gynecology

At the distal portion of the cardinal ligaments, they are known as what?

Utero-sacral ligaments

Average Fallopian tube length and diameter:

~ 10 - 12 cm L, 1-4 mm diameter

Adult nulliparous uterus size:

~ 8 cm L x 5 cm W x 4 cm AP

cervix has ___ and ____

(endocervix) internal os ( opening) and (ectocervix) external os

The lower cervix has 4 fornices as it projects into the vaginal canal:

- anterior - posterior - lateral (x2)

Wolffian Duct or mesonephric duct

- develops into trigone of bladder. in male, wolffian duct under influence of testosterone formed by Leydig cells gives rise to epididymis, vas deferens, and seminal vesicles - in females, lack of testosterone causes Wolffian duct to regress

Anterolateral pelvic wall muscles:

- external oblique - internal oblique - transversus abdominus

What are the 4 sections of the Fallopian tube?

- infundibulum - ampulla - isthmus - intramural/interstitial

What are the 3 wall layers of the ureters?

- inner mucosa - middles smooth muscle - outer adventitia

Ring of 4 bones that make up the pelvis:

- innominate x 2 ( lateral anterior) - sacrum - coccyx

What ligaments anchor the bladder in place?

- lateral umbilical ligaments - median umbilical ligament (urachus - ant/sup)

The floor of the pelvic cavity is made up by the _______ _______ and _______ muscles.

- levator ani - coccygeus

What 2 muscles make up the pelvic diaphragm?

- levator ani - coccygeus

What supplies blood to the ovaries?

- ovarian artery (branches directly off ao) - uterine artery (branches off of internal iliac)

What are the 3 main muscle layers of the uterus?

- perimetrium - myometrium - endometrium

The posterolateral wall of the pelvic cavity is made up by the _______ and _______ muscles.

- piriformis - coccygeus

Pelvic muscles that are only located in the true pelvis:

- piriformis (posterior) - obturator internus (anterolateral) - levator ani

Pelvic muscles that are only located in the false pelvis:

- psoas major - iliacus muscle add together call iliopsoas

What are the 3 muscles that make up the levator ani?

- pubococcygeus (anteromedial) - iliococcygeus - puborectalis

The posterior wall of the pelvic cavity is made up by the _______ and _______ bones.

- sacrum - coccyx

The endometrium has two specific layers. They are:

- superficial functional (zona functionalis) related with period shed each mounth - deep basal (zona basalis)

What lives in the true pelvis?

- uterus - ovaries - adnexae - bladder - small bowel

The peritoneum falls into two spaces in the pelvis. What are they?

- vesicouterine space (anterior cul de sac) - rectouterine space (posterior cul de sac or pouch of Douglas it is normal to have fluid )

functions of the female pelvis

- weight-bearing bridge -direct pathway for fetal head -protects reproductive organs

lateral boundaries of true pelvis

-fused ilium & ischium

posterior boundaries of false pelvis

-iliac crest -base of sacrum

Mullerian Duct also name paramesonephric duct

-paired embryonic duct - 7-12 weeks gestation mullerian duct fuse and form lumen of uterus (endometrium/ endometrial canal) - in female, gives rise to oviducts, uterus, and upper vagina - in males, it regresses because of anti-Mullerian hormones (MIH), which is secreted by the sertoli cells of testis

anterior boundaries of true pelvis

-pubis -pubic rami

posterior boundaries of true pelvis

-sacrum -coccyx

pelvic organs

-urinary bladder -ureters -vagina -cervix -uterus -ovaries -fallopian tubes

With parity, there is normally an increase by more than __ cm in all uterine size dimensions.

1

How can ligaments be classified?

1.) structures that bind the pelvic bones together (osseus) 2.) those which support the uterus and ovaries

Infantile/Prepubertal size of uterus:

2-3 cm L, 0.5-1 cm AP - inverse pear shape (AP cervix > fundus)

Neonatal size of uterus:

2.3-4.6 cm L, 0.8-2.1 cm AP - mother's hormones affect baby and make uterus larger (is larger than infantile/prepubertal uterus)

Post-menopausal uterus size:

3-5 cm L x 2-3 cm W x 2-3 cm AP (approximately 2-3 cm less in all dimensions than nulliparous uterus size)

The vagina is a ~ ___ cm in length.

9

The vagina forms a ___ degree angle with the cervix.

90

anteverted

90 degrees with the vagina or less

How do round ligaments course?

Anteriorly, passing over the pelvic brim to the anterolateral pelvic wall, through the inguinal canal, secures at the labia majora

Posterior Culde Sac

Area in the pelvic cavity between the rectum and the uterus that is likely to accumulate free fluid; Also called the Pouch of Douglas or Rectouterine Pouch. if fluid, peritoneal fluid

Anterior Culde Sac

Area in the pelvic cavity between the uterus and the urinary bladder; Also known as Uterovasical Pouch. if fluid, peritoneal fluid

What ligament is described as wing-like folds of parietal peritoneum; curtains that separate the pelvic cavity into anterior and posterior compartments?

