Session 5 - Female reproductive anatomy

Question 1

Where do the gonads develop?

Answer 1

Within the mesonephric ridge

Question 2

How is the inferior pole of the ovary connected to the external genitalia?

Answer 2

By the gubernaculuym to the labioscrotal folds

Question 3

How does the uterus form?

Answer 3

Mesonephric ducts fuse

Question 4

What are the two main functions of the ovaries?

Answer 4

Endocrine glands

Oocyte released

Question 5

What are the connections of the ovaries?

Answer 5

By the mesovarium to the abdominal wall and the by the ovarian ligament to the uterus

Question 6

What is the ovarian ligament derived from?

Answer 6

Gubernaculum

Question 7

What is the arterial supply of the ovary?

Answer 7

The Ovarian Arteries come directly off the Abdominal Aorta, just below the Renal Arteries.

Abdominal Aorta -> Ovarian Artery

Question 8

What is the venous drainage of the ovaries?

Answer 8

Right ovarian vein -> Inferior vena cava

Left ovarian vein -> Left renal vein -> Inferior vena cava

Question 9

What is the lymphatic drainage of the ovaries?

Answer 9

Para-aortic nodes

Question 10

What is the relationship of the uterus anteriorly?

Answer 10

Uterovesical pocuh

Question 11

What is the relationship of the uterus posteriorly?

Answer 11

Rectouterine pouch

Question 12

What are the three layers of the uterus?

Answer 12

• The perimetrium
• The myometrium
• The endometrium

Question 13

What is the most superficial part of the endometrium called?

Answer 13

Stratum functionalis

Question 14

What is the deepest part of the endometrium caled?

Answer 14

Stratus basalis

Question 15

What are the three phases of the uterus?

Answer 15

THe proliferative phase, the secretory phase and the menstrual phase

Question 16

What occurs in the proliferative phase?

Answer 16

Oestrogen secreted during folliculogenesis stimulates growth and proliferation of the endometrium

Question 17

What occurs in the secretory phase of the uterus?

Answer 17

After ovulation, corpus luteum secretes progesterone which stimulates the endometrial glands to secrete glycogen and causes their extensive coiling, enriching the vascular supply to the mucous membrane. These changes in the endometrium are in preparation for the receipt of embedding (implantation) of the conceptus following fertilisation.

Question 18

What is the menstrual phase of the uterus?

Answer 18

Brought about by luteolysis of corpus luteum, removing supportive effect of progesterone and causing decrease in vascular supply of the endometrium. This results in the breakdown and degeneration of the bulk of the upper endometrium (stratum functionalis, bleeding and shedding of tissues.

Question 19

What is the broad ligament?

Answer 19

Double layer of peritoneum that extends from the sides of the uterus to the lateral walls and floor of the pelvis.

Question 20

What is the round ligament of the uterus?

Answer 20

The embryological remmnant of the gubernaculum which is attached to the ovary and labium majus and well as travelling through the inguinal canal.

Question 21

What is the structure of the uterine tubes?

Answer 21

Fimbrae next to the ovary
Then infuindibulum
Tnen ampulla
Then isthmus and opening into uteriune cavity

Question 22

What is the cervic?

Answer 22

The fubromuscular neck of the uterus which protrudes into the upper vagina and contain the endocervical canal linking the uterine cavity with the vagina

Question 23

What are the two main regions of the cervix?

Answer 23

The endocervic and the exocervix.

Question 24

Outine the structure of the enodcervix

Answer 24

The endocervix is lined by tall columnar epithelium with basally placed nuclei and the greater part of the cytoplasm filled with mucus. The mucosa contains numerous large glands that are also lined with tall, mucus-secreting columnar cells.

Question 25

What is the structure of the exocervix?

Answer 25

. The exocervix is covered with a stratified squamous non-keratinised epitheium (as of the vagina). The change from the columnar to stratified squamous epithelium, at the transformation zone, is abrupt. The remainder of the cervix is composed of circularly arranged smooth muscle fibres lying abundant dense connective tissue.

Question 26

What is the arterial supply of the uterus?

Answer 26

Abdominal Aorta -> Common Iliac -> Internal Iliac -> Anterior Division of Internal Iliac -> Uterine

Question 27

What is the venous drainage of the uterus?

