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anatomy of the female pelvis Flashcards

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0
Q

what is mons pubis

A

pad of fatty tissues that overlies the pubis

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1
Q

What are some external landmarks?

A 
vagina
mons pubis
labia
clitoris
urethral opening
anus
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2
Q

What is the True Pelvis?

A

Below plevic brim to the pelvic diaphragm, contains pelvic organs

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3
Q

what is the false pelvis?

A

above the pelvic brim to the iliac crest - communicates with abdominal cavity superiorly

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4
Q

pelvic cavity

A

true pelvis, inferior to the caudal portion of the parietal peritoneum

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5
Q

what is in the posterior pelvic cavity

A

rectum, colon and ileum

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6
Q

what is in the anterior pelvic cavity

A

bladder, ureters, ovaries Fallopian tubes, uterus and vagina

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7
Q

what is the pouch of douglas

A

rectouterine space - lowest most posterior portion of the peritoneal cavity

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8
Q

what forms the posterior wall?

A

sacrum and coccyx

margin of post-lat wall formed by piriformis and coccygeus muscles

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9
Q

what forms the anterolateral walls?

A

formed by hip bones and obturator internus muscles

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10
Q

what forms the lower margin pelvic cavity?

A

(aka pelvic floor or pelvic diaphragm)

formed by levator ani and coccygeus muscles

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11
Q

muscles of the false pelvis

A

psoas major muscles - originate at the transverse process of lumbar vertebrae - descend inferiorly on pelvic side walls- join iliacus muscles in false pelvis (they do not enter the true pelvis)

lliopsoas muscle, iliacus and psoas major muscles: descend anterior to hip-insert into lesser trochanter, pass outside pelvic bones , do not enter true pelvis

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12
Q

what are the muscles of the true pelvis?

A

Piriformis muscles -

Obturator internus muscles -

pelvic diaphragm -

levator ani muscle (3 muscle groups) Puboccygeus muscles, lliococcygeus muscles, puborectalis (see the slide)

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13
Q

Bladder

A

location: anterior portion pelvic cavity - posterior to pubic symphysis

Function: Collect and store urine

remains in true pelvis when empty
when distended rises behind lower anterior abdominal wall pushes peritoneum away

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14
Q

vagina

A

extends postero-superiorly at a 45 degree angle from external genitalia to cervix, then forms a 90 degree angle to the cervix

average 9 cm long

anterior to rectum/anus - posterior to bladder/urethra

mucus membrane lining muscular walls

passageway for the products of menstruation

easily distended during sexual intercourse and childbirth
posterior wall is longer than the anterior wall

mucus membrane lining muscular walls

upper half above pelvic floor, lower hald within perineum

arterial supply - vaginal and uterine arteries drain into interal iliac veins

upper portion attaches to cervix -posterior portion attaches higher on cervix

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15
Q

what are the fornices?

A

4 arch like recesses formed by cervix protruding into upper portion of vaginal canal
blind pockets formed by inner surface of vagina and outer surface of cervix
continuous ring shaped space

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16
Q

uterus

A

Müllerian ducts enlogate and fuse to form uterus and vagina between 7th and 12th week of gestation

posterior to bladder/anterior to rectum

hollow, pear shaped

largest organ of female pelvis - allows for cyclic physiologic changes assoc with menstruation and after fertilization, serves to sustain, protect and deliver fetus

3 parts: fundus, body, cervix

usually antiflexed and antverted (held in place by round ligaments)

average size 6-8 cm long and 3-5 cm AP and transverse varies with age and parity

supported by levator ani muscles, cardinal ligaments and uter-sacral ligaments

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17
Q

portions of uterus

A 
cervix
isthmus
body of uterus
fundus of uterus
cornua
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18
Q

what is the cervix?

