Flashcard Set Preview
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Uterus
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- small, hollow, pear shaped muscular structure suspended in the mid pelvis
- partially covered...
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3 layers of the uterus
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1. endometrium
2. myometrium
3. serosa
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Endometrium
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- inner most layer
- this is the layer that is shed during menses
- will change in dimension...
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Myometrium
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- muscle layer
- forms the bulk of the uterus
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Serosa
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- thin membrane that covers the myometrium and forms the outer layer of the uterus
- not seen...
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4 regions of the uterus
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1. fundus
2. corpus
3. isthmus
4. cervix
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Fundus
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- the most superior segment of the uterus
- is continuous with the corpus
- rounded or dome...
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Corpus
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- the body of the uterus
-largest uterine region and houses the uterine cavity
- corpus narrows...
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Isthmus
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- constriction of the uterus
- junction between the body and cervix
- marks transition between...
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Cervix
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- lower cylindrical portion of the uterus that projects into the vagina
- different that the...
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Canal of cervix
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- long and narrow
- constricted at upper end by internal os and lower end by external os
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Internal Os
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the junction of the cervix and the uterine cavity
- start of cervix
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External Os
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the junction of the cervix and the vagina
- leaving cervix and going into vagina
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Endometrial Thickness
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- ranges from 1mm immediately after menstruation to 14mm immediately before menstruation
-...
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Post-menopausal Endometrium
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- seen as thin echogenic line
- measuring no more than 8mm
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Uterine Size
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- variable depending on age and prior pregnancies
- uterine growth begins at 7-8yrs, accelerates...
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Uterus increases in size with...
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pregnancy and age
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Prepubertal Uterus
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length: 1.0 to 3.0 cm
AP: 0.5 to 1.0 cm
width: 0.5 to 1.0 cm
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Nulliparous women of reproductive years
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length: 6 to 8.5 cm
AP: 2 to 4 cm
width: 3 to 5 cm
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Multiparous women
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length: 8 to 10.5 cm
AP: 3 to 5 cm
width:4 to 6 cm
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Postmenopausal women
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length: 3.5 to 7 cm
AP: 2 to 3 cm
width: 2 to 4 cm
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Vulva
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the external female genital organs
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Mons pubis
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skin covered mound of adipose tissue that cushions the pubic symphysis
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Labia majora
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- large lips
- elongated folds composed mainly of fat and numerous glands
-covered with pigmented...
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Labia minora
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- small lips
- 2 thin folds, located within the labia majora
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Vestibule
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area between the labia minora
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Clitoris
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located at the anterior end of the labia minora
- composed of erectile tissue
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Urethral Opening
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situated between the clitoris above and the vaginal opening
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Hymen
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a fold of mucous membrane that partially covers the entrance of the vagina
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Perineum
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area between vaginal opening and anus
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episiotomy
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prevents tearing during childbirth
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Vagina
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- 7-10 cm, thin walled, long muscular tube
- extends from cervix of uterus to the vestibule...
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Fornix
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ring shaped, blind pocket between the outer wall of cervix and inner surface of vaginal wall
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Sono appearance of vagina
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- muscular walls of vagina produce a moderately hypoechoic pattern; typical of smooth...
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Function of uterus
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- reproductive
- receive fertilized egg, nourish the developing conceptus, and ultimately...
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Cornual ends
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- the lateral borders of the fundus to which the tubes are connected to
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Endocervical canal
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- lined with mucosa
- mucus serves to impede upper migration of bacteria from vagina to uterus
-...
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Uterine cavity
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- triangular in shape, with the base of the triangle in the fundul position
- cavity of the...
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Layers of uterus
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1. perimetrium (serosa
2. myometrium
3. endometrium
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Myometrium
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- forms bulk of uterine wall
- subdivided into 3 layers
1....
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Endometrium
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- composed of mucosa that varies in thickness and composition through the menstrual cycle
-...
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Fallopian tubes
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- AKA oviducts or salpinx
- are paired, coiled muscular tubes that extend from the cornua...
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Function of fallopian tubes
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to transport the ovum (egg) from ovary to the uterus
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Cilia of fallopian tubes
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- cilia beat continuously toward the uterus
- when ovum is expelled into the peritoneal cavity...
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What can damage the fallopian tubes?
