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Block 5- Kim > Female Reproductive Anatomy > Flashcards

Female Reproductive Anatomy Flashcards

1
Q

Label the parts of the pelvis on the diagram

A
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2
Q

What are the greater and lesser pelvis?

What divides them?

A

Divided by the pelvic inlet (brim)

False (greater) pelvis: lies above the pelvis brim and consists of the abdominal region of the pelvis

True (lesser) pelvis: lies below the pelvic brim- obstetric significance as it provides bony framework for birth canal.

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3
Q

What bones form the pelvic girdle

A

Hip bones x 2

Sacrum

Bound by sacroiliac joints and pubic symphysis

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4
Q

Label the parts of the pelvis on the diagram

A
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5
Q

What structures define the pelvic outlet?

A

Ischeal tuberosities

Pubic symphysis

Coccys

Sacrotuberous ligaments

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6
Q

Where is the pelvic cavity?

A

Lies between the pelvic floor and the pelvic inlet

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7
Q

What is the perineum? What is it divided into?

What do these regions contain?

A

The region below the pelvic floor between the thighs

Can be divided into:

  • Urogenital triangle
  • Anal triangle
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8
Q

Which muscles make up the pelvic floor?

What are their actions?

What is their main innervation

Label them on the diagram

A

Support the pelvic organs, prevent prolapse

  • Levator ani muscles: contract to pull pelvic organs superiorly and anteriorly
    • Ileococcygeus
    • Pubococcygeus
    • Puborectalis: helps to maintain anorectal angle, maintains faecal continence.
  • (Ischeo)Coccygeus:
  • Fascia covering of the muscles

Main innervation: S4

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9
Q

Which structures mark the borders of the perineum?

A

Pubic symphysis

Ischeal tuberosities

Coccyx

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10
Q

What is the surgical/gynaecological perineum?

A

Area between the externa genitalia and the anal canal

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11
Q

At what orientation is the pelvic inlet in an upright individual?

In what direction do the urogenital and anal triangles face?

A

Tilted forward 60° (60 degress to the horizontal)

(ASIS and pubic tubercle lie in the same coronal plane)

Urogenital triangle faces inferiorly (bears the weight of visceral pelvic structures)

Anal triangle faces infero-posteriorly

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12
Q

What are the measurements of the pelvis?

What are the narrowest and widest parts?

A

Narrowest part: true conjugate (pubic symphysis to sacral promontory)

Widest part:

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13
Q

What are the key differences between the shapes of the pelvic girdle in males and females?

A

Female pelvis is adapted for childbirth (gynacoid):

  • Wider
  • Thinner boned
  • More cylindrical pelvic cavity
  • Broad pubic arch
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14
Q

Label the muscles and structures of the pelvis on the diagram

A
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15
Q

What do the levator ani muscles attach to?

A

Tendinous arch on the deep surface of the obturator internus muscle

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16
Q

What is the role of the puborectalis muscle?

A

Contracts to pull rectum anteriorly, reducing the anorectal angle maintaining faecal continence.

Relaxation straightens anorectal angle allowing for defaecation.

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17
Q

Describe the different hiatus in the pelvic floor

A

Urogenital hiatus:

  • Covered by perineal membrane which has openings for urethra and vagina in females.
    • Perineal membrane provides attachment for external genitalia.

Anal aperture

  • Anus passes through
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18
Q

What is the perineal body?

What are its roles?

A

Tough mass of fibres lying between external genitalia and anal canal

  • Provides point of union between pelvic floor muscles and perineal membrane
  • Supports vaginal wall in females
  • Attachment point for anal sphincters
  • Strengthens pelvic floor
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19
Q

What does the perineum contain in males and females?

What does it contain in both sexes?

A

Males:

  • Crura and bulb of penis
  • Urethra
  • Scrotum and testes
  • Bulbourethral glands

Females:

  • Crura of clitoris
  • Bulb of vestibule
  • Labia (majora and minora)
  • Greater vestibular glands

Both sexes:

  • Internal pudendal vessels and branches
  • Pudendal nerve and branches
  • Perineal membrane
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20
Q

What do the urogenital and anal triangles contain?

