L39- Reproductive System PDF

L39- REPRODUCTIVE SYSTEM FEMALE REPRODUCTIVE SYSTEM Dr.Pugazhandhi Bakthavatchalam Assistant Professor of Anatomy and Physiology, AUACAS, American University of Antigua LEARNING OUTCOMES At the end of this lecture, students should be able to  Describe the gross anatomy of ovary, Fallopian tube a...

L39- REPRODUCTIVE SYSTEM FEMALE REPRODUCTIVE SYSTEM Dr.Pugazhandhi Bakthavatchalam Assistant Professor of Anatomy and Physiology, AUACAS, American University of Antigua LEARNING OUTCOMES At the end of this lecture, students should be able to  Describe the gross anatomy of ovary, Fallopian tube and uterus  Describe the applied anatomy (anatomical basis) of common clinical conditions  Describe the gross anatomy of Vagina & external genitalia  Describe the anatomy of mammary gland.  Describe the applied anatomy (anatomical basis) of common clinical conditions. Introduction  Reproductive tract located in pelvic cavity and perineum  During pregnancy, extends into abdomen OVARIES  Are female gonads  Oocytes are formed in them  Situation:  Lies in the ovarian fossa on the lateral pelvic wall  External Features:  In young girls, before the onset of ovulation, the ovaries have a smooth surfaces which are greyish pink in colour  After puberty the surface becomes uneven and the colour changes from pink to grey  Each ovary has :  2 poles or extremities - the upper/tubal pole and lower/uterine pole  2 borders - anterior/ mesovarian border - posterior/ free border  2 surfaces – lateral and medial Arterial supply:  Ovarian artery from abdominal aorta  Uterine artery  Venous drainage:  Veins emerge at the hilus and form a pampiniform plexus around the artery  Lymphatic drainage:  Lateral and pre-aortic nodes  Nerve supply:  Sympathetic nerves (T10, T11) are afferent for pain as well as efferent or vasomotor  Parasympathetic nerves (S2,S3,S4) are vasodilator.  Functions:  Production of oocytes  Production of hormones oestrogen and progesterone  Applied: prolapse of ovaries: - Ovaries are frequently displaced to the pouch of Douglas where they can be palpated by a PV examination ovarian cysts: - The developmental arrest of the ovarian follicles may result in the formation of one or more small ovarian cysts Krukenberg’s Tumour: UTERINE TUBES  Also called as Fallopian tube  Are a pair of tortuous ducts which convey the ova from ovary to the uterine cavity  Length – 10cm each  Situated in the upper free margin of the broad ligament of the uterus  Transport of ova into the uterine tube is facilitated by:  Longitudinal grooves on the inner aspect of the ovarian fibria  Suction created by ciliary beats of the tube  Peristalsis of tubal musculature PARTS OF UTERINE TUBES  2 Openings:  4 Parts: A. Uterine ostium from medial to lateral: B. pelvic/ abdominal A. Pars uterina tubae ostium (intra-mural part) B. Isthmus C. Ampulla D. Infundibulum Blood supply: - Ovarian and uterine arteries and veins Nerve supply: - Sympathetic – T10 to L2 segments - Parasympathetic – - Lateral part of tube from- vagus - Medial part of tube from pelvic splanchnic nerves  APPLIED  Tubal pregnancy (ectopic pregnancy)  Pyosalpinx: Tube is filled with a bag of pus due to infection of the tube  Salpingitis: Inflammation of the uterine tube  Sterility: Inability to have a child is called sterlity. Most common cause in female is tubal blockage which may be congenital or caused by infection  Tubectomy: ligations of both the tubes are employed as one of the method of family planning Uterus  Pear-shaped  Hollow  Muscular  Thick walled  Within true pelvis  Located between bladder & rectum Uterus  Covered with peritoneum except anteriorly.  Uterus Consists of 2 parts:-  Body{corpus uteri} ( upper 2/3)  Cervix (lower 1/3)  Positions of the Uterus  Anteflexion  Long axis of body of uterus bent forward with long axis of cervix  Anteversion  Long axis of cervix is bent forward on the long axis of the vagina  Retroverted (Pic. C)  Fundus and body of uterus bent backward on vagina  Lie in rectouterine pouch  Retroflexed (Pic.D)  Body of uterus bent backward on cervix  Peritoneum passes Peritoneum 1. From the anterior abdominal wall 2. Superior to pubic bone 3. Superior surface of the urinary bladder 4. Vesicouterine pouch between bladder and uterus 5. On the fundus and body of the uterus, posterior fornix and all of the vagina 6. Rectouterine pouch (pouch of Douglas) between rectum and uterus 7. On the anterior and lateral sides of the rectum  Broad ligament:  When bladder is full it has anterior and posterior surfaces  Upper, lower, medial and lateral borders  Upper