Glossary of 4-Female Pelvic Organs

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Where are the uterus and adnexa located?
in the lesser pelvis
What are the two main parts of the uterus? What separates them?
body and cervis
separated by isthmus
What is the superior, rounded portion of the body of the uterus called?
Name the superiolateral portion of the uterus where uterine tubes enter.
Name the elongated inferior portion of the uterus. What does it project into?
projects into the upper vagina and presents an opening, the external os
What is the difference between the external and internal os?
internal-opening through which sperm can access the isthmus of the uterus
external-opening through which sperm can enter the cervix
What is the constricted portion of the uterus called? What does it separate?
body from cervix
What is the internal layer of the uterus? What is its main characteristic?
highly vascular, sloughing during menstral cycle
Define endometriosis.
overgrowth of the uterine endometrium out of the uterus and into the uterine tube and pelvic cavity where it becomes established on the pelvic peritoneum, causing pain
Name the middle and outer layer of the uterus.
What is the term used for when the uterus is turned or shifted backwards? position further back than normal
What is the term used when the uterus is bent backwards? forwards?
What is the normal position of the uterus?
anteverted (tilted forward) and anteflexed (bent forward)
What does the angle of anteversion related to?
the axis of the cervix with respect to the axis of the vagina
What does the angle of anteflexion pertain to?
the axis of theuterine body with respect to the axis of the cervix
When palpating the uterus, what is an early sign of pregnancy?
softening of the uterine isthmus
What type of fascia is located between the peritoneum and superior fascia of the pelvic diaphragm? Is it inferior or superior to the pelvic fascia?
endopelvic fascia
In addition to suspensory functions, what else are the pelvic ligaments associated with?
blood vessels, nerves and lymphatics
Describe the peritoneum of the mesentery? What is another name for the mesentery?
double layer
broad ligament
Name the 3 structures that the broad ligament encloses.
uterine tube, round ligament of uterus, ligament of ovary
What is the main portion of the broad ligament? What is it the mesentery of?
What is the name of the fold of peritoneum from which the uterine tubes are suspended? What does it contain?
Epoophoron-remnants of mesonephric tubules
What is the fold of peritoneum from which the ovaries are suspended? What is it perpendicular to?
perpendicular to mesosalpinx
What is the purpose of the cardinal ligament?
-suspends cervical region of the uterus from the lateral pelvic walls
What are two other names for the cardinal ligament?
Transverse cervical, mackenrodt's ligament
What artery runs with the cardinal ligament?
uterine A
What can be the result of a weakened levator ani?
uterine prolapse
What is the round ligament of the uterus a remnant of?
What does the round ligament of the uterus attach to after it has passed through the broad ligament an dinguinal canal? Where does it attach on the uterus?
skin of the labium majora
just inferior to the uterine tubes
What is the clinical significance of the round ligament during pregnancy?
it can be pulled on and cause pain in the vulvar region
What does the uterosacral ligament attach? What fold is this ligament contained in?
posterior cervix of uterus to the sacrum
uterosacral fold
What does the uterine artery branch from? What does it anastomose with superiorly and inferiorly?
internal iliac
ovarian A superiorly and vaginal A inferiorly
What are the nerves in the true pelvis derived from?
Lumbosacral trunk (L4,5), 5 sacral nerves, and one coccygeal N
What are the somatic nerves that innervate the uterus? Name the specific nerve and its nerve levels?
sacral & coccygeal N plexuses
pudendal N from S2-4
Does the pudendal N come from ventral or dorsal rami?
Name the two main mixed ANS of the pelvis. Which is sympathetic and parasympathetic?
sacral sympathetic trunk pelvic splanchnic nerves-parasympathetic
What does the sacral sympathetic trunk communicate with?
ventral rami of sacral & cocygeal N plexuses and inferior hypogastric plexus
What spinal levels are the pelvic splanchnic nerves from? What do they merge with?
hypogastric nerves
What forms the inferior hypogastric n plexus? What type of nerves are they?
hyupogastric nerves and pelvic splanchnic nerves
Which lymph nodes drain the fundus of the uterus? What do these nodes run with?
superficial inguinal lymph nodes run with the round ligament of the uterus
Which nodes drain the lower body of the uterus?
external iliac
Which nodes drain the cervix?
internal iliac
What type of organ is the vagina? What does it extend from?
from uterus to vulva
What artery supplies the proximal part of the vagina?
vaginal artery
What is the vaginal artery a branch of?
uterine artery
Which artery supplies the distal vagina?
internal pudendal A
What is the lower 1/5 of the vagina innervated by? What is it sensitive to?
somatic nerves
touch and temperature
What do the somatic nerves branch from?
deep perineal branch of pudendal nerve
What is the upper 4/5 of the vagina innervated by? What is it sensitive to?
viscerally innervated by the ANS
Sympathetic fibers derived from the upper lumbar spinal cord levels travel to what plexus?
inferior hypogastric plexus
The inferior hyposgastric plexus is joined by what other nerves?
pelvic splanchnic nerves
Mixed automomic nerves travel toward the uterus and vagina along w/ the uterine artery to form the _______ plexus.
