The Uterus

Question 1

What are the three parts of the uterus?

Answer 1

Fundus - the top, above entry point of the uterine tubes Body Cervix

Question 2

Position of the uterus?

Answer 2

Anteverted with respect to the vagina Anteflexed with respect to the cervix

Question 3

PICTUREWhat does it mean when the uterus is anteverted?

Answer 3

The whole uterus makes a right angle with the longitudinal axis of the vagina

Question 4

PICTUREWhat does it mean if the uterus is anteflexed?

Answer 4

The longitudinal axis of the uterus makes an angle of 170 degrees with the longitudinal axis of the cervix

Question 5

What are the three tissue layers of the fundus and body?

Answer 5

Peritoneum aka perimetrium Myometrium Endometrium

Question 6

What are the three tissue layers of the fundus and body?

Answer 6

Peritoneum aka perimetrium Myometrium Endometrium

Question 7

What is in the myometrium?

Answer 7

Thick smooth muscle layer which undergoes hyperplasia and hypertrophy during pregnancy in preparation for labour

Question 8

What is the endometrium?

Answer 8

The inner mucous membrane which can be divided into -deep stratum basalis which does not change during the cycle -superficial stratum functionalis which proliferates and is shed during menstruation. Regenerates from cells in the stratum basalis

Question 9

What are the effects of hormones on the stratum functionalis?

Answer 9

Oestrogens cause it to proliferate Progesterone causes it to become secretory

Question 10

What is the main support of the uterus?

Answer 10

Tone of the pelvic floor

Question 11

What are the ligaments of the uterus?

Answer 11

Broad ligament - from uterus to pelvis Round ligament - from uterine horns to labia majora Ovarian ligament - ovaries to uterus Cardinal ligament - at base of broad ligament, from cervix to lateral pelvic walls Uterosacral ligament - cervix to sacrum

Question 12

Which ligament is a remnant of the gubernaculum?

Answer 12

The round ligament

Question 13

What does the round ligament of the uterus pass through?

Answer 13

Inguinal canal

Question 14

Which ligament maintains the anteverted position of the uterus?

Answer 14

Round ligament

Question 15

Which ligament contains the uterine artery and vein?

Answer 15

Cardinal ligament

Question 16

What is the vascular supply to the uterus?

Answer 16

Uterine artery Venous plexus in the broad ligament that drains into uterine veins

Question 17

What provides the lymphatic drainage of the uterus?

Answer 17

Iliac, sacral, aortic and inguinal lymph nodes

Question 18

Innervation of the uterus?

Answer 18

Sympathetic - uterovaginal plexus Parasympathetic - pelvic splanchnic nerves (S2-S4) Cervix - inferior nerve fibres of the uterovaginal plexus Afferent fibres ascend through inferior hypogastric plexus to enter the spinal cord via T10-12 + L1

Question 19

Innervation of the uterus?

Answer 19

Sympathetic - uterovaginal plexus Parasympathetic - pelvic splanchnic nerves (S2-S4) Cervix - inferior nerve fibres of the uterovaginal plexus Afferent fibres ascend through inferior hypogastric plexus to enter the spinal cord via T10-12 + L1

Question 20

What abnormal positioning can there be of the uterus?

Answer 20

Excessively anteflexed

Anteflexed and retroverted

Retroflexed and retroverted

Question 21

What can be problem with a retroverted uterus?

Answer 21

Retroverted uterus is positioned directly above the vagina So in increased abdominal pressure, more likely to prolapse into the vagina

Question 22

What can be problem with a retroverted uterus?

Answer 22

Retroverted uterus is positioned directly above the vagina So in increased abdominal pressure, more likely to prolapse into the vagina

Question 23

Why do women normally have a hysterectomy?

Answer 23

Cervical or uterine cancer

Question 24

What do you need to be careful of when doing a hysterectomy?

Answer 24

Uterine artery crosses ureters approximately 1cm lateral to internal os so need to be careful when clamping the arteries ‘water under a bridge’

Question 25

What is endometriosis?

Answer 25

Presence of ectopic endometrial tissue at sites outside of the uterus, commonly in ovaries and ligaments of the uterus. Ectopic tissue is still responsive to oestrogen so get cyclic proliferation and bleeding, forming a cycst

Question 26

What can endometriosis cause?

Answer 26

Dysmenorrhea Infertility

Question 27

What are fibroids?

Answer 27

Benign tumours of the endometrium which affect about 20% of menopausal women. They are oestrogen dependent so enlarge during pregnancy and use of OCP. Regress after menopause Normally asymptomatic

Question 28

What symptoms can fibroids cause?

Answer 28

If large enough, can cause menorrhagia, pelvic pain and infertility

Question 29

What is the most common malignancy of the female genital tract?

Answer 29

Endometrial carcinoma

Question 30

When do endometrial carcinomas normally develop?

Answer 30

During or after menopause

Question 31

What are endometrial carcinomas characterised by?

Answer 31

Abnormal uterine bleeding

Question 32

Where are endometrial carcinomas usually found?

Answer 32

In transformation zone of cervix - between columnar epithelium of endocervix and stratified squamous epithelium of exocervix

Question 33

What is found anteriorly and posteriorly to the uterus?

Answer 33

Anteriorly - uterovesical pouch Posteriorly - Rectouterine pouch aka pouch of Douglas

Question 34

How can access be gained to the pouch of Dou

Answer 34

Via the posterior fornix of the vagina