Female Reproductive System and Breast Flashcards by Kerry Hendrie

What is the perineum?

Shallow space between the pelvic diaphragm (levator ani) and the skin

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List the parts of the female reproductive system in the pelvic cavity

Ovaries
Uterine tubes
Uterus
Superior part of vagina

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List the parts of the female reproductive system in the perineum

Inferior part of vagina
Perineal muscles
Bartholin's glands
Clitoris
Labia

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What is the function of the inferior part of the PARIETAL peritoneum?

Floor of peritoneal cavity

Roof over pelvic organs

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State the two pouches formed by the female periotenum

Vesico-uterine - between bladder and uterus

Recto-uterine - between rectum and bladder (Pouch of Douglas)

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Where does excessive abnormal fluid from the peritoneal cavity usually collect? How is this managed?

Pouch of Douglas (most inf. part of peritoneal cavity)

Drained via needle passed through posterior fornix of vagina

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Name and outline the ligaments of the uterus

Broad ligament (double layer of peritoneum containing uterine tubes and proximal round ligament)
Round ligament (embryological remnant)

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

Helps maintain uterus in correct midline position via lateral attachments

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List the three components of the broad ligament of the uterus, and their associations

Mesosalpinx (uterine tube)
Mesovarian (ovaries)
Mesometrium (uterus)

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What are they layers of the uterus?

Perimetrium
Myometrium
Endometrium

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Which layer of the uterus is shed during the menstrual cycle?

Endometrium

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What is the name for the opening in the center of the ectocervix (passage between vagina and uterus)?

External cervical os

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What is the name for the opening of the uterus from the cervix?

Internal cervical os

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Where does implantation normally occur?

Body of uterus

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Implantation outside the body of the uterus is known as…

Ectopic pregnancy

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List the layers of support that help to hold the uterus in position

Number of strong ligaments e.g. uterosacral
Endopelvic fascia
Muscles of pelvic floor e.g. levator ani

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Weakness of the layers of support for the uterus results in what clinical pathology of the female reproductive system?

Uterine prolapse

Movement of the uterus inferiorly

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What is the most common positions of the uterus?

Anteverted (cervix tipped anteriorly relative to axis of vagina, sits on top of bladder)
Anteflexed (uterus tipped anteriorly relative to axis of cervix)

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List normal variations that can occur in uterine position

Retroverted (uterus tipped posteriorly relative to axis of vagina)
Retroflexed (uterus tipped posteriorly relative to axis of cervix)

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Which area of the cervix should be sampled during cervical smear, and is a common site for cervical dysplasia?

Squamo-columnar junction (transformation zone)

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Outline the route taken by an ovum from ovary to implantation

Ovary
Infundibulum
Ampulla
Isthmus
Uterus

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What structures present on the infundibulum open into the peritoneal cavity and pick up ovum?

Fimbrae

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Where does fertilisation normally occur?

Ampulla of the uterine tube

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What is the clinical term for removal of both uterine tubes and ovaries?

Bilateral salpingophrectomy

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What is the clinical term for removal of one uterine tube?

Unilateral salpingectomy

The uterine tubes provide communication between the genital tract and peritoneal cavity. What is the clinical consequences of this?

PID can cause peritonitis | Ectopic pregnancy can develop in peritoneal cavity

What is the function of the ovaries?

Secrete oestrogen and progesterone in response to FSH and LH

Where do the ovaries develop?

Located on posterior abdominal wall and descend to the lateral pelvic cavity

Ovum are released directly into the periotenal cavity. True/ False?

True | Then picked up by fimbrae

The walls of the vagina are normally in contact. Where is the exception to this?

Superiorly where cervix holds them apart forming a fornix

What is a 'fornix'?

Space around cervix

List the components of a fornix

Anterior Posterior 2 lateral

Where can the ischial spines be palpated on vaginal digital exam?

Laterally at 4 and 8 o'clock

What is assessed during bimanual palpation in a vaginal digital exam?

Position of uterus

How are the adnexae palpated on vaginal digital exam?

Fingers into lateral fornix Press on same iliac fossa Detect any large masses or tenderness

What are the 'adnexae' of the female reproductive tract?

The appendages to the uterus - fallopian tubes, ovaries, and ligaments

What is the function of the openings in the pelvic floor?

