The Uterus Flashcards
What are the three parts of the uterus?
Fundus - the top, above entry point of the uterine tubes Body Cervix
Position of the uterus?
Anteverted with respect to the vagina Anteflexed with respect to the cervix
PICTUREWhat does it mean when the uterus is anteverted?
The whole uterus makes a right angle with the longitudinal axis of the vagina
PICTUREWhat does it mean if the uterus is anteflexed?
The longitudinal axis of the uterus makes an angle of 170 degrees with the longitudinal axis of the cervix
What are the three tissue layers of the fundus and body?
Peritoneum aka perimetrium Myometrium Endometrium
What are the three tissue layers of the fundus and body?
Peritoneum aka perimetrium Myometrium Endometrium
What is in the myometrium?
Thick smooth muscle layer which undergoes hyperplasia and hypertrophy during pregnancy in preparation for labour
What is the endometrium?
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
What are the effects of hormones on the stratum functionalis?
Oestrogens cause it to proliferate Progesterone causes it to become secretory
What is the main support of the uterus?
Tone of the pelvic floor
What are the ligaments of the uterus?
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
Which ligament is a remnant of the gubernaculum?
The round ligament
What does the round ligament of the uterus pass through?
Inguinal canal
Which ligament maintains the anteverted position of the uterus?
Round ligament
Which ligament contains the uterine artery and vein?
Cardinal ligament
What is the vascular supply to the uterus?
Uterine artery Venous plexus in the broad ligament that drains into uterine veins
What provides the lymphatic drainage of the uterus?
Iliac, sacral, aortic and inguinal lymph nodes
Innervation of the uterus?
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
Innervation of the uterus?
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
What abnormal positioning can there be of the uterus?
Excessively anteflexed
Anteflexed and retroverted
Retroflexed and retroverted
What can be problem with a retroverted uterus?
Retroverted uterus is positioned directly above the vagina So in increased abdominal pressure, more likely to prolapse into the vagina
What can be problem with a retroverted uterus?
Retroverted uterus is positioned directly above the vagina So in increased abdominal pressure, more likely to prolapse into the vagina
Why do women normally have a hysterectomy?
Cervical or uterine cancer
What do you need to be careful of when doing a hysterectomy?
Uterine artery crosses ureters approximately 1cm lateral to internal os so need to be careful when clamping the arteries ‘water under a bridge’
What is endometriosis?
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
What can endometriosis cause?
Dysmenorrhea Infertility
What are fibroids?
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
What symptoms can fibroids cause?
If large enough, can cause menorrhagia, pelvic pain and infertility
What is the most common malignancy of the female genital tract?
Endometrial carcinoma
When do endometrial carcinomas normally develop?
During or after menopause
What are endometrial carcinomas characterised by?
Abnormal uterine bleeding
Where are endometrial carcinomas usually found?
In transformation zone of cervix - between columnar epithelium of endocervix and stratified squamous epithelium of exocervix
What is found anteriorly and posteriorly to the uterus?
Anteriorly - uterovesical pouch Posteriorly - Rectouterine pouch aka pouch of Douglas
How can access be gained to the pouch of Dou
Via the posterior fornix of the vagina