A 
"neck of uterus"
lower cylindrical portion of uterus - projects into vaginal canal
muscular
divided into exocervix and endocervix
only portion of uterus firmly supported
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19
Q

ithmus

A

ourter transition point between body of uterus and cervix

“waist” of uterus

point where uterus bends with empty bladder
anteversion bends anteriorly
retroversion bends posteriorly
uterine blood vessels enter at this point

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20
Q

body of uterus

A

aka corpus
between fundus and cervix
largest portion of the uterus
cavity funnel shaped coronal plane, slit-like sagittal plane
potential space for fluid accumulation-dynamic changes during menstrual cycle and pregancy
posterior to vesicouterine pouch and superior surface of bladder
anterior to rectouterine pouch ( pouch of douglas), ilium and colon

walls are together unless something is in there to separate them

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21
Q

fundus of uterus

A

widest portion of uterus

uppermost cephalic poriton of uterus

dome shaped

cornua - lateral borders of fundus, Fallopian tubes enter uterine cavity, interstitial portion of Fallopian tubes

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22
Q

layers of the uterine wall

A

3 histologic layers

perimetrium - serosa - outermost peritoneal covering (external layer)

myometrium - middle layer -muscular- thickest layer- primarily smooth muscle that is longitudinal and circular. contains main branches of uterine vessels and nerves

endometrium - inner layer - glandular tissue lining - mucous membrane - 2 layers which undergo monthly hormonal changes

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23
Q

endometrium

A

continuous with cervical canal - endocervical canal

changes dynamically responding to the cyclic hormonal changes. Appearance varies depedning on the patients menstrual status and period of life

