Female reproductive tract Flashcards

1
Q

Name the 3 components of both the ‘upper’ and ‘lower’ female genital tracts

What divides them?

A

Upper (1/3rd) - Uterus, oviducts/fallopian tubes, ovaries.

Lower (2/3rd) - Cervix and vagina.

Endocervix – divides upper and lower.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the function of the uterus?

A

Secondary sex organ, capable of expansion to accommodate a growing foetus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the two main subdivisions of the uterus?

A

The two main subdivisions of the uterus are the body and the cervix.

Body: Usual site for implantation of the blastocyst.

Cervix: Lower part of uterus linking it with the vagina. This part is structurally and functionally different to the rest of the uterus.

Another part of the uterus is the fundus - this is the top of the uterus, above the entry point of the uterine tubes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is meant by the internalos and externalos?

A

The opening into the uterus is called the internal os (orifice). It marks the narrowing at which the endocervical canal ends and the uterine cavity begins.

The opening into the vagina is called the external os (orifice). The ectocervix is the portions of the cervix that projects into the vagina. It marks the transitions from the ectocervix to the endocervical canal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is meant by the ‘version’ and ‘flexion’ of the uterus?

A

Version/Anteverted – The angle between the longitudinal axis of the cervix, and that of the vagina. Angle of cervix to vagina. This is when the uterus is rotated/displaced either forward (anteflexed) or backwards (retroverted).
Flexion/Anteflexed – The angle between the longitudinal axis of the uterus, and that of the cervix. Angle of uterus to cervix. This is when the uterus bends/folds onto itself either forwards (anteflexed) or backwards (retroflexed).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the main relations of the uterus?

A

Anteriorly related to the bladder.

Posteriorly related to the rectum.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the broad ‘ligament’?

What is the round ligament?

A

This is a double layer of peritoneum attaching the sides of the uterus to the pelvis. It acts as a mesentery for the uterus and contributes to maintaining it in position.

Round Ligament: A remnant of the gubernaculum extending from the uterine horns to the labia majora via the inguinal canal. It functions to maintain the anteverted position of the uterus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the ‘ovarian/proper/utero-ovarian ligament’?

What is the Cardinal Ligament?

What is the Uterosacral Ligament?

A

Joins the ovaries to the lateral surface of the uterus.

Cardinal Ligament: Located at the base (inferior border) of the broad ligament, the cardinal ligament extends from the cervix to the lateral pelvic walls. It contains the uterine artery and vein in addition to providing support to the uterus. When a hysterectomy is being performed due to a malignancy, the cardinal ligaments are often removed as they are common reservoir of cancerous cells.

Uterosacral Ligament: Extends from the cervix to the sacrum. It provides support to the uterus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the ‘suspensory/IP/infundibulopelvic ligament’ of the ovary’?

A

A fold of peritoneum that extends out from the ovary to the wall of the pelvis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why will the ovaries be very small in the cadaver?

A

Ovaries are small in post-menopausal women, ovarian volume DE with age.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the broad ligament divided into?

A

The broad ligament may be divided into three subcomponents:

Mesometrium

The mesentery of the uterus; the largest portion of the broad ligament. 

Surrounds the uterus and is the largest subsection of the broad ligament. It runs laterally to cover the external iliac vessels, forming a distinct fold over them. The mesometrium also encloses the proximal part of the round ligament of the uterus.

Mesosalpinx 

The mesentery of the Fallopian tube. 

Originates superiorly to the mesovarium, enclosing the fallopian tubes.

Mesovarium 

The mesentery of the ovaries.

Part of the broad ligament associated with the ovaries. It projects from the posterior surface of the broad ligament and attaches to the hilum of the ovary, enclosing its neurovascular supply. It does not, however, cover the surface of the ovary itself.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the blood supply of the uterus? From which artery does this arise?

Surgically, which important structure is related to this artery?

A

The uterus is supplied by the uterine artery which arises from the anterior division of the internal iliac artery. It crosses above the ureter on its course to the uterus (bridge over water). The uterine artery commonly anastomoses with the vaginal and ovarian arteries.

The uterine artery crosses the ureters approximately 1 cm laterally to the internal os. Care must be taken not to damage the ureters during clamping of the uterine arteries during a hysterectomy. The relationship between the two can be remembered using the phrase ‘water under the bridge’. Water refers to the ureter (urine), and the uterine artery is the bridge.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Name the 4 parts of the ‘uterine/fallopian tube’ (oviduct).