border is free, anterior and posterior layers become continuous here  Lateral and inferior borders are attached to the corresponding parts of the pelvic wall  Medial border is attached to the lateral margin of uterus  Subdivisions of broad ligament: A. Mesovarium:  Ovary is attached to the posterior layers of ligament through mesovarium B. Ligament of the ovary:  From lower pole of ovary to the lateral angle of uterus C. Mesosalpinx:  Part of the broad ligament between the uterine tube and ovarian ligament of ovary D. Mesometrium:  Part below the ligament of ovary E. suspensory ligament of ovary (infundibulopelvic ligament):  Part of the broad ligament that stretches from the upper pole of the ovary and the infundibulum of the uterine tube to the lateral pelvic wall is called suspensory ligament of ovary Perineal body  Fibromuscular structure  In the perineum between vagina & anal canal  Maintains integrity of the pelvic floor  If damaged during childbirth, prolapse of pelvic viscera may occur Blood supply Uterine artery Venous drainage  Uterine and vaginal veins follows artery & drain into internal iliac vein  Right ovarian vein drains into IVC  Left ovarian vein drains into Left renal vein  Lymphatic Drainage Para aortic nodes Superficial inguinal Internal & External nodes Few lymph vessels follow iliac nodes round ligament of the uterus through inguinal canal & drain into superficial inguinal lymph nodes  Nerve Supply 27  The inferior hypogastric plexuses  Sympathetic fibres are derived from neurones in the T12-L1 spinal segments  parasympathetic fibres arise from neurones in the S2-S4 spinal segments and relay in the paracervical ganglia.  Sympathetic activity - uterine contraction and vasoconstriction  Parasympathetic - activity may produce uterine inhibition and vasodilatation 28-Oct-24  Applied anatomy 28  Uterine Prolapse: Damage of uterine supports structures during childbirth or general poor body muscular tone may result in downward displacement of the uterus called uterine prolapse.  Reteroversion and reteroflexion: Backward displacement of uterus  Ectopic pregnancy  Tubectomy/Tubal ligation 28-Oct-24  Tubectomy/Tubal ligation 29 28-Oct-24  Gross Anatomy of Vagina Female organ of copulation and forms the lower part of birth canal. 30 Extent: From the vestibule upwards and backwards up to the Lumen: vaginal part of the cervix. In lower third-resembles of H In middle third-transverse slit In upper third-rounded in shape. Direction and position: Up & back- 45° with uterus. Size & Shape:  Anterior Wall – 8 cm  Posterior Wall- 10 cm  Gross Anatomy of Vagina In the adult nulliparous state, the cervix tilts forwards 31 relative to the axis of the vagina (anteversion). 28-Oct-24 32 Gross Anatomy of Female External Genitalia 28-Oct-24  Female External Genitalia Pendulum of Valve 33  Mons pubis - fatty hairy eminence over pubic symphysis.  Labia majora - two longitudinal folds of skin which enclose the pudendal cleft - outer surface, pigmented and hairy - inner surface, smooth and set with sebaceous glands. https://www.google.com/search?q=external+genitalia+fem 28-Oct-24 ale  Female External Genitalia 34  Labia minora - 2 small folds between labia majora enclosing the vestibule into which open the orifices of vagina, ducts of vestibular glands and the urethra.  Anteriorly the folds split to enclose the clitoris (prepuce). https://www.google.com/search?q=external+genita 28-Oct-24  Female External Genitalia  35 Clitoris: - Homologue of the male penis - has 2 corpora cavernosa and glans but no corpus spongiosum. - Glans made of erectile tissue, highly sensitive, major role in sexual response. https://www.google.com/search?q=external+genitalia+fem ale 28-Oct-24  Female External Genitalia 36  Bulb of the vestibule: Two masses of erectile tissue one on either side of the vaginal orifice.  Vestibular glands of Bartholin- lie near the vaginal orifice and its long duct opens between hymen & labium minus. 28-Oct-24  Anatomy of External Genitalia 37  Hymen - membrane partly covering the vaginal orifice in virgins.  Not a reliable indicator of virginity. https://www.google.com/search?espv=2&biw=1366&bih 28-Oct-24  Applied Anatomy of Female External 38 Genitalia  Per vaginal examination.  Vaginal smear- Is a gynecologic test a sample of vaginal discharge is examined microscopically. It is used to find the cause of vaginitis and vulvitis.  Cysts of the vestibular gland. 28-Oct-24  Applied Anatomy  Imperforate hymen- Imperforate hymen is a 39 congenital disorder where a hymen without an opening completely obstructs the vagina.  