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OB/GYN 1 > Chapter 39 > Flashcards

Chapter 39 Flashcards

1
Q

Pelvic landmarks

A

mons pubis

labia majora

labia minora

clitoris

urethral opening

vestibule of vagina

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2
Q

Bony pelvis

A

2 coxal bones

sacrum

coccyx

true and flase pelvis

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3
Q

true pelvis

A

situated inferior to caudal portion of parietal peritoneum

condisered pelvic cavity

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4
Q

pelvic cavity

A

posterior wall formed by sacrum and coccyx

posterolateral wall formed by piriformis and coccygeus muscles

anteriolateral walls formed by hip bones and obturator internus muscles, which rim ischium and pubis

lower margin formed by levator ani and coccygeus muscles

known as pelvic diapraghm

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5
Q

perineum

A

area below pelvic floor

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6
Q

pelvic cavity

A

posterior: rectum, colon and ileum
anterior: bladder, ureters, ovaries, fallopian tubes, uterus, vagina

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7
Q

muscles of pelvis

A

psoas major: sidewall

iliacus: sidewall

Piriformis: posterolateral wall

Obturator internus: anterolateral pelvic sidewall

Levator ani: pelvic floor (diaphragm)

Coccygeus: posterior pelvic floor (diaphragm)

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8
Q

Abdominal wall

A

muscles extend superiorly from xyphoid process to symphysis pubis inferiorly

paried rectus abdominis anteriorly

external obliques

internal obliques

transvers abdominis anteriolaterally

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9
Q

muscles of false pelvis

A

Psoas major

iliacus muscles

psoas muscles join with iliacus muscles to form iliopsoas muscles

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10
Q

Muscles of true pelvis

A

Piriformis muscles

obturator internus muscles

muscles of the pelvic diaphragm

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11
Q

muscles of pelvic diaphragm

A

Levator ani (pubococcygeus, iliococcygeus and puborectalis muscles)

Coccygeus muscles

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12
Q

Bladder

A

apex: located posterior to pubic bones

Base: anterior to vagina, superior surface related to uterus

Neck: rests on upper surface of urogenital diaphragm; inferiolateral surfaces relate to retropubic fat, obturator internus, levator ani muscles, pubic bone

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13
Q

Ureters

A

cross pelvic inlet anterior to bifurcation of common iliac arteries

run anterior to internal iliac arteries and posterior to the ovaries

coarse anteriorly and medially under base of broad ligament where crossed by uterine artery

run anterior and lateral to upper vagina to ender posteroinferior bladder

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14
Q

Vagina physical description

A

collapsed musclular tube that extends from external genitalia to cervix of uterus

approx 9cm in length

l

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15
Q

Vagina landmarks

A

normally directed up and back fromning 90 with uterine cervix

extends up and back from vulva

upper half lies above pelvic floor

lower half lies within perineum

vaginal lumen surrounding cervix divided into 4 fornices

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16
Q

Vaginal blood supply

A

from vaginal and uterine arteries

drains into internal iliac vein

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17
Q

Cervix

A

projects into vaginal canal

endocervix

exocervix

protrudes into upper portion of vaginal canal forming 4 recess (fornices)

continuous ring shaped space with posterior fornix running deeper than ints anterior counterpart

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18
Q

Endocervix

A

cervical canal

communicates with uterine cavity by internal os

with vagina by external os

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19
Q

exocervix

A

continuous with vagina

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20
Q

Uterus

A

hollow pear shaped organ

fundus

body

cervix

usually anteflexed and anteverted

covered with peritoneum except anteriorly below os where peritoneum reflected onto bladder

