Week 2 - The Female Reproductive System and Breast Flashcards
The female reproductive system lies within which two areas of the body?
The pelvic cavity and perineum
Which aspects of the female reproductive system lie within the pelvic cavity?
Ovaries, uterine tubes, uterus and superior part of vagina
Which aspects of the female reproductive system lie within the perineum?
Inferior part of the vagina, perineal muscles, Bartholin’s glands, clitoris and labia
The inferior part of the parietal peritoneum forms what?
The floor of the peritoneal cavity and the roof over the superior pelvic organs
The inferior part of the parietal perineum forming a roof over the pelvic organs allows the formation of what structures?
Vesico-uterine and recto-uterine pouches
Excess (abnormal) fluid in the peritoneal cavity tends to collect where? Why?
The pouch of Douglas (rectouterine pouch) - this is the most inferior part of the peritoneal cavity in the anatomical position
Fluid collection in the pouch of Douglas can be drained how? What is this process known as?
A needle gets passed through the posterior fornix of the vagina, this is known as culdocentesis
What is the broad ligament of the uterus formed of?
A double layer of peritoneum
Where does the broad ligament extend between?
The uterus, and the lateral walls and floor of the pelvis
What is the function of the broad ligament?
Helps to maintain the uterus in its correct midline position
What is contained within the broad ligament?
The uterine tubes and the proximal part of the round ligament
The broad ligament is divided into 3 parts. What is the part that covers the uterine tubes known as?
Mesosalpinx
The broad ligament is divided into 3 parts. What is the part that covers the ovary known as?
Mesovarium
The broad ligament is divided into 3 parts. What is the part that covers the uterus known as?
Mesometrium
Which ligament of the uterus is an embryological remnant?
Round ligament
Which aspect of the uterus does the round ligament attach to?
Lateral
The round ligament passes through which structure to attach to the superficial tissue of the female perineum?
Deep inguinal ring
Proximally, the round ligament is contained within what?
The broad ligament
What are the 3 layers of the uterus from outer to inner?
Perimetrium, myometrium, endometrium
Implantation of a zygote occurs where?
In the body of the uterus
What are the 3 structures which form the support to hold the uterus in place?
Strong ligaments, endopelvic fascia, muscles of the pelvic floor
What is the most common position for the uterus to be in?
Anteverted (cervix tipped anterior relative to the axis of the vagina) and anteflexed (uterus tipped anterior relative to the axis of the cervix)
If the uterus is in the correct position, the mass of the uterus should be lying over what structure?
The bladder
Is it normal for the uterus to be retroverted and retroflexed?
Yes, this is a form of normal variation
What specific area of the cervix must always be sampled during a cervical smear?
The squamo-columnar junction (transformation zone)
Where in the uterine tubes does fertilisation occur?
The ampulla
The fimbriae at the ends of the uterine tubes open into where? What is the clinical significance of this?
They open into the peritoneal cavity, meaning that infection can pass between the two areas
Which hormones do the ovaries secrete?
Oestrogen and progesterone
Where do the ovaries develop? Where do they move to after this?
They develop on the posterior abdominal wall and then move onto the lateral wall of the pelvis
The descent of the ovaries during development leads to the formation of what structure?
Round ligament
Which structures of the female reproductive tract, located in the pelvis are not covered in peritoneum?
The ovaries and the fimbriae of the uterine tubes
The walls of the vagina are usually collapsed, apart from where? What does this form?
Superiorly, the cervix holds them apart forming a fornix
What are the 4 parts of vaginal fornix?
Anterior, posterior and 2 lateral
On vaginal examination, what bony structures can be palpated at the 4 and 8 o clock positions?
Ischial spines
How do you feel the ovaries and uterine tubes on vaginal examination?
By placing fingers into the lateral fornix and the pressing deeply on the iliac fossa of the same side with the other hand
What is the perineum?
The shallow space between the pelvic diaphragm and the skin
Perineal muscles are divided into superficial and deep and are supplied by what nerve?
Pudendal nerve
What is the perineal body?
A bundle of collagenous and elastic tissue into which the perineal muscles attach
What is the function of Bartholin’s gland?
Produces mucus for lubrication
What type of muscle is levator ani?
Skeletal (voluntary)
What is the function of levator ani?
Provides support for pelvic organs, contracting during situations of raised intra-abdominal pressure
What nerve supplies the levator ani?
Nerve to levator ani (S3, 4, 5)
The bed of the breast extends to and from where in a superior-inferior direction?
Rib 2 - rib 6
The bed of the breast extends to and from where in a medial-lateral direction?
Lateral border of the sternum to the mid-axillary line
The breast lies on deep fascia which covers which muscles?
Pectoralis major and serratus anterior
What are the spaces which lie between the fascia and breast known as?
Retromammary spaces
The breast is firmly attached to the skin via what? These structures are orientated towards where?
Suspensory ligaments, orientated towards the areola
Which hormone produces breast milk? Which hormone ejects breast milk?
Prolactin / oxytocin
What are the 4 quadrants of the breast known as?
Upper outer, upper inner, lower outer and lower inner
To assess whether or not a breast lump is fixed, you should get the patient to place their hands on their hips to contract which muscle group?
Pectoral muscles
Most lymph from the breasts drains to where? And then where?
Ipsilateral axillary nodes and then to supraclavicular nodes
Lymph from which breast quadrants can drain ipsilaterally or contralaterally?
Inner quadrants
Lymph from the lower inner breast quadrant can also drain to where?
Abdominal nodes
Level 1 axillary nodes are found where?
Inferior and lateral to the pectorals minor
Level 2 axillary nodes are found where?
Deep to the pectorals minor
Level 3 axillary nodes are found where?
Superior and medial to the pectoralis minor
What separates the pelvic cavity from the perineum?
Levator ani
What is removed in a bilateral salpingo-oophorectomy?
Both uterine tubes and ovaries
What is removed in a unilateral salpingectomy?
One uterine tube
What is the anal triangle filled with?
Fat and blood vessels
What vessel supplies the medial aspect of the breast?
Internal thoracic (mammary) artery
What vessel supplies the lateral aspect of the breast? What is this a branch of?
Lateral thoracic artery, a branch of the axillary artery
What vessels supply the deep aspects of the breast?
Intercostal arteries
What vessels are responsible for draining blood from the breast?
Internal thoracic (mammary), lateral thoracic and intercostal veins
What is significant about intercostal veins draining blood from the breast when there is a cancer?
These veins go back to the thorax and so can cause cancer to spread into the thoracic spine