Dyspareunia- Difficult or painful sexual intercourse.  Episiotomy- is a surgical incision of the perineum and the posterior vaginal wall generally done by a midwife or obstetrician during second stage of labor to quickly enlarge the opening for the baby to pass through.  In Paps smear exam done through the posterior fornix. 28-Oct-24 40 Mammary Gland 28-Oct-24  Gross Anatomy of Mammary gland  Modified sweat gland.  41 Derived from the epithelium of the skin.  Males: Rudimentary.  Females: Well developed after puberty.  Location: https://www.google.com/search?biw=1366& bih=662&tbm=isch&sa=1&q=Anatomy+of+e xtension+of++breast - located in the superficial fascia of the anterior chest wall.  Size: variable.  Extension: - 2nd rib – 6th rib along mid clavicular line. - along 4th rib – on the horizontal plane – margin of the sternum to mid axillary line. - extends into axilla – axillary tail of Spence. 28-Oct-24  Gross Anatomy of Mammary gland 42 A small extension pierces the deep fascia lies in the axilla. https://www.google.com/search?biw=1366&bih=662&tbm=isch&sa=1&q=Anatomy+of+Axillary+tail+of+breast 28-Oct-24  Gross Anatomy of Mammary Gland 43  Nipple is the conical elevation.  Areola is pigmented area around the nipple – has modified sebaceous glands, which enlarge during pregnancy – tubercles of Montgomery that lubricate the breast during breast feeding. 28-Oct-24  Suspensory ligament of Cooper  Fibrous tissue extends from the skin to the underlying fascia covering the 44 muscle –becomes weak in elderly female and makes it pendulous (sagging).  The breast is attached to the dermis of the overlying skin by connective tissue structures known as Cooper's ligaments. 28-Oct-24 https://www.google.com/search?biw=1366&bih=662&tbm=isch&sa=1&q=Sagging+of++breast  Internal structure of Mammary gland  15-20 lobes separated by a 45 fibrous connective tissue.  Each lobe drained by – lactiferous duct. - ducts from each lobe converge to open at the summit of the nipple. https://www.google.com/search?esp - lactiferous ducts show a v=2&biw=1366&bih dilatation called – lactiferous sinus. 28-Oct-24  Structure of Mammary gland 46 https://www.google.com/search?biw=1366&bih=662&tbm=isch&sa=1&q=Anatomy+of+internal+str 28-Oct-24 ucture  Lymphatic Drainage of Breast 47 https://www.google.com/search?q=Lymphatic+drainage+of+breast&source=lnms&tbm 28-Oct-24  Mammary gland lymphatic drainage 48 Applied anatomy 28-Oct-24  Lymphatic Drainage of Breast with their clinical implications  Peau d'orange 49 (French for "orange peel skin" or, more literally, "skin of an orange") describes anatomy with the appearance and dimpled texture of an orange peel. Peau d'orange is caused by cutaneous lymphatic edema, which causes swelling. However, the infiltrated skin is tethered by the sweat ducts such that it cannot swell, leading to an appearance like orange skin. 28-Oct-24  Advanced Breast Carcinoma 50  Tumors may grow through retro mammary space.  Subsequently invade deep fascia & pectoralis major muscle.  Leads to fixation of malignant breast lesion to chest wall.  Shortens suspensory (Cooper’s) ligaments.  Leads to irregular dimpling of skin or retraction of nipple.  Majority of cancers develop in upper outer quadrant.  Large amount of glandular tissue here.  An axillary tail of breast tissue often extends into axilla 28-Oct-24  Applied Anatomy of Mammary Gland  Amastia (absence of breast) athelia (absence of 51 nipple) and may occur bilaterally or unilaterally.  Amastia-rare condition and results when the mammary ridges fail to develop or completely disappear.  Amastia can be treated with augmentation mammoplasty. 28-Oct-24  Applied anatomy of Mammary Gland 52 Polymastia Extra breast most commonly occur along the milk line, These accessory tissues may undergo malignant transformation (cancer) and should be removed. 28-Oct-24  Applied Anatomy of Mammary Gland 53 Gynecomastia is a benign and usually self-limited condition that occurs in 50-60% of boys during early adolescence. Gynecomastia occurs in Klinefelter syndrome, testicular feminization, hormone-secreting tumors, hyperthyroidism, hypothyroidism. 28-Oct-24 References Susan. 2008. Gray’s Anatomy- The Anatomical Basis of clinical Practise. 40th edition. New York: Elsvier. Snell, R.S. 2008. Clinical Anatomy by Regions. 8th edition. Philadelphia: Lippincott Williams & Wilkins. Ellis, H. 2006. Clinical Anatomy- A revision and Applied Anatomy for Clinical Students. 11th edition. Victoria: Blackwell Publishing. Moore, K.L., Dalle,A.F. & Agur, A.M. 2010. Clinically Oriented Anatomy. 6th edition.Philadelphia: Lippincott Williams & Wilkins.