TBL 30 Flashcards
What is a bicornate uterus?
Duplication of the uterus result from lack of fusion of the paramesonephric ducts in a local area or throughout their normal line of fusion.
Bicornate uterus- in which two horns enter a common vagina.
Why can peritonitis cause salpingitis and why is the latter a major cause of female infertility?
Female genital tract communicates with the peritoneal cavity through the abdominal ostia of the uterine tube. Inflammation of the uterine tube (SALPINGITIS) may result from infection spread from the peritoneal cavity- peritonitis.
Salpingitis may obstruct the uterine tube leading to infertility.
Why is primary peritonitis rare in females?
Females have a protective mechanisms of a mucous plug which effectively blocks the external os (opening) of the uterus to most pathogens except sperms.
What conditions contribute to the prolapse of a retroverted uterus?
Instead of pressing the uterus against the bladder, increased intra-abdominal pressure tends to push the retroverted uterus, a solid mass positioned upright over the vagina (a flexible, hollow tube), into or even through the vagina.
The situation is exacerbated in the presence of a disrupted perineal body or with atrophic (“relaxed”) pelvic floor ligaments and muscles.
Which pelvic structure must be identified to preclude its damage or obstruction during surgical ligation of the uterine artery?
Ureter.
Why can cervical cancer metastasize to the bladder or to the brain?
Because no peritoneum intervenes between the anterior
cervix and the base of the bladder, cervical cancer may
spread by contiguity to the bladder. It may also spread by
lympho genous (lymph borne) metastasis to external or internal iliac or sacral nodes. Hematogenous (blood borne) metastasis may occur via iliac veins or via the internal vertebral venous plexus.
What is the frequency of tubal pregnancies and why can a ruptured right tubal pregnancy be incorrectly diagnosed as acute appendicitis?
Tubal pregnancy is the most common
type of ectopic gestation; it occurs in approximately 1 of every 250 pregnancies in North America.
On the right side, the appendix often lies close to the ovary and uterine tube. This close relationship explains why a ruptured tubal pregnancy and the resulting peritonitis may be misdiagnosed as acute appendicitis. In both cases, the parietal peritoneum is infl amed in the same general area, and the pain is referred to the right lower quadrant of the abdomen.
What is the most common tumor in the female pelvis and what is its primary symptom?
Leiomyomas, commonly known as fibroids, are benign tumors of the uterus that arise as localized hyperplasia of smooth muscle cells of the myometrium. They are the most common tumors in the female pelvis.
A common symptom is excessive and prolonged bleeding at menstruation.
- From Clinical Point, pp. 418: What is the probable pathogenesis of endometriosis?
Endometriosis is a common gynecologic disease in which endometrial tissue appears at unusual locations in the lower abdomen and pelvis.
The disorder may result when endometrial cells peel off the uterine lining during the menstrual cycle and migrate via fallopian tubes to the peritoneal cavity. The condition often subsides after menopause, when estrogen
stimulation declines.
Why is benign hypertrophy of the prostate associated with nocturia, dysuria, and urinary frequency?
How can tumor cells from a prostatic adenocarcinoma metastasize vascularly to the brain?
An enlarged prostate projects into the urinary bladder and impedes urination by distorting the prostatic urethra.
The middle lobule usually enlarges the most and obstructs the internal urethral orifi ce. The more the person strains, the more the valve-like prostatic mass occludes the urethra. BHP is a common cause of urethral obstruction, leading to nocturia (need to void during the night), dysuria (difficulty and/or pain during urination), and urgency (sudden desire to void).
In advanced stages, cancer cells metastasize both via lymphatic routes (initially to the internal iliac and sacral lymph nodes and later to distant nodes), and via venous routes (by way of the internal vertebral venous plexus, to the vertebrae and brain).
- From Clinical Point, pp. 396 (EH): What is the frequency of benign prostatic hypertrophy and how are its symptoms commonly treated?
Benign prostatic hypertrophy is a common clinical condition affecting 30% of men older than 50 years. Its frequency and severity increase with aging.
The drugs used for treatment include a1-adrenergic receptor blockers, which inhibit contraction of prostatic smooth muscle and may help alleviate symptoms.
