Session 2: Case Studies Flashcards
Explain how infection may spread to the peritoneum from the female reproductive tract.
Because the site of where fimbrae and ovary meet is open to the peritoneal cavity.
Infection can start in vesico-uterine pouch or recto-uterine pouch (Pouch of Douglas).
What may be the consequence of infection in the uterine tubes?
Formation of scar tissue and formation of adhesions. These adhesions can make it hard for the zygote to travel to the uterus and might cause the zygote to implant into the fallopian tube wall causing an ectopic pregnancy.
A 25 year old woman presents with abdominal pain and per vaginal bleeding.
What questions would you want to ask this lady to make a list of differentials?
Sexual active? Contraceptive? Pregnant? Quality, radiation and location of pain. Any other sickness Abroad? Other symptoms? How much bleeding? Vaginal bleeding common?
What histological structures of the fallopian tube facilitates transport of the ovum towards the uterus?
Mainly the ciliated cells which propels the ovum forwards.
Give some sites of ectopic implantation.
Ampulla of fallopian tube (most common)
Isthmus
Infundibulum
Intra-abdominal
Where in the abdomen would pain be felt with an ectopic prengancy implanted in the ampulla of the uterine tubes?
In the left or right iliac fossa as a localised pain.
Explain why pain may be felt at the shoulder tip following rupture of an ectopic pregnancy.
Fluid can accumulate to irritate the diaphragm and therefore the phrenic nerve with nerve roots C3,4,5.
These nerve roots also supply shoulder and can be fooled causing the patient to feel pain in shoulder tip.
Why ectopic pregnancy an emergency?
Because the network of the ovarian arteries which surrounds the fallopian tube can rupture as the embryo grows and cause internal haemorrhage.
What investigations might you want to request?
Pregnancy test
Serum HCG.
What are the normal angles of the uterus in relation to the vagina canal called?
Anteflexion and anteversion.
Explain anteflexion.
Less than 180 degrees between the line of the uterus and line of the cervical canal.
Explain anteversion.
Less than 180 degrees between the line of the cervical canal and the line of the vaginal canal.
What other positions can the uterus adopt?
Retroflexion and retroversion if the angle is more than 180 degrees.
What are the anatomical relations of the vagina:
Anteriorly
Posteriorly
Laterally
Anteriorly: Bladder
Posteriorly: Rectum
Laterally: Levator ani and ureter as well as the pelvic side walls.
Explain why the ureter is in danger of being damaged during a hysterectomy.
When clamping the uretine artery you can damage the ureter since they are close to each other.
Remember water under the bridge where the ureter goes inferior to the artery.