Answer 27

Uterine venous plexus which merges to form the uterine veins, which are tributaries of the internal iliac vein Uterine Venous Plexus -> Uterine -> Internal Iliac -> Common Iliac -> IVC

Question 28

What is the lymphatic drainage of the uterus

Answer 28

plex: o Fundus  Aortic nodes o Body  External iliac nodes o Cervix  External and internal iliac nodes and sacral nodes

Question 29

What are the three layers of the vagina?

Answer 29

Mucous membrane Muscular coat Adventitia

Question 30

What does the mucous membrane of the vagina consist of?

Answer 30

Stratified squamous epithelium with underlying lamina propria composed of dense conective tissue

Question 31

Describe the muscle layer of the vagina

Answer 31

Smooth muscle bundles arranged circularly and longitudinally

Question 32

What are the vaginal fornices?

Answer 32

Recesses of the vagina around the cervix

Question 33

What is the arterial supply of the vagina?

Answer 33

Superior part supplies by the uterine artery Middle and inferior supplies by Abdominal Aorta  Common Iliac  Internal Iliac  Anterior Division of Internal Iliac  Uterine  Vaginal Abdominal Aorta  Common Iliac  Internal Iliac  Anterior Division of Internal Iliac  Pudendal

Question 34

Outline the venous drainage of the vagina

Answer 34

Vaginal Plexus  Vaginal  Uterine  Internal Iliac  Common Iliac  IVC

Question 35

Outline the innervation of the vagina

Answer 35

o Inferior 1/5th of the Vagina receives somatic innervation from the Pudendal Nerve (S2-4) o Superior 4/5th of the Vagina and Uterus receives innervation from the Uterovaginal plexus

Question 36

What is the pelvic pain line?

Answer 36

o Pain afferents vary depending on the pelvic pain line. Considered to be above the pelvic pain line if touches visceral peritoneum – EXCEPT in sigmoid colon, where it is located about midway.  Above line – Pain refers back up, follows sympathetic fibres.  Below line – Local pain, follows parasympathetic fibres.

Question 37

What are the three main parts of the female external genitalia?

Answer 37

``` o Labia Majora  Enclosing the pudendal cleft o Labia Minora  Enclosing the vestibule of the vagina  Bulbs of vestibule  Clitoris o Vestibule  Orifices of urethra, vagina and greater (Bartholin) and lesser vestibular glands ```

Question 38

What do ovarian cysts develop from?

Answer 38

Follicles

Question 39

What do ovarian tumours arise from?

Answer 39

Epithelial components or germ cells

Question 40

Give two conditions of the uterus

Answer 40

Salpinigitis | Endometriosis

Question 41

What is salpingitis

Answer 41

 Inflammation of the uterine tube caused by microorganisms  Causes fusions or adhesions of the mucosa and thus can partially or completely block its lumen – leading to infertility  Blocked or dysfunctional tubes may result in ectopic (tubal) pregnancy or implantation outside of the uterus

Question 42

What is endometriosis?

Answer 42

 A condition in which ectopic endometrial tissue is dispersed to various sites along the peritoneal cavity and beyond (e.g. near to the umbilicus).  May be associated with the ovaries or attachments of the uterus  Associated with severe period pain (Dysmenorrhoea), infertility or both

Question 43

What is an endometrial carcinoma?

Answer 43

 Malignancy of the endometrium  Usually occurs in postmenopausal women  Junction between columnar cells of endovervix and squamous cells of exocervix (Transformation zone) is where the majority of neoplasms form  Major symptom is abnormal uterine bleeding

Question 44

What is the difference between cervical examination and bimanual examination?

Answer 44

Cervical - Use of a speculum to isolate the external os of the cervix Bimanual - Two fingers are inserted into the vagina until they isolate the cervix.  Test of cervical motion tenderness (Sign of PID) o Examiner palpates the uterus

Question 45

What can go wrong witth the greater vestibular glands (Bartholin glands) of the vagina

Answer 45

Bartholinitis | Bartholin gland cyst

Question 46

What is vaginitis?

Answer 46

Inflammation of the vagina

Question 47

What is vagnismus?

Answer 47

 A condition making any sort of vaginal penetration (sexual intercourse, insertion of tampons) painful or impossible  Reflex of the pubococcygeus muscle.

Question 48

What is an ectopic pregnancy?

Answer 48

Implantation anywhere except for the uterine body