Uterine tube, Ovary, Vagina Flashcards
Boundaries of ovarian fossa:
- ANTERIORLY – External iliac vessels
- POSTERIORLY – Ureter and internal iliac vessels
Obturator nerve and vessels are related to lateral surface. - In the ovarian pathology, pain may be shooting down to the knee because of its relation to obturator nerve
- Medial surface is in contact with the terminal part of uterine tube
Peritoneal attachments to the Ovary
SUSPENSORY (Infundibulo-pelvic) LIGAMENT:
* Attached to the upper part of the lateral surface of the ovary.
* It contains the ovarian vessels & nerves.
* Passes superiorly over the external iliac vessels, genito-femoral nerve, ureter and psoas major.
OVARIAN LIGAMENT :
* Attaches the uterine pole of the ovary to the lateral angle of the uterus.
* Contains some smooth muscle cells
* Remnant of gubernaculum
MESOVARIUM:
It is a short peritoneal fold, which attaches the ovary to the posterior layer of the broad ligament.
ARTERIAL SUPPLY OF OVARY:
- Ovarian artery ( a branch of abdominal aorta). The artery reaches the ovary by passing through the suspensory ligament of ovary, mesosalpinx and mesovarium
VENOUS DRAINAGE OF OVARY:
- From the pampiniform plexus the ovarian veins arise. The right ovarian vein ends in the IVC. On the left side the left vein ends in the left renal vein.
LYMPHATIC DRAINAGE OF OVARY:
Pre-aortic and lateral aortic lymph nodes.
NERVE SUPPLY OF OVARY:
supplied by sympathetic nerves; the preganglionic fibres are derived from T10 & T11 segments of
spinal cord.
Referred Pain – Peri-umbilical, lower abdominal wall & supra-pubic region (by T10-T11)
Polycystic Ovary Disease (Stein-Leventhal Syndrome)
- Oligomenorrhoea – infrequent menstruation
- Anovulation – lack of normal regular ovulation
- Infertility
- Hirsutism - or frazonism is the excessive hairiness on women in those parts of the body where terminal hair does not normally occur or is minimal
- Obesity
- Bilaterally enlarged and cystic ovaries
- Excessive secretions of androgens and low levels of FSH
Clinical Correlation of Ovarian torsion
May occur due to an abnormally long mesoovarium and suspensory ligament of the ovary
Clinical Correlation of dysgenesis
Congenital absence of one or both ovaries is found in Turner’s syndrome
Clinical Correlation of Ectopic ovaries
The ovaries may fail to descend into the pelvis or ovary rarely may be drawn downward with the round ligament of the uterus into the inguinal canal or even into the labium majus
There are 4 main parts of the Uterine or Fallopian tube:
- INTRA-MURAL [Pars uterina tubae] – 0.7mm wide, lies within myometrium
- ISTHMUS
- AMPULLA
- INFUNDIBULUM – Funnel-shaped; opens at the abdominal os.
Relations of uterine tube
Within the broad ligament
Below – anastomosis of ovarian and uterine vessels
Below and in front – round ligament of uterus
Below and behind – ligament of the ovary with the ovary
Arterial supply of uterine tube:
Medial 2/3 by uterine artery and lateral 1/3 by ovarian artery.
Venous drainage of uterine tube:
corresponding veins
Lymphatic drainage of uterine tubes:
Most of the tube is drained into the pre-aortic and lateral aortic lymph nodes following ovarian blood vessels.
Intra-mural part drains into superficial inguinal lymph nodes following the round ligament of uterus
Nerve supply of uterine tube:
Sympathetic and parasympathetic through ovarian and uterine plexus (inferior hypogastric plexuses)
Parasympathetic is both from the vagus and pelvic splanchnic nerves.
The sympathetic innervations is from T10 to T12 spinal segments.
Referred pain – Classically described as occurring in the ILIAC FOSSA as a result of local peritoneal irritation.
Uterine tube
Consists of three layers :
A. Mucosa
* It is the innermost layer and is highly folded. Because of these folding sometimes lumen may not be visible.
* The epithelium consists of a single layer of columnar cells with or without the cilia, resting on the basement membrane
* Lamina propria is made up of loose connective tissue with fibroblasts and blood vessels.
B. Muscle coat:
* Made up of inner circular and outer longitudinal layer of smooth muscle fibers. C. Serosa:
* It is the outermost layer with simple squamous epithelium.
What is Tubal pregnancy:
A tubal pregnancy is the commonest variety of Ectopic gestation.
* Ectopic gestations usually end with extrusion through the abdominal ostium or natural death and resorption.
* Occasionally they can continue to expand and rupture through the uterine tube causing severe haemorrhage.
What is Tubal blockage:
- Uterine tubes may be blocked intrinsically or extrinsically by scar tissue.
- Most common causes –
*Inflamation
(SALPINGITIS
Pyosalpinx) - Endometriosis
- Adhesions from the previous
surgery.
The 2 most common methods for assessing tubal patency are: - laparoscopic dye insufflations (LDI)
and - Hysterosalpingography (HSG): is a radiologic procedure to investigate the shape of the uterine cavity and the shape and patency of the fallopian tubes
Relations of the vagina:
Relations of the vagina
The anterior wall –
* Base of the Urinary bladder * Urethra
The posterior wall –
UPPER PART
Covered by peritoneum in the upper part
MIDDLE HALF
Separated from the rectum by recto- uterine pouch of Douglas and also by moderately loose connective tissue (Denonvillier’s fascia)
LOWER PART
Separated by the anal canal by the musculo-fibrous perineal body.
Importance of glycogen content of vagina:
its glycogen content increases after ovulation and diminishes at the end of the cycle.
The glycogen is converted into lactic acid by the fermentative action of the Doderlein’s bacilli.
Blood Supply of the Vagina:
Arterial Supply:
- Vaginal branches of the internal iliac artery.
- They form 2 median longitudinal vessels, the azygos arteries of the vagina
- Internal pudendal, middle rectal, uterine arteries may also contribute to blood supply.
Venous Drainage of Vagina:
- The vaginal veins, one on each side, form lateral plexuses that connect with uterine, vesical & rectal plexuses and drain into internal iliac veins.
NERVE SUPPLY. OF VAGINA:
- The Upper vagina – Upper two third – pain insensitive – pelvic splanchnic nerve (S2,S3,S4)
- The Lower vagina –
– Pudendal nerve (S2,S3,S4)
Sympathetic – L1 and L2
