Reproduction 5 - Female anatomy Flashcards
The uterine tubes lie in the free edge of which ligament?
Broad ligament
List the mechanisms, which facilitate movement of an ovum along the duct?
Cilia and smooth muscle contraction (peristalsis)
Explain how infection may spread to the peritoneum from the female reproductive tract.
The opening of the uterine tube at the INFUNDIBULUM into the peritoneal cavity allows infection such as gonorrhea to spread from the vagina and cervix, via the uterus and uterine tubes into the peritoneal cavity.
What may be the consequence of infection in the uterine tubes?
Adhesions, which do not allow an ovum to pass through to the uterus. Hence, this may cause infertility or an ectopic pregnancy.
List both common and very rare sites of implantation of an ectopic pregnancy.
Common: fimbrial, ampullary, isthmic or interstitial (of the uterine tubes); ovary Rare: Pouch of Douglas, abdominal viscera.
Where would pain be felt with an ectopic pregnancy implanted in the ampulla of the uterine tubes?
lower abdominal quadrants
Explain why pain may be felt at the shoulder tip following rupture of an ectopic pregnancy?
If lying down blood in the peritoneal cavity may collect beneath the diaphragm irritating the phrenic nerve. Since this nerve originates with cutaneous nerves from C3, 4 and 5, pain may be referred to the dermatomes for these segments; i.e. shoulders. Pain felt in the lower quadrants is due to stretching and tearing of the peritoneum. Blood passing from the vagina is usually withdrawal bleeding (not a result of bleeding at the site of the rupture), caused by reduction in the hormone hCG which maintains the corpus luteum and hence prepares the endometrium for implantation.
Describe the arterial blood supply to the uterine tubes?
It is an anastomotic system of the ovarian and uterine arteries.
Draw and label relevant structures of the uterus and cervix.
see notes/ anatomy text Should include rectum rectouterine pouch (pouch of Douglas) uterus and broad ligament of the uterus uterine (Fallopian) tube and ovary cervix vagina uterovesicle pouch urinary bladder interpubic disk vestibule of the vagina labia majora and minora
The lateral reflection of the peritoneum off the body of the uterus forms which ligament?
Broad ligaments (which also contain uterine vessels) The broad ligament may be subdivided. 1) The mesometrium is mesentery of the uterus 2) The mesosalpinx is mesentery of the uterine tube. 3) The mesovarium is that part of the broad ligament that suspends the ovary.
Histologically, what are the three layers of the uterus and which of these layers is shed during menstruation?
1) Perimetrium (outer) 2) Myometrium (consisting of three muscle layers) 3) Endometrium (inner) (consisting of the stratum functionalis - shed during menstruation) and the stratum basalis (which produces new stratum functionalis after each menstruation)
The endometrial lining of the uterus is of which type of epithelial cells?
Simple columnar epithelium (either are ciliated or have microvilli) with glycogen producing glands changing from simple to highly coiled over the course of the uterine cycle.
The cervical canal epithelium is?
Tall columnar cells, with branched glandular cells, which form an alkaline mucus.
How does the epithelium of the body of the uterus change during the menstrual cycle?
menses days 1 – 4 : desquamation of 2/3, bleeding days 5 – 7 : rapid re-growth from remaining epithelial cells days 7 – 14 : endometrial re-growth is completed This concludes the proliferative phase days 14 – 28 : Secretary phase includes endometrial thickening, enlargement of glandular cells, oedematous, proliferation of white cells. 3 layers : compact superficial zone spongy middle zone (glandules) inactive basal layer As menses approach the arteries go in to spasm, retracting back to the deeper layers evoking ischaemia.
Explain why the ureter is in danger of being damaged during hysterectomy
In clamping off the uterine artery, the ureter may be accidentally damaged (remember : water (urine) under the (arterial) bridge).
The lymphatic drainage of the fundus of uterus
aortic nodes (lesser to inguinal lymph nodes)
The lymphatic drainage of the body of the uterus
external iliac nodes
The lymphatic drainage of the cervix
external and internal iliac nodes, sacral nodes.
In what position does the uterus usually lie ?
anteverted and anteflexed
What is assessed in a bimanual examination?
Insertion of one or two fingers into the vagina to examine the cervix. The external hand palpates the uterus (and ovaries if enlarged) from the anterior surface of the body to assess for pregnancy or irregularity. The uterus is assessed for mobility, consistency, pain, regularity, position, size (usually of a plum, 10weeks pregnancy it is the size of an orange), etc
If the uterus is retroverted, which structure would be the presenting part on a speculum or vaginal examination?
Os or the posterior lip (rather than the anterior lip) of the cervix.
Secretory cells of the cervix produce a cervical mucus. Comment on its contents and how the mucus changes during the uterine cycle.
