Female Pelvic Anatomy - CBD College PDF

TOPICS TO BE COVERED FEMALE PELVIC ANATOMY ◦ UTERUS ◦ FALLOPIAN TUBES ◦ SURROUNDING SPACES ◦ LIGAMENTS ◦ BONY PELVIS ◦ OVARIES ◦ULTRASOUND APPEARANCE ◦Pelvic Vasculature 1  PELVIC ANATOMY UTERUS ◦ Pear shaped muscular organ ◦ 4 regions:...

TOPICS TO BE COVERED FEMALE PELVIC ANATOMY ◦ UTERUS ◦ FALLOPIAN TUBES ◦ SURROUNDING SPACES ◦ LIGAMENTS ◦ BONY PELVIS ◦ OVARIES ◦ULTRASOUND APPEARANCE ◦Pelvic Vasculature 1  PELVIC ANATOMY UTERUS ◦ Pear shaped muscular organ ◦ 4 regions: 1. Fundus 2. Corpus 3. Isthmus 4. Cervix Servier Medical Art 2  LAYERS OF THE UTERUS THREE TISSUE LAYERS: SEROSA (PERIMETRIUM) ◦ Outermost MYOMETRIUM ◦ Middle layer ENDOMETRIUM ◦ inner mucous membrane, glandular portion of uterine body 3 LAYERS OF THE UTERUS 4  UTERUS SHAPE & SIZE VARIES WITH AGE AND OBSTETRIC HX Prior to menarche - cylindrical & narrow Mature uterus - corpus & fundus enlarge After menopause - regresses in size Premenarchal: 1.0 to 3.0 cm long by 0.5 to 1.0 cm wide Menarchal: 6.0 to 8.0 cm long by 3.0 to 5.0 cm wide With multiparity: Increases size by 1.0 to 2.0 cm Postmenopausal: 3.5 to 5.5 cm long by 2.0 to 3.0 cm wide 5  UTERUS SHAPE & SIZE Postmenopausal uterus. Sagittal (A) and transverse (B) views demonstrating an atrophic postmenopausal uterus (between calipers). 6 7 VARIANTS IN UTERINE POSITION 8  ULTRASOUND APPEARANCE UTERUS UTERUS MYOMETRIUM ◦ Mid gray or medium level echoes ◦ Even homogeneous texture and pattern ◦ Smooth even contour ENDOMETRIAL CAVITY ◦ Varies in thickness and shape in relation to menstrual phase VAGINA ◦ Mid gray to medium level echoes ◦ Vaginal canal is hyperechoic line 9 UTERUS MIDLINE 10 RETROFLEXED UTERUS ML 11 TRANSABDOMINAL PELVIS 12 TRANSABDOMINAL PELVIS 13  FALLOPIAN TUBES 4 PORTIONS: INTERSTITIAL (INTRAMURAL) Narrowest part, nearest cornua ISTHMUS Slightly wavy and longer AMPULLA Tortuous and longest part INFUNDIBULUM Lateral, trumpet shaped, fimbriae 14 FALLOPIAN TUBES 15  PELVIC SPACES ANTERIOR CUL DE SAC (VESICOUTERINE POUCH) ○ Reflection of peritoneum over anterior surface of uterus and bladder POSTERIOR CUL DE SAC (RECTOUTERINE POUCH, POUCH OF DOUGLAS) ○ Reflection of peritoneum over posterior surface of uterus and rectum SPACE OF RETZIUS (RETROPUBIC SPACE) ○ It can be identified between the anterior bladder wall and the pubic symphysis. 16 Pelvic spaces 17  UTERINE LIGAMENTS Broad: lateral aspect of uterus to pelvic sidewall Mesovarium: posterior fold of broad ligament; encloses ovary Mesosalpinx: upper fold of broad ligament; encloses fallopian tube Mesometrium Round: Extends from uterine cornua to anterior pelvic sidewalls; holds uterus forward 18  UTERINE LIGAMENTS Cardinal: extend across pelvic floor laterally; firmly supports cervix the cardinal ligaments house the vasculature of the uterus. Uterosacral: extend from uterine isthmus downward, alongside rectum to sacrum; firmly supports cervix 19 UTERINE LIGAMENTS 20  PELVIC GIRDLE Consists of four bones ◦ Two innominate (coxal) bones ◦ Sacrum ◦ Coccyx Divided into two continuous compartments (true and false pelvis) by oblique plane that passes through pelvic brim ) 21  DIVISION OF TRUE AND FALSE PELVIS LINEA TERMINALIS AKA {ILIOPECTINEAL LINE} 22  MUSCLES OF THE PELVIS RECTUS ABDOMINUS - form anterior abdomino - pelvic wall Muscles of the False Pelvis ◦ Psoas major ◦ Iliacus muscles ◦ In false pelvis, psoas muscles join with iliacus muscles to form iliopsoas muscles. 23 Muscles of the False Pelvis 24  MUSCLES OF THE PELVIS Muscles of the True Pelvis Piriformis muscles Obturator internus muscles Muscles of pelvic diaphragm ○ Levator ani: ○ Pubococcygeus muscles, iliococcygeus muscles, puborectalis muscles ○ Coccygeus muscles 25 Muscles of the True Pelvis 26  THE OVARIES LOCATION: ◦ Lateral to the uterus in the adnexa ◦ In posterior fold of broad ligament ◦ May be superior or posterior to uterine fundus, ◦ May be in posterior cul de sac SIZE: ◦ SAG = 2.5-5.0 cm ◦ TRV= 1.5-3.0 cm ◦ AP =.6-2.2 cm 27  THE OVARIES LIGAMENTS: ◦ Mesovarian - anchors ovary to posterior surface of broad ligament ◦ Ovarian ligament - anchors ovary to uterine cornu ◦ Infundibulopelvic ligament - anchors ovary to pelvic brim 28  THE OVARIES FACTS: ONLY ABDOMINAL ORGAN NOT COVERED BY PERITONEUM (NUDE OVARY) PRODUCES HORMONES AND GAMETES COMPOSED OF 2 PARTS: CORTEX (OUTER) - contains primordial follicles Servier Medical Art MEDULLA (INNER) - contains connective tissue, nerves, blood supply, lymphatics & smooth muscle tissue Tunica albuginea surrounded by single, thin layer of cells known as germinal epithelium 29  OVARIAN FOLLICLES Born with millions of primordial follicles 300-400 mature in lifetime Graafian Follicle - the follicle that matures each month Graafian Follicle ruptures with ovulation at approximately 1.8 TO 2.5 cm After rupture, follicular cavity becomes the corpus luteum of menstruation If ovum fertilized, corpus luteum remains, if not it resolves 30  ULTRASOUND APPEARANCE OF OVARIES SIMILAR TO MYOMETRIUM IN ECHOGENICITY FOLLICLES GIVE “SWISS CHEESE APPEARANCE” POST MENOPAUSAL OVARIES DIFFICULT TO VISUALIZE TIPS FOR VISUALIZATION ○ Turn down gains ○ Look for posterior enhancement ○ Ovary may be anterior to internal iliac vessel 31 ULTRASOUND APPEARANCE OF OVARIES 32 ULTRASOUND APPEARANCE OF OVARIES 33  PELVIC VASCULAR SUPPLY HYPOGASTRIC ARTERY (INTERNAL ILIAC) UTERINE ARTERY OVARIAN ARTERY VEINS HAVE SIMILAR PATTERN VEINS ARE DISTENSIBLE & VARY IN SIZE WITH CERTAIN CONDITIONS 34 PELVIC VASCULATURE 35