Anatomy of Female Reproductive Tract and Breast

Question 1

the female reproductive system lies within which cavity?

Answer 1

both the pelvic cavity and perineum

Question 2

what aspects of the female reproductive system are found within the pelvic cavity?

Answer 2

ovaries
uterine tubes
uterus
superior part of vagina

Question 3

what aspects of the female reproductive tract are found within the perineum?

Answer 3

inferior part of vagina
perineal muscles
bartholin's glands
clitoris
labia

Question 4

what forms a roof over pelvic organs?

Answer 4

inferior part of parietal peritoneum (floor of peritoneal cavity)

Question 5

what pouches are formed by the peritoneum overlying the pelvic organs?

Answer 5

vesico-uterine pouch
recto-uterine pouch (pouch of douglas)
- most inferior part of peritoneal cavity in anatomical position so any excess fluid tends to collect here

Question 6

how is fluid removed from the pouch of douglas?

Answer 6

drained via needle passed through the posterior fornix of vagina

Question 7

what is the broad ligament of the uterus?

Answer 7

double layer of peritoneum which extends between the uterus and lateral walls and the floor of the pelvis

Question 8

what is the function of the broad ligament of the uterus?

Answer 8

contains the uterine tubes and the proximal part of the round ligament
helps maintain the uterus in its correct midline position

Question 9

what is the round ligament and what path does it take?

Answer 9

embryological remnant which attaches to the lateral aspect of the uterus, then passes through the deep inguinal ring to attach to the superficial tissue of the female perineum
(proximal part contained within broad ligament)

Question 10

3 layers of the uterus and which is shed during menstruation?

Answer 10

perimetrium
myometrium
endometrium (shed)

Question 11

where in the uterus does the zygote implant?

Answer 11

thickened endometrium of body of uterus

Question 12

what holds the uterus in place and prevents prolapse?

Answer 12

3 levels of support

• number of strong ligaments (e.g uterosacral ligament)
• endopelvic fascia
• pelvic floor muscles (e.g levator ani)

Question 13

most common position for the uterus to be found in?

Answer 13

anteverted and antiflexed

anteverted
- cervix tipped anteriorly relative to the axis of the vagina

anteflexed
- uterus tipped anteriorly relative to the axis of the cervix (mass of uterus lies over bladder)

Question 14

other normal variations in uterus position?

Answer 14

retroverted and retroflexed

retroverted
- cervix tipped posteriorly relative to the axis of the vagina

retroflexed
- uterus tipped posteriorly relative to the axis of the cervix

uterus is basically tipped backwards against the rectum

Question 15

how is a cervical smear performed?

Answer 15

must use a speculum as walls of vagina are normally collapsed
sample the squamo-columnar junction (transformation zone)

Question 16

how do the uterine tubes usually lie?

Answer 16

asymmetrically

Question 17

what is a bilateral salpingo-oophrectomy?

Answer 17

removal of both uterine tubes and ovaries

Question 18

how do the genital tract and peritoneal cavity communicate?

what is the impact of this?

Answer 18

the fimbrae at the ends of the uterine tubes open into the peritoneal cavity
therefore infection could pass between the 2 areas
(i.e PID can cause peritonitis and ectopic pregnancy can develop in peritoneal cavity)

Question 19

location of the ovaries?

Answer 19

develop on posterior abdominal wall and move onto the lateral wall of the pelvis in the pelvic cavity (round ligament of uterus)

Question 20

function of ovaries?

Answer 20

secrete oestrogen and progesterone in response to anterior pituitary hormones FSH and LH
every month releases an ovum into the peritoneal cavity which is picked up by the fimbrae of uterine tube

Question 21

what is the fornix?

Answer 21

the space around the cervix

where cervix holds walls of vagina apart at the superior aspect of the vagina

Question 22

what are the 4 parts of the fornix?

Answer 22

anterior
posterior
2 X lateral

Question 23

what can be palpated on digital vaginal examination?

Answer 23

ischial spines (laterally and at 4 and 8 o'clock position)
position of uterus (assessed by bimanual palpation)
palpation of adnexae (uterine tubes and ovaries - can detect large masses or tenderness affecting these structures)

Question 24

what is the perineum and what forms the boundaries of it?

Answer 24

shallow space between pelvic diaphragm and the skin

Question 25

what forms the pelvic diaphragm?

Answer 25

levator ani and coccygei muscles

Question 26

what openings are found in pelvic diaphragm?

Answer 26

openings for passage of distal parts of alimentary, renal and reproductive tracts from pelvis to perineum

Question 27

describe levator ani muscle?

Answer 27

made up of a number of smaller muscles skeletal muscle (voluntary) forms majority of pelvic diaphragm (including its fascial coverings)

Question 28

function of levator ani muscle?

Answer 28

support of pelvic organs - tonic contraction - reflexively contracts further during situation of increased intra-abdominal pressure - weakness can cause prolapse of pelvic organs

Question 29

what innervated levator ani muscle?

Answer 29

S3, S4, S5 | potentially has dual supply

Question 30

divisions of perineal muscles and what supplies them?

Answer 30

superficial and deep perineal muscles | both supplied by pudenal nerve

Question 31

what is the perineal body?

Answer 31

bundle of collagenous and elastic tissue located just deep to skin into which the perineal muscles attach important to pelvic floor strength and can be disrupted during labour

Question 32

what are the bartholins glands?

Answer 32

(same as bulbourethral glands in males) | two small pea sized alveolar glands which sit either side of posterior vagina and secrete mucous to lubricate vagina

Question 33

where is the bed of breasts located?

Answer 33

between ribs 2-6 | between lateral border of sternum and mid-axillary line

Question 34

what do the breasts sit on top of?

Answer 34

deep fascia covering pec major and serratus anterior

Question 35

what lies between fascia and the breast?

Answer 35

retromammary space

Question 36

what attaches the breast tissue to the skin?

Answer 36

suspensory ligaments

Question 37

what is the name of the tapering end of breast tissue towards the axilla?

Answer 37

axillary tail (of spence)

Question 38

how is the position of an abnormality (e.g lump) described in the breast?

Answer 38

``` clock face (e.g 3 o'clock position) or in 4 quadrants (upper outer/inner, lower outer/inner) ```

Question 39

how else is a lump in the breast described?

Answer 39

asses whether fixed to any underlying tissue (e.g pectoral fascia) - ask patient to stand with hands on hips causing contraction of pectoral muscles)

Question 40

lymphatic drainage in the breast?

Answer 40

75% of lymph from breast drains to ipsilateral axillary lymph nodes and then to supraclavicular nodes lymph from inner quadrants can drain to parasternal nodes lymph from lower quadrants can drain to abdominal nodes

Question 41

what are the implications of removing axillary nodes for other body areas?

Answer 41

can cause lymphoedema in upper limb as lymph from upper limb also drains to axillary nodes

Question 42

axilla forms a pyramidal passageway between arms and chest, what is found within this area?

Answer 42

brachial plexus and branches axillary artery/vein and branches axillary lymph nodes all embedded in axillary fat

Question 43

surgeons use levels to describe extent of axillary node clearence in breast cancer surgery, what are these levels and how are they determined?

Answer 43

level 1 = inferior and lateral to pectoralis minor level 2 = deep to pectoralis minor level 3 = superior and medial to pectoralis minor

Question 44

blood supply and drainage of breast?

Answer 44

axillary artery and internal thoracic (internal mammary) = supply lateral thoracic vein (mostly) and internal thoracic vein (and some from internal intercostal vein) = drainage