Passage of distal alimentary, renal and reproductive tracts from pelvis to perineum

The perineum is divided into...

Superficial and deep pouches

What is the urogenital triangle?

The anterior half of the perineum, bounded by the pubic symphysis and ischial spines

What is the anal triangle?

The posterior half of the perineum, bounded by the ischial spines and coccyx

The levator ani muscle is made up of...

A number of smaller muscles

The levator ani is a skeletal/smooth muscle for involuntary/voluntary control

Skeletal muscle | Voluntary control

Which muscle forms the majority of the pelvic diaphragm?

Levator ani

What is the function of the levator ani muscle?

Continual support for pelvic organs | Undergoes tonic contractions

In what situation does the levator ani muscle contract more?

Increased intrabdominal pressure

Weakness of the levator ani is a factor in development of what pathological condition?

Prolapse of pelvic organs

What is the nerve supply to the levator ani muscle?

Nerve to levator ani | Pudenal nerve

State the nerve roots of the pudenal nerve

S3,4,5

Superficial and deep perineal muscles are supplied by...

Pudenal nerve

What is the perineal body? What is it's function?

Bundle of collagenous and elastic tissue where perineal muscles attach, located just deep to the skin Pelvic floor strength

Where is Bartholin's gland or the greater vestibular gland located? What pathology can arise here?

Right and left gland around external urethral orifice | Become enlarged due to infection (forms abscess)

What anatomical surface feature is located anterior to pubic bones?

Mons pubis

List, from superior to inferior, the external surface openings for the female reproductive tract

External urethral orifice Vaginal orifice Anus

State the two components of the labia of the vulva

Labum majus | Labum minus

What is the vulval vestibule?

Part of the vulva between the labia minora containing the external urethral orifice and vaginal orifice

What are the surface borders of the female breast?

Ribs 2-6 Lateral border of sternum Mid-axillary line

What is the axillary tail of Spence?

Extension of the tissue of the breast that extends into the axilla and drains lymph nodes

The female breast lies on deep fascia covering which two muscles?

Pectoralis major | Serratus anterior

What is the clinical term for the loose areolar tissue that separates the breast from the fascia?

Retromammary space

The female breast attach to skin via...

Suspensory ligaments

What is the function of the lactiferous ducts?

Connect the nipple to the lobules of the mammary gland

State the two types of lobules present within the mammary gland

``` Non-lactating lobules Lactating lobules (only in pregnant women) ```

What female harmone is involved with the production ejaculation of breast milk respectively?

Prolactin | Oxytocin

What is the areola?

Area of coloured skin at base of nipple

State the divisions of the breast used to describe a position of a lump

``` Upper outer (9-12 o'clock) Upper inner (12-3 o'clock) Lower outer (6-9 o'clock) Lower inner (3-6 o'clock) ```

Outline the drainage of the majority of lymph from the breast

Ipsilateral axillary nodes --> Supraclavicular nodes

Which divisions of the breast can drain into both ipsilateral or contralateral axillary nodes? Why?

Inner breast quadrants | Can also drain into parasternal nodes

Which divisions of the breast can drain into abdominal lymph nodes?

Lower inner breast quadrant

Lymph from the upper limb also drains to axillary lymph nodes. What is the clinical significance of this?

Axillary clearance in treatment of breast cancers can cause LYMPHOEDEMA

List important structures contained within the axillary fat

Brachial plexus Axillary artery and vein Axillary lymph nodes

Axillary node levels are used by surgeons in clearance of lymph nodes. These are related to which muscle?

Pectoralis minor

State the boundaries of level 1 axillary node clearance

Inferior and lateral to pectoralis minor | BELOW PEC MINOR

State the boundaries of level 2 axillary node clearance

Deep to pectoralis minor | BENEATH PEC MINOR

State the boundaries of level 3 axillary node clearance

Superior and medial to pectoralis minor | ABOVE PEC MINOR

Outline the blood supply to the different aspects of the female breast

Subclavian artery --> Internal thoracic (internal mammary): PARASTERNAL --> Axillary artery: LATERAL Intercostal arteries: DEEP

Outline the venous drainage from the female breast

Internal thoracic (internal mammary) vein Axillary vein --> Subclavian vein Intercostal veins