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Gross III Final > Uterus > Flashcards

Uterus Flashcards

1
Q

What is the uterus?

A

Thick walled, pear shaped muscular organ of gestation located in lesser pelvis

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2
Q

What general structures make up the uterus?

A

Body and Cervix

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3
Q

What structures make up the body of the uterus?

A

uterine cavity, uterine horns, fundus, isthmus

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4
Q

What is the body of the uterus?

A

Freely movable superior 2/3 of uterus

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5
Q

What are the surfaces of the body (uterus)?

A

Vesical surface- adjacent to urinary bladder

Intestinal surface- adjacent to rectum

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6
Q

What is the uterine cavity?

A

narrow, slit like lumen about 6cm in length

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7
Q

What are the uterine horns?

A

superolateral origins of uterine tubes

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8
Q

What is the fundus?

A

rounded part of body superior to the uterine horns

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9
Q

What is the isthmus?

A

short, constricted region just superior to cervix

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10
Q

What is the cervix?

A

Cylindrical inferior portion of uterus protruding into vagina

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11
Q

What is the cervix divided into?

A

Supravaginal and Vaginal part

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12
Q

Where is the Supravaginal part of the cervix?

A

between the isthmus and vagina

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13
Q

What is the supravaginal part of the cervix separated from the rectum by?

A

posteriorly by rectouterine pouch

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14
Q

Where does the vaginal part of the cervix protrude and what is it surrounded by?

A

Protrudes into vagina and surrounded by vaginal fornix

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15
Q

What structures are located within the vaginal part of the cervix?

A

internal os, external os and cervical canal

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16
Q

what is the internal os?

A

internal opening to uterine cavity of isthmus

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17
Q

What is the external os?

A

external opening to the vagina

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18
Q

What is the cervical canal?

A

spans cervix from internal os to external os

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19
Q

How is the adult uterus oriented, relative to the vagina?

A

anteverted

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20
Q

How is the adult uterus oriented, relative to the cervix?

A

anteflexed

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21
Q

What does the uterine body normally lie on/is supported by?

A

urinary bladder

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22
Q

T/F: The uterine position doesn’t change as urinary bladder and/or rectum fill?

A

False, moves for both

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23
Q

Histological layers of the uterus?

A

perimetrium, myometrium and endometrium

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24
Q

What is the perimetrium layer of the uterus?

A

Thin outer serosal covering

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25
Q

What is the myometrium?

A

Thickest layer comprised of irregularly arranged smooth muscle
-Changes drastically during pregnancy (but not during menstrual cycle)

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26
Q

What is the endometrium?

A

thins mucosal lining; site of blastocyst implantation

-Changes dramatically during each menstrual cycle

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27
Q

What are the ligaments of the uterus and ovaries?

A 
Broad lig. of the uterus
Round lig. of uterus
Ovarian lig.
Suspensory lig. of ovary
Cardinal lig.
Uterosacral lig.
Pubocervical lig.
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28
Q

What is the Broad lig. of the uterus?

A

Double layer of peritineum that helps hold uterus in place

  • anterior lamina borders vesicouterine pouch
  • posterior lamina borders rectouterine pouch
29
Q

Are the anterior and posterior lamina of the broad lig. of the uterus continuous at some point?

A

Yes, continuous with each other over free edge of uterine tubes

30
Q

Where does the broad lig. of the uterus extend? and what does it form?

A

extends form lateral wall of uterus to lateral walls and floor of pelvis (this isn’t misspelled, so leave me alone)
- Froms a transverse septum in pelvic cavity

31
Q

What are the portion of the Broad lig. of the uterus?

A

Mesometrium, mesovarium and mesosalpinx

32
Q

What is the mesometrium?

A

large section of the broad l. lateral to uterus

33
Q

What is the mesovarium?

A

Extension of broad l. forming mesentery of overy

34
Q

what is the mesosalpinx?

A

Extension of broad l. forming mesentery of uterine tube

35
Q

What is the round lig.?

A

Attaches anteroinferiorly to uterotubal junction (uterine origin is between layers of Broad l.)
-Passes through inguinal canal to insert into labium majus

36
Q

What structure is the adult remnant of the inferior part of the gubernaculum? (in women, duh)

A

Round lig. of the uterus

37
Q

What is the ovarian lig.?

A

Spans from uterus to ovary

  • attaches posteroinferiorly to uterotubal junction
  • uterine origin is between layers of broad l.
38
Q

What is the adult remnant of the superior part of the gubernaculum? (once again in women…..)

A

Ovarian lig.

39
Q

What is the suspensory l. of the ovary?

A

superior extension of broad lig. toward abdomen

surrounds neurovascular elements supplying ovary

40
Q

What is the cardinal lig.?

