Gyn anatomy

Question 1

ureter relationship to the uterine artery

Answer 1

the Ureters passes Under the Uterine artery

**you should be worried about ligating the ureter when attempting to ligate the uterine arteries

Question 2

ovaries drain to what nodes…

Answer 2

para-aortic

Question 3

uterus drains to which nodes

Answer 3

external iliac

Question 4

cervix and proximal vagina drain to which nodes

Answer 4

internal iliac

Question 5

distal vagina drains to which nodes

Answer 5

superficial inguinal

Question 6

infundibulopelvic ligament

Answer 6

“suspensory ligament” of the ovaries –> connects ovary to lateral pelvic wall

contains ovarian vessels

is ligated in oophorectomy, can torse!!!!

Question 7

cardinal ligament

Answer 7

connects cervix to side wall, also holds in place bladder and rectum –> childbirth can cause pelvic floor relaxation

contains uterine vessels

is ligated during hysterectomy, must be wary of ureters

Question 8

round ligament

Answer 8

connects the uterine fundus to the labia majora and passes through the deep inguinal canal (above artery of sampson)

Question 9

broad ligament

Answer 9

connects the uterus, ovaries and fallopian tubes to the pelvic sidewall

fold of peritoneum (mesosalpinx, mesometrium, mesovarium)

contains the ovaries, round ligament and fallopian tubes

Question 10

ovarian ligament

Answer 10

attaches lateral uterus to ovary

Question 11

describes the histopathology of the female reporductive tract

Answer 11

being in vagina and ectocervix with stratified squamous epithelium —> transition zone (MC for cervical cancer) goes to squamocolumnar junction —> endocervix/uterus are simple columnar (where uterus us long vs coiled glands during proliferative phase vs secretory phase)

fallopian- simple columnar, ciliated
ovary- simple cuboidal

Question 12

retroperitoneal organs (SAD PUCKER)

Answer 12

Suprarenal glands
Aorta/IVC
Duodenum (2/4)
Pancreas
Ureters
Colon (asc/desc)
Kidneys
Esophogus
Recutum

Question 13

layers of the abdominal wall

Answer 13

Skin
Fascia
------>Campers (fatty)
-------> Scarpas (membranous)
External oblique
Internal oblique
Transversus abdominis
Transversalis fascia
Extraperitoneal fascia
Parietal Peritoneum

• *if you go slightly medially, you will hit the aponeurosis of the rectus abd and the external oblique
• **if you go medial, you go first through the rectus sheath

Question 14

what do you need to consider with trocar placement in an abdominal laproscopic entry

Answer 14

superior epigastric vessels, which are about 4-8cm from the midline

Question 15

what muscles do you ALWAYS penetrate with a trocar for port placement?

Answer 15

rectus abd, external oblique, internal oblique, transversus abd

Question 16

blood supply of ovaries

Answer 16

• ovarian artery from Aorta
• R ovarian vein goes Right into the IVC
• L ovarian vein goes into L renal vein

Question 17

blood supply of uterus

Answer 17

uterine artery from internal iliac

**you can ligate uterine artery/ internal iliac in PPH. You can’t go higher than the internal iliac so next step is hyst

Question 18

uterosarcral ligament

Answer 18

connects uterus to sacrum

MUST be removed during hyst, but look like ureters

Question 19

grading of uterine inversion

Answer 19

II is at the opening of the vagina, IV= full external inversion

Question 20

approach to acute bleeding uterus (non surgical)

Answer 20

2 large bore IV
IVF bolus
type and cross and transfuse PRN
IV estrogen

(surgery if needed)

Question 21

surgical approach to uterine bleed

Answer 21

• intracavitary tamponade
• D&C
• uterine artery embolization
• TAH= definitive

Question 22

relationship of ureters to ovarian vessels

Answer 22

run MEDIAL