Pelvic Viscera II

Question 1

What is the uterus?

Answer 1

Hollow organ with thick muscular wall

Parts:

Fundus - superior entrance of uterine tubes

Body

Cervix - connects to vagina

Question 2

What is the normal anatomical position of the uterus?

Answer 2

Horizontal with fundus pointing anteriorly

Anteversion and Anteflexion

Abnormal position occurs in approximately 25% of women, can be associated with dyspareunia and dysmenorrhea

Question 3

Describe the peritoneal covering of the uterus?

Answer 3

Peritoneum covers uterus except at cervix, where is is reflected onto superior surface of bladder

Question 4

What is the vesicouterine pouch?

Answer 4

Floor of the peritoneal reflection from cervix to bladder

Question 5

What is the rectouterine pouch?

Answer 5

Peritoneal reflection from rectum to upper part of vagina and uterus

Question 6

What is the Broad ligament of the uterus?

Answer 6

Two-layered lateral reflection of peritoneum from the uterus to the lateral pelvic wall

Divided into four parts

Mesometrium, mesovarium, mesoalpinx, suspensory ligament of the ovary

Question 7

What are the contents of the broad ligament of the uterus?

Answer 7

Uterine tube

Round ligament of uterus

Round ligament of the ovary

Uterine artery and vein

Terminal branches of ovarian artery and vein

Question 8

What is the uterine artery?

Answer 8

Courses medially from internal iliac, enters broad ligament, crosses superior to ureter at level of cervix

During hysterectomy, ligate the artery but do not clamp underlying ureter

Has a vaginal branch

Question 9

Describe the lymphatic drainage from the uterus.

Answer 9

Fundus - Drain to lumbar (para-aortic) nodes

Body and cervix - iliac lymph nodes

Question 10

What are the ligaments of the cervix?

Answer 10

Condensations of endopelvic fascia on superior surface of pelvic diaphragm

Stretching of ligaments during childbirth may contribute to prolapse

Ligaments: Cardinal, Vesicouterine, Uterosacral

Question 11

What is prolpase of the uterus?

Answer 11

Downward movement of uterus resulting in cervix protruding into or through vaginal orifice

Adjacent organse bulge against walls of vagina

Cystocele - bladder

Rectocele - rectum

Question 12

What are the parts of the uterine tubes?

Answer 12

Infundibulum - near ovary, has fimbria

Ampulla - middle, fertilization normally takes place here

Isthmus - medial to ampulla

Uterine part

Question 13

What is the blood supply and lymphatic drainage of the uterine tubes?

Answer 13

Uterine and ovarian arteries

Lymphatics to lumbar and internal iliac nodes respectively following arteries

Question 14

What is the mesosalpinx?

Answer 14

Part of broad ligament immediately inferior to uterine tube

Question 15

What are the complications associated with blockage of the uterine tube?

Answer 15

Major cause of infertility

Result of adhesions from healed infections

Ectopic tubal pregnancy can result if fertilization occurs

Question 16

What is Hysterosalpingography?

Answer 16

Radiography of uterus and uterine tubes following injection of radiopaque material to determine patency of uterine tube

Question 17

What are the ovaries?

Answer 17

Almond-shaped gonads

Fibrous capsule, tunica albuginea

Normally found in ovarian fossa on lateral wall of pelvis

Diseased ovary can affect obturator nerve, resulting in medial thigh pain

Question 18

What is the mesovarium?

Answer 18

Two-layered reflection of peritoneum from posterior layer of broad ligament of uterus to ovary

Contains ovarian neurovasculature

Question 19

What is the suspensory ligament of the ovary?

Answer 19

Superior-lateral most part of braod ligament lateral to attachment of ovary by mesovarium

Contains ovarian neurovasculature

Question 20

What is the blood supply to the ovaries?

Answer 20

Ovarian arteries that arise from aorta at L2

Cross over external iliac to enter suspensory ligament

Clinical* - don’t ligate ureter at same location during ovariectomy

Question 21

Describe the ovarian venous drainage

Answer 21

Drain to IVC on right

Drain to left renal vein on left

Question 22

Where do lymphatics from the ovary drain?

Answer 22

Lumbar lymph nodes

Question 23

What is the fornix of the vagina?

Answer 23

part of vaginal lumen which surrounds servix

Divided into four regions

Anterior, posterior and two lateral fornices

Question 24

What structures are located anterior to the vagina?

Answer 24

Cervix, posterior surface of bladder, urethra

Question 25

What structures are located posterior to vagina?

Answer 25

Rectouterien pouch

Rectum ampulla

Perineal body

Question 26

What is the importance of the relation of posterior fornix to rectourterien pouch?

Answer 26

Provides route of access for drainage of infected peritoneal fluid

Culdocentesis

Question 27

Describe the vascular supply and lymph drainage to the vagina

Answer 27

Vaginal artery formes from vaginal branch of uterien artery

Lymphatics - external and internal iliac nodes