Broad ligaments (not considered a major suspensory ligament)

What two groups of ligaments provide rigid support for the cervix and maintain its normal axis? (They're perpendicular to the vaginal canal)

Cardinal ligaments and uterosacral ligaments

Broad Ligament is a

Double Layer of Peritoneum

Ligaments are either extensions of _____ ______ or _________ _____ that maintain the position of the uterus.

Either extensions of parietal peritoneum or fibromuscular cords

The ________ ________ are muscular tubes that open up into the peritoneal cavity laterally.

Fallopian tubes

True or False: the uterus is a retroperitoneal structure.

False: it is infra/extraperitoneal

The urinary bladder is ______

Hollow, muscular organ that acts as a temporary reservoir for urine, can hold~ 1 L of fluid

Which bones fuse to form the hip (innominate) bone?

Ilium, Ishium, and pubis

This ligament arises from the lateral pelvic wall and extends to the lateral side of the ovary and infundibulum of the the uterine tube. Within the folds of peritoneum are contained ______ _____

Infundibulopelvic ligament, aka suspensory ligament of the ovary; contains ovarian vessels.

The part of the uterine broad ligament that constitutes the largest portion of the broad ligament?

Mesometrium

What are the three subdivisions of the broad ligaments of the uterus?

Mesometrium, mesovarium, and mesosalpinx

The part of the uterine broad ligament that is on its free margin, where fallopian tubes travel.

Mesosalpinx

The part of the uterine broad ligament that is a double layer of peritoneum anchoring the anterior surface of the ovary to the posterior surface of the broad ligament

Mesovarium; a short, double fold of peritoneum that extends from the posterior aspect of the broad ligament to the ovarian hilum.

How do broad ligaments appear sonographically?

Region of medium to low-level echoes extending from the uterine cornua to the ovary.

What ligament courses between layers of broad ligaments?

Round ligaments

What ligament is responsible for the anterior tilt of the uterus and aids in stabilizing the fundus of the uterus?

Round ligaments

What two sets of ligaments aren't true ligaments but are folds of peritoneum?

Round ligaments and suspensory (aka infundibulopelvic) ligaments.

What ligaments are fibromuscular bands that extend from the uterine cornua to the labia majora?

Round ligaments; they frequently cause pain during pregnancy.

What three groups of paired ligaments provide structural support to the uterus?

Round, cardinal, and sacro-uterine ligaments

What are some examples of osseus ligaments?

Sacro-iliac, sacro-sciatic, sacro-coccygeal, and pubic ligaments.

Space of Retzius

Space located between the pubic symphysis and anterior wall of the urinary bladder; Sometimes abscess formation takes place here. no peritoneal fluid! - if fluid there - bladder leak/trauma

What does the infundibulopelvic ligament help the broad ligament do?

Support the uterine tubes and ovaries

What ligament connects the lateral side of the ovary to the pelvic side walls and vessels of the ovaries pass through them?

Suspensory, aka infundibulopelvic ligaments

What do broad ligaments cover?

The anterior and posterior surfaces of the uterus, extending to the pelvic lateral walls: most of the fallopian tubes, round ligaments of uterus, uterine vessels, ovarian ligament, and a portion of the ovarian vessels.

This ligament lies within the peritoneal folds of the broad ligament and supports the medial aspect of the ovary to the uterine cornua.

Proper ovarian ligament

What are the two sets of paired ligaments that assist ovaries in maintaining their position in the adnexal regions?

Proper ovarian ligaments and infundibulopelvic (aka suspensory) ligaments

Adnexa

The space in the peritoneal cavity that's posterior to the broad ligaments; consists of ovaries, fallopian tubes, vessels, and ligaments.

What pelvic ligament has ovarian vessels that pass through it?

The suspensory ligament, aka the infundibulopelvic ligament

Parametrium

The tissue (fat and conn tissue) between the two layers of the broad ligaments; contains loose connective tissue, smooth muscle, BVs, and nerves

Utero-sacral ligaments are _____ ______ that lie on either side of the rectum and connect the posterior aspect of the cervix to the _____

They are peritoneal extensions connecting the posterior aspect of the cervix to the sacrum.

Cardinal ligaments are also known as _____ _____ _____

Transverse cervical ligaments

True or False: there is no physical connection between the Fallopian tubes and the ovaries.

