Gynaecology Pg No 11 -20

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Questions and Answers

What is the most common type of cancer associated with the Squamo-columnar junction?

Adenocarcinoma

Cervical lymphoma

Endometrial carcinoma

Squamous cell carcinoma (correct)

The transformation zone is a static area that does not change over time.

False

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 __________.

internal os Signup and view all the answers

Match the cervix types with their descriptions:

Nulliparous = Pin-point Multiparous = Transverse slit-like Signup and view all the answers

What type of vaginal epithelial cells are pink and eosinophilic?

Superficial cells Signup and view all the answers

Intermediate cells have big nuclei.

False Signup and view all the answers

Which vaginal epithelial cells are observed when no hormone predominates?

Parabasal cells Signup and view all the answers

What is the deepest fornix called?

Posterior fornix Signup and view all the answers

The Pouch of Douglas is located anterior to the ampulla of the rectum.

False Signup and view all the answers

The vaginal epithelial cells observed when estrogen predominates are called __________ cells.

superficial Signup and view all the answers

Match the type of vaginal epithelial cells with their characteristics:

Superficial cells = Pyknotic nuclei Intermediate cells = Small nucleus Parabasal cells = Big nuclei Not hormone predominating = Blue, basophilic cells, hazy outline Signup and view all the answers

What procedure is associated with the applied aspect of the cul-de-sac?

Culdocentesis Signup and view all the answers

The __________ is a ligament that runs laterally and supports the cervix.

transverse cervical ligament Signup and view all the answers

Match the following anatomical structures with their corresponding relations:

Bladder = Anterior Pouch of Douglas = Posterior Bartholin gland = Lateral Uterus = Superior Signup and view all the answers

What is the endometrial thickness immediately after menstruation?

1-2 mm Signup and view all the answers

The endometrial thickness during the late proliferative phase can reach up to 11 mm.

True Signup and view all the answers

What is the range of endometrial thickness during the secretory phase?

7-16 mm Signup and view all the answers

The endometrial thickness during the early proliferative phase is ___ mm.

5-7 Signup and view all the answers

Match the time of the menstrual cycle with its corresponding endometrial thickness:

Immediately after menstruation = 1-2 mm Early proliferative phase = 5-7 mm Late proliferative phase = Until 11 mm Secretory phase = 7-16 mm Signup and view all the answers

Which artery is a direct branch of the abdominal aorta and located anterior to the ureter?

Ovarian artery Signup and view all the answers

The most common area of ureteral injury during a hysterectomy is at the internal os.

False Signup and view all the answers

What is the best way to identify the ureter during surgery?

visualize peristalsis of ureter Signup and view all the answers

The measurement between the median sacral artery and the ureter is ___ cm.

3 Signup and view all the answers

Match the following areas of susceptibility for ureteral injury to their descriptions:

Pelvic brim = Most common area of injury, crosses over iliac vessels Water under the bridge = Uterine artery crossing, located 2cm lateral to internal os Internal os = Near the cervix Signup and view all the answers

Which artery supplies blood to the vagina?

Vaginal artery Signup and view all the answers

The lower part of the vagina receives nerve supply primarily from the S2 - S4 segments.

False Signup and view all the answers

What is the anatomical description of the vagina?

Fibromuscular hollow tube Signup and view all the answers

The upper part of the vagina drains lymph into the _____ nodes.

HOPE Signup and view all the answers

Match the vaginal characteristics with their descriptions:

Rugae = Transverse folds within the vagina Angle of anteversion = 90° angle made with cervix Anterior wall = Shorter wall of the vagina Posterior wall = Longer wall of the vagina, by 2cm Signup and view all the answers

What is the primary composition of the cervix?

Collagen and smooth muscle fibers Signup and view all the answers

Ectropion or eversion of the cervix results in both red and pink epithelium at the external os.

True Signup and view all the answers

What appearance does the endocervix have during per speculum examination?

Red Signup and view all the answers

The exocervix is lined with __________ epithelium.

stratified squamous Signup and view all the answers

Match the following components of the cervix with their descriptions:

Endocervix = Lining: Columnar epithelium, appears red Exocervix = Lining: Stratified squamous epithelium, appears pink Ectropion = Red epithelium outside external os Effacement = Breakdown of collagen during labor Signup and view all the answers

Which arteries are primarily responsible for the blood supply of the cervix?

Uterine artery Signup and view all the answers

The hypogastric lymph nodes are also known as internal iliac lymph nodes.

True Signup and view all the answers

What is the mnemonic used to remember the lymphatic drainage of the cervix?

HOPE Signup and view all the answers

The sensory nerve supply to the cervix is provided by the _______ ganglion.

Franken Hauser Signup and view all the answers

Match the following lymph nodes with their names:

Hypogastric = Internal iliac lymph nodes Obturator = Located near the obturator foramen Paracervical = Adjacent to the cervix External iliac = Located along the external iliac artery Signup and view all the answers

What is the primary nature of vaginal pH during the reproductive age?

Acidic: 4-4.5 Signup and view all the answers

Doderlein bacilli disappear after puberty.

False Signup and view all the answers

What type of epithelium lines the vagina?

Non Keratinized stratified squamous epithelium Signup and view all the answers

The vaginal pH is slightly _______ during the first two weeks of life due to maternal estrogen.

acidic Signup and view all the answers

Match the following age groups with their corresponding vaginal pH and reasons:

Birth - 2 wks = Slightly acidic: Maternal estrogen At puberty = Acidic: Doderlein bacilli Menopause = Alkaline: ↓ Doderlein bacilli Menstruation = Alkaline: Blood Signup and view all the answers

Which type of hysterectomy has the highest risk of ureteric injury?

Modified/Wertheim's Radical Hysterectomy Signup and view all the answers

In a simple hysterectomy, the ovaries are usually removed.

False Signup and view all the answers

What structures are removed during a Radical Hysterectomy?

Uterus, Cervix, Fallopian Tubes, Ovaries Signup and view all the answers

The procedure known as __________ involves a Total Abdominal Hysterectomy plus the removal of ovaries and fallopian tubes.

Panhysterectomy Signup and view all the answers

Match the types of hysterectomy with the structures removed:

Type 1 = Uterus + Cervix Type 2 = Uterus + Cervix + Fallopian tubes + Ovaries Type 3 = Uterus + Cervix + Fallopian tubes + Ovaries Panhysterectomy = Uterus + Cervix + Fallopian tubes + Ovaries + Ovaries Signup and view all the answers

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.