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Flashcards in S2) The Woman Deck (45)
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Identify the following structures in the female reproductive system:


Describe the clinical basis for a sharp pain at ovulation

- Mittelschmerz pain is pelvic/lower abdominal pain felt during ovulation 

- Exact cause is unknown


Why do nuns tend to get ovarian cancer? 

They have the maximum number of follicular ruptures, thus get repeated healing/scarring which predisposes them to cancer


What are ovarian cysts?

Ovarian cysts are large fluid filled lesions on the ovary 


How might a patient with an ovarian cyst present?

- Lower abdominal pain (stretching of perineum, rupture / torsion of ovary)

- Bloating 

- Back pain


Identify the following structures on the uterus:

- Uterine tube

- Fundus

- Vagina

- Cervix

- Body


What sort of structure is the cervix?

Fibrous or muscular?

Fibrous structure


Distinguish between the external Os of a cervix that has had a baby passed through and one that hasn't


Why do pregnant women experience the following symptoms:

- Acid reflux

- Constipation

- Polyuria

- Acid reflux: uterus pushes on stomach from below 

- Constipation: uterus pushes backwards onto large intestine 

- Polyuria: uterus pushes downwards onto bladder


In terms of fertilisation, what is the clinical significance of the uterine tubes?

Site of fertilisation


What is notable about the ampulla region of the fallopian tube?

Most common site for ectopic pregnancies


What is the most important investigation in women of reproductive age with abdominal pain?

Pregnancy test


Identify the peritoneal ligaments

- Broad ligament 

- Round ligament

- Ovarian ligament

- Suspensory ligament of the ovary


Describe the structure of the broad ligament

Broad ligament – peritoneal fold


Describe the structure of the suspensory ligament of the ovary

Suspensory ligament of the ovary – neurovascular pathway bulging into peritoneum 


Describe the origins of the round ligament and the ligament of ovary

Round ligament and ligament of ovary – remnants of the gubernaculum


What is the mesovarium?

Mesovarium is the portion of the broad ligament of the uterus that suspends the ovaries



What is the mesosalpinx?

Mesosalpinx is the portion of the broad ligament that stretches from the ovary to the level of the uterine tube


What is the mesometrium?

Mesometrium is the mesentery of the uterus, composing most of the broad ligament of the uterus, excluding only the mesosalpinx and the mesovarium


How does the uterus get its blood supply?

- Uterine artery 

- Ovarian artery


What is significant about the axis of cervix?  

- Axis of cervix to axis of vagina < 180= cervix is anteverted (most common)

- Axis of cervix to axis of vagina >180= cervix is retroverted


What is significant about the axis of uterine body?

- Axis of uterine body to axis of vagina < 180o = uterus is anteflexed (most common)

- Axis of uterine body to axis of vagina > 180= uterus is retroflexed


How is anteversion/anteflexion maintained?

Peritoneal ligaments


Describe the three different types of vaginal mutilation 

- Removal of clitoris

- Removal of all except urethra and vagina

- Everything is removed, sewn up and leaving a tiny opening for urine


What is the origin of the blood supply to the ovary?

The ovarian artery arises from the abdominal aorta


Describe the venous drainage of the left and right ovaries

- Left ovarian vein (LOV) drains into left renal vein 

- Right ovarian vein (ROV) drains into the inferior vena cava


To which lymph nodes does the ovary drain?

Para-aortic lymph nodes


Identify the following areas in the fallopian tube:

- Fimbriae

- Ampulla

- Isthmus 


How might infection spread to the peritoneum from the female reproductive tract?

Via the fimbrae


Describe how the tissue structure of the Fallopian tube facilitates the transport of the ovum towards the uterus

- Peristalsis: muscular tube moves ovum in peristaltic waves

Cilliary sweeps: unidirectional movement of ovum


What may be the consequence of infection in the uterine tubes?

- Scarring 

- Ectopic pregnancy 

- Infection could spread to peritoneum (peritonitis)


Where would pain be felt with an ectopic pregnancy implanted in the ampulla of the uterine tubes?

Iliac fossa


Why is shoulder tip pain associated with the rupture of an ectopic pregnancy?

Blood runs up paracolic recesses (spaces between abdominal wall and colon) which compresses the phrenic nerve


Describe the arterial supply to the uterine tubes

- Uterine arteries 

- Ovarian arteries


Be able to identify the following structures:

- Ovarian artery

- Uterine artery

- Vagina artery

- Internal pudendal artery


Why is the ureter at risk of being damaged during a hysterectomy?

- When removing the uterus, the uterine artery is clamped

- The ureter is closely associated to the uterine artery (water under the bridge)


What are the posterior anatomical relations of the vagina?

- Rectum

- Anus


What are the anterior anatomical relations of the vagina?

- Bladder 

- Urethra


What are the lateral anatomical relations of the vagina?

- Ureter

- Uterine artery


In terms of lymphatic drainage, identify the structures below:


In terms of the vulva, label the following structures:

- Mons pubis

- Labia majora & minora

- Clitoris

- Vestibule of the vagina 

- External urethral orifice

- Anus


Describe the structure of the recto-uterine pouch

- Aka pouch of Douglas

- It is an extension of peritoneum between the posterior wall of uterus and the rectum in females


Describe the structure of the vesico-uterine pouch

Vesico-uterine pouch is a second but shallower pouch formed from the peritoneum over the uterus and bladder


In a bimanual/pelvic examination, which structure can be palpated anteriorly from the fornix?

Vesico-uterine pouch


In a bimanual / pelvic examination, what structures can be palpated from the posterior fornix?

Recto-uterine pouch