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- infection
- scar tissue
- endometriosis
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3 layers of fallopian tubes
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1. outer serosal layer
2. middle muscular layer
3. inner mucosa layer (this layer has cilia)
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4 parts of the fallopian tubes
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1. interstitial
2. isthmus
3. ampulla
4. infundibulum
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Interstitial
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- AKA intramural
- narrowest portion that is enclosed within the uterine wall
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Isthmus
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- short, straight narrow portion
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Ampulla
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- longest portion
- most tortuous portion
- terminates in the trumpet shaped infundibulum
***...
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Infundibulum
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- 4th most lateral portion with a funnel shaped opening
- has numerous finger like projections...
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size and shape of fallopian tubes
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- total length = 7- 14 cm
- tubal lumen widens as it moves away from the uterus
interstitial...
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sono appearance of fallopian tubes
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- rarely recognized except when distended with fluid (hydrosalpinx)
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Ectopic pregnancy
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- fertilized ovum implants in an area outside the endometrial cavity- 97% occur in fallopian...
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non tubal sites for ectopic
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ovaries, abdomen
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clinical symptoms
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pain, bleeding, pelvic mass
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most dangerous ectopic
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cornual pregnancy**goes undetected for a longer period of time because it is surrounded by...
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heterotopic pregnancy
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simultaneous intrauterine and extrauterine implantation- rare but increasing # due to increase...
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ovaries
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- paired almond shaped organs lying on the posterior segment of the broad ligament- surface...
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composition of ovary
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1. medulla2. cortex3. tunica albuginea4. outer suface
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medulla
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central portion of ovary containing loose CT, vessels, and nerves
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cortex
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dense CT and ovarian follicles
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tunica albuginea
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tough, white fibrous CT
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outer surface
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layer of simple epithelium
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hilum of ovary
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located at the attachment of the ovary to the mesovarium-point of entrance for blood vessels,...
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ovarian size of menstruating years
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length: 2.5-5.0 cmAP: 0.6-2.2 cmwidth: 1.5-3.0 cm
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post-menopausal ovarian size
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- ovary atrophies and follicles disappear**- any persistent cyst in the post menopausal ovary...
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ovarian volume
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normal ranges: pre menarchal 3.0 cm 3rdmenstruating years: not greater than 9.8 cm 3rdpost...
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location of ovary
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- posterior surface of broad ligament- anchored in position by ovarian ligament, infundibulopelvic...
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support of ovary
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- lateral and posterior borders of each ovary are free- lower pole of uterus is attached to...
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sono appearance of ovary
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- consists of a background of low amplitude echoes with scattered bright reflectors and distinctive...
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graafian follicle
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dominant/ mature follicle- all other follicles with atrophy
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bladder
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- thick walled highly distendible sac that lies between the symphysis pubis and vagina- anterior...
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layers of bladder
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1. outer epithelial layer --> Not Visible2. middle muscular layer --> gives bladder contractibility3....
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sono appearance of bladder
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empty: walls are quite thick and easily demonstratedfull: walls become stretched and thin
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ligaments of the pelvis
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various ligaments serve to suspend the pelvic organs
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broad ligament
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- major suspensory ligament for the uterus- wing like structure from lateral uterine wall to...
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3 regions of broad ligament
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1. mesosalpinx2. mesovarium3. mesometrium
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round ligament
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- extends anteriorly and laterally from uterine wall in or around area of fallopian tube to...
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cardinal ligament
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- AKA transverse cervical ligament- wide bands of fibromuscular tissue that originate from...
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uterosacral ligament
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- extends from cervix to sacrum
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uterosacral and cardinal ligaments
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both anchor the cervix and provide rigid support for the cervix
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ovarian ligament
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- extends from uterine cornua to the medial or uterine pole of the ovary**ovaries are anchored...
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suspensory ligament
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-AKA infundibulopelvic- fibromuscular strands intertwined with ovarian vessels and lymphatics-...
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mesovarium ligament
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- short, suspensory ligament which anchors the ovary to the posterior surface of the broad...
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pelvic spaces
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- peritoneum's function is isolating and lubricating the surfaces of organs- peritoneum is...
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retro pubic space
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- space of retzius- region between symphysis pubis and urinary bladder
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anterior cul-de-sac
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- vesico- uterine pouch- lies between the anterior surface of the uterus and bladder- space...
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posterior cul-de-sac
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- pouch of douglas- lies between the posterior wall of the pelvis and the posterior wall of...
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causes of free fluid
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- small amounts normal with cycle- cyst rupture- ectopic pregnancy- PID- malignancy
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Transvaginal ultrasound
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- can provide excellent images of pelvic anatomy or gestational structures- 7.5- 9 mHz- also...
