Reproduction 2 - Female Reproductive System Flashcards
What are some of the female reproductive organs?
- Uterus
- Fallopian tubes
- Vagina
- Ovaries
Is the duct system of the female reproductive tract short or long?
The duct system for the transference of gametes is short, and leads from the ovaries to the uterus, where implantation and development of the zygote occurs.
Where does implantation and development of the zygote occur?
ampulla of the fallopian tube
What are the 3 structures of the birth canal?
Cervix
Vagina
Vulva
What are the 3 layers of the uterus?
Perimetrium – outer serous coat, made of peritoneum supported by thin layer of connective tissue
Myometrium – middle muscular coat of smooth muscle which gradually becomes distended during pregnanct, main branches of blood vessels and nerves are located here
Endometrium – inner mucous coat
In what layer of the uterus are the main blood vessels and nerves located?
Myometrium
As pregnancy advances, how can the uterus be split physiologically?
As pregnancy advances the uterus physiologically has an ‘upper’ segment and a ‘lower segment’
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What area of the uterine body does the lower segment develop from?
Isthmus
When a caesarean delivery is done which part of the uterus is opened to deliver the baby?
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What area develops into the lower segment of the uterus during pregnancy?
The area between the cervix and uterus develops into the lower segment
What kind of incision is used for caesarean section?
When a caesarean section is required the uterus is opened at the lower segment with a transverse incision for delivery of the baby (Pfannenstiel)
Describe the normal position of the uterus?
The normal position of the uterus is ‘anteflexed’ and ‘anteverted’
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What is the opposite of anteverted and anteflexed?
Retroverted and retroflexed
What could happen if the position of the uterus is very retroverted and retroflexed, particularly in early pregnancy? Think of the position of the other organs…
Bladder or rectum problems
At any surgical management of miscarriage why might it be important to know prior to instrumentation of the uterine cavity whether the uterus is anteverted or retroverted?
Could perforate the uterus
What peritoneal spaces are around the vagina?
rectouterine and uterovesical peritoneal spaces
What are the fornices of the vagina?
Definition – recess around the protruding cervix
1) Anterior – fundus of urinary bladder and urethra
2) Lateral – levator ani, visceral pelvic fascia and ureters
3) Posterior – anal canal, rectum and recto-uterine pouch
How many fornices of the vagina are they?
3
What forms the following fornices of the vagina:
- anterior
- lateral
- posterior
1) Anterior – fundus of urinary bladder and urethra
2) Lateral – levator ani, visceral pelvic fascia and ureters
3) Posterior – anal canal, rectum and recto-uterine pouch
Through which vaginal fornix you can access the rectouterine pouch? What is the clinical significance of this?
Posterior fornix
What are the ligamentous attachments that anchors the uterus and cervix in position?
- Ligament of ovary
- Suspensory ligament of ovary
- Round ligament of uterus
- Broad ligament
Which ligament (part of the pelvic fascia, which is one of the main supports of the uterus) is called the cardinal ligament of the uterus?
Broad ligament of uterus
Apart from pelvic fascia, what other structure in the pelvis is also an important support of the uterus?
Muscles of pelvic floor (perineal muscles)
What is the difference between the cervix and the uterus in terms of movement?
In the pelvis the cervix is a fixed structure, supported by strong ligaments to prevent movement. The uterus is supported, but has ability to move, especially when increasing in size during pregnancy.
What are the 4 parts of the uterine tubes?
1) Infundibulum
2) Ampulla
3) Isthmus
4) Intramural or uterine part
What part of the uterine tube is the longest and widest?
Ampulla
Fertilisation occurs in which part of the uterine tube?
Ampulla
What is meant by tubal (ectopic) pregnancy?
Implantation occurs in mucosa of uterine tube (most commonly ampulla) due to blastocyst failing to reach the uterus
What might a cornual ectopic pregnancy be?
Implantation occurs in the cavity of a rudimentary horn of the uterus
Where are the ovaries located?
The ovaries are located in the lateral walls of the pelvis, supported by 2 ligaments.
What happens to the ovaries after menopause?
After menopause they become atrophied and fibrous
What are the two ligaments associated with the ovary?
- From uterus to ovary
- Ligament of ovary
- Ovary to lateral pelvic wall
- Suspensory ligament
What does the ligament of ovary connect?
Uterus to ovary
What does the suspensory ligament connect?
Ovary to lateral pelvic wall
What are the 2 major branches from the aorta that supplies blood to gonads and genitalia?
the ovarian (gonadal) and internal iliac arteries.
What does the ovarian artery correspond to in males?
The ovarian artery corresponds to the male testicular artery, in that they are branches directly from the abdominal aorta
At what vertebral level doe the ovarian arteries originate?
L2
As the ovarian artery descends, what does it pass within?
As it descends the artery passes within the suspensory ligament to supply the ovaries via the broad ligament.
What does the ovarian artery anastomose with?
Uterine artery
Where do the ovarian veins drain into?
- Left
- Left renal vein
- Right
- IVC
Where does the uterine artery cross over the ureter?
Approximately 2cm superior to the ischial spine, the ureters run underneath the uterine artery.
