Repro Session 5 Flashcards
4 component parts of female reproductive system?
paired ovaries- produce ova and sex hormones
fallopian (uterine) tubes- provide site for sperm and ovum to come into contact with 1 another, and convey product of fertilisation to uterus
uterus- desired area of implantation of conceptus= posterior uterine wall
vagina and external genitalia
how are the ovaries attached to the posterior surface of the broad ligament of the uterus?
by the mesovarium
name given to inflammation of uterine tubes due to microorganisms?
salpingitis
what occurs as a result of inflammation of the uterine tubes?
fusions or adhesions of mucosa occurs, that can cause partial or complete blockage of lumen of uterine tube, leading to infertility.
blocked or dysfunctional tubes may result in ectopic pregnancy (tubal) or implantation outside the uterus
function of cervix?
allow sperms deposited in vagina at coitus to enter uterine cavity and proceed to site of fertilisation, and, at other times, to protect the uterus and upper genital tract from bacterial invasion
epithelial lining of exocervix?
stratified squamous non-keratinized
lining of endocervix?
tall columnar epithelium with basally positioned nuclei and greater part of cytoplasm filled with mucus. Mucosa has numerous large glands also lined with tall, mucus-secreting columnar cells
in which condition is ectopic endometrial tissue dispersed to various sites along the peritoneal cavity and beyond e.g. near to umbilicus?
endometriosis
what might endometriosis be associated with?
ovaries or attachments of uterus, and often associated with dysmenorrhoea, infertility, or both.
major symptom of endometrial carcinoma?
abnormal uterine bleeding
at which site of uterus and cervix due majority of neoplasms form?
junction between columnar cells of endocervix and squamous cells of exocervix
what is the pelvic inlet demarcated by?
broad ‘wings’ of iliac bones, sacrum and pubic symphysis
what is the pelvic outlet demarcated by?
paired inferior pubic rami, ischial bones, ischial spines, and the coccyx
how can male and female pelves be distinguished on X-rays?
pelvic inlet oval in female and heart shaped in male subpubic angle (between inferior pubic rami) narrow in male, wide in female soft tissue shadow of penis and scrotum can usuallt be seen when not shielded by a lead screen
composition of pelvic floor?
pelvic diaphragm- levator ani and coccygeus, and related fascial coverings
superficial muscles and structures: anterior (urogenital) perineum and posterior (anal) perineum
how is the uterus tethered to the pelvic wall?
via the broad ligament
what name is given to the opening of the uterine tubes into the periotneal cavity?
the abdominal ostium
what is the bulb of the vestibule surrounded by in the female?
the bulbospongiosus muscles
Why must an ectopic pregnancy be operated on?
risk of rupture of site of implantation e.g. ampulla of fallopian tube, resulting in severe haemorrhage, fluid and blood can collect in the Pouch of Douglas between the rectum and uterus, and spread within the peritoneum, causing an acute abdomen- may feel rigid and painful. Loss of blood may mean patient goes into SHOCK.
Other than the abdomen, where else is pain felt in an ectopic pregnancy and why?
Shoulder
blood from rupture can spread within the greater sac via the paracolic gutters to the subphrenic space below the diaphragm, causing diaphragmatic irritation, and as the diaphragm is innervated by the phrenic nerve with nerve roots C3-C5 which supply dermatomes over shoulder, pain is referred to the shoulder
why is endometrial cancer currently on the increase?
OBESITY
fat is a site for androgen conversion to oestrogens so in an obese patient, there is is increased oestrogen production which stimulates the proliferation of endometrial cells, increasing risk of endometrial cancer
outer covering of uterus?
perimetrium
gubernaculum remnants?
ovarian ligament and round ligament of uterus
importance of L ovarian vein drainage in pregnancy?
increased susceptibility to obstruction of vein and thrombus formation
3 key sections of fallopian tube?
infundibulum, ampulla, isthmus
origin of uterine arteries?
anterior divison of internal iliac arteries
what stops ovaries descending?
uterus- formed by fusion of paramesonephric ducts
blood supply of ovaries?
ovarian arteries from abdominal aorta, just below renal arteries
venous drainage of ovaries?