A

Extend from cervix and lateral fornix of vagina to lateral walls of pelvis
-Located along inferior margins of broad lig.

41
Q

What is the uterosacral lig.?

A

Pass superoposteriorly from sides of cervix to middle of sacrum
-Tension here is possibly responsible for anteversion of uterus

42
Q

Is the uterosacral lig. palpable via digital rectal exam?

A

yes

43
Q

what is the pubocervical lig.?

A

Extends from posterior surface of pubic bones to cervix

44
Q

How is uterine position maintained?

A

by the ligaments and support from pelvic diaphragm

45
Q

Uterine prolapse is inhibited by what?

A

position of uterus overlying urinary bladder

46
Q

When would prolapse be more likely?

A

if uterus were in same vertical plane as vagina

47
Q

What does prolapse mean? (for those of us that don’t spend there life in a medical dictionary)

A

to fall out of place

48
Q

What is a caudal epidural block?

A

Anesthetic administered in advance of actual delivery

49
Q

How is a caudal epidural block administered?

A

via in-dwelling catheter in sacral canal

-enables additional anesthetic to be administered as necessary

50
Q

Which nerve roots are anesthetized via a caudal epidural block?

A

nerve roost of S2-S4

-anesthetizes fibers in Pudendal n. plus uterus and upper vagina

51
Q

Are women aware of uterine contractions with a caudal epidural block?

A

yes, but doesn’t experience most of the pain

52
Q

Are spinal headaches associated with caudal epidural blocks?

A

No, because vertebral epidural space is not continuous with cranial epidural space

53
Q

What is a pudendal n. block?

A

Anesthetic injected near pudendal n. where it passes over ischial spine

  • effects S2-S4 dermatomes (majority of perineum and lower vagina)
  • additional anesthetic may be re-administered if necessary
54
Q

Does a pudendal n. block anesthetize sensation of uterine contractions from the uterus and upper vagina?

A

No

55
Q

What is a hysterectomy?

A

Excision of the uterus

-may be performed through abdominal wall or vagina

56
Q

Relationships between uterus anteriorly?

A

Associated with vesicouterine pouch and superior surface of urinary bladder
-supravaginal part of cervix separated from urinary bladder by loos CT

57
Q

Relationships between uterus posteriorly?

A

associated with rectouterine pouch and anterior surface of rectum
-loops of ilium may fill rectouterine pouch

58
Q

Relationships between uterus laterally?

A

Anchored to lateral pelvic wall by broad lig. and cardinal lig.
-Ureters pass slightly superior to the vaginal fornix

59
Q

What is the arterial supply to the uterus?

A

Uterine a. (branch from internal iliac a.)

-Ovarian a. and vaginal a. anastomose with uterine a.

60
Q

What is the venous drainage of the uterus?

A

uterine venous plexus drains to internal iliac v.

61
Q

What is the lymphatic drainage of uterus?

A
  • Fundus drains primarily to lumbar plexus
  • Body drains through broad lig. to external iliac nodes
  • Cervix drains to either internal iliac or sacral lymph nodes
62
Q

What is the innervation to the uterus?

A

Uterovaginal plexus that travels with uterine a. at base of broad lig.
-extension of inferior hypogastric plexus

63
Q

What are the sympathetics and parasympathetics supplied by?

A

sym- lumbar splanchnic n.

para- pelvic splanchnic n. (S2-S4)

64
Q

What do the visceral afferents follow?

A
  • afferents form body/fundus –> follow sympathetics (lumbar splanchnic n.)
  • afferents from cervix follow parasympathetics (pelvic splanchnic n.)
65
Q

General anesthesia

A

Not commonly used except in emergency procedures

  • renders woman unconscious and unaware of labor and delivery
  • childbirth occurs passively under control of maternal hormones
  • clinicians monitor and regulate maternal respiration and maternal respiration and maternal/fetal cardiac function
66
Q

Regional anesthesia

A

Allows woman to participate in child birth by assisting contractions
-Reduces exposure to pain of labor and child birth

67
Q

What is a spinal block?

A

anesthetic agent introduced into subarachnoid space at L3/L4

  • anesthetizes everything inferior to waist including perineum, pelvic floor, birth canal, uterine pain sensations, motor/sensory of lower limbs
  • difficult of impossible to re-administer if labor is long
68
Q

Is electronic monitoring of contractions necessary for spinal blocks?

A

yes, required

69
Q

What is an issue with spinal blocks?

A

The anesthetic stays in lower spinal subarachnoid space when sitting/upright, but when lying flat, the anesthetic circulates to cranial cavity commonly resulting in severe headaches

Gross III Final (15 decks)

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