic fibres of the uterus = pelvic splanchnic nerves (S2-S4).
The afferent fibres mostly ascend through the inferior hypogastric plexus to enter the spinal cord via T10-T12 and L1 nerve fibres.
What is the course of the round ligament?
originate at uterine horns, in the parametrium.
round ligament exits pelvis via the deep inguinal ring
passes through the inguinal canal
continues on to the labia majora
its fibers spread and mix with the tissue of the mons pubis.
What is the male equivalent to round and ovarian ligaments?
scrotal ligament
At what gestation does the pregnant uterus become palpable per abdomen?
after 12 weeks
At what gestation does the pregnant uterus reach the umbilicus?
20 weeks
How does the uterus change during pregnancy?
uterus thickens
blood vessels enlarge to provide nourishment to the fetus.
uterus expands
What are menstrual disorders?
Menorrhagia, metrorrhagia, dysmenorrhoea, oligomenorrhoea
What is menorrhagia?
abnormally heavy bleeding
What is metorrhagia?
abnormal bleeding
What is dysmenorrhoea?
painful menstruation
What is oligomenorrhoea?
infrequent menstrual periods
What are the grades for uterine prolapse?
Grade 1: uterus may drop slightly and remain above the introitus
Grade 2: uterus drops further so that the cervix or lower portion of the uterus reach the region of the introitus
Grade 3: cervix or even the entire uterus bulges out of the introitus
Grade 4: drops completely out
What are uterine fibroids?
benign smooth muscle growth (tumour)
What are the symptoms of uterine fibroids?
Heavy menstrual bleeding Menstrual periods lasting more than 1 week Pelvic pressure or pain Frequent urination Difficulty emptying the bladder Constipation Backache or leg pains
What is endometriosis?
enometrium tissue grows elsewhere like ligaments of uterus, fallopian tube, ovary etc.
What are the symptoms of endometriosis?
Pelvic pain- worse during period period pain that prevents normal activities pain during/after sex pain when peeing or pooing feeling sick constipation diarrhoea blood in pee during period difficulty getting pregnant
Why does endometrial carcinoma incidence increase?
more obesity
HRT
diff reproductive trends- less children, have children later
What is an adnexa?
Structures between the uterus & pelvic side wall: fallopian tubes, ovaries, and ligaments
How do you palpate an adnexal mass?
bimanual palpation: insert two gloved, lubricated fingers in the vagina & palpate lower abdomen with other hand
Which ducts do the fallopian tubes arise from?
paramesonephric duct
What attaches the oviduct (tubes) to the broad ligament?
mesosalpinx
How long is the uterine tube?
10cm to 13cm
What are the 4 parts of the uterine tube?
isthmus
ampulla
infundibulum
fimbraie
Where does fertilisation take place?
ampulla
Which is the narrowest?
isthmus
What type of cells are in the oviduct (tube) and what is the function?
ciliated columnar epithelium
move the egg
What can happen in the fallopian tube that is a medical emergency?
ectopic preggo
What is the blood supply of the fallopian tube?
medial 2/3rd of tube= UTERINE ARTERY
lateral 1/3rd of tube= OVARIAN ARTERY
What is salpingitis?
inflammation of the fallopian tubes
What is a sequelae?
consequence of previous disease
What is hydro-salpinx?
fallopian tube is blocked and fills with serous or clear fluid near the ovary (distal to the uterus). The blocked tube may become substantially distended giving the tube a characteristic sausage-like or retort-like shape.
What is pylosalpinx?
fallopian tube filled with pus
What is cervical excitation?
Severe pain found during pelvic examination. Suggest pelvic pathology, e.g. pelvic inflammatory disease/ ectopic pregnancy
How do you test for cervical excitation?
bimanual palpation
Which germ layer does the ovaries arise from?
mesoderm
How many oocytes exist at 20 weeks gestation?
5 million
How many oocytes exist at birth?
500,000
How many oocytes at puberty?
50,000
Where do ovaries developmentally start?
high on abdominal wall
Where do the ovaries descend to?
pelvic brim
Where do the gonadal arteries arise?
abdominal aorta
L2
What is the course of the ovarian vessels?
The ovarian (or testicular) arteries arise from the abdominal aorta pass downward and laterally on the anterior surface of psoas major. They continue to descend and as they cross the pelvic inlet they travel in the suspensory ligament of the ovary. The arterial supply must travel a long course because, just like the testes, the ovaries develop high on the posterior abdominal wall and then descend before birth, bringing with them their vessels, lymphatics and nerves
What is the infundibulo-pelvic ligament/ suspensory ligament of the ovary?
Fold of peritoneum that extends out from ovary to wall of pelvis
Where do the ovarian veins drain to?
Left: renal vein then IVC
Right: IVC
Where do lymphatics drain?
para-aortic
iliac nodes involved too
clinical significance: biopsy
What does the ovarian ligament do?
medial pole of ovary to uterus
What is the difference between pre and post menopausal women?
Uterus size & ovarian volume decrease
What is neoplasia?
uncontrolled cell growth
What is polycystic disease?
more androgens facial hair less periods infertility Compression - Pain, bleeding, constipation, urge incontinence, bloating
Why does ovarian pathology affect medial aspect of thigh?
because obturatory nerve goes past ovary
supplies thigh muscles
What 3 cells are found in ovary?
germ
epithelial
stromal
Which cell gives rise to cancer?
epithelial cells
Why does ovarian cancer have poor prognosis?
symptoms late
What are they symptoms of ovarian cysts
Pain, bloating, irregular period
What complications of ovarian cyst can you get that can cause problems?
Rupture, haemorrhage, ovarian torsion
What are the components of the lower genital tract?
cervix, vagina, vulva
How long is the vagina?
8cm
How is the vagina lubricated?
It doesn’t have any glands, but there’s transudation & secretion from uterus & Bartholin’s gland
What is the posterior relation of the posterior fornix?
rectouterine pouch
clinical significance: Pus and urine can collect into them. It’s used for catheters for end stage renal failure
What is the plane of the vaginal canal?
horizontal and parallel to plane of pelvic inlet
What is the blood supply of the vagina?
Vaginal & uterine arteries
venous: vaginal venous plexus
lymphatics: superficial inguinal, iliac
What is the hymen?
Membrane over external vaginal opening
What is purpose of hymen?
keep germs out
Which gland opens below the hymen?
bartholin’s gland- If it becomes infected it can cause Bartholin’s abscess. If it’s blocked it causes a cyst
What is vestibule?
Opening between labia minora
