Podcast
Questions and Answers
What is the most common type of cancer associated with the Squamo-columnar junction?
What is the most common type of cancer associated with the Squamo-columnar junction?
The transformation zone is a static area that does not change over time.
The transformation zone is a static area that does not change over time.
False
Where is the external os located?
Where is the external os located?
It is the point where the cervix opens into the vagina.
The cervix connects to the uterus at the __________.
The cervix connects to the uterus at the __________.
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Match the cervix types with their descriptions:
Match the cervix types with their descriptions:
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What type of vaginal epithelial cells are pink and eosinophilic?
What type of vaginal epithelial cells are pink and eosinophilic?
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Intermediate cells have big nuclei.
Intermediate cells have big nuclei.
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Which vaginal epithelial cells are observed when no hormone predominates?
Which vaginal epithelial cells are observed when no hormone predominates?
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What is the deepest fornix called?
What is the deepest fornix called?
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The Pouch of Douglas is located anterior to the ampulla of the rectum.
The Pouch of Douglas is located anterior to the ampulla of the rectum.
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The vaginal epithelial cells observed when estrogen predominates are called __________ cells.
The vaginal epithelial cells observed when estrogen predominates are called __________ cells.
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Match the type of vaginal epithelial cells with their characteristics:
Match the type of vaginal epithelial cells with their characteristics:
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What procedure is associated with the applied aspect of the cul-de-sac?
What procedure is associated with the applied aspect of the cul-de-sac?
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The __________ is a ligament that runs laterally and supports the cervix.
The __________ is a ligament that runs laterally and supports the cervix.
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Match the following anatomical structures with their corresponding relations:
Match the following anatomical structures with their corresponding relations:
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What is the endometrial thickness immediately after menstruation?
What is the endometrial thickness immediately after menstruation?
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The endometrial thickness during the late proliferative phase can reach up to 11 mm.
The endometrial thickness during the late proliferative phase can reach up to 11 mm.
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What is the range of endometrial thickness during the secretory phase?
What is the range of endometrial thickness during the secretory phase?
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The endometrial thickness during the early proliferative phase is ___ mm.
The endometrial thickness during the early proliferative phase is ___ mm.
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Match the time of the menstrual cycle with its corresponding endometrial thickness:
Match the time of the menstrual cycle with its corresponding endometrial thickness:
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Which artery is a direct branch of the abdominal aorta and located anterior to the ureter?
Which artery is a direct branch of the abdominal aorta and located anterior to the ureter?
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The most common area of ureteral injury during a hysterectomy is at the internal os.
The most common area of ureteral injury during a hysterectomy is at the internal os.
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What is the best way to identify the ureter during surgery?
What is the best way to identify the ureter during surgery?
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The measurement between the median sacral artery and the ureter is ___ cm.
The measurement between the median sacral artery and the ureter is ___ cm.
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Match the following areas of susceptibility for ureteral injury to their descriptions:
Match the following areas of susceptibility for ureteral injury to their descriptions:
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Which artery supplies blood to the vagina?
Which artery supplies blood to the vagina?
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The lower part of the vagina receives nerve supply primarily from the S2 - S4 segments.
The lower part of the vagina receives nerve supply primarily from the S2 - S4 segments.
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What is the anatomical description of the vagina?
What is the anatomical description of the vagina?
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The upper part of the vagina drains lymph into the _____ nodes.
The upper part of the vagina drains lymph into the _____ nodes.
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Match the vaginal characteristics with their descriptions:
Match the vaginal characteristics with their descriptions:
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What is the primary composition of the cervix?
What is the primary composition of the cervix?
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Ectropion or eversion of the cervix results in both red and pink epithelium at the external os.
Ectropion or eversion of the cervix results in both red and pink epithelium at the external os.
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What appearance does the endocervix have during per speculum examination?
What appearance does the endocervix have during per speculum examination?
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The exocervix is lined with __________ epithelium.
The exocervix is lined with __________ epithelium.
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Match the following components of the cervix with their descriptions:
Match the following components of the cervix with their descriptions:
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Which arteries are primarily responsible for the blood supply of the cervix?
Which arteries are primarily responsible for the blood supply of the cervix?
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The hypogastric lymph nodes are also known as internal iliac lymph nodes.
The hypogastric lymph nodes are also known as internal iliac lymph nodes.