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Advantages of TVS
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- higher frequency transducer- examination of patients who are unable to fill bladder- examination...
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Limitations of TVS
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- not performed on virgins- small field of view- not advised in presence of PROM (premature...
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uterine positions
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- highly variable and changes with varying degrees of bladder and rectal distention- normal...
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dextroposition
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the uterus is displaced to the right
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levoposition
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the uterus is displaced to the left
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retroverted uterus
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the uterine fundus is oriented posteriorly**most common displacement
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retroflexion
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the uterine fundus is folded posteriorly beneath the uterine body- the uterine body is bent...
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retroversion/retroflexion may result in:
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1. poor visualization of the endometrial canal on TAS2. difficulty imaging the fundus of a...
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oral contraceptives
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- contain estrogen and progesterone- change cervical mucus and inhibit ovulation- keeps endometrial...
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Depot- Medroxyprogesterone Acetate (DMPA)
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- injected IM every 3 months- inhibits ovulation and thickens cervical mucus
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Levenorgesteril Implants
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- thin capsules inserted under skin of upper arm- tiny amounts of progesterone released into...
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post-coital hormonal contraception
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- PCC- morning after pill- should be administered after intercourse within 72 hours
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abortion pill
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- RU 486- mifeprex- may be used up to 9 weeks of pregnancy- causes miscarriage
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methods of contraception
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1. diaphragm2. cervical cap3. condoms4. sponge
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Intrauterine contraceptive device (IUD)
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- foreign body placed in endometrial cavity, providing a hostile environment- discouraging...
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types of IUD
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1. paragard- t-shaped- copper; kept up to 10 yrs2. mirena- releases small amount of progesterone;...
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risks of IUD
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1. abscess formation2. spontaneous abortion3. ectopic pregnancy4. embedded in endometrium or...
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pelvic muscles
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- important to identify sonographically- can have similar appearance to ovaries and may be...
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2 groups of pelvic muscles
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1. pelvic wall muscles2. pelvic diaphragm/ floor muscles
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obturator internus
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- pelvic wall muscle- lies alongside bony pelvic wall- lateral to ovaries- functions to rotate...
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piriformis
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- pelvic wall muscle- thigh muscle- confused with ovary- triangular muscle- lateral rotator...
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psoas
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- pelvic wall muscle- not exclusively pelvic muscle; extends through abdominal region as well-...
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iliopsoas
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- pelvic wall muscle- below level of iliac crest, fibers of psoas muscle interconnect with...
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pelvic diaphragm
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- supports pelvic viscera and forms pelvic floor- made up of levator ani and coccygeus muscles
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Levator ani
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- made up of ileococcygeus + pubococcygeus + puborectalis- this tripart muscle mass forms a...
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coccygeus
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- supports the coccyx
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female pelvic skeleton
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- the bony pelvis of adult female is ring shaped- made up of:1. sacrum2. coccyx3. innominate...
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innominate bones
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- hip bones- joined together posteriorly @ sacrum and anteriorly @ pubic symphysis- 2 large...
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acetabulum
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socket for femoral head
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sacrum and coccyx
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modified segments of the vertebral column- permits little or no motion
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functions of bony pelvis
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- protects reproductive organs- directs pathway of fetal head during childbirth- provides support...
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abdominal aorta
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bifurcates into the common iliac arteries which branch into external and internal iliac arteries
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external iliac artery
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- remains in the false pelvis with a lateral and anterior course lying on the medial border...
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internal iliac artery
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- AKA hypogastric artery- subdivides into varying # of branches***IMPT BRANCH = UTERINE...
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blood supply to uterus
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- comes predominantly from the uterine arteries
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arcuate arteries
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arise @ regular intervals off the uterine artery- they encircle or "arc" around the uterus...
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myometrial supply
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- radial arteries branch off arcuate arteries- they penetrate or "radiate" into the myometrial...
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endometrial supply
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1. spiral arteries- feed endometrium and supply the functional layer of the endometrium2. straight...
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venous circulation of uterus
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uterine veins --> internal iliac vein --> common iliac vein --> IVC
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arterial supply of the ovary
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- ovary has dual supply derived from 2 major vessels:1. aorta2. internal iliac artery
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blood supply to ovary
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- the ovarian artery is a branch off abdominal aorta to supply ovary and fallopian tubes- this...
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venus circulation of ovary
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- right ovarian vein --> IVC- left ovarian vein --> left renal vein --> IVC
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