The mucus is a mixture of water, glycoprotein, lipids, other proteins, enzymes and inorganic salts. Production of mucus is greatest during the follicular phase, in readiness for ovulation. It changes from cloudy to clear. At ovulation it is a clear, acellular mucus with high stretchability (spinnbarkeit). (Such characteristics may enable a women to self-assess the time of ovulation - it dries in a glass slide with a characteristics fern-patterning). Following ovulation (as progesterone increases), the mucus again becomes cloudy and more sticky but in diminishing quantities.
What happens to the cervical mucus during pregnancy?
A thick cervical mucus -plug forms - the loss of which may indicate labour.
From what cells of the cervix do Nabothian cysts develop? What is their implication for coitus?
From the cervical glandular ducts. Infection of the endocervical glands (as in chronic cervicitis) can result in blockage of the ducts and hence cyst formation (between 2mm to 1cm). There presence, especially if infected, can reduce chances of pregnancy by making the cervix inhospitable to sperm.
What are the (anterior, posterior & lateral) anatomical relations of the vagina?
Anteriorly – base of bladder and urethra (embedded in anterior vaginal wall)
Posteriorly – anal canal, rectum and most superiorly pouch of Douglas
Laterally – levator ani and ureters (lying just superior to lateral fornices) (A ureteric stone can sometimes be palpated from the vagina)
Which structures may be palpated in a vaginal examination?
Anteriorly – bladder, urethra and pubic symphysis
Posteriorly – rectum (prolapsed uterine tubes and ovary) Laterally – ovary and uterine tube, sidewall of pelvis (ischial spines)
Apex – cervix (ante or retro-verted)
In bimanual / pelvic examination, which of the cervical fornices is the usually largest and why?
Since the uterus is usually anteverted and anteflexed, the posterior fornix is the deepest (more of the posterior part of the cervix enters the vagina compared to anteriorly). The fornices form a continuous recess around the cervix.
What structures can be palpated from each fornix?
Palpation of the posterior fornix is used to assess posterior fundus, uterosacral ligaments, posterior broad ligaments/ovaries and Pouch of Douglas.
Palpation of the anterior fornix might address bladder, recto-pubic space
Palpation of the lateral fornices might address broad ligaments and associated structures. The Fallopian tubes and ovaries cannot normally be felt.
which lymph nodes drain the vagina?
Inguinal lymph nodes
How does the epithelial lining of the vagina reflect its function?
Stratified squamous epithelia, hence external layers are shed with friction. Cells are swollen due to glycogen production. Lubrication is via cervical mucus, shed vaginal cells.
Which bony (and fibrous) structures form the boundaries of the perineum?
Pubic symphysis, inferior pubic rami, ischial rami, ischial tuberosity, sacrotuberous ligaments, coccyx
which structures are found within the urogenital and anal triangles in the female?
UT Triangle - external genitalia Anal Triangle - Anus
Describe the arterial blood supply of the ovaries, uterus & vagina
The Ovarian Arteries which come directly off the Abdominal Aorta, just below the Renal Arteries.
Uterus & vagina - The uterine & vaginal arteries usually arises from the anterior division of the internal iliac artery.
Anatomically, the broad ligament can be divided into three regions, what are they?
Mesometrium – Surrounds the uterus and is the largest subsection of the broad ligament. It runs laterally to cover the external iliac vessels, forming a distinct fold over them. The mesometrium also encloses the proximal part of the round ligament of the uterus.
Mesovarium – Part of the broad ligament associated with the ovaries. It projects from the posterior surface of the broad ligament and attaches to the hilum of the ovary, enclosing its neurovascular supply. It does not, however, cover the surface of the ovary itself.
Mesosalpinx – Originates superiorly to the mesovarium, enclosing the fallopian tubes.
What are the anatomical relations of the broad ligament - what does it contain?
The broad ligament is attached to the uterus, fallopian tubes and ovaries. These organs are supplied by the ovarian and uterine arteries, which are also contained within the broad ligament.
Three other ligaments of the female reproductive tract are located within the broad ligament:
- Ovarian ligament.
- Round ligament of uterus.
- Suspensory ligament of ovary (also known as the infundibulopelvic ligament).
What ligamental structures attach to the uterus?
Superior aspect – supported by the broad ligament and the round ligaments.
Middle aspect – supported by the cardinal, pubocervical and uterosacral ligaments.
The levator ani is a broad sheet of muscle. Name the three separate paired muscles and their innervation
pubococcygeus, puborectalis and iliococcygeus
Innervated by branches of the pudendal nerve, roots S2, S3 and S4.
What are the anatomical boundaries of the perineum?
Anterior – Pubic symphysis.
Posterior- The tip of the coccyx.
Laterally – Inferior pubic rami and inferior ischial rami, and the sacrotuberous ligament.
Roof – The pelvic floor.
Base – Skin and fascia.
What is the function of the perineal body?
It functions as a point of attachment for muscle fibres from the pelvic floor and the perineum itself:
Levator ani (part of the pelvic floor).
Bulbospongiosus muscle.
Superficial and deep transverse perineal muscles.
External anal sphincter muscle.
External urethral sphincter muscle fibres.
