Relevent Anatomy Flashcards
Other name for Müllerian ducts
For wolfian duct
Paramesonephric
Mesonephric
Which of the following is false
- Müllerian ducts are lateral to wolfian ducts
- Both ducts appear in foetus at 8weeks
- Müllerian duct disappears in male at 9 weeks
- Müllerian duct disappears due to MIS (mullerian inhibiting substance)
- Wolffian duct disappears in female at 10weeks
2 and 5 are false
Both ducts appear at 6 weeks of gestation
Wolffian duct in female and Müllerian duct in male both disappears at 9 weeks of gestation
Source of MIS
Sertoli cells
Ipsilateral release of MIS from testes will cause what
Disappearance of Müllerian duct of same side
Müllerian duct forms
Uterus
Cervix
Fallopian tube
Upper 2/3rd of vagina
Wolffian duct forms
Seminal vesicles Ejaculatory duct Epididymis Ductus deferens When testosterone acts on the wolffian duct it converts into male internal genitalia
Remnants of mullerian duct will be present in male or female and name them
Remnants of wolfian duct will be present in male or female and name them
Male child ,appendix of testis
Female child ,
Epoophoran (cranial remnant of duct )
Paroophoron (caudal remnant of mesonephric tubule )
Gartner’s duct (caudal remnant of mesonephric duct )
Hydatid of morgagni
Relation of paroophoron ,epoophoron, gartner’s duct, hydatid of morgagni with broad ligament
Paroophoron is medial part of broad ligament
And the rest i.e epoophoron , gartner’s duct, hydatid of morgagni lateral part of broad ligament
D/d of cyst on lateral wall of vagina
Anterolateral wall of vagina - gartner’s duct cyst
Posteriolateral wall of vagina - bartholin’s duct cyst
Where does garter’d duct open
Lateral wall of vagina
Mc cyst of vagina
Inclusion cyst
How is uterus formed
At what period of gestational age is uterus formed
Cavity of uterus is formed when
Septum dissolution is in high direction
Mullerain duct lateral to wolfian duct comes in midline and fuse to form uterus
10 weeks
*fusion begins in centre and then more cranial and caudal
18 weeks
Caudalto cranial
Internal genitalia differentia into male and female at what age
10 weeks
Mc mullerian anomaly is
Septate uterus
Appearance of uterus on Saggital section and coronal section
Gross appearance of uterus
Cleft like and triangular
Pyriformis
Weight of uterus in nulliparous and multiparous
50-70gm nulliparous
80gm multiparous
Length of uterus
6-8cm long
Volume of non pregnant female uterus
10ml cube
Weight of pregnant uterus
1000gm / 1.1kg `
Volume of uterus at term
5L
Which of the following is false
- Uterus undergoes hypertrophy more then hyperplasia
- Pregnant uterus weighs 1.1kg where as normal uterus weighs 50gm
- Pregnant uterus volume 5L where as normal uterus volume 10ml
- Weight of uterus at 6 weeks post partum is 80-100gms
All of the following statements are true
At what level uterus opens into cervix
Internal os
Isthmus is present between what
Anatomical and histological internal os (just 1cm)
*histological internal os is below anatomical internal os
At what time LUS is formed
It is formed by
And during labour it is formed by
At term the length of LUS
Begins forming after 1st trimester
Formed by isthmus
During labour LUS formed by isthmus + cervix (known as effacement )
5cm which stretch to become 10cm and by that time the pt. goes into labour +Ca is taken up
Where is LSCS done(site)
At LUS (below loose fold of peritoneal attachments )
In OT while doing LSCS how to identify the LUS
Loose fold of peritoneal attachment is through which we identify
Most common incision for uterus for LS
2nd incision
3rd incision
And the risk of rupture
Lower segment pfannensteil or transverse incision -KERRS incision (0.2-1.5%)
lower segmentVertical incision-KRONIGS incision (1-7%)
Upper segment vertical incision-CLASSICAL incision (4-9%)—WEAKEST
Weakest incision for LSCS
Classical
Indications of classical incision for LSCS
Only indication (absolute) for classical : Ca cervix
Others
-dense adhesions b/w L.S and bladder
-very preterm LS
-post mortem CS
-anterior located placenta previa (only if a not trained doctor )
Ans : for ant. PP
Technique of LSCS
Advantage
Joel Cohen : blunt dissection technique (only small incision with scalpel on LUS and layers are separated by fingers
- Less blood loss
- Less time to reach
- Less operative time
- Less post op. Pain
3 structures attached to upper part of uterus and their ant.-post. Relations + sup.-inferior relations with each other
MC mistake made here is what and occurs due to what