R ovarian vein to IVC
L to L renal vein
how are ovaries suspended?
mesovarium- short peritoneal fold which is a division of the broad ligament of the uterus- larger mesentery
how do ovarian vessels, lymphatics and nerves pass to and from ovaries?
via suspensory ligament of ovary- becomes continuous with broad ligament
why does cervix project partly into vagina?
as cervix formed from mullerian ducts which contact the urogenital sinus and open into it, with further modification then forming the vagina
how is the deepest part of the pouch of Douglas reflected?
by the posterior fornix= part of vagina posterior to cervix
how is broad ligament of uterus formed?
fusion of paramesonephric ducts in midline as grow towards each other, pushing into peritoneal cavity and taking peritoneum with them
what does broad ligament assist with?
keeping uterus in position
what does broad ligament enclose?
uterus, uterine tube and ovary, and their NV supply
importance of round ligament travelling through inguinal canal for lymphatic drainage?
ligament lies anteroinferiorly between layers of broad ligament, and as runs through inguinal canal to labia majora, some drainage from fundus of uterus is to superficial inguinal LNs
which part of the broad ligament encloses the uterine tubes?
mesosalpinx
how does round ligament assist anatom positon of uterus?
due to tethering to labia majora
describe position of uterus within pelvic cavity
anteverted with respect to vagina, and antiflexed with respect to cervix
what is retroversion?
uterus tilted posteriorly with respect to vagina
what is retroflexion?
uterus tilted posteriorly with respect to cervix
where does the oocyte expelled at ovulation pass into?
peritoneal cavity, but then trapped by fimbriae of infundiblum, and so passes into uterine tube via abdominal ostium, and is then carried into ampulla
contrast lining of uterine cavity and uterine tubes, and explain clinical significance of this
tubes= simple columnar ciliated and non-ciliated cells
cavity= endometrium
lining of tubes specialised for movement on non-motile gamete, and NOT implantation, so consequence for ectopic implantation
function of uterine tube?
conduct oocyte into uterine cavity
normally site of fertilisation
why are females more prone to pelvic inflammatory disease than men?
as peritoneal cavity is open to exterior in females via abdominal ostium of infundibulm of fallopian tubes, so a reproductive tract infection can ascend to involve the peritoneum
what is the transverse cervical ligament?
a thickening of CT at base of broad ligament, which tethers uterine cervix to lateral pelvic wall
function of transverse cervical ligament?
assists in maintaining integrity, provides lateral stability of cervix
how is anteversion of uterus helped to be maintained?
by uterosacral ligament
function of uterosacral ligament?
opposes anter pull of round ligament, assists in maintaining anteversion
what does anterior division of internal iliac artery give rise to?
internal pudendal
uterine
vaginal arteries
lymphatic drainage of ovary?
paraaortic nodes
lymphatic drainage of fundus of uterus?
aortic nodes and superficial inguinal LNs
lymphatic drainage of body of uterus?
external iliac nodes
lymphatic drainage of cervix?
external and internal iliac nodes, and sacral nodes
what does the labia majora enclose?
the pudendal cleft
what does the labia minora enclose?
the vestibule of the vagina- bulbs of vestibule, clitoris
what is within vestibule?
orifices of urethra, vagina, and greater and lesser vestibular glands (Bartholin glands)
importance of vaginal fornices clinically?
can perform a culdocentesis: can access peritoneal cavity via posterior fornix. Once needle inserted in P fornix, can then gain access to Pouch of Douglas
innervation to inf 1/5 of vagina?
somatic innervation from pudendal nerve
innervation to sup 4/5 of vagina and uterus?
uterovaginal plexus
pain afferents above pelvic pain line?
inferior thoracic lumbar spinal ganglia
pain afferents below pelvic pain line?
S2-S4 spinal ganglia
perineum innervation?
pudendal nerve- S2-S4
ilioinguinal nerve
course of pudendal nerve?
exits pelvis via greater sciatic foramen
enters perineum via lesser sciatic foramen
travels through pudendal canal
where does the broad ligament extend?
from sides of uterus to lateral pelvic wall
where does ovarian ligament travel between?
medial pole of ovary to lateral wall of uterus, just below entry of uterine tubes on each side
where does round ligament of uterus extend?
from lateral wall of uterus, just below entry of uterine tubes, to lateral pelvic wall on each side
where are main branches of blood vessels and nerves of uterus located?
myometrium
what is the perimetrium?
outer serous coat of uterus, consisiting of peritoneum supported by a thin layer of CT
tissue compostition of cervix?
mostly fibrous, mainly collagen with a small amount of smooth muscle and elastin
venous drainage of uterus?
uterine veins which enter broad ligaments with arteries and form a uterine venous plexus on each side of cervix, where veins then drain into the internal iliac veins, then into the common iliac veins and the IVC.
blood supply to vagina?
uterine arteries to superior part
middle and inferior parts from vaginal and internal pudendal arteries= both branches of anterior division on internal iliac
venous drainage of vagina?
vaginal veins form a vaginal venous plexuses along sides of vagina and within vaginal mucosa. These veins are continuous with uterine venous plexus as the uterovaginal venous plexus, and drain into internal iliac vein through uterine vein.