A

Isthmus – Narrow section of the uterine tubes connecting the ampulla to the uterine cavity

Ampulla – Widest section of the uterine tubes. Fertilization usually occurs here.

Infundibulum – Funnel-shaped opening near the ovary to which fimbriae are attached.

Fimbriae – Finger-like, ciliated projections which capture the ovum from the surface of the ovary. It engulfs the ovary, at ovulation, to receive the oocyte.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Where does fertilisation occur?

A

Fertilisation occurs in the ampullary segment of the fallopian tube. Transit time of the zygote from the ampulla to the ampulla-isthmic junction is approximately 30 hours, after which the zygote remains in the isthmus another 30 hours before resuming transit through the isthmus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which life threatening condition is associated with the uterine tube?

A

Ectopic pregnancy, occurs when the embryo does not implant in the uterus. In many cases, the embryo implants in a Fallopian tube. If not diagnosed early, the implanted blastocyst can cause rupture and haemorrhage of the affected tube.

Note that, developmentally, the ovaries (like the testes) arise, retro-peritoneally, on the posterior abdominal wall and then descend (but only to pelvic brim).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Where does the ovarian blood supply come from?

A

The ovarian artery is an artery that supplies oxygenated blood to the ovary in females. It arises from the abdominal aorta below the renal artery.

17
Q

Where do the ovarian veins drain to? Is it the same on both sides?

The vagina is a fibro-muscular tube capable of expansion. How long is it?

A

The left ovarian vein drains into the left renal vein.

The right ovarian vein empties directly into the inferior vena cava.

The average vagina is 3-4 inches long. Posterior wall = 9cm it is > than Anterior wall = 8cm.

18
Q

What are the vaginal ‘fornices’?

A

The fornices of the vagina (sing. fornix of the vagina or fornix vaginae) are the superior portions of the vagina, extending into the recesses created by the vaginal portion of cervix. The word “fornix” is Latin for “arch”.

These vault like recesses are formed by protrusion of the cervix into the vagina.

The relationship of posterior fornix with the lowest part of the abdominal cavity forms the Pouch of Douglas/Rectouterine pouch which allows fluid/pus to accumulate in cases or situations of infection.

19
Q

What is the practical significance of the posterior fornix with the lowest part of the abdominal cavity?

What do clinicians assess here and what can be detected?

What is PID?

Are the Pelvic organs palpable?

A

It is clinically important because it is closely associated with the pouch of Douglas. It is the lowest point of the peritoneal cavity in the female. Clinicians, diagnostically, can access the peritoneal cavity by culdocentesis (placing the needle through the wall of the posterior fornix into the pouch of Douglas).

Blood, pus and other free fluids in the peritoneal cavity pool in the pouch because of its dependent location.

Detects haemoperitoneum (presence of blood in the peritoneal cavity).

When ultrasonography is not available PID (Pelvic inflammatory disease – occurs when bacteria spreads from vagina to uterus), ruptured ectopic pregnancy.

Appreciate that the vagina must expand in order to allow the passage of a foetus.

Note that normal sized pelvic organs are confined to pelvic cavity and are not palpable per abdomen.

20
Q

Describe the parts of the female reproductive tract

A

On image

21
Q

What is the vulva?

What is the Mons pubis?

What is the Labia Majora?

A

The external genital organs of the female are collectively known as the vulva.

Mons pubis: A fat pad at the anterior of the vulva, which is covered in pubic hair.

Labia majora: Two hair-bearing external folds, embryologically derived from labioscrotal swellings. They fuse posteriorly and extend anteriorly to the mons pubis.

22
Q

What is the Labia minora (where does it lie, what is it derived from? where does it fuse?) , Vestibule, Bartholin’s Glands: and Clitoris?

A

Labia minora: Two hairless folds of skin, embryologically derived from urethral folds. They lie within the labia majora. They fuse anteriorly to form the prepuce (hood) of the clitoris and extend posteriorly either side of the vaginal opening. They fuse again posterior to the vestibule, creating a fold of skin called the fourchette.

Vestibule: The area between and surrounding the labia. The external vaginal orifice (vaginal opening) and urethra open into the vestibule.

Bartholin’s Glands: Located either side of the vaginal orifice, these glands secrete lubricating mucus from small ducts during sexual arousal.

Clitoris: Located under the prepuce and embryologically derived from the genital tubercle. The clitoris is formed of erectile corpora cavernosa tissue, which becomes engorged with blood during sexual stimulation.