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What is the mnemonic used to remember the lymphatic drainage of the cervix?
What is the mnemonic used to remember the lymphatic drainage of the cervix?
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The sensory nerve supply to the cervix is provided by the _______ ganglion.
The sensory nerve supply to the cervix is provided by the _______ ganglion.
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Match the following lymph nodes with their names:
Match the following lymph nodes with their names:
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What is the primary nature of vaginal pH during the reproductive age?
What is the primary nature of vaginal pH during the reproductive age?
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Doderlein bacilli disappear after puberty.
Doderlein bacilli disappear after puberty.
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What type of epithelium lines the vagina?
What type of epithelium lines the vagina?
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The vaginal pH is slightly _______ during the first two weeks of life due to maternal estrogen.
The vaginal pH is slightly _______ during the first two weeks of life due to maternal estrogen.
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Match the following age groups with their corresponding vaginal pH and reasons:
Match the following age groups with their corresponding vaginal pH and reasons:
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Which type of hysterectomy has the highest risk of ureteric injury?
Which type of hysterectomy has the highest risk of ureteric injury?
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In a simple hysterectomy, the ovaries are usually removed.
In a simple hysterectomy, the ovaries are usually removed.
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What structures are removed during a Radical Hysterectomy?
What structures are removed during a Radical Hysterectomy?
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The procedure known as __________ involves a Total Abdominal Hysterectomy plus the removal of ovaries and fallopian tubes.
The procedure known as __________ involves a Total Abdominal Hysterectomy plus the removal of ovaries and fallopian tubes.
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Match the types of hysterectomy with the structures removed:
Match the types of hysterectomy with the structures removed:
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Study Notes
Squamo-columnar Junction (SCJ)
- Transformation zone: area between new and old SCJ
- Most common type of cervical cancer: Squamous cell carcinoma (SCC)
- Most frequent site of cervical cancer: Transformation zone > SCJ
- Adenocarcinoma: Endocervix
External os
- Point where cervix opens into vagina
- Pin-point (Nulliparous)
- Transverse slit-like (Multiparous)
Internal os
- Point where cervix connects to the uterus
Fornices
- 4 fornices (Posterior: Deepest fornix)
- Peritoneal covering: only on upper 1/3rd of posterior wall, called Pouch of Douglas/Rectouterine pouch/Cul-de-sac
- Applied aspect: Culdocentesis, performed for Ruptured ectopic
Relations
- Anterior: Bladder, Urethra
- Lateral: Transverse cervical/Mackenrodt's/Cardinal Ligament, Ureter, Bartholin gland
- Posterior: Pouch of Douglas (POD), Ampulla of rectum, Perineal body
Vaginal Epithelial Cells
- Superficial cells: Pink, eosinophilic cells, pyknotic nuclei, seen when Estrogen predominates
- Intermediate cells: Blue, basophilic cells, small nucleus, seen when Progesterone predominates
- Parabasal cells: Blue, basophilic cells, hazy outline, large nucleus, seen when no hormone predominates
Vaginal Cytology
- Can predict hormonal profile of patient
- Sample: upper 1/3rd of lateral vaginal wall (hormonally sensitive)
Endometrial Thickness During Various Phases
- Immediately after menstruation: 1-2 mm
- Early proliferative phase: 5-7 mm
- Late proliferative / preovulatory phase: Until 11 mm
- Secretory phase: 7-16 mm
- Postmenopausal females:
URETER
- Arteries anterior to ureter: Ovarian artery (Direct branch of abdominal aorta), Uterine artery (Branch of Anterior division of Internal Iliac A)
- Arteries posterior to ureter: Common Iliac A. (Divides after ureteric crossing), Internal Iliac A.
- Landmark for entry of ureter into pelvis: Distance between median sacral artery & ureter = 3cm.
- Lateral relation of external iliac artery: Iliopsoas muscle + Genitofemoral Nerve.
- Best way to identify ureter during surgery: Visualize peristalsis of ureter.
