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MD3002 Week 9 > 1. Female pelvic viscera > Flashcards

1. Female pelvic viscera Flashcards

1
Q

List the female pelvic viscera?

A

Reproductive tract: Ovary, uterine tube, uterus, cervix and vagina
+ Bladder, Rectum and anal canal

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2
Q

Muscles are are found in the lateral pelvic floor and wall

A

Pelvic floor:

  • Levator ani S 3,4. Divided into…
    1. Iliococcygeus
    2. Pubococcygeus

Lateral wall:

  • Puborectalis: Sling around recto-anal junction to aid rectal continence
  • Pubovaginalis: Spincter around vagina, for close and general support of the urogenital organs
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3
Q

Position of the ovary?

A

On lateral pelvic wall in an ovarian fossa in the angle between the internal and external iliac vessels.
Medial to the obturator nerve and the thin wall of the acetabulum**

*Central dislocation of the hip may injure the ovary

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4
Q

Role of ovary?

A

Produces an ovum monthly is response to FSH and LH from the pituitary gland.
Produces oestrogen and progesterone to maintain uterine cycle

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5
Q

Relation of ovary to peritoneum?

A

The peritoneum is absorbed into the ovarian wall, therefore the ovary is truly intraperitoneal i.e. it actually lies inside the peritoneal cavity

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6
Q

Support of the ovary?

A

Hangs off the posterior aspect of the broad ligament on the mesovarium
Is supported by the ovarian ligament and suspensory ligament

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7
Q

What is the suspensory ligament of the ovary?

A

In the broad ligament and carrying the ovarian blood vessels

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8
Q

Relations of the ovarian ligament?

A

In the broad ligament and between the ovary and uterus

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9
Q

Relations of the round ligament?

Remnant of..

A

Is a continuation of the ligament of the ovary. Passes from the uterus and to the labia (through inguinal canal)
Remnant of GUBERNACULUM

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10
Q

Where is the ovum secreted into from the ovary?

Risk?

A

Ovulation into the peritoneal cavity, where the ovum is “picked up” by the fimbriated end of the uterine (Fallopian) tube.
Risk: As the ovum is secreted into the peritoneal cavity, ectopic pregnancy may occur in the peritoneal cavity or in the uterine tube

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11
Q

Position of the ureter in relation to the ovary? Risk?

A

The ureter lies posteriorly and is at risk during surgical procedures on the ovary

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12
Q

Position of the obturator nerve in relation of the ovary? Risk?

A

The obturator nerve lies laterally

Risk: Ovarian disease may cause referred pain to the medial thigh

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13
Q

Vascular supply of the ovary?

A

Ovarian artery from the aorta at L1/2
Ovarian vein: Form a plexus that coalesces into the ovarian vein. The left drains to the left renal vein. The right ovarian vein drains to the IVC

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14
Q

Nerve supply of the ovary?

Referred pain?

A

By symphatic nerves derived from T10/11

Referred pain is to the peri-umbilical region

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15
Q

Ovary lymph drainage?

A

To the para-aortic nodes

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16
Q

Sections of the uterine tube?

A
  1. Ostium surrounded by fimbriae (within peritoneal cavity)
  2. Infundibulum
  3. Ampulla (where fertilisation occurs)
  4. Isthmus
  5. Intramural part through uterine wall
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17
Q 
Uterine tube:
Ligament attachments
Blood supply?
Referred pain?
Function?
A

Ligaments: In the upper, free edge of the broad ligament (mesosalpinx)
Blood supply: From anastomosis between the uterine and ovarian arteries
Referred pain: Lower abdomen
Function: Ovum fertilisation and transport

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18
Q

Uterus structural features?

A

Pear shaped
Thick walled
Muscular

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19
Q

Function of uterus?

A

Central pelvic organ for implantation of the fertilised ovum and growth of the foetus and placenta

20
Q

Muscular support of the uterus from..

A
  1. Levator ani
  2. Perineal body
  3. Perineal membrane
21
Q

The visceral and parietal fasciae meet and fuse as the organs pierce the pelvic floor, forming the….

A

Tendinous arch of the pelvic fascia

22
Q

Facial thickenings on the pelvic floor that form uterine ligaments..

