Internal genital organs in this study

Uterus Uterine tubes/fallopian tubes Ovaries

Uterus- Internal organ of female reproductive system, Nidus for developing embryo, Situated in the true pelvis above the pelvic diaphragm, between the urinary bladder and the rectum.

Uterus is a flattened pear shaped organ . approximately - 8 cm/5 cm /3 cm

Axis and position of the uterus. Anteflexed-forward bending of its long axis, Anteverted forward bending of the long axis of uterus in relation to the long axis of the vagina, Dextroverted--The long axis is slightly tilted to the right. ( or to the left) Dextrorotated--Uterus is slightly rotated to the right. (or to the left).

Structure of the uterusMuscular organ with a thin cavity. Uterine walls consists of Myometrium ---smooth muscle - Endometrium---inner lining, - Serous coat ---outer covering (visceral peritoneum).

Parts of uterus Fundus Fundus part above the entrance of the fallopian tubes. Cornua -- area at the entrance of the uterine tubes Body -- below the level of cornua, Isthmus and cervix -- part below the body, -- Cervix opens into the vagina.

Part of cervix is clasped by vagina forming; - supravaginal and vaginal parts of cervix. The space around the vaginal part is the fornix.

Uterine cavity Cervical canal -Internal Os ----External Os --------

space in the body of the uterus space in the cervix, uterine opehing of the cervical canal vaginal opening of the cervical canal, level of the ischial spines circular in nullipara transverse in multipara

Surfaces of the uterus Intestinal surface - usually coils of intestine rest on it Vesical surface in relation to urinary bladder, Borders of the uterus----Right and Left, The round ligaments of the uterus and ligaments of the ovary are attached near the cornua.

Peritoneal reflections & topographical relations

The peritoneum from the borders of uterus form the broad ligaments, upto the lateral walls of the pelvis (in two layers).

Broad ligament has two layers. Structures between the layers; Parametrium--condensed pelvic fascia Mesosalpinx-- upper part, with fallopian tubes with related vessels and nerves, Mesovariumin the posterior layer, where the ovarian veseels and nerves pass to the ovary

Broad ligament continued

Suspensory ligament of the ovary superolateral part of broad ligament, ovarian vessels pass in it, Uterine vessels & lymphatics run along the lower part of the broud ligament and close to the uterine borders. Broad ligament continued

Ligament of the ovary Round ligament of the uterus Epoophoron Paroophoron

Blood supply Uterine arteries- from the internal iliac arteries, Each uterine artery passes in the broad ligament along its lower border towards the cervix , here it is in close relation to the ureter. Then runs upwards along the uterine borders. Branchesvaginal, uterine, tubal and ovarian branches.

Venous drainage of uterus internal iliac veins via the utero-vaginal plexus.

Lymphatic drainage of the uterus Internal iliac External iliac Pre-sacral Pre Superficial inguinal

Nerve supply to uterus-- myometrium is sensitive to hormones Autonomic nerves supply from pelvic plexus Sympathetic - T12 and L1. - vasoconstrictor - afferent - may also be motor to the myometrium Parasympathetic - pelvic splanchnic..S,2,3/4. afferents from cervix

Hysterosalpingogram

Clinical aspects. Proximity of ureters to cervix and uterine vessels care to be taken to protect the ureters at hysterectomy.

Retroverted uterus - abnormal position, uterine axis bends backwards on vaginal axis. In early pregnancy anteriorly directed cervix can compress bladder-neck against the pubis, leading to retention of urine.

Developmental abnormalities Tumours, Etc

Fallopian tubes

Fallopian tube Located - in the upper margin of the mesosalpinx About 10 cm , OpensOpens-into uterine cavity = uterine ostium , OpensOpens-into peritoneal cavity = abdominal ostium.

Parts of the fallopian Tube Infundibulum----Fimbriated end, Ampulla, Isthmus, Intramural -

Fallopian Tubes contd. Infundibulum---- funnel shaped, has finger like processes called fimbriae-close to the ovary. one of the fimbrae is attached to the ovary-ovarian fimbria.