Sx: Resulting periurethral nodules may compress the urethra so that urine flow is reduced and the bladder difficult to empty.
Discuss the initial formation of the bilateral gonads.
the bilateral gonads initially form in the intermediate mesoderm as a pair of longitudinal genital ridges medial to the mesonephros.
Discuss the spatial transition of primordial germ cells.
The primordial germ cells are derived from what layer of the inner cell mass of the blastocyst.
epiblast-derived primordial germ cells pass through the primitive streak and temporarily reside among the endodermal cells of the yolk sac before migrating along the dorsal mesentery of the hindgut into the genital ridges.
Discuss the formation of the primitive sex cords.
the germ cells stimulate invagination of the genital ridge epithelium, which forms primitive sex cords that characterize the indifferent gonads.
Discuss the formation of primary follicles. During what transition period does this occur?
during transformation of the indifferent gonads into the ovaries, the sex cords degenerate and follicular cells from the genital ridge epithelium organize as monolayers around the germ cell-derived oocytes to form primary follicles.
Discuss the descent of the ovaries.
the ovaries descend from their upper lumbar origins into the pelvic cavity during the degeneration of the mesonephros.
Discuss the creation of the mullerian duct “AKA”.
The mullerian duct parallels the (structure) in both sexes.
Discuss the communication of Para-mesonephric ducts with peritoneal cavity.
a longitudinal infolding of the gonadal ridge epithelium creates the paramesonephric (aka mullerian) duct.
it parallels the mesonephric duct in both sexes
proximally, the lumens of the bilateral para-mesonephric ducts are directly continuous with the peritoneal cavity.
Discuss the formation of the uterine canal.
the dissension of the ovaries into the pelvis moves the paramesonephric ducts medially and caudally, and the midline fusion of their distal portions forms the uterine canal.
uterine canal differentiates into (3).
the uterine canal differentiates into the fundus, body, and cervix of the uterus.
Discuss the formation of the uterine tubes.
the proximal and middle portions of the paramesonephric ducts form the uterine tubes that perforate the wall of the uterine body (i.e., continuity between the peritoneal cavity and uterine lumen is established).
Discuss the regression of the paramesonephric ducts in males. Which ducts degenerate in females?
the production of mullerian inhibiting substance (MIS) in the testes causes complete regression of the paramesonephric ducts in males; and recall the mesonephric ducts degenerate in females.
Discuss the role of lacking MIS and testosterone in females.
the lack of MIS and testosterone in females allows the paramesonephric ducts to persist and results in the degeneration of the mesonephric ducts, respectively.
Define broad ligament.
the broad ligament is a reflection of parietal peritoneum that drapes over the uterus and uterine tubes.
Define ovarian ligament and its function.
the ligament of the ovary (aka ovarian ligament) is a fold of the broad ligament that forms the surface epithelium of the ovaries and tethers them to the uterus.
discuss formation of suspensory ligament of ovary and its function.
an elongation of the broad ligament forms the suspensory ligament of the ovary that provides passage to ovarian vessels and accompanying nerves from the lateral pelvic wall.
Origin of ovarian arteries and route therefore.
after arising from the abdominal aorta, the ovarian arteries descend retroperitoneally to enter the suspensory ligaments of the ovaries.
Which nerve fibers accompany the ovarian arteries.
postsynaptic sympathetic fibers and visceral afferent fibers from the DRG at T12-L2 accompany the ovarian arteries.
discuss the positioning of the uterus and ovaries.
the uterus is centered in the pelvic cavity and the ovaries are positioned midway to the pelvic wall.
discuss what forms the 1/3s of the uterus.
the rounded fundus and body form the superior two thirds of the uterus and the cylindrical cervix forms the inferior third, which is subperitoneal.
discuss the normal position of uterus onto an EMPTY bladder!
observe the uterus is normally anteverted onto the empty bladder for passive support.
Discuss the function of the cardinal ligament.
the cardinal ligament suspends the uterine cervix (and vagina) from the lateral wall of the pelvic cavity.
Discuss the origin of uterine and vaginal arteries.
Define the role of the cardinal ligament.
the uterine and vaginal arteries arise from the internal iliac artery
the cardinal ligament conveys the arteries to the viscera.