True

A ________ uterus has a cervix that accounts for 2/3 of its total length.

infantile/prepubertal - inverse pear shape (AP cx> fundus)

The ovaries lie ________ to the Fallopian tubes.

inferior

The ________ of the Fallopian tube is the distal, funnel-shaped, fibriated end.

infundibulum

superior boundary of false pelvis

abdominal cavity

anterolateral boundary of false pelvis

abdominal wall

The false pelvis lies (above/below) the pelvic brim.

above

The ________ of the Fallopian tube is the longest, most coiled section. Fertilization m/c occurs here.

ampulla

The ________ of the Fallopian tube is the m/c place for ectopic pregnancy.

ampulla

Uterine position definitions

ante- means forward retro- meand backward -verted means that the entire uterus tilts -flexed means the uterus bends as the isthmus (level of the internal os)

The ovaries lie ________ to the internal iliacs and ureter.

anterior

The urinary bladder lies ________ and inferior to the peritoneal cavity.

anterior

The ureters run _____and ______to the psoas muscles

anterior and medial

what is the most common uterine position

anteverted or anteflex (forward)

flexion

axis of body of the uterus in relation to the cervix

version

axis of the cervix in relation to the vagina

The true pelvis lies (above/below) the pelvic brim.

below -inferior to the parietal peritoneum

where is adnexae

between uterus and iliac vessels usually where ovaries are found

The pelvis is separated into the true and false pelvic compartments by the pelvic _______.

brim (aka the ileopectineal line) - sacrum and symphysis pubis

The ________ forms the lower portion of the uterus that projects into the vaginal canal.

cervix

The ________ is the only fixed portion of the uterus.

cervix

The ureters sit one inch lateral to the _______, before turning and entering the bladder at the trigone.

cervix

The ovaries lie posterior to the uterus at the level of the ________.

cornua

Triangular shaped area between the body and the fundus of the uterus where the Fallopian tubes come off is called the:

cornua (horns of the uterus)

levoversion

deviation towards the left side in TRV

dextroversion

deviation towards the right side in TRV

adult uterus size

diameter and length of body double that of cx

The ________ is the inner mucosal layer lines the uterine cavity.

endometrium

the ureters is

fibromuscular tubes, it is in retroperitoneal

The vaginal ________ cause edge shadowing on the US.

fornices (pockets)

The Fallopian tube comes off of the ________ of the uterus.

fundus

anteflexed

fundus is bent forwards towards abdominals

retroflexed

fundus is bent towards sacrum

infundibulum

funnel-shaped opened distal end toward the ovary that has finger like projections that drape over the ovary called fimbriae

sono appearances of muscles

hypo, areas of echogenicity usually tendons

The ________ portion of the Fallopian tube is ~ 1cm in length, is the narrowest part of the tube, and is continuous with the endometrium.

intramural/interstitial (is located where the tube enters into the uterus)

The ________ are almond-shaped and have the job of producing the reproductive cells (ovum) and hormones (estrogen, progesterone).

ovaries

The ureters pass anterior to the IIAs and IIVs, and they pass posterior to the ________.

ovaries

The Fallopian tubes extend from the cornua of the uterus laterally, curving over the ________.

ovary

Anterior pelvic wall muscles:

paired rectus abdominus (below the level of umbilicus has no posterior fascial layer)

inferior boundary of false pelvis

pelvic cavity

inferior boundary of true pelvis

pelvic floor muscles - levator ani - coccygeus

The ________ is the outer serous membrane of the uterus.

perimetrium

What muscle of the true pelvis is m/c mistaken for an ovary?

piriformis

The urinary bladder lies ____ to the pubic bones

posterior

The uterus, vagina, and OI muscles lie directly ________ to the bladder.

posterior

vagina anterior of ____ and _________

rectum and anus

The ________ surface of the bladder comes into contact with the peritoneum.

superior

The iliopsoas muscles lie lateral and ________ to the bladder.

superior

the middle line of the innominate bones are________

symphysis pubis

what is stretched in order for there to be a retroverted uterus?

the round ligament. it arise from cornua, anterior to tubes within broad ligament.

The ________ connects the superior aspect of the bladder to the umbilicus to prevent it from falling anteriorly.

urachus

The ________ is a thick-walled pear-shaped muscular organ that is composed of a fundus, body, isthmus, and cervix.

uterus

The ________ is a collapsed fibromuscular tube that extends from the external genitalia to the cervix.

vagina

The ________ of the Fallopian tube is the medial third of the tube that is continuous with the ampulla. It is wide and round in shape.

isthmus

at what point does version or flexion occur?

isthmus is the point where uterus bends

The bony pelvis and and acetabulum lie ________ and inferior to the bladder.

lateral

The infundibulum lies superior and ________ to the ovary.

lateral

The ovaries lie ________ to the external iliacs.

medial

ampulla

middle whitest region where fertilization usually occurs

retroverted

more than 90 degrees with vagina

What lives in the false pelvis?

mostly bowel

The ________ is the middle smooth muscle layer of the uterus.

myometrium

The anterolateral wall of the pelvic cavity is made up by the hip bones and _______ _______ muscles.

obturator internus muscles