What rib levels is the female breast typically located at?
What seperates the breast tissue from the underlying supportive musculature of the pectoralis muscles?
a layer of loose CT called the retromammary space
Describe the anatomy of breast tissue
the breast consists of mammary glands, which are modified sweat glands consisting of a series of ducts and associated secretory lobules that converge to form 15-25 lactiferous ducts which open independently onto the nipple
How does breast composition change in lactating women?
The breast tissue becomes more glandular (i.e. more mammary and lactiferous glands) in lactating women, while it is more fatty in non-lactating women
What is the major connective support of the breast?
In between the mammary glands in the breast lie well-organized stroma that in places condense to form suspensory ligaments of the breast (Copper's ligaments) that span between the dermis of the skin and the deep fascia of the pectoralis major muscle
What is the blood supply of the breast?
branches of the internal thoracic a. (medial) and lateral thoracic a. (lateral)
What is the sensory (GSA) innervation to the breast?
intercostal nerves II-VI
What is the lymph drainage of the lateral breast?
axillary nodes, via the pectoral nodes which are the sentinel nodes from the lateral breast (i.e. check these for lateral breast cancer)
What is the lymph drainage of the medial breast?
parasternal nodes. NOTE: because the parasternal ndoes on either side can communicate with one another, theres is the possibility of metastasis to the contralateral breast
Describe what is occurring here
breast carcinomas can sometimes create tension on the Copper's ligaments, resulting in dimpling of the skin giving this characteristic peau d'orange appearance
Mastectomy is likely to cause damage to which nerves?
long thoracic or thoracodorsal
The female external genitalia are called what?
External genitalia in the Female (Vulva)
The ______ is the female homologue of the scrotum
mons pubis and labia majora
What is the female homologue of the penis?
Anteriorly, the labia minora split to the form the ____ and the posterior ____ of the clitoris
What is the vestibule?
the smooth area bounded by the labia minora, in which the vaginal canal and the urethra open, as well as the orificies of the greater vestibular glands (aka Bartholin's glands)
Describe the structure of the clitoris
Consists of an external glans and two cylindrical cavernous bodies that terminate as the bulb of the vestibule. Two internal crura which form the body of the clitoris.
What is the clitoris innervated by?
perineal branch of the pudendal nerve
What muscles support the clitoris?
the bulbospongiosus muscle extends from the perineal body to surround the orifice of the vagina and cover the vesitbular bulbs
the ischiocavernosis muscle arises from the ischiopubic ramus and coers the crus clitoris on each side.
What is the role of bulbospongiosus?
it reduces the size of the vaginal orifice and compresses the deep dorsal veins of the clitoris to assist in maintaining an erection
What is the role of the ischiocavernosus muscles?
compress the crus clitoris on each side and assist in erection
Describe the blood supply of the clitoris
the deep aa. of the clitoris travel within the right and left corpora cavernosa (and are responsible for maintaining erection)
the a. to the bulb supplies the bulb of the vestibule
the dorsal arteries of the clitoris supply the skin and subQ tissues of the clitoris
What is the GSA of the clitoris?
dorsal nerve of the clitoris
What is the blood supply of the labia?
branches of the internal pudendal a. and the external pudendal branches of the femoral a.
GSA of the labia?
ilioinguinal n., the genital branc of the genitofemoral n., the posterior labial n. (from the perineal n.) and the posterior cutaneous nerve of the thigh
How is erection initiated/innervated in men and women?
Erection is a vascular event that is generated by parasympathetic innervation (pelvic splanchnics) from S2-S4 that leave the ventral horn and enter the inferior hypogastric plexus
The uterus is enveloped in a fold of peritoneum called the __________.
the mesometrium of the broad ligament (note the other parts of this ligament include the mesosalpinx and the mesovarium)
What is the cervix?
the neck of the uterus that is continuous with the vaginal canal
NOTE: The cervical canal connects the uterus with the vagina and the uterine opening is the interal os while the vaginal opening is referred to as the external os.
What artery crosses over the ureter at the levels of the bladder?
the uterine a. (runs inside the cardinal ligament)
What is the pouch of Douglas?
aka the rectouterine pouch, formed between the posterior wall of the uterus and the rectum. This pouch is the lowest part of the abdominopelvis cavity in the supine position and is a frequent site of fluid accumulation and potentially infection
What is the blood supply in the uterus?
the uterine artery, a branch of the internal iliac a.
2-3 smaller vaginal aa.
What structure does the ovarian a. follow in its route to the uterus?
the suspensory ligamant as it travels within the mesovarium
What structure does the uterine a. follow in its route to the uterus?
the tranverse cervical (aka cardinal) ligament in the base of the broad ligament-- which connects the cervix to the pelvic wall
NOTE: The round ligament of the uterus, which connects the uterine fundus to the labia majora, does not contain any vessels (Round like the number 0)
The uterine tubes are suspended in the ______ of the broad ligament
Describe the anatomy of the uterine tubes
They begin laterally with infundibulum which are in contact with the ovaries, and contain fimbriae which are small fingerlike projections responsible for moving an ovulated egg into the medial ampulla where conception normally occurs), and then to the narrowed isthmus just before joining the fundus of the uterus
The ovaries are suspended from the uterus and attached to the pelvic wall by the _____ which attaches to the inferior pole of the ovary.
The superior pole of each ovary is suspended from the lateral wall of the pelvis by the ________
suspensory ligament of the ovary
NOTE: This ligament transmits the ovarian a., v., and nerve supply
What is the arterial blood supply to the ovaries?
the overian aa. suspended in the suspensory ligament of the ovary as well as a collateral source arising from the anastomosis of the overaina aa. with the terminal parts of the uterine a.
What is the venous blood supply to the ovaries?
the right ovarian vein drains straight to the IVC while the left ovarian vein drains first to the left renal vein
What are the muscles of the pelvic diaphragm?
the levator ani and the coccygeus
What is a spinal nerve block for childbirth?
injection into the subarachnoid space at L3/L4 numbs the entire lower body
What is a caudal nerve block for childbirth?
Anesthesia is administered into the epidural space to bathe the S2-S4 spinal roots. This type of anesthesia has the advantage that the lower limbs are not usually affected, allowing the mother to walk around during labor and actively push during delivery
What is the 'true (obstetrical)' conjugate?
the minimum anterior to posterior diameter of the lesser pelvis measured between the sacral promontory and the pubic symphysis. This is the narrowest fixed distance that the baby's head must pass thru during a vaginal delivery.
NOTE: This distance cannot be measured directly due to the presence of the bladder
What is the 'diagonal' conjugate?
measured manually during a pelvis exam by palpating the sacral promontory with the tip of the middle finger while using the other hand to mark the level of the inferior margin of the pubic symphysis on the examining hand. The true conjugate is then measured as the distance between the tip of the index finger and the marked level of the pubic symphysis. This estimated true conjugate should be 11+ cm for safe delivery.
Note that the broad ligament connects the uterus, fallopain tubes, and ovaries to the pelvic wall and is more like a wide sheet (parts are the mesosalpinx, mesovarium, and mesometrium in order from superior to inferior)
Describe the epithelium of the intenal female tract
It slowly transitions from simple cuboidal in the ovary to columnar in the fallopian tubes, uterus, and endocervix, to stratified squamous in the ectocervix and vagina