What is A?
Ovarian artery
What is B?
Ureter
What is C?
Vaginal artery
What is D?
Pudendal artery
What is E?
Uterine artery
What is F?
Ovary
What is commonly damaged during caesarean section or hyperectomy?
Due to the close proximity of the ureter and bladder to the female reproductive organs, it is not uncommon that either can be damaged during a caesarean section or hysterectomy (removal of the uterus)
What does lymphatic drainage of the internal pelvic organs follow?
The lymphatic drainage of the internal pelvic organs largely follows the arterial supply and venous drainage described above.
Which group of lymph nodes drains the ovary?
Para-aortic lymph nodes
What is the lymphatic drainage of the following:
- fundus and upper uterine body
- most parts of uterine body
- uterine cervix and upper vagina
- lower vagina
- Fundus and upper uterine body
- Pre-aortic group
- Most part of uterine body
- Iliac
- Uterine cervix and lower vagina
- Internal iliac and sacral
- Lower vagina
- Inguinal and femoral nodes
What kind of glands are the breasts?
The breasts are highly modified exocrine glands
Where do the breasts lie in?
Lying in the superficial fascia of the pectoral region
How many lobes does each breast consist of?
Each breast consists of 15-25 lobes
What are the breasts composed of?
Each breast consists of 15-25 lobes with tubulo-acinar glands (parenchyma) and stroma (connective tissue).
From what ribs does the breasts extend between vertically?
What do the breasts extend between horizontally?
Breast extends vertically from the 2nd rib to the 6th or 7th rib and horizontally from the lateral border of sternum to the mid-axillary line.
The deep surface of the breast is related to what muscles?
- Pectoralis Major
- Pectoralis Minor
- Serratus Anterior
What is the axillary tail of the breast?
The axillary tail of the breast is an extension of the breast tissue into the axilla, and is important to appreciate in the spread of breast cancer (more on this later)
What is the breast also called?
Mammary gland
Branches of what arteries supplies the breasts?
The mammary gland is extremely vascular. They are supplied by branches of subclavian and axillary arteries.
What is A?
Lateral thoracic artery
What is B?
Intercostal arteries
What is C?
Internal thoracic artery
What is D?
Subclavian artery
List the main group of lymph nodes draining the breast tissue and their area of drainage?
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- Parasternal
- Supraclavicular
- Pectoral (anterior)
- Subscapular (posterior)
- Abdominal
Which group of lymph nodes first receives lymph from the lateral part (quadrant) of the breast tissue?
Axillary lymph nodes
Why are malignant cells of the breast able to spread so easily?
Due to the vascularity and good lymphatic drainage of the breast, malignant cells can quickly spread either to the opposite breast, or to other sites in the body (bone, lung, brain)
What are the treatment options for breast cancer?
1) Chemotherapy +/- Hormone Treatment (depending on the sub-type of breast cancer)
2) “Lumpectomy” + lymph node Biopsy (removal of suspicious lump, with surrounding biopsy of cancerous ‘hot’ lymph nodes – these are tagged using radioactive dye
3) Mastectomy + Axillary Clearance – Removal of breast + axillary tail.
What changes the histology of breast tissue?
Breast tissue undergoes cyclical changes in activity, controlled by hormones involved with the ovarian cycle.
What is this?
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Inactive breast
What is this?
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Active breast during (pregnancy or lactation not sure)
What is this?
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Active breast during (either pregnancy or lactation not sure)
What changes the histology of the female reproductive system?
Study the below slides of female reproductive organs specifically the uterus, ovary and uterine (fallopian) tubes – click on each label to view the online histology, and changes related to hormones excreted from the pituitary gland.
What is this?
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Proliferative phase of uterus
What is this?
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Secretory phase of uterus
What is this?
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Uterine tube
What are the layers of the uterine tube?
- Adventitia
- Muscularis mucosa
- Mucosa
- Lumen
NEED TO ADD HISTOLOGY OF TYPES OF FOLLICLE
NEED TO ADD HISTOLOGY OF OVARY
What does the placenta develop from?
It develops from the trophoblast following implantation of the blastocyst into the uterine endometrium
What are the differences between the 2 surfaces of the placenta?
- Maternal side
- That one surface of the placenta is disc shaped and the structure is rough and spongy
- Foetal side
- The reverse side is smooth and bears the attachment of the umbilical cord.
Which of A and B is the maternal and foetal side of placenta?
A - foetal surface
B - maternal surface
What are 4 functions of the placenta?
- Gaseous exchange
- Metabolic transfer
- Hormone secretion
- Foetal protection
At what stage of labour does the placenta physiologically separate from the uterine wall?
Third stage of labour
What can you see here?
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Look carefully at the cut-end of the umbilical cord, you should be able to see at least three structures - these are the two umbilical arteries and single umbilical vein.
What is the function of umbilical arteries in the foetal circulation?
Delivery oxygenated blood with nutrients to foetus
What structure (ligament) does the umbilical vein persist as?
Ligamentum teres
What is the function of umbilical veins in the foetal circulation?
Return waste products an CO2 to mother circulation
What is structure labelled W?
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Wharton’s jelly