Female Reproductive System and Breast Flashcards
What is the perineum?
Shallow space between the pelvic diaphragm (levator ani) and the skin
List the parts of the female reproductive system in the pelvic cavity
Ovaries
Uterine tubes
Uterus
Superior part of vagina
List the parts of the female reproductive system in the perineum
Inferior part of vagina Perineal muscles Bartholin's glands Clitoris Labia
What is the function of the inferior part of the PARIETAL peritoneum?
Floor of peritoneal cavity
Roof over pelvic organs
State the two pouches formed by the female periotenum
Vesico-uterine - between bladder and uterus
Recto-uterine - between rectum and bladder (Pouch of Douglas)
Where does excessive abnormal fluid from the peritoneal cavity usually collect? How is this managed?
Pouch of Douglas (most inf. part of peritoneal cavity)
Drained via needle passed through posterior fornix of vagina
Name and outline the ligaments of the uterus
Broad ligament (double layer of peritoneum containing uterine tubes and proximal round ligament) Round ligament (embryological remnant)
What is the function of the broad ligament of the uterus?
Helps maintain uterus in correct midline position via lateral attachments
List the three components of the broad ligament of the uterus, and their associations
Mesosalpinx (uterine tube)
Mesovarian (ovaries)
Mesometrium (uterus)
What are they layers of the uterus?
Perimetrium
Myometrium
Endometrium
Which layer of the uterus is shed during the menstrual cycle?
Endometrium
What is the name for the opening in the center of the ectocervix (passage between vagina and uterus)?
External cervical os
What is the name for the opening of the uterus from the cervix?
Internal cervical os
Where does implantation normally occur?
Body of uterus
Implantation outside the body of the uterus is known as…
Ectopic pregnancy
List the layers of support that help to hold the uterus in position
Number of strong ligaments e.g. uterosacral
Endopelvic fascia
Muscles of pelvic floor e.g. levator ani
Weakness of the layers of support for the uterus results in what clinical pathology of the female reproductive system?
Uterine prolapse
Movement of the uterus inferiorly
What is the most common positions of the uterus?
Anteverted (cervix tipped anteriorly relative to axis of vagina, sits on top of bladder)
Anteflexed (uterus tipped anteriorly relative to axis of cervix)
List normal variations that can occur in uterine position
Retroverted (uterus tipped posteriorly relative to axis of vagina)
Retroflexed (uterus tipped posteriorly relative to axis of cervix)
Which area of the cervix should be sampled during cervical smear, and is a common site for cervical dysplasia?
Squamo-columnar junction (transformation zone)
Outline the route taken by an ovum from ovary to implantation
Ovary Infundibulum Ampulla Isthmus Uterus
What structures present on the infundibulum open into the peritoneal cavity and pick up ovum?
Fimbrae
Where does fertilisation normally occur?
Ampulla of the uterine tube
What is the clinical term for removal of both uterine tubes and ovaries?
Bilateral salpingophrectomy
What is the clinical term for removal of one uterine tube?
Unilateral salpingectomy
The uterine tubes provide communication between the genital tract and peritoneal cavity. What is the clinical consequences of this?
PID can cause peritonitis
Ectopic pregnancy can develop in peritoneal cavity
What is the function of the ovaries?
Secrete oestrogen and progesterone in response to FSH and LH
Where do the ovaries develop?
Located on posterior abdominal wall and descend to the lateral pelvic cavity
Ovum are released directly into the periotenal cavity. True/ False?
True
Then picked up by fimbrae
The walls of the vagina are normally in contact. Where is the exception to this?
Superiorly where cervix holds them apart forming a fornix
What is a ‘fornix’?
Space around cervix
List the components of a fornix
Anterior
Posterior
2 lateral
Where can the ischial spines be palpated on vaginal digital exam?
Laterally at 4 and 8 o’clock
What is assessed during bimanual palpation in a vaginal digital exam?
Position of uterus
How are the adnexae palpated on vaginal digital exam?
Fingers into lateral fornix
Press on same iliac fossa
Detect any large masses or tenderness
What are the ‘adnexae’ of the female reproductive tract?
The appendages to the uterus - fallopian tubes, ovaries, and ligaments
What is the function of the openings in the pelvic floor?
