Station 5

Question 1

Fundus of uterus

Answer 1

-

Question 2

Cervical canal

Answer 2

1. Communicates with cavity of body through internal ostium and with vagina through external ostium

Question 3

Posterior Fornix

Answer 3

1. Drainage of rectouterine is through the posterior fornix

Question 4

Douglas pouch

Answer 4

1. Contents: coils of intestines + Sigmoid colon
2. Clinical significance:
   
   • Fluid can accumulate in this space and is drained through the posterior fornix
   • DRE: enlargement of uterus, uterine tubes and ovaries can be felt

Question 5

Ovary

Answer 5

1. Mesovarium attaches it to broad ligament [posterior aspect]
2. Occupies rectouterine pouch after partition
3. Related to ovarian fossa [which is bounded by the obliterated umbilical artery anteriorly, ureter and internal iliac artery posteriorly and obturator internus muscle with obturator nerve on it laterally]
4. Disease in ovary, referred pain to medial thigh
5. Peritoneum covering its surface is modified to germinal [cuboidal] epithelium
6. Anterior border is is attached to the posterior layer of the broad ligament by the mesovarium
7. Inferior pole of the ovary is attached to ovarian ligaments
8. Superior pole of the ovary is attached to suspensory ligament and broad ligament
9. Supplied by the ovarian arteries which are branches of the abdominal aorta
10. Right ovarian veins drain into IVC and left ovarian veins drain into left renal vein

Question 6

Uterine tube

Answer 6

1. Related to all parts of the ovaries except the lower pole and lateral side
2. Supplied by uterine and ovarian arteries
3. Mesopalhinx: part of the broad ligament between the uterine tube and ovarian ligament

Question 7

Ovarian Ligament

Answer 7

1. Mesopalhinx: part of the broad ligament between the uterine tube and ovarian ligament
2. Mesometrium: portion of the broad ligament below the ovarian ligament

Question 8

Suspensory ligament of the ovary

Answer 8

1. Ovarian arteries descends over the posterior abdominal wall and enters the suspensory ligament of the ovary to send branches to the ovaries and continues medially through broad ligament to anastomose with uterine arteries

Question 9

Broad ligament

Answer 9

1. Mesopalhinx: part of the broad ligament between the uterine tube and ovarian ligament
2. Mesometrium: portion below the ovarian ligament
3. Mesovarium attaches the ovaries to the posterior aspect of the broad ligament
4. Ovarian and uterine arteries anastomose in this ligament
5. Uterine tubes run in the free superior margin of broad ligament
6. There are two ligaments that extend from superolateral angle [round ligament and ligament of the ovary]
7. Supports the uterus

Question 10

Uterine artery

Answer 10

1. Found in the transverse cervical ligament on either side of cervix
2. Crosses the ureter superficially from lateral to medial side and ascends along the lateral border of the uterus, with a tortuous course
   
   1. Ureter is at risk during surgery when ligating this artery
3. Supplies: Uterus, cervix, vagina, ovaries and uterine tube
4. Why is the uterine artery tortuous at the sides of the uterus? [so it can supply enlarged uterus during pregnancy]

Question 11

11. Perineal body

Answer 11

1. Central tendon of the perineum
2. Lies between the anus and vagina
3. Provides attachment for:
   
   1. external anal sphincter
   2. pubovaginalis/puboprostate
   3. Bulbospongiosus
   4. Superficial transverse perinei
   5. Deep transverse perinei
4. Crucial in maintaining the anatomical and functional integrity of the perineum in the female
   
   1. Clinical significance: Injury to it during childbirth may weaken the pelvic floor and lead to prolapse of the vagina and uterus

Question 12

Anal column

Answer 12

1. 5 to 10 longitudinal folds of mucosa in the upper half each contains a small artery and a small vein
2. divided into
   
   1. upper 2⁄3 (visceral portion, derived from the hind gut), which belongs to the pelvis
      
      1. Epithelium: Columnar
      2. Blood supply: Superior rectal veins [to Portal Venous system]
      3. Nerves: Pelvic plexus [visceral type]
      4. Lymphatic drainage: Internal iliac nodes
      5. Internal hemorrhoids
   2. lower 1⁄3 (somatic portion, derived from ectodermal proctodeum)
      
      1. Epithelium: Stratified squamous
      2. Blood supply: Middle and Inferior rectal veins [to caval system]
      3. Nerves: Pudendal nerve [sensory]
      4. Lymphatic drainage: Superficial inguinal nodes
      5. External hemorrhoids
   3. Pectinate line divides these two
3. Anal valves are crescent shaped mucosal folds that connect the lower ends of anal canal
4. Anal sinuses are a series of pouch-like recesses at the lower end of the anal column in which the anal glands open

Question 13

Internal anal sphincter

Answer 13

1. thickening of the circular smooth muscle, that is separated from the external anal sphincter by the intermuscular groove called Hilton’s white line

Question 14

External anal sphincter

Answer 14

1. thickening of the circular smooth muscle, that is separated from the external anal sphincter by the intermuscular groove called Hilton’s white line
2. Surrounds the anal canal
3. Supplied by inferior rectal nerve

Question 15

Perineal membrane

Answer 15

1. fibrous tissue which forms the base upon which the penis and penile musculature are fixed
2. superficial perineal pouch between the perineal membrane and the superficial fascia (Colles’ fascia)

Question 16

Greater vestibular gland

Answer 16

1. AKA Bartholin’s glands
2. Found in the superficial perineal pouch
3. Situated on either side near the vaginal opening and have ducts that open into the vestibule immediately lateral to the attachment of the hymen.
4. Secretion keeps the vulva moist

Question 17

Bulbourethral gland

Answer 17

1. Its ducts are found in the superficial perineal pouch, while the glands are in the deep pouch

Question 18

18. Pelvic Splanchnic nerve

Answer 18

1. Arises from S2, S3, S4 nerves and joins the inferior hypogastric plexus.
2. Sympathetic and parasympathetic nerves in superior and inferior hypogastric nerve plexus and their effect on bladder, rectum and erectile tissues of the genital organs
   
   1. Bladder
   2. Rectum
   3. Erectile tissue