Session 2 - Lecture 1 - Female Anatomy Flashcards
1 - SKIP
Anatomy of the female reproductive system
2 - Contents
Contents • Overview of the female reproductive system – the journey of the egg • Some microscopic features of the ovary • The uterus and uterine tubes • Peritoneal relations • Blood supply • Describing the position of the uterus and vagina • The vagina and vulva
3 - Overview of the female reproductive system
Overview of the female reproductive system
Reproductive system
- Uterine tube
- Ovary
- Uterus
- Vagina
Urinary system
- Bladder
- Urethra
Gastrointestinal system
- Rectum
- Anal canal
- Anal aperture
“Overview of the female system – on surface looks v diff to male, but as you’ll learn in embryology, see many overlaps in dvlpmntal structures. Ofc like male system female repro system found in pelvic cavity, ovaries with adjoining uterine tubes, uterus sitting in midline, and vagina communicating with outside world. Can see uterus has important neighbours, clinically need to know these anatomical relations to form an examination competently (PRs and vaginal examinations - ObGyn)“
4 - Microstructure of the ovary
- Why do I sometimes get a sharp pain at ovulation?
- Why do nuns tend to get ovarian cancer?
Microstructure of the ovary
- Ovarian surface (germinal) epithelium
- Early primary follicle
- Primordial follicles
- Late primary follicle
- Atretic follicle
- Secondary (antral) follicle
- Tunica albuiginea
- Teritary (Graafian follicle)
- Ruptured follicle
- Oocyte at ovulation
- Active corpus luteum
- Regressing corpus luteum
- Medulla
- Corpus albicans
- Cortex
- Hilum
- Ovarian vessels
- Peritoneum
Why do I sometimes get a sharp pain at ovulation?
Why do nuns tend to get ovarian cancer?
“Ovary, will do more lectures on the ovary - Large proportion concerned with physiology of the ovary - v complex,. Main thing I want to point out to you, structure of the ovary, v similar to the structure of the testis - oval shaped structure; where gametes produced; hilum, where vessels go in and out; and same dvlpmntl origin. Can see number of follicles which go through diff stages (not remit of this lecture), but important thing to point out is surface capsule or surface epithelium of ovary – otherwise known as the germinal epithelium - where stem cells are that produce the follicles. (For interest/further reading: Now been shown only a finite number of eggs in the ovary - actually not such a simple question, why is this, even why do we go through menopause, is it bc there are a finite number of eggs in the ovary?) As follicle develops we have the process of ovulation, where follicle ruptures through surface epithelum of ovary and oocyte enters the peritoneal cavity, for a short time. Ovary is actually covered with a layer of peritoneum, and this peritoneum has innervation, in some women, ovulation can feel sharp pain- as that egg bursts through wall of ovary and into peritoneal cavity – and this is a thing called Mittelschmerz (it means middle pain, i.e. middle of cycle day 14) – down to rupture of ovary due to oocyte being released. Now 2nd question also related to surface epithelium, been known for a long time that certain groups of women at high risk of developing ovarian cancer, important group originate from germinal epithelium – and fact that nuns have a higher incidence of ovarian cancer – nuns undergo far far more ovulations than most other women (vow of celibacy; never get pregnant) – ovulation is a traumatic event where follicle ruptures through the capsule of the ovary, every time you have trauma like this, presumably this leads to increased risk of mitosis, increased risk of mutations and neoplasia. Clinically, if you think about other groups of women with fewer ovulations e.g. lots of children, they are at low risk of ovarian cancer – so women, minimise the number of ovulations during your life – doesn’;t have to be constant dependent, other ways we can minimise ovulations which we learn about in contraception lectures”
5 - Ovarian cysts
How might a patient with an ovarian cyst present?
Ovarian cysts
Ovarian cyst uterus - normal ovary - ovary with cyst - vagina https://www.healthstatus.com/health_blog/pcos/symptoms-ovarian-cysts/
http://reference.medscape.com/features/slideshow/ovarian-cysts#page=3
How might a patient with an ovarian cyst present?
“Ovary is related to the testes, and this will give us a lil clue to answer this q at the bottom. Now ovaries are known on occasion to develop cysts, i.e. epithelial lined fluid filled cavity – Left diagram showing ovary with cyst (left ovary has a cyst) Most cysts can be small, in fact, often undetectable. Right – laparotomy being done on a lady, this is an ovarian cyst (huge! - rare) When you take these cysts out you have to be very careful to not burst, bc if this is caused by cancer, the fluid within cyst can be full of cancer cells - burst it, see the whole peritoneum full of cancer cells, although generally don’t know what cause of it is until after. Now we said they don’t freq cause a problem, so How might an ovarian cyst cause a problem , around cricket ball size – maybe you could have mass effects – ovary in pelvis – so compressing adjacent structures – uterus and ovaries sit close to bladder. What else might happen, thinking about what I said about parallel with testes – bulky ovary – testes known to do – it can twist – get ovarian torsion - that can lead to blood supply being compromised to ovary, pain, and similar kind of syndromes to testicular torsion. Now, of course there are many other presentations of ovarian cysts and tumours, and still have a lecture in cancer week but many of these are cystic in nature. So we could get torsion mainly.”
6 - Parts and relations of the uterus
Parts and relations of the uterus
- Opening of uterine tube
- Uterine tube
- Fundus
- Body
- Cervix
- Vagina
- Suspensory ligament of ovary
- Mesovarium
- Deep inguinal ring
- Round ligament of the uterus
- Inguinal canal
- Superficial inguinal ring
- Labium majorus
- Ligament of ovary
- Ovarian vessels
“So, we’ve looked at the ovary, now What about the uterus? This sits in the midline, in humans we have just a single uterus sitting in the midline, you’ll do the dvlpmnt of uterus this afternoon, and you’ll learn that it is formed by convergence (fusing) of 2 tubes, - reflected in anatomy of other animals – many other animals have 2 horns of uterus going off 2 left and right hand side – and even see bicorneate uterus in women – but that comes up in dvlpmnt lecture. So here’s out uterus - has a fundus (top of uterus – fundamental – get to the bottom of it so top or bottom depending on which way), it has a body, (main ‘meat’ of the uterus) and then the cervix, which is part of the uterus, which is more fibrous than muscular, and look at that in a bit more detail later on – cervix lowermost part, plugs into vagina, coming off into uterus are tubes. And we said Uterus has impootant anatomical relations, anterior to uterus is the bladder – so in front of and slightly beneath of the uterus sits the bladder, and you know this in pregnacncy bc you’ll find urinary freq increases b/c of pressure on bladder itself due to close anatomical relationshins. Can feel the rectum posteriorly to uterus – so if you’re doing a vaginal examination, here through the vagina – can feel bladder anteriorly and rectum posteriorly, likewise doing a rectum examination – feel vagina and cervix anteriorly – so lot that you can feel. Male GP did a PR, and he said he can feel a linear mass in the anterior wall of the rectum … she thought that’s v odd, she examined the pt, and what was the linear mass? It was a tampon in the vagina! So this male GP had forgotten that some women use tampons at certain times of the month – failed to take a proper hx, pelvic examination in a women – need to be asking these v basic qs, otherwise fall into silly traps like that – so all these structures v v close together in pelvis – see hwo close they are when you go down to DRr.”
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