Lecture 23: Female Reproductive Tract Flashcards
Embryonic development
Also tell me about the ovarian decent
No testosterone, no Mullerian inhibiting factor (MIF) =
➡Mesonephric duct regresses
➡Paramesonephric (Mullerian) duct progresses to form uterine tubes, uterus and cervix. Side 4
Ovarian decent:
-ovaries descend from posterior abdominal wall to a point just inferior to the pelvic brim
-they DO NOT pass through the inguinal canal at any point
-tethered by gubernaculum slide 5
-the cranial gubernaculum becomes ovarian ligament
-caudal (lower) gubernaculum forms the ROUND LIGAMENT OF UTERUS
-ovaries are just inferior to the pelvic brim
-intra-peritoneal
-media
To external iliac blood vessels-posterior to uterus
-anterior to internal iliac vessels
Learn slide 7
Sex is programmed at conception but not visible until weeks ____or development?
Paramesonphrenic (Mullerian) duct gives rise to:
Weeks 8-9
- uterine tubes
- uterus
- cervix
Learn the external development- slide 9
External development:
Aren’t differentiated until the 12th week
Urethral folds➡ labia minors
Labioscrotal folds➡ labia majora
Learn the image on slide 9 and muscles on slide 10
Also what does the pudendal nerve provide motor and sensory innervation to?
Muscles and skin of the Peronism
Bulbospongiosus and ischiocavernosus. What are they what do they do? What are they innervated by?
-muscles that maintain erection of penis or coitoris by compressing out-floe of veins and pushing blood from root to body of erectile organ.
Innervated by deep branch of perineal nerve (branch of pudendal nerve)
Tell me about the clitoral erection ie innervation and blood supply
Innervation: dorsal nerve of clitoris (branch of PUDENDAL)
Blood supply: internal pudendal artery (branch of INTERNAL ILIAC)
Tell me the innervation of the external genitalia
And know how to label slide 14 and 15
What dermatome is the vaginal area?
What’s the major nerve and two of its branches?
What innervates the mons pubis and labia majora?
What innervates the skin above the pubis?
S3 dermatome
Pudendal nerve
-posterior labial branch
-perineal nerve
Ilioinguinal nerve:
-mons pubis and labia majors
Genitofemoral nerve
-mons pubis and labia majora
Iliohypogastric nerve
-skin above the pubis
Slide 14 learn the shit out of it babes
Be able to label the topography on slide 16 and the pelvic peritoneum (superior view) on slide 17, and peritoneal pouches on slide 18
Do it
The uterus is ______ to the urinary bladder
The Uterus is _____ to vesicouterine pouch and____ to rectouterine pouch
-round ligament enters inguinal canal and inserts into _____
The uterus is __(posterosuperior)____ to the urinary bladder
The Uterus is _(posterior)____ to vesicouterine pouch and__(anterior)__ to rectouterine pouch
-round ligament enters inguinal canal and inserts into _(mons pubis)____
Sagittal view of the female reproductive tract slide 20
Study it.
Study slide 21 and 22 and 23 and 25
Do it
We’re does fertilisation normally take place?
Ampulla
What are the 3 layers of the uterine wall?
- Perimetrium: visceral peritoneum
- Myometrium: thick muscular
- Endometrium: mucosal
2 main layers:
- Stratum functionalis “functional layer”
- Stratum basal is “basal layer”
What is the blood supply of the uterine wall?
Accurate artery
Uterine artery which is a branch of the internal iliac artery. The vaginal artery also branches of the uterine artery
Learn the cyclical changes on slide 29
Yep
Vagina sheath. What are the 3 layers- slide 30
- Outer fibroelastic adventitia
- Smooth muscle muscularis
- Mucosa- marked by rugae
- no glands I’m vaginal mucosa-lubricated by cervical mucous glands
What are the arteries of the female pelvis?
-internal iliac artery, the uterine artery branches of this and the vaginal artery branches of that. Slide 31
The ovarian arteries branch from the abdominal aorta
The uterine and vaginal artery branch from the internal iliac arteries. Slide 32
Defs check out slide 33 and know it
Yep
Tell me about the nut cracker phenomenon
- the superior messengering artery overlies the left renal vain
- left renal vein drains left ovary, left sides of uterus, bladder, vagina, urethra and rectum
- congestion of organs and collateral vessels can cause pain
Tell me about the innervation of the female pelvis
Slide 35
- superior hypo gastric plexus (plexus were the abdominal aorta birfucates)
- sacral splanchnic nerve (sympathetic)
- inferior hypo gastric plexus
- pelvic splanchnic nerves (parasympathetic)
Pudendal nerve - know the shit out of it
From sacral plexus (S2-S4)
- main nerve of the Perineum
- chief sensory nerve of the external genitalia
- it leaves the pelvis through the greater sciatic foremen between the piriformis and coccygeus muscles. It then hooks around the ischial spine and sacrospinous ligament and enters the perineum through the lesser sciatic foremen.
Autonomic innervation of the female pelvis
Know the shit out of it
-pre-synaptic SYMPATHETIC fibres arising from the IML do spinal cord levels T12-L2 traverse the sympathetic trunk and pass through the LUMBAR SPLANCHNIC NERVES to synapse in PREVERTEBRAL GANGLIA with post-synaptic fibres
-pre-synaptic PARASYMPATHETIC fibres arising from S2-S4 anterior rami pass through the pelvic splanchnic nerves to synapse with post-synaptic fibres on uterus and vagina (and also vasodilator fibre to erectile tissue of clitoris)
-autonomic fibres travel through SUPERIOR AND INFERIOR HYPOGASTRIC PLEXUS to reach the pelvic viscera.
Slide 38 and 39
Somatic innervation:
Know the shit out of it
SOMATIC SENSATION from the opening of the vagina
Also passes to the S2-S4 spinal ganglia via the PUDENDAL nerve- only inferior portion sensitive to touch and temperature.
Refferd pain: know the shit out of it
-visceral affront (pain) fibres from ovaries and uterus travel with least thoracic and lumbar splanchnic nerves to spinal ganglia at vertebrae T12-L2
Where is the pain from menstrual cramps felt?
Visceral afferent (pain) fibres from cervix and vagina travel with pelvic splanchnic nerves to spinal ganglia of vertebrae S2-S4?
We’re is the pain from Pap smear felt?
Endometriosis
-endometrium growing outside
Pain: severe cramping on both sides of pelvis, radiating down lower back and rectal area and down legs
What dermatomes does this involve?