A 
Tendinous arch of PF
\+ 
Lateral ligament of the bladder
\+
Paracolpium, divided into...
- Uterosacral posteriorly
- Transverse cervical / Cardinal ligament (carries uterine artery) laterally
- Pubocervical anteriorly
23
Q

Weakness of the ligaments and of the pelvic floor muscles may lead to ….

A

PROLAPSE

24
Q

Which ligaments hold the uterus anteverted and anteflexed over the bladder?

A

Broad and round ligaments

25
Q

Parts of the uterus?

A

Fundus, body and cervix

26
Q

What are the fornices of the vagina?

Clinical importance?

A

The cervix pushes into the vagina forming the fornices
The posterior fornix is related to the peritoneal recto-uterine pouch of douglas

Clinical:

  • Distensible
  • Foreign bodies may get “lost”
  • Peritoneal cavity may be accessed via the posterior fornix
27
Q

The cervix:
The isthmus of the uterus leads to the _____ os and the narrow _____ of the cervix – about 2.5 cms long, with supravaginal and vaginal parts
The latter opens into the vagina as the external os and has the vaginal _____ around it

A

The isthmus of the uterus leads to the internal os and the narrow cylinder of the cervix – about 2.5 cms long, with supravaginal and vaginal parts
The latter opens into the vagina as the external os and has the vaginal fornices around it

28
Q

Angulation of the:

  1. Cervix and body?
  2. Uterine cervix to vagina?
A
  1. Cervix and body = Anteflexed
  2. Uterine cervix to Vagina = AnteVerted

Retroversion and/or retroflexion may cause back-ache and difficulty in conception

29
Q

Why is the vagina wall distensible?

A

For intercourse and childbirth

30
Q

Vagina blood supply?

A

Anastomosing uterine and vaginal arteries (vesical arteries involved too)

31
Q

Structure of vagina?

A

Angled upwards and backwards
Passes from cervix to vestibule, between labia minora
It’s anterior and posterior walls are in contact with each other, so it takes on an H-shape
Urethra embedded in anterior wall

32
Q

When the vagina passing through levator ani and into the perineum, where it is surrounded by the…

A

Urethral or urethrovaginal sphincter

33
Q

The ureter passes ______ to the uterine artery adjacent to the lateral fornices

A

The ureter passes inferior to the uterine artery adjacent to the lateral fornices

34
Q

Vagina blood supply?

A

Superior vesical
Vaginal
Internal pudendal
Uterine arteri

35
Q

Urethra blood supply?

A

Vaginal

Internal pudental

36
Q

Structural features of females urethra:
Glands?
Journey?
External sphincter?

A

Many small mucous glands and lacunae, para-urethral glands and ducts near orifice

Passes through deep perineal pouch with external sphincter and then perineal membrane

Ext. sph. signet ring, marked anteriorly; other muscle is longitudinal to make shorter, wider urethra during micturition

37
Q

Epithelium of the urethra:

A

Urinary but quickly becomes stratified squamous

38
Q

Bladder and Urethra lymph driange to…

A

external and internal iliac nodes

39
Q

Ovary lymph drainage?

A

Para-aortic nodes

40
Q

Uterus and proximal vagina lymph drainage?

A

Internal iliac nodes

41
Q

Uterine tubes lymph drainage?

A

Para-aortic (also to sup inguinal)

42
Q

Distal vagina and urethra lymph drainage to..

A

Deep and superficial inguinal nodes

43
Q

Sympathetic pre-aortic plexus, boosted by lumbar splanchnics from the sympathetic trunk continues as…

A

sup. hypogastric plexus, which becomes left and right pelvic plexuses, boosted by sacral splanchnics Essentially T12 to L2

44
Q

Nerve supply of ovary and distal uterine tube?

A

Mainly via pre-aortic sympathetic from T10 and 11.

Pain to peri-umbilical region

45
Q

Uterine body and proximal uterine tubes nerve supply?

A

Via branches of the pelvic plexus with the sympathetics mainly from T12 and L1.
Pain= Suprapubic

46
Q

Pain from the uterine cervix and proximal vagina (i.e. structures inferior to the peritoneum, the “Pain Line”) is via ….

A

the parasympathetic pelvic splanchnics (and pelvic plexuses), therefore felt deeply in the pelvis

47
Q

Distal vagina nerve supply?

A

Pudendal nerve

MD3002 Week 9 (10 decks)

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