What areas are numbed by a caudal epidural?
subperitoneal and somatic areas
How can the pudendal nerve be accessed for a nerve block?
accessed where n crosses the lateral aspect of the sacrospinous ligament near its attachment to the ischial spine
What nodes does the superior part of the vagina drain to?
internal and external iliac lymph nodes
What nodes does the middle part of the vagina drain?
internal iliac
What nodes does the inferior vagina drain?
sacral and common iliac and superficial inguinal lymph nodes
What can be palpated during a vaginal exam?
cervix, ischial spines, sacral promontory, ovarian cysts
What is the part of the uterine tube that passes through the upper body of the uterus?
uterine/intramural portion
Where is the uterine tube the narrowest?
at the uterine/intramural portion of uterine tube
Name the 3 extramural portions of the uterine tube.
isthmus, ampulla, infundibulum
Name the longest portion of the tube? Where does this tube end?
ampulla, ends in dilation near fimbriae
Name the distal end of the uterine tube? What is it open to?
peritoneal cavity
In what part of the uterine tube does fertilization occur?
What is the opening of the infundibulum called that is in close proximity to the ovary?
ovarian fimbria
Infections of the vagina, uterus, and uterine tubes may result in _____.
What is a major cause of infertility in women?
blockage of the uterine tubes (often the result of pelvic infection and inflammation)
Where are the ovaries located w/ respect to the broad ligament?
above and behind it
What does the suspensory ligament of the ovary contain?
ovarian A&V, nerves and lymphatics
Where does the suspensory ligament of the ovary run?
just inferior to the uterine tube
What do the ovarian arteries branch from?
abdominal aorta
What do the ovarian arteries anastomose with?
uterine arteries
What does the R ovarian vein drain to? L?
R-vena cava
L-L renal vein
What supplies the PSNS innervation to the ovaries?
pelvic splanchnic nerves
Sympathetic and afferent fibers reach the _____ plexus by descending along the ovarian vessels and via communications from the _____ plexus
pelvic (uterovaginal)
Which nodes do the ovaries drain to?
Describe the pathway of sperm starting at the vagina.
vagina-external os of uterus-cervical canal-internal os-isthmus-body-horn-intramural uterine tube-extramural (isthmus to ampulla) portions of uterine tube
What can occur if the ovum is released from the ovary but not captured by the fimbriae of the uterine tube?
ectopic pregnancy
What can occur if the ovum is fertilized in the peritoneal cavity?
ectopic pregnancy
The urethra runs from bladder to _____.
urethral orifice
Name the 3 ligaments of the bladder.
inferior (arcuate) pubic, lateral & medial pubovesicle
What supplies blood to the inferior aspect of the bladder in females?
vaginal/inferior vesicle artery
What is the main artery supplying the bladder? What is this artery a branch of?
superior vesicle artery
(proximal) part umbilical artery
In females, what is the space between the pubis symphysis and bladder?
retropubic (prevesical) space
What are the concave recesses lateral to the bladder?
paravesical fossa
What are the concave recesses lateral to the rectum? What do these spaces allow for?
pararectal fossa
permit expansion of rectum
What is herniation of bladder into the vaginal wall?
What is the space between the portions of the uterus and bladder that are covered w/ peritoneum?
vesicouterine pouch
What is the space between the portions of the uterus and rectum which are covered w/ peritoneum?
rectouterine pouch/cul-de-sac of Douglas
What is the most inferior part of the peritoneal cavity in women?
rectouterine pouch/cul-de-sac of Douglas
Infections of the rectouterine pouch can be drained through the _____ of the vagina.
posterior fornix
Indoscopic instruments can be introduced into the lower peritoneal cavity through the posterior fornix. What is this procedure called? What is its purpose?
diagnostic purposes of rectouterine pouch
What is the vaginal fornix?
recess around the superior end of the vagina resulting from projection of cervix into proximal vagina
What completely encircles the cervix?
Which umbilical fold contains the occluded umibilical artery?
What did the umbilical artery extend from?
superior vesicle arteries to the umbilicus
What does the median umbilical fold ascend to? What does it contain?
ascends to umbilicus
contains urachus
What is the urachus?
canal between bladder and allantois in the fetus
The uterosacral/sacrouterine/rectouterine fold passes superiorly and posterior from the _____ to the middle of the sacrum.
What is the name of the raised peritoneum over the ureter as it enters the pelvis?
ureteric fold
What is located between the peritoneum and the superior fascia of the pelvic diaphragm?
endopelvic fascia
What is the name of the fascia that is a continuation of the fascia covering the muscles surrounding the abdominal cavity?
superior fascia of pelvic diaphragm/parietal pelvic fascia
In the pelvis, the fascia covering the upper surface of the pelvic diaphragm can be separate into 3 fascia types. Name them.
pubococcygeus, iliococcygeus and coccygeus fascia
What is the thickening on either side of the midline of the superior fasica of pelvic diaphragm referred to as?
tendinous arch of pelvic fascia
Anteriorly, the thickened fascia attaches the base of the bladder to the pubis in the female to form what ligament?
Fascia attaches to the sacrum by what ligament?
What is the hypogastric sheath formed by?
pelvic fascia that resolves itself into three layers
The anterior most portion of the hypgastric sheath carries what artery? What is this ligament called?
superior vesicle
lateral vesicle ligament
What does the posterior most portion of the hypgastric sheath carry? What is this ligament called?
middle rectal A
lateral rectal ligament
What is the middle subdivision of the hypogastric sheath called?
transverse cervical ligament of Mackenrodt

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