two layers- zona funtionalis and zona basalis

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24
zona funtionalis
superficial layer of glands and stroma (supporting tissue) sheds with menses
25
zone basalis
basal layer layer of endometrial glands which regenerate new endometrium after menses
26
uterine ligaments
anchor uterus in proper position in midline of pelvis broad ligaments round ligaments uterosacral ligaments cardinal ligaments
27
broad ligaments
double fold of peritoneum drapes over uterus, ovaries Fallopian tubes lateral aspect of uterus to sidewalls of pelvis - provides lateral support for the uterus covers both anterior and posterior surfaces of uterus contain uterine vessels and nerves 3 separate areas: mesometrium, mesosalpinx and mesovarium
28
mesometrium
portion of broad ligament over the uterus
29
mesosalpinx
portion of broad ligament - upper fold encloses Fallopian tubes
30
mesovarium
posterior portion of the borad ligament that encloses the ovaries
31
round ligaments
hold fundus and body in forward position (anterior support) attach to anterior lateral portion of fundus, extend to inguinal canal insert into labia majora holds uterine fundus in normal anteflexed position
32
uterosacral ligaments
attach posterior-lateral aspect of uterus at level of internal cervical os extend posteriorly and inferiorly to sacrum support cervix with round ligaments hold uterus in normal anteflexed position
33
cardinal ligaments
aka: transverse cervical ligaments, mackenrodt ligaments or parametrium provide lateral support of cervix and lower uterine segment continuation of broad ligaments which extend across pelvic floor laterally from isthmus/cervix to pelvic sidewalls with uterosacral ligaments hold cervix in fixed position important landmarks for surgery - contain uterine vessels
34
explain the support system in the pelvis
explain which muscles and ligaments and where on the bone they attach
35
positions of the uterus
variable most common anteverted/anteflexed full bladder will tip average uterus backward anteversion anteflexion retroversion retroflexion retroverted/retroflexed ``` dextroversion dextroflexion levoversion levoflexion uterine prolapse ```
36
anteversion
cervical canal forms 90 degree or smaller angle with vaginal canal anteriorly
37
anteflexion
fundas and body curved forward on cervix | approx 170 degree angle between uterine /cervical canal
38
retroversion
cervical canal forms > 90 degrees angle with vaginal canal (entire uterus tips posteriorly)
39
retroflexion
fundus and or body curved backward on cervix two angles (version/flexion) are independent of each other - uterus can be in any combination of version and flexion
40
dextroversion
entire uterus/cervix tilts to the right
41
dextroflexion
uterine body at isthmus bends to the right
42
levoversion
entire uterus/cervix tilts to the left
43
levoflexion
uterine body at isthmus bends to the left
44
uterine prolapse
abnormal dropping of the uterus- uterine and pelvic floor muscles weak and allow uterus to protrude into the vagina
45
pelvic spaces
cul-de-sacs or gutters- potential spaces where fluid can accumulate
46
vesicouterine space
anterior cul-de-sac between bladder and fundus of uterus
47
rectouterine space
aka: "pouch of douglas" posterior cul-de-sac between uterus and rectum most inferior and posterior region of the peritoneal cavity
48
space of retzuis (reezts e us)
between symphysis pubis and anterior bladder wall usually contains subcutaneous fat hematoma or abscess may displace urinary bladder posteriorly
49
Fallopian tubes
also called oviducts or salpinx coiled muscular tubes normal length 7-12 cm in length, 1-4 mm in diameter picks up egg released by ovary transports egg to endometrial cavity through peristaltic contractions of the muscle walls innermost region-mucosal layer runs directly into endometrium not able to visualize on US if normal may use Doppler to distinguish between blood vessels and dilated tube 4 segments: interstitial, isthmus, ampulla, and infundibulum
50
Fallopian tube : interstitial portion
intramural narrowest segment passes through uterine cornua connects to endometrial cavity approx 1 cm long
51
ovaries
solid "almond shaped" structures lie in ovarian fossa (waldeyer's fossa) normal position: posterior-lateral to cornua, medial to external iliac vessels, anterior to internal iliac vessels and ureters vary in size during lifespan depending on hormonal status Fallopian tube + Ovary = ADNEXA
52
ovary blood supply
ARTERIAL: dual blood supply arterial blood via gonadal arteries from aorta ovarian arteries arise in distal aorta-distal to renal arteries ovarian arteries anastamose with uterine artery in broad ligament ovarian branch of uterine artery continues to feed ovary VENOUS DRAINAGE: right ovarian vein drains directly into IVC Left ovarian vein drains into Left renal vein
53
ovarian size
average ovarian length in menarcheal female 3.0 cm size dependent on menstrual/hormonal status (menarcheal 2.5-5.0cm in length, 1.5-3.0 cm in width and height) volume (L x W x H x 0.523) know this formula) pre-puberty: up to 8 cc Mernarcheal: up to 18cc (usually 6-10 cc) (3.0x2.0x2.0cm x 0.523) Post- menopausal: up to 8cc (usually 5.8 cc) (2.0x0.5x1.0cm x 0.523)
54
what are the different positions of the ovaries?
for scanning purposes not for test... ovaries are mobile and may change in position based on pregnancy, ligament laxity, previous surgeries/pathology, uterine position and bladder filling May Lie: anterior to the internal iliac vessels medial to the external iliac vessels from the posterior cul-de-sac to the lower abdomen orientation may be vertical, horizontal or anywhere in between
55
normal anatomy for ovary
cortex - medulla - ovum - hormones -
56
estrogen and progesterone
hormones produced by ovaries responsible for producing and maintaining secondary gender characteristics, preparing uterus for implantation and development of mammary glands estrogen: secreted by follicles Progesterone: secreted by corpus luteum
57
ovarian ligaments
ovarian ligament suspensory ligament - mesovarian ligament -
58
Pelvic Vasculature