A

Urogenital triangle:

  • Deep perineal pouch (between perineal membrane and pelvis floor muscles)
  • Superficial pouch (between perineal membrane and superficial perineal fossa)

Anal:

  • Ischoanal fossae: fat filled spaces deep to the pelvic floor either side of the anus
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21
Q

What does the deep perineal pouch contain?

A

Voluntary muscles innervated by the pudendal nerve (S2-S4)

In males it also contains bulbourethral glands (equivalent to greater vestibular glands in females)

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22
Q

Where do the crura of the penis/clitoris attach to?

A

Attach to pubic arch and inferolateral parts of perineal membrane.

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23
Q

Label the parts of the female deep perineal pouch on the diagram

A
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24
Q

Label the parts of the male deep perineal pouch on the diagram

A
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25
Q

In females, what muscles help to stabilise the position of the perineal body?

A

Deep and superficial transverse perineal muscles

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26
Q

Label the parts of the external female genitalia on the diagram

A
27
Q

Label the parts of the external female genitalia on the diagram

Where do the Greater Vestibular (Bartholin’s) glands lie in respect to the vaginal opening?

A

Bartholin’s glands lie at the 5 and 7 o clock position on the vaginal opening when the patient is in the lithotomy position.

28
Q

Name some pathologies that the greater vestibular (Bartholin’s glands) can undergo

A

Can become infected or inflamed or can form cysts or abscesses

29
Q

What structures lie within the female superficial perineal pouch?

Label them on the diagram

A
30
Q

What are the bulb of vestibule and the paired corpora cavernosa?

What are they covered by?

A

Erectile tissues that contribute to the formation of the clitoris

Covered by the bulbospongiosis and ischeocavernosus muscles

31
Q

What provides sensory innervation to both the penis and clitoris?

A

Pudendal nerve (S2-S4)

32
Q

What are the similarities between the female and male external genitalia?

A

Clitoris is an erectile tissue similar to the penis

  • Both have paired corpora cavernosa

Bulb of vestibule in females is similar to corpus spongiosum of the penis

Greater vestibular glands in females are similar to bulbourethral glands in males

Both penis and clitoris receive sensory innervation from the pudenal nerve (S2-S4)

33
Q

What is an episiotomy?

What is the most common type?

What does this cut through?

A

Surgical incisions of the perineum to widen the vaginal opening and facilitate delivery.

Not routinely indicated.

Mediolateral most common, cuts through:

  • Posterior wall of vagina
  • Transverse perineal muscles
  • Perineal membrane
  • Levator ani
  • Perineal skin and subcutaneous tissue
34
Q

What comprises the female reproductive tract?

Where does the majority of it lie?

What does the female reproductive tract link?

A
  • Vagina
  • Cervix
  • Uretus
  • Fallopian tubes
  • Ovaries

Lies mainly within the lesser (true) pelvis with the peritoneum draped over the top.

Links the external environment with the peritoneal cavity

35
Q

What are close anatomical relations of the lateral cervix and uterus?

A

Ureters

36
Q

Label the parts of the female reproductive tract on the image

A
37
Q

What is a potential complication of having the female pelvis organs in close proximity?

A

Pathologies such as infections and cancers can easily involve other organs.

38
Q

What pouches are formed in the pelvis cavity by the peritoneum that lies on top of the female pelvic organs?

Label them on the diagram

Which of these is the most gravity dependent region? What can accumulate here?

A

Vesicouterine pouch: between the uretus and bladder

Rectouretine pouch (of Douglas): between the uterus and rectum

  • Most gravity dependent region in female peritoneal cavity, fluid, blood, pus can accumulate here
39
Q

Describe the sensory innervation to the vagina

What position is it in at rest?

What can prolapse against the vagina and through its walls?

A

Distal vagina innervated by pudendal nerve (S2-S4)

Proximal vagina innervated by pelvic splanchnic nerves (S2-S4)

Walls of the vagina are usually opposed but separate during coitus and parturition.

Structures can prolapse agains the vagina and its walls:

  • Bladder (cystocoele)
  • Rectum (rectocoele)
  • Uterus
40
Q

Which fibres does vaginal pain travel with?

A

Travel with pelvic splanchnic nerves as it is below the pelvic pain line:

  • Distal vagina- somatic sensory nerves
  • Proximal vagina: visceral sensory nerves
41
Q

Label the parts of the female reproductive tract and cervix on the diagram

What is the vaginal fornix?

