Week 5.0 - Female reproductive tract Flashcards
What is the gubernaculum?
- Structure in both males and females which tethers the gonads to the labialscrotal folds
- Becomes round ligament of uterus in women
Describe the arterial supply and venous drainage of the ovary
- Arterial supply directly from abdominal aorta
- Venous drainage R ovarian vein -> IVC L ovarian vein -> L renal vein -> IVC
Name the parts of the uterus
- Fundus
- Body
- Cervix
Which part of the uterus can be palpated during pregnancy?
-Fundus
Name the pouches of the pelvis, relative to the uterus
- Uterovesicle pouch anteriorly
- Rectouterine pouch (pouch of douglas) posteriorly
Why are the peritoneal pouches of clinical significance?
-Fluid can collect here
Describe the descent of the ovary
- Gonads develop within urogenital ridge on posterior abdominal wall
- Descend through abdomen behind peritoneum
- Stop in the pelvis as physically obstructed by developing paramesonephric ducts
Describe the development of the uterus and uterine tubes
- Paramesonephric ducts begin to develop and they open into the peritoneum cranially and attached to the urogenital sinus caudally
- In the absence of MIH they ducts grow towards each other and fuse in the midline
- This forms the uterus which is covered by broad transverse fold of peritoneum as it pulls it with it
What is the broad ligament? Describe its sections
- Mesentery of the uterus, uterine tube and ovary which attaches them to the side walls and floor of the pelvis
- Formed by a transverse fold of peritoneum which contains the uterine tubes and ovarian vessels
- Mesometrium is the section covering the uterus
- Mesosalpinx is the section covering the uterine tube
- Mesovarium is the segment covering the ovary
Why is it important that the broad ligament is mobile?
-Allows mobility so ovary catches gamete
What is the round ligament?
- Remnant of the gubernaculum
- Attaches ovary to labia majora via the inguinal canal
- Round ligament of the ovary from ovary to reflect of sidewall of uterus where it becomes round ligament of uterus
In which ligament are the uterine vessels?
-Broad ligament
What is the suspensory ligament?
- Fold of peritoneum which extends from the ovary to the side wall of the pelvis (extension of broad ligament)
- Contains ovarian vessels, nerves and lymphatics
In what position does the uterus lie?
- Anteverted (with respect to vagina)
- Anteflexed (with respect to cervix)
Name the sections of the uterine tube
- Abdominal ostium
- Fimbrae
- Infundibulum
- Ampulla
- Isthmus
What is the function of the uterine tube?
- Conduct the oocyte into uterine cavity
- Site of fertilisation
Why is it significant that the lining of the uterine tube is different to the lining of the uterine cavity?
-Ectopic implantation can lead to severe haemorrhage due to lack of decidual cells to monitor implantation and closely associated with many vessels
Why is it clinically significant that the peritoneal cavity is open to the vagina?
-Spread of infection
Describe the main features of the cervix
- Internal os
- Endocervical canal
- External os
- Anterior, posterior and lateral fornices
How is the pouch of douglas accessed?
-Through the posterior fornix (culdocentesis)
What is the main support of the pelvic viscera?
- Transverse cervical ligament -> tickening at base of broad ligament to give the viscera lateral stability
- Uterosacral ligament-> opposes pull of round ligament and assists in maintaining anteversion
Name the main arteries supplying the female internal genitalia
- Ovarian artery (br abdo aorta)
- Uterine artery (ant Internal iliac)
- Vaginal artery
- Internal Pudendal artery (ant internal iliac)
- Many anastamoses between arteries to ensure rich vascular supply
Describe the anatomical relationship between the ureter and the uterine vessels
Why is this clinically significant?
- The ureter passes posteriorly to the uterine arteries
- Important in a hysterectomy not to ligate the ureter
Describe the lymphatic drainage of the uterus
-aortic (fundus), external and internal iliac nodes (body), sacral nodes and inguinal nodes (cervix)
(reflects everything it passes during development)
What is the lympatic drainage of the ovary?
-Paraaortic nodes
What glands are within the vestibule of the vagina?
- Greater vestibular glands (bartholin glands)
- Lesser vestibular glands
Name two common clinical problems occuring with greater vestibular glands
- Bartholinitis
- Bartholin gland cyst
What is a cervical fornix?
-Recess of vagina around the cervix
Describe the innervation of the uterus and vagina
- Inferior 1/5 vagina recieves somatic innvervation from pudendal nerve
- Superior 4/5 vagina and uterus receives innervation from uterovaginal plexus
What is the pelvic pain line? What is its clinical significance during child birth?
- Anything touched by the peritoneum is said to be above the pelvic pain line anything inferior is below
- Above pain fibres are carried by lumbar splanchnics and below pain fibres are carried by sacral splanchnics along with pudendal nerve which innervates external genitalia
- Pudendal nerve block = external genitalia only -> birth canal pain still present
- Epidural = will numb everything below pelvic pain line -> uterus above ppl so will still feel contractions
- Spinal block will stop all feeling
Describe the innveration of the perineum
-Pudendal nerve and ilioiguinal nerve
Describe the course and distribution of pudendal nerve
- Exits pelvis via greater sciatic foramen
- Enters perineum by lesser sciatic foramen
- Travels through pudendal canal