supported by levator ani muscles, cardinal and uterosacral ligaments

round ligaments hold uterus in anteverted position

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21
Q

Uterine size

A

premenarchal: 1-3 cm long by .5-1 cm wide
menarchal: 6-8 cm long by 3-5 cm wide

w/multiparity: increases by 1-2 cm

postmenapausal: 3.5-5.5 cm long by 2-3 cm wide

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22
Q

uterine body

A

posterior to vesicouterine pouch and superior surface of bladder

anterior to rectouterine pouch (of Douglas), ilium, colon

medial to broad ligaments and uterine vessels

uterine cavity is funnel shaped in coronal plane, slitlike in sagital plane

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23
Q

layers of uterus

A

perimetrium

myometrium

endometrium

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24
Q

perimetrium

A

serous outer layer of uterous

serosa

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25
myometrium
muscular middle layer of uterus composed of thick smooth muschle supported by connective tissue
26
endometrium
inner mucous membrane glandular portion of uterine body
27
uterine ligaments
broad mesovarium mesosalpinx round cardinal uterosacral suspensory ovarian
28
broad uterine ligament
lateral aspect of uterus to pelvic sidewall
29
mesovarium uterine ligament
posterior fold of broad ligament encloses ovary
30
mesosalpinx uterine ligament
upper fold of broad ligament encloses fallopian tube
31
Round uterine ligament
fundus to anterior pelvic sidewalls holds uterus forward
32
cardinal uterine ligament
extend across pelvic floor laterally firmly supporst cervix
33
uterosacral ligament
extend from uterine isthmus downward along side rectum to sacrum firmly supports cervix
34
suspensatory uterine ligament
extends from lateral aspect of ovary to pelvic sidewall
35
ovarian uterine ligament
extends medially from ovary to uterine cornua
36
Uterine postions
anteversion dextroversion retroversion retroflexion
37
Anteversion uterus
most common position fundus and body bent forward toward cervix
38
Dextroversion uterus levoversion
normal variant in absence of pelvic masses
39
retroversion uterus
entire uterus tilted posteriorly
40
retroflexion uterus
fundus and body bent backward towards cervix
41
Fallopian tubes
infundibulum ampulla isthmus interstitial portion 12 cm in length blood supplied by ovarian arteries and veins
42
fallopian infundibulum
funner shaped lateral tube projects beyond broad ligament to overlie ovaries free edge of the funnel has fimbriae
43
Ampulla of fallopian tube
widest part of tube where fertilization occurs
44
isthmus of fallopian tube
hardest part lies lateral to uterus
45
interstitial of fallopian tube
pierces uterine wall ar cornua
46
Ovaries
almond shaped attached at posterior aspect of broad ligament by mesovarium lie in ovarian fossa fossa bounded by ext iliacs, ureter obturator nerve dual blood supply ovarian and uterine artery blood drained by ovarian vein into IVC on right and renal vein on left
47
Variable postinos of ovaries
anterior to internal iliac artery and vein medial to external iliac artery and vein ellipsoid shape with long azis oriented vertically location highly variable as ligaments loosen, especially after pregnancy
48
Ovaries normal anatomy
outer layer (cortex) medulla
49
ovary cortex
primarily follicles in varying stages of development covered by layer of dense connective tissue tunica albuginea tunica albuginea surrounded by single layer of cells germinal epithelium
50
medulla of ovary
composed of connective tissue containing blood, nerves, lymphatic vessels and some smooth muscle at region of hilum
51
Ovarie reproductive cell
ovum two known hormones estrogen: secreted by follicles progesterone: secreted by corpus luteum
52
ovarian hormone responisibility
responsible for producing and maintaining secondary gender characteristics preparing uterus for implantation of fertilized ovum development of mammary glands in female
53
ovarian ligaments
supported medially by ovarian ligaments originating bilaterally at cornua of uterus laterally by suspensory (infundibulopelvic) ligament extending from infundibulim of fallopian tubke and ovary to sidewall of pelvis Ovary also attached to posterior aspect of broad ligament via mesovarium
54
Pelvic vasculature
ext iliacs arteries: medial psoas border ext iliac veins: medial and posterior to arteries Int iliac arteries: posterior to ureters and ovaries Int iliac veins: posterior to arteries uterine arteries and veins: between layers of broad ligaments, lateral to uterus
55
Pelvic vasculature branches
arcuate arteriers radial arteries straight and spiral arteries ovarian arteries ovarian veins
