1. Applied anatomy STUDENT VERSION PDF.pdf

APPLIED ANATOMY OF FEMALE GENITAL TRACT Sample Sub-heading FEMALE GENITALIA • External genitalia • Internal genitalia Hymen demarcates external and internal genitalia Manipal University College Malaysia 2 VULVA • Reproductive structures (Vulva) • • • • • • • • • Mons Pubis Labia Majora, Labia...

APPLIED ANATOMY OF FEMALE GENITAL TRACT Sample Sub-heading FEMALE GENITALIA • External genitalia • Internal genitalia Hymen demarcates external and internal genitalia Manipal University College Malaysia 2 VULVA • Reproductive structures (Vulva) • • • • • • • • • Mons Pubis Labia Majora, Labia Minora Clitoris Vestibule Vestibular gland Bartholin Gland Skene’s gland Urethral opening Vaginal opening Manipal University College Malaysia 3 EMBRYOLOGY OF EXTERNAL GENITALIA Manipal University College Malaysia 4 EMBRYOLOGY OF EXTERNAL GENITALIA Manipal University College Malaysia 5 BLOOD SUPPLY OF EXT GENITALIA • Internal pudendal: Internal Iliac→Common Iliac • Superficial External pudendal:Femoral→External Iliac • Venous drainage: • Internal pudendal: Internal Iliac→Common Iliac • External Superficial pudendal: Saphanous→External Iliac Manipal University College Malaysia 6 LYMPHATIC DRAINAGE OF EXTERNAL GENITALIA • Superficial Inguinal Lymph nodes → Deep Inguinal Lymph nodes → Common Iliac lymph nodes • Clitoris: Deep Inguinal Lymph nodes → Common Iliac lymph nodes Manipal University College Malaysia 7 NERVE SUPPLY OF EXTERNAL GENITALIA Pudendal nerve: S2, 3, 4 segments. Sensory to: 1) Skin of vulva & clitoris. 2) External urethral meatus. 3) Lower vagina. 4) Perinium Motor to: 1) Levator ani muscle. 2) Compressor urethra. 3) Vaginal sphincter. 4) External anal sphincter. Other nerves : Ilioinguinal, Genitofemoral, Post femoral cutaneous nerve L1,2 Applied anatomy: 1) Pudendal nerve block Manipal University College Malaysia 8 SYMPTOMS • Asymptomatic • Discharge, Itching, Ulcer, Vesicles, Growth • Vulvodynia: Rec infections, Cosmetics • Dyspareunia Manipal University College Malaysia 9 CLINICAL SIGNIFICANCE • U Tract: • Foley Catheter • UTI • STI: Ulcers due to H Ducreyi, Syphilis Infections: C Trochamatis, G Cocci, H simplex, Candidiasis HPV: 6,11,16,18 • Bartholin cyst • Lichen Sclerosis, Lichen Simplex Chronicus • Imperforate Hymen Manipal University College Malaysia 10 INTERNAL GENITALIA • Internal genitalia • Vagina • Cervix • Uterus • Fallopian tube • Ovary Manipal University College Malaysia 11 INTERNAL GENITALIA VAGINA Applied Anatomy • Post Fornix: Culdocentesis, Culdotomy • Lat fornix: Ureter within 1-2 cms Manipal University College Malaysia 12 UTERUS AND CERVIX Manipal University College Malaysia 13 SUPPORTS OF UTERUS Manipal University College Malaysia 14 THE PELVIC FLOOR • Two L Ani muscles which with their fascia form a musculofascial gutter. • Pierced by urethra, Vagina and rectum • Applied Anatomy • The configuration of the bony pelvis together with the gutter shaped pelvic floor muscles encourage the fetal head to flex and rotate as it descends through the midpelvis towards Manipal University College Malaysia 15 pelvic outlet PERINIUM • The muscle and tissues located between the vaginal opening and anal canal • It supports and surrounds the lower parts of the urinary and digestive tracts • It has abundance nerve supply Manipal University College Malaysia 16 PERINEAL BODY • A condensation of fibrous & muscular tissue lying between the vagina and the anus. • Attachments from bulbocavernous muscle, superficial and deep perineal muscles, ext anal sphincter. • The perineum is taut and resistant in nulliparous muscle, vaginal birth may result in tearing of the perineum and perineal muscles. • The perineum may be stretchy and less resistant in multiparous women , resulting in faster labor and high probability of delivering with in intact perineum. Manipal University College Malaysia 17 SURGICAL CONSIDERATIONS • Episiotomy • Perineal tear Manipal University College Malaysia 18 UROGENITAL DIAPHRAGM • The triangular ligament, is a strong, muscular membrane that occupies the area between the symphysis pubis and ischial tuberosities • Stretches across the triangular anterior portion of the pelvic outlet. Manipal University College Malaysia 19 FALLOPIAN TUBE • Anatomy • Functions • Applied anatomy: Infection, PID, Ectopic • Tubal pain is referred to the tubal points (On the lower abdominal wall 1/2 an inch above the midinguinal points). Manipal University College Malaysia 20 OVARY Manipal University College Malaysia 21 BLOOD, LYMPHATIC, NERVE SUPPLY OF INTERNAL GENITAL ORGANS Internal A→ Uterine A Aorta→ Ovarian A Rt Ovarian V→ R Renal Manipal University College Malaysia Lt Ovarian V→ Inf Vena Cava Sympathetic: T10-L1 (Sensory) T 5,6 (Motor) Parasympathetic: S2-4 Epidural: T10-L1 22 Lower vagina: Pudendal nerve EMBRYOLOGY OF INTERNAL GENITALIA Manipal University College Malaysia 23 EMBRYOLOGY OF INTERNAL GENITALIA Manipal University College Malaysia 24 SURGICAL CONSIDERATIONS Conditions • Fibroid uterus • Adenomyosis • Ovarian cyst • Imperforate hymen Symptoms • Asymptomatic • Menstrual • Dysmenorrhoea • Dysparunia • Discharge per vagina • Mass per abdomen •Manipal Pressure symptoms University College Malaysia 25 SURGICAL CONSIDERATIONS Prolapse uterus • Symptoms • Mass per vagina • Urinary and bladder symptoms Manipal University College Malaysia 26 SURGICAL CONSIDERATIONS • Endometrial Cancer • Ovarian cancer • Cystectomy, Salpingectomy, Hysterectomy, • Uterine Artery Embolization • Salpingitis, Oophoritis, Ectopic • ART Manipal University College Malaysia 27 DIFFERENCES IN SEXUAL DEVELOPMENT • 46 XX DSD • Disorders of androgen excess: CHA (Fetal 21- or 11-hydroxylase deficiency) • 46 XY DSD • Disorders of androgen action: AIS • Disorders of androgen synthesis: 5 alfa synthetase deficiency • Sex chromosomal DSD • 45 XO • 47 XXY • Ovotesticular DSD Manipal University College Malaysia 28 Congenital Adrenal Hyperplasia Androgen Insensitivity Syndrome • Turner’s Syndrome Manipal University College Malaysia 29