presentation of polycystic ovary syndrome?
ovaries have thickened capsule and prominent subcapsular cysts, elevations in ratio of LH to FSH, weight gain, insulin insensitivity.
amenorrhea, or abnormal uterine bleeding, and infertile
hirsuitism, acne, virilisation (developing male characteristics) doe to excess androgens
LH stimulate theca cells- androstenedione and testosterone prod with corresponding FSH stim of granulosa cells for oestrogen prod.
major symptom of endometrial cancer?
abnormal uterine bleeding
problems with greater vestibular glands?
bartholinitis
bartholin gland cyst- duct of gland becomes blocked, forming a cyst
vaginismus is due to reflex of which muscle?
pubococcygeus
what does coccygeus overlie?
sacrospinous ligament
3 muscles of levator ani?
pubococcygeus
puborectalis
iliococcygeus
where is the site of collection of urine if urethra is ruptured below perineal membrane?
superficial perineal pouch
free edge of which ligament do uterine tubes lie in?
broad ligament
how is ovum helped to be moved along uterine tube?
cilia
smooth muscle contraction
common sites of implantation of ectopic pregnancy?
ampulla isthmus fimbiral interstitial parts of uterine tube ovary
rare sites of implantation of ectopic pregnancy?
pouch of Douglas
abdominal viscera
what is responsible for causing pain in lower quadrants of abdomen in an ectopic pregnancy?
stretching and tearing of peritoneum
where does blood leaving via the vagina in an ectopic pregnancy tend to arise from?
withdrawl bleeding: reduction in hCG which maintain corpus luteum and hence prepares endometrium for implantation
shape of ovaries?
almond
from what cells of cervix do nabothian cysts develop?
cervical glandular ducts
how might nabothian cysts devlop?
infection of endocervical glands e.g. in chronic cervicitis, can cause blockage of cervical glandular ducts and so cyst formation
problem of nabothian cysts?
can reduce chances of pregnancy as cysts, espec if infected, make cervix less hospitable to sperm
what is found anterior to vagina?
base of bladder and urethra
what is found posterior to vagina?
rectum, anal canal and pouch of Douglas
what is found lateral to vagina?
levator ani and ureters, so ureteric stone may be palpated from vagina
what is palapation of posterior fornix used to assess?
posterior fundus
uterosacral ligaments
posterior broad ligaments/ovaries
pouch of Douglas
what is palpation of anterior fornix used to assess?
bladder
recto-pubic space
what is palpation of lateral fornices used to assess?
broad ligaments and assoc. structures
which LNs drain vagina?
inguinal
which structure is found at midpoint of line joining ischial tuberosities?
perineal body
which muscles reduces lumen of vagina?
bulbospongiosus
which muscle extends between perineal body and ischial ramus/tuberosity?
superficial transverse perineus
what does internal os of uterus mark junction of?
body of uterus and cervix
what is prepuce of clitoris formed by?
labia minora
2 openings in vulva?
urethra and vagina
which part of vagina is covered with peritoneum?
upper 1/4 by pouch of Douglas
importance of perineal body?
The perineal body is essential for the integrity of the pelvic floor, especially in females, anchoring the perineal muscles and rectum.
damage in childbirth can cause pelvic floor wkness and vaginal prolapse
what does perineal body provide attachment for?
It is a point of attachment for: o Anal sphincters o Bulbospongiosus o Superficial transverse perineal muscles o Fibres of levator ani
how can damage to perineal body in cbirth be avoided?
episiotomy
RFs for pelvic floor dysfunction?
Age Menopause -Atrophy of tissues after oestrogen withdrawal Obesity Chronic cough Intrinsic connective tissue laxity -Defined conditions -Constitutional CHILDBIRTH
what can damage to pelvic floor result in?
Stretch of the Pudendal Nerve
-Neuropraxia and muscle weakness
Stretch and damage of the pelvic floor and perineal muscles
-Muscle weakness
Stretch / Rupture of ligament supports of muscles
-Ineffective muscle action
Pelvic floor damage may also result in prolapse of organs and stress incontinence.
Tments for pelvic floor dysfunction?
Pelvic floor muscle exercises are easy, safe, effective and will cure incontinence in 50-75% of patients along with preventing or delay worsening of prolapses.
Continence Surgeries o Increase support to sphincter mechanism and prevent descent of bladder neck Colposuspension Tension-free vaginal tape o Effective (85-90% cure rate) o Side effects Voiding difficulty / Urinary retention Overactive bladder disease (obstruction)
Prolapse Procedures o Replace prolapsed organs o Restore connective tissue supports o Maintain function o Side effects Recurrence New incontinence Dyspareunia (Painful sexual intercourse)
