L9 Review - Anatomy PDF

Lecture 9: Gross Anatomy - Female Reproductive Vagina: serves as organ of copulation, birth canal, & outlet for menstrual fluid from uterus Structure: distensible musculomembranous tube w/ mucosal folds (rugae); surrounds the cervix as vaginal fornix (anterior, posterior, & lateral fornices) Relati...

Lecture 9: Gross Anatomy - Female Reproductive Vagina: serves as organ of copulation, birth canal, & outlet for menstrual fluid from uterus Structure: distensible musculomembranous tube w/ mucosal folds (rugae); surrounds the cervix as vaginal fornix (anterior, posterior, & lateral fornices) Relationships: anterior = vesicouterine pouch, bladder, parts of ureter, urethra; posterior = rectouterine pouch, rectum, perineal body; lateral = broad ligament, ureter, uterine vessels (fornix level), levator ani, greater vestibular glands, vestibular bulb, UGD (inferiorly) Sensory innervation: somatic sensory by pudendal n. (lower ⅓), upper ⅔ is relatively insensitive Uterus: serves as site of blastocyst implantation & fetal development, provides propulsive force during birth Structure: perimetrium (outer serous coat), myometrium (muscular layer), endometrium (inner mucous lining, shed & regenerated during menses) Body: upper ⅔ of uterus; fundus = portion above entry of uterine tubes; cornua = uterine tube cavity Isthmus: transition zone b/w body & cervix Cervix: lower ⅓, extends into vagina Cervical canal: connects uterine cavity to vagina; usually plugged with mucus ​ Cervical os (ostium): opening of the cervical canal into the vagina Position: anteflexed (bent anteriorly b/w axis of cervix & axis of uterine body) & anteverted (inclined anteriorly between axis of vagina and axis of cervix) Relationships: anterior = bladder and vesicouterine pouch; posterior = rectum, rectouterine pouch, rectouterine fold; lateral = ureters, uterine tubes/ovaries, broad ligament, cardinal ligament Innervation: VA SANS via pelvic plexus; sensory afferents travel to T10-L2 (area of referred pain) Broad ligament: double walled sheet of peritoneum originating from the lateral pelvic wall; encloses the uterus, uterine tubes, ovarian & round lig. and part of the uterine vessels, ureter, & ovary Mesosalpinx: part of the broad ligament which surrounds and suspends the uterine tube Mesovarium: part of the broad ligament which suspends the ovary Round ligament: attaches near the cornua of the uterus; travels w/in broad ligament; enters inguinal canal; terminates in labium majus; homologue of gubernaculum Ligament of the ovary: attaches near the cornua of the uterus; travels in the mesovarium; attaches to inferior pole of the ovary; also a homologue of gubernaculum Suspensory ligament of the ovary: the peritoneum surrounding the ovarian vessels & nerves; originates in abdomen; attaches to superior pole of ovary Uterosacral ligament: fascial thickening underlying the rectouterine fold (forms as peritoneum of rectouterine pouch reflects onto rectum; contains part of uterine vessels & ureter) Transverse cervical (cardinal) ligament: fascial thickening at the base of the broad ligament containing the uterine vessels and ureter; water under bridge Uterine tubes: transport ova from the ovary and sperm from the uterine cavity; fertilization usually occurs within its ampulla; transports zygote to the uterine cavity for implantation Structure: muscular tube extending laterally from the cornua of the uterus to the ovary; opens medially into the uterine cavity and laterally into the peritoneal cavity Infundibulum: funnel shaped distal end which embraces the superior pole of ovary; draws ova into its ostium with its fimbriae Ampulla: widest and longest part of the tube; usual site of fertilization Isthmus: narrow and thick walled portion between ampulla and uterine cornua Uterine part: within the uterine myometrium; contains the uterine ostium Ovary: produces ova & hormones Structure: oval shaped organs about 3 cm in length; nearly vertically oriented Relationships: upper pole relates to uterine tube & attaches to suspensory ligament of ovary; lower pole attaches to ovarian ligament; ant. border attaches to mesovarium; post. border not covered by peritoneum Arterial supply: Uterine a.: reaches the lateral aspect of the cervix by traveling in the broad ligament; tortuous route along lateral aspect of the uterus allows for expansion during pregnancy; eventually anastomoses w/ ovarian a.; also contributes to blood supply of uterine tubes & upper portion of vagina Ovarian a.: travels in suspensory ligament of ovary and mesovarium; supplies ovary and uterine tubes; anastomoses w/ uterine a. Vaginal a.: may arise from int. iliac, uterine a., or common trunk w/ uterine a.; supplies middle and lower vagina and may also supply bladder Internal pudendal a.: supplies lower end of vagina Venous drainage: Uterovaginal plexus: drains the uterus, vagina, proximal part of uterine tubes; empties into uterine veins; may have anastomosis w/ sup. rectal v. to provide a portal-systemic connection Ovarian v.: drains ovary and distal part of uterine tubes; forms a plexus in broad ligament Internal pudendal v.: drains lower part of vagina Lymphatics: Most of vagina & uterus: internal, external or common iliac nodes → aortic nodes Ovaries, fundus of uterus, & fallopian tubes: along ovarian vessels to aortic nodes Lower end of vagina: superficial inguinal nodes