Which is the deepest fornix?

A

A continuous recess formed from the projection of the cervix into the vaginal vault.

Posterior fornix is deepest due to the angle at which the vagin meets the cervix (travels superiorly and posteriorly)

42
Q

Where is the transformation zone? Where is it?

What is the clinical significance?

A

The region between the internal and externus os within the cervix.

Cells in this region can undergo metaplasia from squamous to columnar and have the potential to become cancerous.

This is the area sampled during cervical screening

43
Q

Where may cervical cancer spread to?

A

Nearby structures such as:

  • Bladder
  • Rectum
  • Ureters
  • Uterus
  • Vagina
44
Q

Label the parts of the uterus on the diagram

What is the uterine cavity lined by? What is this linked to?

What are the layers of the uterus?

A

Uretine cavity lined by endometrium which also lined the uterine (fallopian) tubes

Layers (internal to external):

  • Endometrium
  • Myometrium: thick muscular layer
  • Perimetrium: outer serosal layer
45
Q

What relatively common pathology can occur in the uterus?

A

Fibroids: benign uterine smooth muscle tumours

46
Q

What different positions can the uterus lie in? What provides passive support in this position?

What is the angle of version and the angle of flexion?

What may a fixed retroverted and retroflexed uterus indicate?

A

Uterus is normally in an anteverted and anteflexed position. Passive support in this position by bladder.

Other positions:

  • Anteversion and retroflexion
  • Retroversion and anteflexion
  • Retroversion and retroflexion

Angle of version lies between the vagina and cervix

Angle of flexion lies between the cervix and uterus

Fixed retroverted and retroflexed uterus can indicate pathology e.g. Endometriosis

47
Q

Label the parts of the uterine tube on the diagram

Where do fertilisation and implantation normally take place?

What is the role of fimbriae?

A

Fertilisation usually takes place in the ampulla

Implantation usually takes place in the uterine cavity but can occur ectopically

Fimbriae are part of the infundibulum; they lie over the ovary and aim to recieve fertilised ovum at ovulation and sweep it into the uterine tubes

48
Q

How is the shape and patency of the uterine cavity observed?

A

Hysterosalpingogram

49
Q

What is the most common site for ectopic pregnancy?

What may an ectopic pregnancy in this region lead to?

What can the uterine tubes act as a route for infection spread from? What can this cause?

A

Uterine tubes are most common site of ectopic pregnancy

  • Ectopic pregnancy in the uterine tubes can lead to rupture and a haemoperitoneum.

Uterine tubes can provide a route for infection spread from the vagina. Can cause inflammatory pelvic disease (salpingitis, tubal/tuboovarian abscesses which can lead to increased risk of:

  • Ectopic pregnancy
  • Subfertility
50
Q

What do ovaries develop from? What is this similar to in males? What vertebral level does this occur at?

Where do the adult ovaries sit? What can be impinged by ovarian pathology?

What are the ovaries covered by? What is this continuous with?

A

Ovaries develop from intermediate mesoderm on the posterior abdominal wall (L2) and descend to adult position, as do the testes in males.

Adult ovaries sit suspended by a fold of peritoneum called the broad ligament close to the lateral pelvic wall and obturator nerve which can be impinged by ovarian pathology.

Ovaries are covered by peritoneum which is continuous with its surface epithelium (germinal layer).

51
Q

Where does ovulation take place?

A

Through Germinal layer into Peritoneal cavity

52
Q

What do ovaries take with them when they descend?

Where is their lymph drainage to?

A

Ovaries form on the posterior abdominal wall and take their blood supply and lymph with them when they descend.

Their lymph drainage is therefore to the para-aortic lymph nodes.

53
Q

What suspends the ovary from the posterior aspect of the broad ligament?

What contains the ovarian vessels and lymphatics?

What connects the ovary to the uterus?

Where runs from the uterus to the labia majora? What does this ligament provide a route for?

A

Suspended off the posterior aspect of the broad ligament by the mesovarium.

Ovarian vessels and lymphatics contained in the suspensory ligament of ovary

Round ligament of ovary links the ovary to the uterus

Round ligament of uterus runs from uterus to labia majora via the inguinal canal. Provides a route for uterine cancers to spread to inguinal lymph nodes.