Ao to common iliac arteries (ant and med to psoas muscles) Common iliac arteries - external and internal iliac (hypogastric) arteries uterine Artery - arcuate arteries - radial arteries (branches of arcuate arteries) straight and spiral arteries
59
explain the blood supply to the pelvis and it's structures
finish | venus flow is the same as arterial just backwards
60
what makes up the bony pelvis?
two compartments divided by iliopectineal line - superior border of sacrum to superior margin of pubis symphysis false pelvis true pelvis pelvic brim - corresponds with iliopectineal line and sacral promontory
61
what bones make up the bony pelvis?
``` from the right of the spine: posterior superior iliac spine iliac crest tubercle of crest anterior superior iliac spine acetabulum ischial tuberosity ischiopubic ramus pubic symphysis obturator foramen lesser sciatic notch ischial spine greater sciatic notch posterior sacral foramen sacrum coccyx ```
62
where is the perineum?
It the area below pelvic floor
63
where is the piriformis muscles?
posterolateral wall triangular, flat muscles anterior sacrum through greater sciatic notch inserts to superior aspect of greater trochanter of femur posterior to rectum, vagina and uterus
64
where are the obturator internus muscles?
anterolateral wall trianglular sheets of muscles anterolateral pelvic wall surround obturator foramen through lesser sciatic notch inserts to superior aspect of greater trochanter lateral at the level of the transverse cerix
65
what is the pelvic diaphragm?
floor of the true pelvis | formed by levator ani and coccygeus muscles
66
levator ani muscles
3 muscle groups role in rectal and urinary continence forms anterior part of diaphragm forms "hammock" to support rectum and pelvic floor *major supporting structure for pelvic structures*
67
puboccygeus muscles
most anterior and medial pubic bones to coccyx surround urethra, vagina and rectum
68
iliococcygeus muscles
anterolateral pelvic wall to coccyx
69
puborectalis muscles
lower part of pubic symphysis surround lower part of rectum form sling
70
what are ureters?
ureters- tubes from kidneys to trigone of bladder. anterior to the internal iliac arteries. posterior to ovaries and uterine arteries. 'jets" in the posteriorinferior portion of the bladder with color doppler.
71
what are the layers of the uterus?
perimetrium myometrium endometrium
72
what is premenarchal uterine size?
length: 1.0-3.0 cm width: 0.5-1.0cm AP cm: 0.5-1.0 volume: n/a Cervix/corpus ratio: 1/2 : 1/2
73
what is the uterine size for menarchal nulliparous?
length: 6.0-8.0 cm width: 3.0-5.0 cm AP cm: 3.0-5.0 volume cc: 30-40 cervix/corpus ratio: 1/3 : 2/3
74
what is the uterine size for menarchal parous?
``` Length: 8.0-10.0cm width: 5.0-6.0cm AP cm: 5.0-6.0 volume cc: 60-80 cervix/corpus ratio 1/3 :>2/3 ```
75
what is the uterine size of postmenopausal?
length: 3.0-5.0cm width: 2.0-3.0cm AP cm: 2.0-3.0 volume cc:14-17 cervix/corpus ratio: 2/3 :1/3
76
what is the exocervix?
squamous epithelium | continuous with the vagina
77
what is the endocervix?
cervical canal columnar cells, excrete mucus constricted at upper end by internal os - communicates to uterine cavity constricted at lower end by external os - communicates to vagina
78
retroverted/retroflexed uterus
uterus tipped and flexed backward...a common varient
79
Fallopian tube : isthmus
medial portion between interstitial portion and ampulla increases in diameter as it extends towards ampulla thick muscular wall approx. 2cm long
80
Fallopian Tube: ampulla
longest most coiled portion area where fertilization of the ovum usually occurs most distensible region of tube approx 5 cm long
81
Fallopian Tube: infunibulum
Wide, trumpet shaped, lateral portion fimbriae - fringe like structures - extend toward ovary (direct ovum into the Fallopian tube
82
ovarian anatomy: Cortex
outer layer consists primarily of follicles in various stages covered by dense connective tissue TUNICA ALBUGINEA TUNICA ALBUGINEA COVERED BY THIN LAYER OF CELLS- GERMINAL EPITHELIUM
83
Ovarian anatomy: Medulla
central portion composed of connective tissue - blood nerves lymphatics smooth muscle at hilum
84
what do ovaries produce?
an OVUM (a reproductive cell) hormones
85
Ovarian Ligament
medial support originate bilaterally at the cornua of the uterus attach to lower pole of ovary keeps ovary close to uterus
86
suspensory ligament of the ovary
aka: infundibulopelvic from infundibulum to Fallopian tube/ovary to sidewall of pelvis keeps ovary close to Fallopian tube
87
Mesovarioum (ovarian support)
attaches ovary to posterior aspect of broad ligament
88
What is the pelvic vasculature?
Ao -> common iliac arteries -> uterine artery -> arcuate arteries -> radial arteries -> straight and spiral arteries VENOUS SYSTEM: left ovarian vein drains into left renal vein right ovarian vein drains directly into IVC
89
common iliac arteries
external and internal iliac (hypogastric) arteries external iliac arteries continue to legs- femoral artery internal iliac arteries feed bladder, uterus, vagina and rectum
90
uterine artery
anterior branch of internal iliac artery - through the base of broad ligament to cervix tortuous spirals up sides of uterus to cornua travels laterally to anastomose with ovarian artery
91
arcuate arteries
many branches perforate serosa, carry blood to myometrium...these form the arcuate arteries circle uterus visualized in outer 3rd of uterus as anechoic tubular structures
92
radial arteries
branches of arcuate arteries penetrate myometrium at 90 degree angle to base of endometrium
93
spiral arteries
supply zona basalis of endometrium lengthen during regeneration of endometrium after menses to supply zona functionalis supply blood to inner 2/3 of endometrium supply proliferating endometrium each menstrual cycle blood from spiral arteries is shed during menses responds to hormonal changes of ovary
94
straight arteries
supply zona basalis of endometrium supply blood for outer 1/3 of endometrium NOT affected by menstrual cycle maintains blood supply allows regrowth of endometrium

OB/Gyn (14 decks)

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