Pelvic Viscera II Flashcards
What is the uterus?
Hollow organ with thick muscular wall
Parts:
Fundus - superior entrance of uterine tubes
Body
Cervix - connects to vagina
What is the normal anatomical position of the uterus?
Horizontal with fundus pointing anteriorly
Anteversion and Anteflexion
Abnormal position occurs in approximately 25% of women, can be associated with dyspareunia and dysmenorrhea
Describe the peritoneal covering of the uterus?
Peritoneum covers uterus except at cervix, where is is reflected onto superior surface of bladder
What is the vesicouterine pouch?
Floor of the peritoneal reflection from cervix to bladder
What is the rectouterine pouch?
Peritoneal reflection from rectum to upper part of vagina and uterus
What is the Broad ligament of the uterus?
Two-layered lateral reflection of peritoneum from the uterus to the lateral pelvic wall
Divided into four parts
Mesometrium, mesovarium, mesoalpinx, suspensory ligament of the ovary
What are the contents of the broad ligament of the uterus?
Uterine tube
Round ligament of uterus
Round ligament of the ovary
Uterine artery and vein
Terminal branches of ovarian artery and vein
What is the uterine artery?
Courses medially from internal iliac, enters broad ligament, crosses superior to ureter at level of cervix
During hysterectomy, ligate the artery but do not clamp underlying ureter
Has a vaginal branch
Describe the lymphatic drainage from the uterus.
Fundus - Drain to lumbar (para-aortic) nodes
Body and cervix - iliac lymph nodes
What are the ligaments of the cervix?
Condensations of endopelvic fascia on superior surface of pelvic diaphragm
Stretching of ligaments during childbirth may contribute to prolapse
Ligaments: Cardinal, Vesicouterine, Uterosacral
What is prolpase of the uterus?
Downward movement of uterus resulting in cervix protruding into or through vaginal orifice
Adjacent organse bulge against walls of vagina
Cystocele - bladder
Rectocele - rectum
What are the parts of the uterine tubes?
Infundibulum - near ovary, has fimbria
Ampulla - middle, fertilization normally takes place here
Isthmus - medial to ampulla
Uterine part
What is the blood supply and lymphatic drainage of the uterine tubes?
Uterine and ovarian arteries
Lymphatics to lumbar and internal iliac nodes respectively following arteries
What is the mesosalpinx?
Part of broad ligament immediately inferior to uterine tube
What are the complications associated with blockage of the uterine tube?
Major cause of infertility
Result of adhesions from healed infections
Ectopic tubal pregnancy can result if fertilization occurs
What is Hysterosalpingography?
Radiography of uterus and uterine tubes following injection of radiopaque material to determine patency of uterine tube
What are the ovaries?
Almond-shaped gonads
Fibrous capsule, tunica albuginea
Normally found in ovarian fossa on lateral wall of pelvis
Diseased ovary can affect obturator nerve, resulting in medial thigh pain
What is the mesovarium?
Two-layered reflection of peritoneum from posterior layer of broad ligament of uterus to ovary
Contains ovarian neurovasculature
What is the suspensory ligament of the ovary?
Superior-lateral most part of braod ligament lateral to attachment of ovary by mesovarium
Contains ovarian neurovasculature
What is the blood supply to the ovaries?
Ovarian arteries that arise from aorta at L2
Cross over external iliac to enter suspensory ligament
Clinical* - don’t ligate ureter at same location during ovariectomy
Describe the ovarian venous drainage
Drain to IVC on right
Drain to left renal vein on left
Where do lymphatics from the ovary drain?
Lumbar lymph nodes
What is the fornix of the vagina?
part of vaginal lumen which surrounds servix
Divided into four regions
Anterior, posterior and two lateral fornices
What structures are located anterior to the vagina?
Cervix, posterior surface of bladder, urethra
What structures are located posterior to vagina?
Rectouterien pouch
Rectum ampulla
Perineal body
What is the importance of the relation of posterior fornix to rectourterien pouch?
Provides route of access for drainage of infected peritoneal fluid
Culdocentesis
Describe the vascular supply and lymph drainage to the vagina
Vaginal artery formes from vaginal branch of uterien artery
Lymphatics - external and internal iliac nodes
