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Ob/Gyne > Module 1 : Female Pelvis > Flashcards

Module 1 : Female Pelvis Flashcards

1
Q

Bones of the pelvis

A

Innominate
Sacrum
Coccyx

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2
Q

Innominate bones

A

Ilium
Ischium
Pubis
ALL MEET AT THE ACETABULUM

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3
Q

Boundaries of the pelvis

A

True pelvis and false pelvis divided by the ARCUATE LINE

Anteriorly
Superior margin of the symphysis pubis
Posteriorly
Sacral prominence

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4
Q

Arcuate Line

A

divides the true pelvis from false pelvis
LINEA TERMINALIS
PELVIC BRIM
ILIOPECTINEAL LINE

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5
Q

Structures in true pelvis and false pelvis

A

Inferior - uterus, ovaries, Fallopian tubes, vessels, muscles, some bowel, lymph nodes

Superior - bowel

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6
Q

Uterus segments

A

Fundus - right at the top
- Fallopian tubes enter here
Corpus (body)
Isthmus - between body and cervix PLACE WHERE UTERUS BENDS
Cervix - part of uterus; not its own thing

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7
Q

Uterine positions

A

Anteflexed - normal bend forward
Anteverted - normal tilt forward
Retroflexed - bend backward ( fundus lower than cervix)
Retroverted- tilt backwards ( unverted)

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8
Q

Uterus shape

A

Pear shaped in reproductive years and postmenopausal years

Bilobed in newborns and infants

Hollow structure

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9
Q

Uterus size

A

Infantile about 3cm long and 1cm thick
Neonatal is slightly larger than infant

REPRODUCTIVE : NULLIPAROUS 8x5x4 cm

  • add one cm in all directions for multiparous
  • coronal Plane is better for interrogation of endometrial canal
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10
Q

Uterine layers

A 
Endometrium 
 -stratum functionalis (decidual)
        \+ layer that is shed 
 -stratum basalis
       \+ never shed; next layer of functionalis 
Myometrium
 -muscle layer
Perimetrium (Serosa)
 -peritoneal coat
 -
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11
Q

Endometrium

A 
Proliferative Phase (3 stripe phase)
 - 4 to 8mm (double layer)
Secretory Phase (after ovulation)
 -7 to 14mm (double layer)

POSTMENOPAUSAL BLEEDING : <5mm (sign of cancer)
WITHOUT BLEEDING <9mm
POSTMENOPAUSAL BLEEDING MAY BE NORMAL IF WOMEN IS HRT (hormone replacement therapy)

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12
Q

Endometrial phases

A 
Menstrual 
 - <1mm
Proliferative 
 - 5 to 8mm
Secretory
 - 9 to 14mm
  • women on BCPs will have thin endometrium
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13
Q

Vagina relationships

A

Encases the cervix and creates fornices
Fornices - potential space around the cervix
Vagina attaches at level of the internal os

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14
Q

Cervix

A

Between vagina and uterus
External os- opening into vagina
Internal os- opening into uterus

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15
Q

Adnexa/ Fallopian tubes

A

Contained in the mesosalpinx of broad ligament

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16
Q

Fallopian tube - segments

A

Interstitial - narrowest
Isthmus - directly adjacent
Ampulla - longest and widest
-where fertilization takes place
- most common place of ectopic pregnancy
Infundibulum - contains fimbriae

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17
Q

Ovaries - location

A

Location is variable

  • fossa of waldeyer
  • LANDMARK FOR OVARIES IS INTERNAL ILIAC ARTERIES
18
Q

Ovaries - structure

A 
Cortex
 -outer 
 -where follicles live
Medulla
 -inner
19
Q

Ovaries - size and shape

A 
Reproductive years
 -ALMOND SHAPED
 - 6cc VOLUME
 - 3x2x2 CM
 - CAN BE UP TO 20cc 
Neonatal 
 -wide range up to 3.66cc
Infants
 -sausage shaped
To menarche
 - upper normal of 8cc
Post menopausal
 -1 to 5.8 cc 
 - >8cc abnormal 
Normal adult
 -length 2.5 to 5 cm 
 -width 1.5cm to 3cm 
 - AP .6 to 2.2cm 
 - volume 6cc
20
Q

