Uterus Flashcards
Parts of uterus:
- Fundus
- Body
- Cervix
Position of fundus:
- The fundus is superior to the entry point of the uterine tubes.
- The dome like fundus is covered by peritoneum and is directed
forwards when the bladder is empty - Fertilized ovum is usually implanted in the posterior wall of the fundus
BODY OF FUNDUS–
2 Surfaces–
* Anterior surface (Vesical surface)
Covered by the peritoneum which is reflected onto the bladder as the uterovesical fold.
* Posterior surface (Intestinal surface)
Its
peritoneal covering continues down to the cervix and upper vagina and is then reflected back to the rectum to form the recto- uterine pouch (of Douglas).
*2 lateral borders – gives attachment to broad ligament of uterus.
BODY OF CERVIX:
2 parts – SUPRA-VAGINAL PART
* Anteriorly – urinary bladder
* Posteriorly – rectouterine pouch with coils of intestine and rectum
* On each side – ureter and uterine artery
VAGINAL PART.
The vaginal part of the cervix projects into the vaginal cavity forming grooves around its perimeter termed VAGINAL FORNICES
What is Vaginal part of the cervix:
-Projects into the vagina and forms the vaginal fornices
-Cervical canal opens into the vagina through external os
-The upper end of cervical canal communicates with the uterine body via the internal os and the lower end opens into the vagina at the external os.
FALSE LIGAMENTS (peritoneal folds):
they are mere peritoneal folds which do not provide any support to the uterus:
* Utero-vesical fold [anterior false ligament]
* Recto-vaginal fold [posterior false ligament]
* Recto-uterine fold
* A pair of BROAD LIGAMENTS
SUPPORTS OF THE UTERUS:
PRIMARY SUPPORT:
* Pelvic diaphragm – levator ani & coccygei
* Perineal body – fibromuscular mass in the midline of the perineum
* Urogenital diaphragm - sphincter urethrae along with deep transverse perineal muscles.
SECONDARY SUPPORT:
True ligaments – having a fibrous composition
1. Round ligament of uterus [ligamentum teres
uteri]
2. Mackenrodt’s ligament [transverse cervical ligament]
3. Utero-sacral ligament
4. Pubo-cervical ligament
What are True ligaments :
- Round ligaments of uterus
functionally pulls the fundus forwards and maintains the anteversion and anteflexion of the uterus - Mackenrodt’s ligaments
* It keeps the cervix in position and prevents the downward displacement of uterus through the vagina – hence called cardinal ligament of uterus
* Tightening of this ligament is commonly employed in surgical repair of the prolapse of the uterus - Utero-sacral ligaments
* The ligaments pull the cervix backwards and help in the maintenance of anteversion and anteflexion - Pubo-cervical ligaments
* Ligaments pull the cervix forwards.
Blood supply of uterus:
Arterial supply:
Uterine artery – branch of anterior
division of internal iliac artery
* After crossing the ureter the uterine artery gives ureteric, vaginal and cervical branches.
* Along the side of the body of uterus it gives branches to the body of the uterus
* Along side the fallopian tube it gives off tubal branches and few ovarian branches
Ovarian artery – branch of abdominal aorta at the level of L1
Venous drainage of uterus:
Drains into systemic veins via uterine & ovarian veins
Uterine veins communicate with superior rectal vein establishing porto-caval anastomosis
LYMPHATIC DRAINAGE OF UTERUS:
From fundus and upper part of the body
Pre and Para-aortic lymph nodes
along the ovarian vessels
From the lateral angles (cornua) –
superficial inguinal lymph nodes
From the lower part of the body External iliac lymph nodes
From the CERVIX –
Laterally – external iliac &
Obturator lymph nodes
Postero-laterally – Internal iliac nodes
Posteriorly – Sacral lymph nodes along with the utero-sacral ligaments
Nerve supply of uterus:
Sympathetic – Vasoconstrictor and produce uterine contraction. * T12 – L1.
Parasympathetic – Vasodilator and uterine inhibitor.
* S2,S3,S4
Development of uterus :
- Uterus develops from fused portion of the paramesonephric duct
In a non-pregnant woman the cyclical activities are divided into 3 phases :
—Proliferative (follicular) phase:
* During this phase the epithelium consists of single layer of columnar cells.
* In the lamina propria there are many simple tubular uterine glands lined by simple columnar epithelium.
* The deeper part of endometrium shows cut section of these glands and coiled arteries.
* The connective tissue stroma between the glands is made up of fibroblasts and reticular fibres.
—Secretory phase:
* During this period endometrium becomes much thicker because of secretion of glands and oedema of uterine stroma.
* Glands in the lamina propria continue to grow in size, become tortuous and develop saculations.
* The basal part of glandular cells is filled with glycogen and nuclei are shifted towards apical side.
* The convolutions of tortuous arteries continue and extend up to superficial part of endometrium.
* During this phase the endometrium can be divided into three parts - Stratum compactum (Superficial part), Stratum spongiosum (Middle part) and Stratum basale (Deep part)
—Menstrual phase:
* In this phase the glands of the endometrium stop secreting
* The spiral arteries constrict and the superficial part of the endometrium undergoes necrosis
* The stratum functionalis part of endometrium is shed off and inner wall of the uterus is covered by blood clot. The basal 1/3 with straight arteries remains.
Uterus
Presence of 3 layers :
–A. Endometrium:
* It is the innermost layer of the uterus.
* It undergoes monthly cyclic structural changes starting from puberty till menopause.
* It is divisible into a basal 1/3 (stratum basale) and superficial 2/3 (stratum functionalis), which under goes cyclical changes.
—B. Myometrium:
* Thickest layer made up of 3 layers of smooth muscle fibers
* They are outer and inner longitudinal layers, which are thinner and middle circular
layer, which is thicker.
* Between the fibers there is connective tissue with blood vessels.
—C. Serosa:
* It consists of single layer of squamous cells.
What is ENDOMETRIOSIS:
ENDOMETRIOSIS —- Presence of endometrial tissue outside the uterus. – Theexactcauseforendometriosisisunknown
– SITES of ENDOMETRIOSIS:
* Ovaries
* Pelvic peritoneum
* Uterine ligaments
* Rectovaginal septum * Laparotomy scars
* Appendix
* Umbilicus
* Hernial sacs
When endometriosis occurs in the pelvis, women develop painful periods and painful intercourse.
When endometriosis occurs in the ovary, a cyst of endometrial tissue, an endometrioma, can occur. These are sometimes called chocolate cysts because they contain old blood from repeated monthly haemorrhage into the cyst.
WHat are LEIOMYOMATA (FIBROIDS) ?
Benign tumours of myometrial cells are called LEIOMYOMATA (FIBROIDS)
* 3 variety – submucous, subserous,
intramural
* Submucous fibroids increase the surface area of the endometrium and can result in heavy menstrual bleeding.
* Most women have no symptoms from their fibroids but occasionally they can get pain as well as excessive menstrual blood loss.
* Large fibroids can cause pain in pregnancy and can also obstruct labour.
Risk factors for cervical cancers
HPV – Human Papilloma Virus (80-90%)
Behavioral & sexual factors
Multiple sexual partners
Oral contraceptives
Early sexual activity
Smoking
Multiparity
