Anatomy and Physiology Ch 41 Flashcards
(136 cards)
1
Q
external pelvic landmarks
A
- mons pubis
- labia majora
- labia minora
- clitoris
- urethral opening
- vestibule of vagina
2
Q
the bony pelvis consists four bones
A
- Two innominate (coxal) bones
- Sacrum
- Coccyx
3
Q
Divided into two continuous compartments by oblique plane that passes through pelvic brim
A
- True Pelvis
- False Pelvis
4
Q
True Pelvis is considered
A
the pelvic cavity, and is situated inferior to the caudal portion of the parietal peritoneum
5
Q
Posterior wall is formed by the
A
sacrum and coccyx
6
Q
Posterolateral wall is formed by the
A
piriformis and coccygeus muscles.
7
Q
Anterolateral walls formed by the
A
hip bones and obturator internus muscles.
8
Q
Lower margin of pelvic cavity (the pelvic floor) formed by
A
levator ani and coccygeus muscles.
9
Q
The pelvic floor is also known as the
A
pelvic diaphragm.
10
Q
Area below the pelvic floor is the
A
perineum.
11
Q
Posteriorly pelvic cavity occupied by the
A
- rectum
- colon
- ileum
12
Q
Anteriorly pelvic cavity occupied by the
A
- bladder
- ureters
- ovaries
- fallopian tubes
- uterus
- vagina
13
Q
true pelvic musculature
A
- Piriformis (posterolateral wall)
- Obturator Internus (anterolateral pelvic sidewall)
- Levator Ani (Pelvic Floor/Diaphragm)
- Coccygeus (Posterior Pelvic Floor/ Diaphragm)
14
Q
false pelvic musculature
A
- Psoas Major (pelvic sidewall)
- Iliacus (pelvic sidewall)
- In the false pelvis, psoas muscles join with the iliacus muscles to form iliopsoas muscles.
15
Q
Bladder Apex
A
posterior to pubic bones
16
Q
Bladder Base
A
anterior to vagina
17
Q
Ureters run
A
anterior to internal iliac arteries and posterior to the ovaries
18
Q
Coarse anterior and lateral to
A
upper vagina where they then enter posteroinferior bladder
19
Q
Location ureters enter bladder are also where
A
“ureteral jets” can be seen.
20
Q
vagina
A
Collapsed muscular tube that extends from external genitalia to the cervix.
21
Q
A
21
Q
vagina is posterior
A
to bladder and urethra
22
Q
Normal position of the vagina is
A
directed upward and backward, forming a 90 degree angle with cervix.
23
Q
vagina is approximately
A
9cm in length
24
vagina is anterior
to rectum
25
cervix
protrudes into upper portion of vaginal canal forming four archlike recesses known as fornices.
26
The cervix is a continuous
ring-shaped space with posterior fornix running deeper than anterior counterpart.
27
The endocervix communicates with the
uterine cavity by the internal os and the vagina with the external os.
28
The exocervix is continuous
with the vagina
29
uterus
Hollow, pear-shaped organ
30
uterus divided into three main parts:
fundus, body, cervix
31
uterus usually in the
anteverted or anteflexed position, but can be retroverted or retroflexed
32
Round ligaments hold the uterus in
anteverted position.