54
Q

What are the round ligaments remants of?

A

The ovarian gubernaculum

55
Q

What is the broad ligament?

A

Double fold of peritoneum that surrounds and supports the uterus, uterine tubes and ovaries.

Has 3 layers:

  • Mesometrium (against uterus)
  • Mesosalpinx (related to uterine tubes)
  • Mesovarian (related to ovaries)
56
Q

How can the approximate size and position be assessed?

How can the uterus and pelvic organs be accessed?

A

Bimanual palpation can be used to approximate size and position of uterus.

Uterus and pelvic organs can be accessed by suprapubic incision

57
Q

What are the different types of hysterectomy?

A

Total abdominal hysterectomy (TAH) – surgical removal of the uterus & cervix via an abdominal incision – also possible to remove it via the vagina (vaginal hysterectomy)

Subtotalhysterectomy – cervix preserved

Radicalhysterectomy – uterus, cervix, associated supporting tissues & lymphatics removed

Bilateralsalpingo-oophorectomy(BSO) – surgical removal of both uterine tubes & ovaries

58
Q

Label the pelvic fascia on the diagram

Where does the pelvic fascia lie?

What is the endopelvic fascia?

A

Pelvis fascia lies below the peritoneum and consists of parietal and visceral parts.

The endopelvic fascia fills the gaps between the visceral and perietal fascia. Usually loose and fatty but in parts is thickened to form supportive ligaments

59
Q

What does the dense endopelvic fascia form?

What is the paracolpium?

Label the structures on the diagram

A

Comes together at the tendinous arch which runs form the pubis to the sacrum.

Forms key parametrial ligaments:

  • Cardinal ligament (transverse cervical): lateral pelvic wall to lateral uterus
  • Sacrocervical (uterocervical): uterus to sacrum
  • Pubocervical: uterus to pubis

Paracolpium is the fascia that supports and surrounds the vagina that connects it to the tendinous arch. Prevents pelvic organs from prolapsing into the vagina.

60
Q

Describe the blood supply to the female reproductive pelvic organs and perineum.

What is the purpose of the anastamotic supply?

A

Majority of the pelvic organs supplied by the internal iliac artery; branches:

  • Uterine artery
    • Vaginal branch of uterine artery
      • Ascending branch
    • Vaginal artery
  • Internal pudendal artery supplies perineum

Ovaries supplied by:

  • Ovarian arteries which branch from aorta

Rich anastamoses between arteries of vagina, uterus, uterine tubes and ovaries allows for large increase in flow needed during pregnancy

61
Q

What is at risk of damage during a hysterectomy?

A

Ureter as it passes below uterine artery lateral to cervix

62
Q

What is the lymph drainage of the pelvic organs?

A

Ovaries, uterine tubes and fundus of uterus: para-aortic lymph nodes.

Body of uterus, cervix and proximal vagina: internal and external iliac lymph nodes & sacral nodes

Distal vagina and external genitalia: superficial and deep inguinal lymph nodes & external iliac nodes

Round ligament of uterus provides route by which parts of the uterus can drain to the superficial inguinal lymph nodes.

63
Q

Describe the innervation of the pelvis organs

How might they be anaesthetised?

A

Uterus, uterine tubes, bladder roof and upper rectum:

  • Visceral sensory nerves travel with sympathetics- lower thoracic/upper lumbar levels (T10-L1/2)
  • Above pelvic pain line
  • Spinal epidural

Cervix and proximal vagina:

  • Visceral sensory neurons travel with parasympathetics (S2-S4)
  • Below pelvic pain line
  • Caudal epidural

Distal vagina:

  • Sensory neurons travel with somatic pudendal nerve (S2-S4)
  • Below pelvic pain line
  • Pudendal nerve block
64
Q

Describe the route of the pudendal nerve

What are its main branches?

What does it supply?

Where can it be impinged?

A

(S2-S4) Passes out of pelvic cavity via greater sciatic foramen and into perineum via lesser sciatic foramen

Somatic sensory:

  • External genitalia
  • Skin of perineum
  • Skin around anus and anal canal

Somatic motor:

  • Levator ani muscles
  • Ischeocavernosus
  • External urethral sphincter
  • External anal sphincter

Block 5- Kim (12 decks)

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