56
arcuate arteries
arclike arteries that encircle uterus in outer third of myometrium
57
radial arteries
branches of arcuate arteries that extend from myometrium to base of endometrium
58
Straight and spiral arteries
branches of radial arteries that supply zona basalis of endometrium
59
ovarian arteries
branch laterally off aorta run within suspensatory ligaments and anstomose with uterine arteries
60
ovarian veins
right vein drains into IVC left drains into left renal vein
61
Mestrual cycle
reproductive years begin around 11-13 at onset of menses end around age 50 whn menses ceases cycle approx 28 days in length begins with first day of menstrual bleeding
62
polymenorrheic
mestrual cycle occurs less than 21 days
63
oligomenorrheic
menstrual sycel occurs longer than 35 days
64
menstrual status
premenarche: prepuberty menarche: menstruating approx every 28 days menopause: cessastion of menses
65
Ovulation
explosive release of ovum from ruptured graafian follicle rupture associated with small amounts of fliud in posterior cul-de-sac midcycle midcycle dull ache on either side of lower ab lasting a few hrs "mittelschmerz" middle pain
66
luteal phase
begins with ovulatoin and about 14 days in length menstruation almost always occurs 14 days aftern ovulation cells in lining of ruptured ovarian follicle begin to multiply and create corpus luteum (yellow body) luteinization and is stimulated by LH surge corpus luteum begins secreting progesterone
67
9-11 days after ovulation
corpus luteum degenerates causing progesterone levels to decline this decline causes menstration to occur and the cycle begins again
68
conception and implantation
human chorionic gonadotropin (HCG) produced by the zygote causes corpus luteum to persist it will continue to secrete progesterone for 3 more months until placenta takes over
69
endometrial changes
varying levels of estrogen/progesterone levels induce changes changes correlate with ovulatory cycles of ovary 3 phases menstrual phase proliferative phase secratory phase
70
Endometrial menstrual phase
lasta approx 1-5 dyas and begins with declining progesterone levels causes spiral arterioles to constrict decreased blood flow to endometrium resulting in ischemia and shedding of zona functionalis first 5 days coincide with follicular phase of ovarian cycle as follicles produce estrogen they stimulate the superficial layer of endometrium to regenerate and grow
71
Endometrial proliferative phase
lasts until luteiniation of graafian follicle around ovulation with ovulation and luteinization of graafian follicle progesterone secreted by ovary causes spiral arteries and endometrial glands to enlarge prepares endometrium for implanation should conception occur
72
Endometrial secretory phase
extends from approx day 15 to onset of menses (day 28) secretory phase corresponds to luteal phase of ovarian cycle
73
Proliferative phase summary
days 1-14 corresponds to follicular phase of ovarina cycle mestruation occurs on days 1-4 thin endometrium estrogen level increases as ovarian follicles develope 'increasing estrogen causes uterine lining to regenerate and thicken ovulation occurs on day 14
74
Secretory phase summary
days 15-28 corresponds to uteal phase of ovarian cycle ruptured follicle becomes corpus luteum corpus luteum secretes progesterone endometrium thickens no pregnancy, estrogne/progesterone decrease menses day 28
75
Endometrial changes
during menses not uncommon to see varying levels of fluid and debris with uterine cavity with menstruation endometrium becomes thin echogenic line during early proliferative phase as regeneration occurs endometrium will thicken to 4-8mm in proliferative phase
76
endometrium sonogram appearance
hypoechoic 3 line sign Zona basalis anteriorly and posteriorly central line representing the cavity
77
Endometrium at ovulation
measures 6-10 mm and becomes isoechoic with myometrium just before ovulation after ovulation thickest dimension avg 7-14 mm becomes echogenic blurring 3 line appearance
78
postmenopausal endometrium
patients NOT on HRT thickness of patients on HRT or taking tamoxifen may be up to 8 mm
79
menorrhagia
abnormally heavy or long periods
80
dysmenorrhea
painful periods
81
amenorrhea
absence of menstruation
82
pelvic recess
vesicouterine pouch rectouterine pouch \retropubic space
83
vesicouterine pouch
anterior cul-de-sac anterior to fundus between uterus and bladder
84
rectouterine pouch
posterior cul-de-sac posterior to uterine body and cervix between uterus and rectum
85
retropubic space
space of retzius between bladder and symphysis pubis

OB/GYN 1 (31 decks)

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