Round ligament Fallopian tube Ovarian ligament - ant.-post. R RL FT OL (Ant) (Post.) -sup.-inf.R FT- superior RL/OL:same level below FT -failure of sterilisation -occurs due to ligation of the wrong structure
Structures derived form GUBERNACULUM
Proximal part - ovarian ligament
Distal part - round ligament
Canal of nuck
+ in foetus only
It is a fold of peritoneum in foetus that contains round ligament and extends into inguinal canal
What pulled the uterus anteriorly in its opinion
Round ligament
What attaches uterus to ovaries
Ovarian ligament
Main supports of uterus
- Mackendrodt
- Broad ligament
- Cardinal ligament
- Pubocervical
- levator ani
- Uterosacral
- Round ligament
- Mackendordt
- Cardinal
- Levator ani
Supports of uterus
Ant- pubocervical
Post- uterosacral
Lateral- mackenrodt aka cardinal ligament aka transverse cervical ligament
Inferiorly- levator ani
Main ligament or support of uterus
Main ligament :cardinal ligament/transverse cervical / mackendrodt
Triradiate ligament
Illiococygeous
Pucococcygeous (mainly this one )
Puborectalis
Muscles attached to perineal body
Sup. And deep transverse perinei Bulbospongious Levator ani External anal sphincter External urinary sphincter
Antevered and antiflexed explain
Angle b/t cx and vagina -90degree : anteverted
Angle b/t long axis of uterus and cx : anteflexed :120degree(approx120-170)
If fundus is towards bladder it is known as
If fundus towards sacrum known as
Antiflexed
Acute retro flexion
Main ligament for antiversion and anti flexion
Round ligament (mainly ) (Round ligament+pubocervical)
Which ligament prevents retroversion
Uterosacral
Which layer is known as the living ligature of uterus
Middle myometrium layer arranged in crisis cross fashion is called the living ligature of uterus
Which of the following is false
- Uterus is a muscular organ
- Uterus mainly made of myometrium:2.5cm thick
- Fundus is part which lies above the attachment of Fallopian tube
- Antiversion and anti flexion present in 80% of the female
- Their are 2 layers in the myometrium (Criss cross and circular)
5th is false Their are 3 layers in the myometrium Outer : longitudinal Middle : Criss cross (living ligature ) Inner : circular (sphincteric action )
3 areas of sphenteric action of inner layer
2cornu or Ostia and 1 internal os
Blood supply Of uterus
Uterine A. Which is a br. Of anterior internal iliac A.
Uterine A. Gives the rest of the br.
Arcuate A. — supply outer 2/3 rd of myometrium
Radial A.-2 branches (basal and spiral)— supply inner 1/3 rd of myometrium
Basal A.-supply basal endometrium (take part in regeneration)
Spiral A. - supply superficial endometrium (shed off during menstrual cycle )(aka functional)
What is water under bridge
Uterine artery runs parallel to the ureter
Therefore horizontal position of uterine artery runs above the peristaltic movements of ureter
Mc site of ureteric injury
2nd mc site of ureteric injury
Water under bridge
Pelvic brim - where it is crossed over by ovarian vessels
Location of water under bridge
2cm lateral to cervix or 1.5cm lateral to fornix
Artery suppling round ligament
Uterine artery gives a special br. Samson’s A.
Blood supply of cervix
Descending cx artery which is a br of uterine A.
Blood supply of upper 1/3rd of vagina
Descending vaginal branch of uterine artery
Nerve supply of uterus
Ganglion for uterus nerve supply
T10 T11 T12 L1 Responsible for pain sensation during uterine contractions Franken hauser ganglion
Epidural analgesia
Level of block
Type of block
Mc drug used
Aka labour analgesia (cause painless labour)
T10
Sensory block
Bupivacaine 0.25%
M.c anaesthesia used for LSCS
Location
Why t4
Spinal anaesthesia
T4
To block nerve supply of peritoneum (sensory block )
Anaesthesia used in force
Done when
Pudendal nerve block
Only when complete dilatation (head at +3 station )
Q
Pudendal nerve is present where
Pierce which ligament
Direction
Present in pudendal canal present behind ischial spine
Saccrospinous ligament
Posterio medial
Lymphatic drainage of uterus
Internal iliac L.N (mainly )
External lilac
Superficial iliac
Fundus - para aortic LN
Cervix - Gross shape Canal Length Opens into vagina at what level
Conical shape
Fusiform /spindle shape
3-4cms
At external os
Shape of cervix in nulliparous and in multiparous
Nulliparous : circular
Multiparous : transverse slit
Uterus is made of
Cervix is made of
Muscle Connective tissue (mainly collagen) and only 10% is made of muscle