Passage of distal alimentary, renal and reproductive tracts from pelvis to perineum
The perineum is divided into…
Superficial and deep pouches
What is the urogenital triangle?
The anterior half of the perineum, bounded by the pubic symphysis and ischial spines
What is the anal triangle?
The posterior half of the perineum, bounded by the ischial spines and coccyx
The levator ani muscle is made up of…
A number of smaller muscles
The levator ani is a skeletal/smooth muscle for involuntary/voluntary control
Skeletal muscle
Voluntary control
Which muscle forms the majority of the pelvic diaphragm?
Levator ani
What is the function of the levator ani muscle?
Continual support for pelvic organs
Undergoes tonic contractions
In what situation does the levator ani muscle contract more?
Increased intrabdominal pressure
Weakness of the levator ani is a factor in development of what pathological condition?
Prolapse of pelvic organs
What is the nerve supply to the levator ani muscle?
Nerve to levator ani
Pudenal nerve
State the nerve roots of the pudenal nerve
S3,4,5
Superficial and deep perineal muscles are supplied by…
Pudenal nerve
What is the perineal body? What is it’s function?
Bundle of collagenous and elastic tissue where perineal muscles attach, located just deep to the skin
Pelvic floor strength
Where is Bartholin’s gland or the greater vestibular gland located? What pathology can arise here?
Right and left gland around external urethral orifice
Become enlarged due to infection (forms abscess)
What anatomical surface feature is located anterior to pubic bones?
Mons pubis
List, from superior to inferior, the external surface openings for the female reproductive tract
External urethral orifice
Vaginal orifice
Anus
State the two components of the labia of the vulva
Labum majus
Labum minus
What is the vulval vestibule?
Part of the vulva between the labia minora containing the external urethral orifice and vaginal orifice
What are the surface borders of the female breast?
Ribs 2-6
Lateral border of sternum
Mid-axillary line
What is the axillary tail of Spence?
Extension of the tissue of the breast that extends into the axilla and drains lymph nodes
The female breast lies on deep fascia covering which two muscles?
Pectoralis major
Serratus anterior
What is the clinical term for the loose areolar tissue that separates the breast from the fascia?
Retromammary space
The female breast attach to skin via…
Suspensory ligaments
What is the function of the lactiferous ducts?
Connect the nipple to the lobules of the mammary gland
State the two types of lobules present within the mammary gland
Non-lactating lobules Lactating lobules (only in pregnant women)
What female harmone is involved with the production ejaculation of breast milk respectively?
Prolactin
Oxytocin
What is the areola?
Area of coloured skin at base of nipple
State the divisions of the breast used to describe a position of a lump
Upper outer (9-12 o'clock) Upper inner (12-3 o'clock) Lower outer (6-9 o'clock) Lower inner (3-6 o'clock)
Outline the drainage of the majority of lymph from the breast
Ipsilateral axillary nodes –> Supraclavicular nodes
Which divisions of the breast can drain into both ipsilateral or contralateral axillary nodes? Why?
Inner breast quadrants
Can also drain into parasternal nodes
Which divisions of the breast can drain into abdominal lymph nodes?
Lower inner breast quadrant
Lymph from the upper limb also drains to axillary lymph nodes. What is the clinical significance of this?
Axillary clearance in treatment of breast cancers can cause LYMPHOEDEMA
List important structures contained within the axillary fat
Brachial plexus
Axillary artery and vein
Axillary lymph nodes
Axillary node levels are used by surgeons in clearance of lymph nodes. These are related to which muscle?
Pectoralis minor
State the boundaries of level 1 axillary node clearance
Inferior and lateral to pectoralis minor
BELOW PEC MINOR
State the boundaries of level 2 axillary node clearance
Deep to pectoralis minor
BENEATH PEC MINOR
State the boundaries of level 3 axillary node clearance
Superior and medial to pectoralis minor
ABOVE PEC MINOR
Outline the blood supply to the different aspects of the female breast
Subclavian artery
–> Internal thoracic (internal mammary): PARASTERNAL
–> Axillary artery: LATERAL
Intercostal arteries: DEEP
Outline the venous drainage from the female breast
Internal thoracic (internal mammary) vein
Axillary vein
–> Subclavian vein
Intercostal veins