Blood supply for uterus

A

Aorta - CIA - IIA (hypogastric) - Anterior branch of IIA- uterus

Uterine Artery - arcuate Artery - radial Artery- straight arterioles ( supply basal layer) - spiral arterioles (supply decidual layer)

21
Q

Venous return from uterus

A

Venous plexus (veins around uterus) - uterine vein - IIV - CIV - IVC

22
Q

Blood supply for ovaries

A

Abdominal aorta to ovarian arteries to hilum of ovary

Venous return

  • RIGHT OVARIAN VEIN TO IVC
  • LEFT OVARIAN TO KEFT RENAL VEIN
  • OVARIAN ARTERIES WILL FORM ANASTOMOSES WITH THE UTERINE ARTERIES (of ovary twists collateral blood supply comes from uterus this doesn’t happen in males)
23
Q

Ligaments

A

2 broad ligaments (double fold peritoneum)
2 round ligaments
2 uterosacral ligaments
2 ovarian ligaments
2 suspenseful ligaments ( infundibulopelvic)
2 mesosalpinx and 2 mesovarium

24
Q

Broad Ligament

A

Double fold of peritoneum that drapes over uterus and Fallopian tubes
- mesosalpinx
+ drapes over Fallopian tubes
- mesovarium
+ posterior portion of the peritoneum that attaches to the ovary

  • project from broad ligament
25
Q

Round ligament

A

Help hold uterine fundus and body in a forward position

- retroflexed uterus = weak round ligaments

26
Q

Uterosacral ligaments

A

Help to anchor cervix posteriorly

27
Q

Ovarian ligaments

A

Attach ovary to uterus

28
Q

Suspensory ligaments of infundibulopelvic

A

Attach ovary to lateral pelvic wall

29
Q

Muscles in abdominopelvis

A 
Rectum abdominus
 - anterior wall of abdomen
 -linea alba 
   \+ aponeoroses that fuse 2 rectus muscles as well as oblique and transverse muscles at the midline 
   \+ very dense and gets in the way 
Psoas
 - posterior abdominal wall 
 - part of iliopsoas muscle 
 - extreme lateral aspect of pelvis
30
Q

Muscles in false pelvis

A

Iliopsoas

  • anterior and lateral in pelvis
  • lateral to external iliac vessels
31
Q

Muscles in true pelvis

A

Obturator internus muscle
Piriformis
Levator ani
Coccygeus

32
Q

Obturator internus muscle

A

Side walls of pelvis
directly lateral to uterus
Hard to see

33
Q

Piriformis

A

Posterior walls of pelvis

Posterior to cervix

34
Q

Levator ani

A

Most inferior

Like a hammock with coccygeus for pelvic floor

35
Q

Coccygeus

A

Posterior floor of pelvis

36
Q

Perineum

A 
Space between the thighs
Urethra
Vagina
Rectum
Coccygeus muscle
Levator ani muscle
 \+pubococcygeus
  \+ iliococcygeus
37
Q

Potential spaces

A 
Intraperitoneal 
 -posterior cul de sac
    \+ recto uterine pouch 
    \+ pouch of Douglas
      -most posterior and inferior 
 -anterior cul de sac
    \+ vesico uterine pouch 
Extraperitoneal 
 -vaginal fornices
 -space of retzius
38
Q

Urinary bladder

A

Variable states of distension can cause uterus to fold

39
Q

Ureters

A

Travel inferior to ovaries and enter bladder posteriorly st trigone

40
Q

Urethra

A

Makes up third point of trigone

Anterior to vagina

41
Q

Trigone

A

Only area that does not expand or contract

Does not have specialized tissue

Ob/Gyne (24 decks)

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