Lect 4 - Female Pelvis and Perineum Flashcards
Jan 16, 2019
What is another name for the rectouterine pouch?
Pouch of Douglas
The ovaries and testes are both what type of organs?
Gonadal
The ovaries lie on which surface of the broad ligament?
posterior
The ovaries are held to the uterus through which ligament? The ovaries are held to the broad ligament through which tissue?
1) proper ovarian ligament
2) mesovarium
The ovarian arteries come off which arterial supply?
aorta
Where do the ovarian veins feed into?
Left: renal vein, right: IVC
Where does ovarian pain refer to?
T10/11
Where does lymph from the ovaries flow to?
Lumbar nodes
What are the four sections of the uterine tubes?
1) intramural
2) isthmus
3) ampulla
4) infundibulum
Which portion of the uterine tube is widest? Which is narrowest? Which is the most common site of ectopic pregnancy?
Widest: infundibulum
Narrowest: isthmus
Ectopic: ampulla
Where does fertilization occur?
ampulla, usually
A woman of child-bearing age comes into the ER with abdominal pain. She is not sexually active. Do you still rule out ectopic pregnancy?
Yes.
Visceral afferents above the pelvic pain line travel with which fibers?
Sympathetic
What are the four regions of the uterus?
1) fundus
2) body
3) cervix
4) cavity
What are the three parts of the cervix?
1) internal os
2) external os
3) cervical canal
What is the relation of the uterus to the cervix? The cervix to the vagina?
Uterus-cervix: anteflexed (bent forward)
Cervix-vagina: anteverted (turned foward)
What complication can a retroverted uterus cause?
BACK PAIN
What part of the uterus can be visualized in the vaginal canal?
external os of the cervix
What is another name for the internal os?
endocervix
What changes happen to the cervix with parity?
Nulliparous women have small, pinpoint cervices, while those of multiparous women have larger, linear openings
What types of changes are seen in HPV infection which lead to cancer?
dysplasia
What does a hysterosalpingogram detect?
patency of the fallopian tubes
What are the three parts of the broad ligament called?
1) mesosalpinx
2) mesovarium
3) mesometrium
What are the major ligaments of the uterus?
1) pubocervical
2) transverse cervical/cardinal
3) uterosacral
Which of the major ligaments are anterior? Which are posterior?
Anterior: pubocervical
Posterior: uterosacral
Which of the major ligaments of the uterus is the strongest?
Uterosacral
What is the posterior wall of the vagina?
rectovaginal septum
What are the domes around the cervix which protrude past the uterus called?
fornices
Which fornix is clinically significant? Why?
Posterior fornix is clinically significant because behind it is where fluid will accumulate in the Pouch of Douglas
What is the operation used to fix uterine prolapse?
The Manchester operation
What are risk factors associated with uterine prolapse?
1) obesity
2) smoking
3) multiparity
4) chronic constipation
Anything that increases intra-abdominal pressures
What are the STIs which cause pelvic inflammatory disease?
1) chlamydia
2) gonorrhea
What more serious infection can PID lead to?
peritonitis
Through what mechanism can PID lead to peritonitis?
through uterine tubes
What is the pathognomonic sign for PID?
cervical motion tenderness
What does PID increase the chances for?
tubal pregnancies
What are the five major blood supplies for the uterus?
1) uterine artery
2) middle rectal artery
3) vaginal artery
4) superior vesical artery
5) internal pudendal artery
What is the name of anastomoses of the blood supply of the uterus?
Uterovaginal arterial plexus
What does the anastomosis of the arterial blood supply of the uterus facilitate?
metastasis of cancer
What are the fibers which travel along with visceral afferents above and below the pelvic pain line?
Above the PPL: sympathetics (T10-L2)
Below the PPL: parasympathetics (S2-S4)
What is the innervation of the lower 1/4 of the vagina?
Somatic innervation via the pudendal nerve
Where does lymph flow from the uterine fundus? What about the uterine body, cervix, and upper vagina? What about the lower vagina and round ligament?
Fundus: lumbar nodes
Uterus/cervix/upper vagina: external/internal iliac nodes
Lower vagina/round ligament: superficial inguinal
What is analogous body part of the labia majora in males? what about the labia minora?
Labia majora: scrotum
Labia minora: urogenital folds
What is the purpose of an episiotomy?
spare the perineal body
What muscles are likely damaged in an episiotomy?
1) bulbospongiosus
2) superifical transverse perineal
What is the perineal body?
fibrous body where all the perineal muscles converge