33
Premenarchal
1-3cm in length by 0.5-1cm wide
34
Menarchal
6-8cm in length by 3-5cm wide
35
Multiparity
increase in size by 1-2cm
36
Postmenopausal
3.5-5.5cm in length by 2-3cm wide
37
uterine position usually in the
anteverted or anteflexed position, but can be retroverted or retroflexed
38
Flexion refers to
axis of uterine body relative to cervix
39
Version refers to
axis of cervix relative to vagina
40
layers of the uterus
- perimetrium
- myometrium
- endometrium
41
Perimetrium
serous, outer layer of uterus
42
Myometrium
muscular middle layer of uterus composed of thick, smooth muscle
43
Endometrium
inner mucous membrane, glandular portion of uterine body
44
uterine ligaments
- broad
- round
- cardinal
- uterosacral
- suspensory
- ovarian
45
Broad
lateral aspect of uterus to pelvic sidewall
46
Round
fundus to anterior pelvic sidewalls, holds uterus forward
47
Cardinal
extend across pelvic floor laterally, supports cervix
48
Uterosacral
extend from uterine isthmus downward, along rectum to sacrum, also supports cervix
49
Suspensory
extends from lateral aspect of ovary to pelvic sidewall
50
Ovarian
extends medially from ovary to uterine cornua
51
parts of the fallopian tubes projections that overlie ovary
- interstitial
- isthmus
- ampulla
- infundibulum
52
Interstitial
pierces uterine wall at cornua
53
Isthmus
hardest part, lateral to uterus
54
Ampulla
widest part of tube, location of fertilization
55
Infundibulum
funnel-shaped tube, free edge of the funnel has fimbriae (finger-like projections that overlie ovary
56
ovaries
Almond shaped
57
ovaries attached to
broad ligament by mesovarium
58
ovaries supported medially by
ovarian ligaments and laterally by suspensory (infundibulopelvic) ligament
59
Ovarian fossa bounded by
external iliac vessels, ureter, and obturator nerve
60
ovarian blood Supply
ovarian artery and uterine artery
61
ovaries blood drained by
ovarian vein into IVC on right and into renal vein on left
62
ovaries vary in
pelvic location
63
ovaries made up of
outer layer (cortex), which surrounds the central medulla
64
ovaries cortex covered by
layer of dense connective tissue known as the tunica albuginea
65
ovaries medulla composed of
connective tissue containing blood, nerves, lymphatic vessels and smooth muscle at hilum
66
ovaries produce
reproductive cell- ovum
67
ovaries secretes two hormones
- estrogen (secreted by follicles)
- progesterone (secreted by corpus luteum)
68
ovarian hormones are responsible for
producing and maintaining gender characteristics (mammary glands in females, etc.), and preparing uterus for pregnancy
69
pelvic vasculature
-External Iliac Arteries- medial to psoas border
- External Iliac Veins- medial and posterior to arteries
- Internal Iliac Arteries- posterior to ureters and ovaries
- Internal Iliac Veins- posterior to arteries
- Uterine Arteries and Veins- between layers of broad ligaments, lateral to uterus
70
pelvic vasculature continued
- Arcuate arteries: arc-like arteries that encircle uterus in outer third of myometrium
- Radial arteries: branches of arcuate arteries that extend from myometrium to base of endometrium
- Straight and spiral arteries: branches of radial arteries that supply zona basalis of endometrium
- Ovarian arteries: branch laterally off aorta, run within suspensory ligaments and anastomose with uterine arteries
71
Female reproductive years begin around
11 to 13 years of age at onset of menses
72
menstrual cycle ends around age
50, when menses ceases
73
menstrual cycle is approximately
28 days in length
74
Premenarche
prepubescent
75
Menarche
menstruating approximately once a month
76
Menopause
cessation of menses
77
approximately 28 days
beginning with first day of menstrual bleeding
78
polymenorrheic
Cycle occurs at intervals of less than 21 days-
79
oligomenorrhic
Cycle prolonged for more than 35 day
80
Menorrhagia
abnormally heavy or long periods
81
Dysmenorrhea
painful periods
82
Amenorrhea
absence of menstruation
83
Proliferative Phase
- Days 1 to 14
- Corresponds to follicular phase of ovarian cycle
- Menstruation occurs on days 1 to 4
- Thin endometrium
- Estrogen level increases as ovarian follicles develop.
- Increasing estrogen levels cause uterine lining to regenerate and thicken.
- Ovulation occurs on day 14
84
Secretory Phase
- Days 15 to 28
- Corresponds to luteal phase of ovarian cycle
- Ruptured follicle becomes corpus luteum.
- Corpus luteum secretes progesterone.
- Endometrium thickens.
- If no pregnancy, estrogen and progesterone decrease.
- Menses on day 28
85
Ovulation
ovum released once a month by one of two ovaries (during menarchal years)
86
Ovulation usually occurs
about mid cycle around day 14 of a 28 day cycle
87
All ova begin to develop during
embryonic life, and remain within preantral follicle as an immature oocyte until menses begins.
88
Each female ovary contains
around 200,000 oocytes at time of birth.
89
Process of ovulation regulated by
hypothalamus
90
At puberty, hypothalamus begins releasing
gonadotropin-releasing hormones (GnRHs)
91
GnRHs stimulate
anterior pituitary gland to secrete varying levels of gonadotropins.
92
Secretion of follicle-stimulating hormone
(FSH) by
anterior pituitary gland causes
follicles to develop during the first half of the
menstrual cycle.