Ureteral Injury in Hysterectomy
- Areas of susceptibility: At pelvic brim (most common) crosses over iliac vessels, Water under the bridge (most common) uterine artery crossing (2cm lateral to internal os), At the internal os (near cervix)
Types of Hysterectomy
- Simple/Total Abdominal Hysterectomy: (most common for benign lesions) Uterus + Cervix
- Modified/Wertheim's Radical: Uterus + Cervix + Fallopian tubes + Ovaries, medial half of CL and USL removed, upper 1/3rd(1cm) of vagina removed
- Radical Hysterectomy: Uterus + Cervix + Fallopian tubes + Ovaries, Complete CL and USL removed, upper 2/3rd of vagina (2cm) removed
- CL = cardinal ligament
- USL = uterosacral ligament
Hysterectomy with Highest Risk of Ureteric Injury
- Wertheim's (Type 2) hysterectomy
Simple Hysterectomy (Type 1)
- Most frequent cause of ureteric injury
Panhysterectomy (TAH + BSO)
- Removal of ovaries and fallopian tubes (Total Abdominal Hysterectomy + Bilateral Salpingo-oophorectomy - TAH+BSO)
VAGINA
- Blood supply: Vaginal artery (Branch of internal iliac artery), supplies vagina + base of bladder
- Nerve supply: Upper part: S2 - S4, Lower part: Pudendal nerve
- Lymphatic drainage: Upper part: "HOPE", Lower part: Superficial inguinal nodes
General Points & Anatomical Relations of Vagina
- Description: Fibromuscular hollow tube
- Walls: Anterior, Posterior (Longer by 2cm)
- Angle of anteversion: 90° angle made with cervix.
- Angle with horizontal: 45°.
- Rugae: Transverse folds, Most specific feature.
Applied Anatomy: Cervix and Vagina
Cervix
- Composition: Major: Collagen (Connective tissue), 10-15%: Smooth muscle fibers
- Applied Aspect: Effacement during labor (due to breakdown of collagen + increased water content)
Per Speculum (P/S) Findings
- Endocervix: Part of cervix close to the uterus, lining: Columnar epithelium, appears red
- Exocervix: Part of cervix inside the vagina, lining: Stratified squamous epithelium, Aka portio vaginalis, appears pink
Ectropion/Eversion
- Red epithelium (Endocervix) (+) outside external os, normally only pink epithelium (+), physiological: common in pregnancy, C/o: Post coital bleeding, Biopsy: Not required
Neurovascular Supply & Lymphatic Drainage of Cervix & Vagina
Cervix
- Blood Supply: Descending cervical artery: Branch of uterine artery, located at 3 o'clock and 9 o'clock positions
- Lymphatic Drainage: "HOPE", Hypogastric lymph nodes (AKA internal iliac lymph nodes), Obturator lymph node, Paracervical lymph node, External iliac lymph node
- Cancer cervix + superficial inguinal node involvement = Implies distant metastases (Stage 4B)
- Paracervical block: Given at 2 & 4 o'clock/8 & 10 o'clock positions, C/1: 3 & 9 o'clock position
- Nerve Supply: S2-S4, Sensory supply: Franken Hauser ganglion
- Peritoneal covering: Posterior surface (+), Anterior surface (-)
Vagina Histology and Applied Aspects
- Histology of Vagina: Lining: Non Keratinized stratified squamous epithelium, Glands: Absent
- Applied Aspect: Vaginal discharge: Cervical discharge (mainly) + Endometrial gland discharge + Bartholin gland discharge (only during intercourse)
pH of Vagina
- Acidic, due to Doderlein bacilli
- Estrogen (glycogen) involved
Nature of Vaginal pH in Different Age Groups
- Birth - 2 wks: Slightly acidic, Maternal estrogen
- 2 wks - puberty: Alkaline: 6-8, Cervical secretions
- At puberty: Acidic: 4-5, Doderlein bacilli
- Reproductive age: Acidic: 4-4.5, ↑ Doderlein bacilli
- Menopause: Alkaline: 6-8, ↓ Doderlein bacilli
- Menstruation: Alkaline: 6-8, Blood: Alkaline
- Pregnancy: ↑ Acidic: 3.5-4, ↑ Doderlein bacilli
Doderlein Bacilli
- Inhabitant bacteria of vagina, Lactobacilli, Glycogen (due to estrogen) and lactic acid, Appear: At puberty, Disappear: menopause
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Description
Test your knowledge on the cervical anatomy, including the squamo-columnar junction and the external and internal os. Explore the connections and clinical significance of various structures, including the fornices and their relations. This quiz covers essential aspects that are crucial for understanding cervical health and disease.