93
The follicular phase begins on cycle day
one of menstrual bleeding and continues
until ovulation around day 14.
94
As follicles grow, they fill with
fluid and secrete estrogen.
95
Typically, 5 to 8 preantral follicles begin to
develop, but
only one reaches full maturity.
96
Mature follicle is known as the
graafian follicle- around 2cm right before ovulation
97
As estrogen level in the blood rises,
pituitary gland inhibited from further
production of FSH, and then starts secreting luteinizing hormone (LH)
98
LH level will normally increase rapidly
24-36 hours before ovulation, this
process is known as LH surge (used to predict release of ovum)
99
LH level usually peaks
10–12 hours prior to ovulation
100
Ovulation is the explosive release of the
ovum from the ruptured dominant follicle
(graafian follicle)
101
Can be associated with
small amount of fluid in the posterior cul-de-sac
102
Midcycle dull ache on either side
of lower abdomen (pelvic area) lasting a few hours
is known as "mittelschmerz" (from German origin meaning "middle pain")
103
After ovulation,
ovary enters luteal phase, which lasts about 14 days
104
Menstruation usually occurs
14 days after ovulation
105
During luteal phase,
cells in lining of ruptured ovarian follicle begin to multiply and create the corpus luteum (this process is known as luteinization, stimulated by LH surge)
106
Corpus luteum immediately begins
secreting progesterone
107
9 to 11 days after ovulation,
the corpus luteum degenerates, causing progesterone levels to decline
108
As those levels decline,
menstruation occurs and cycle begins again
109
If conception and implantation has occurred,
the human chorionic gonadotropin (hCG) produced by the zygote will cause the corpus luteum to persist
110
Will continue to secrete
progesterone for 3 more months until placenta takes over
111
Varying levels of
estrogen and progesterone throughout menstrual cycle induce changes in
endometrium, changes correlate with ovulatory cycles of ovary
112
Typical endometrial cycle identified and described in
three phases, beginning with menstrual
phase.
113
Menstrual phase lasts approximately
1 to 5 days and begins with declining progesterone levels, causing spiral arterioles to constrict.
114
Causes decreased
blood flow to endometrium, resulting in ischemia and shedding of zona functionalis.
115
First 5 days coincide with
follicular phase of ovarian cycle.
116
As follicles produce estrogen,
.
estrogen stimulates superficial layer of endometrium to regenerate and grow.
117
Phase of endometrial regeneration called
proliferative phase and will last until luteinization of graafian follicle
around ovulation.
118
With ovulation and luteinization of graafian follicle,
progesterone secreted by ovary causes spiral arteries and
endometrial glands to enlarge.
119
Prepares endometrium for
implantation, should conception occur.
120
Endometrial phase after ovulation referred to as
secretory phase.
121
Extends from approximately
day 15 to onset of menses (day 28).
122
Secretory phase of endometrial cycle corresponds to
luteal phase of ovarian cycle
123
Sonographic appearance of endometrium changes
dramatically
among the three phases of endometrial cycle.
124
endometrium changes should be
correlated to patient’s menstrual status.
125
Thickness of endometrium will
decrease with menstruation,
becoming thin echogenic line during early proliferative phase.
126
As regeneration of endometrium occurs,
endo will thicken to an average of 4 to 8 mm in proliferative phase, when measured as double layer from anterior to posterior. ("three-line" sign)
127
Three echogenic lines seen in
proliferative endometrium represent zona basalis anteriorly and posteriorly, with central line representing uterine cavity.
128
Right before ovulation, endometrium measures
6 to 10 mm and becomes
isoechoic with myometrium.
129
After ovulation, during secretory phase,
endometrium reaches thickest
dimension, averaging 7 to 14 mm.
130
Becomes echogenic,
blurring “three-line” appearance
131
Postmenopausal patients who are not on HRT should have endometrial thickness of
<5 mm.
132
Postmenopausal patients on HRT or taking
tamoxifen may demonstrate
normal endometrial thicknesses up to 8 mm.
133
Vesicouterine pouch:
anterior cul-de-sac; anterior to fundus between uterus and bladder
134
Rectouterine pouch (Pouch of Douglas):
posterior cul-de-sac; posterior to uterine body
and cervix, between uterus and rectum
135
Retropubic space:
space of Retzius; between bladder and symphysis pubis