Ampulla thin walled, more than half the length of fallopian tube, has a tortuous lumen due to folded lining, fertilization of the ovum usually occurs in this part .

Fallopian tube. Contd.

Fallopian tubes cntd.Isthmus About 1/3 the length of the fallopian tube, Has a narrow lumen.

Fallopian tubes

cntd.

Intra mural / uterine part- with in the uterine wall, about 1cm in length, opens into the uterine cavity.

Blood supply of the f fallopian Tube Tubal branch of ovarian artery & tubal branch of uterine artery. Venous drainage - into ovarian and uterine veins. .

Lymphatics of the fallopian tubes Para aortic lymph nodes Internal iliac lymph nodes Inguinal lymph nodes from intramural part.

Nerve supply to the fallopian tubes; Sympathetic - from T10 to L 1. contraction of smooth muscle of the tubes and blood vessels, Fallopian tubes are sensitive to touch and cutting Para sympathetic pelvic spanchnic.

Fallopian Tubes contd. Clinical aspects Tubal ligation, Infection----Salpingitis, Tubal pregnancy .Ectopic gestation. Etc.

Ovary There are two ovaries-- right and left, Located in the ovarian fossa on the parietal peritonium of the pelvis close to the pelvic aspect of the acetabulum. Related to ovarian fossa are; External iliac vessels superiorly, * Ureter and intennal iliac vessels inferiorly, * Obturator nerve crosses the floor. * * retro peritoneal.

Structure of the ovary Almond shaped (ovoid) 3/2/1. cm. Surfaces medial lateral Borders, Anterior Posterior Poles tubal pole--close to fimbria of the uterine tube Uterine pole lig. of the ovary is attached to it, Firm to touch.

Ovary is covered by peritoneum only near its hilum,

Attachments of the ovary, Ovary is attached to the posterior layer of the Broad ligament by mesovarium.

Attachments of the ovary continued Suspensory ligament of the ovary superolateral part of broad ligament, ovarian vessels pass in it,

Attachments of the ovary continued Ligament of the ovary / ovarian ligament Remnant of the gubernaculum extends between the ovary and the uterus.

Arterial supply of the ovary.o Ovarian artery from the abdominal aorta (level of L2) descends on the psoas major muscle to the suspensory ligament of ovary then to the mesovarium to reach the ovary. gives a tubal branch to anastamoses with the tubal branch of uterine artery. o Ovary is also supplied by ovarian branch of uterine artery.

Venous drainage of the ovary- Venous channels form - pampiniform plexus, Union of these channels form ovarian veins, Right ovarian vein joins the inferior vena cava, Left one joins the left renal vein.

Lymphatics from the ovaries reach para-aortic lymph nodes -- at the origin of the ovarian arteries.

Nerve Supply to Ovaries. Ovarian function is under the control of hormones, Autonomic nerves Sympathetic --Aortic plexus-T10 & T11segments vasoconstrictor afferent (pain referred to umbilical region) Parasympathetic-- Inferior hypogastric plexus -vasodilator.

Clinical Aspects Ovaries may be palpated per vaginal examination, Pain from pelvic peritoneum is referred to the medial aspect of the thigh or to the area of knee (obturator nerve,) Pain at the time of ovulation --mittelschmerz --mittelschmerz Ovary can herniate into the sac of inguinal hernia Ovarian pain can mimic the pain related to vermiform Appendix, ( right side ) Ovarian masses Ovaries prolapsed into the pouch of Douglas may cause dyspareunia (painful coitus). Etc.

End of topic Begining of troubles

The Uterus Objectives Shape, Size, Axis and position, Structure and function, Peritoneal reflections Topography, Radiological study Blood supply, Lymphatic drainage, Nerve supply, Clinical aspects.

Supports of uterus, histology and embryology will be done in other lectures.

Fallopian tube Objectives Location Length Uterine ostium , Abdominal ostium. Descriptive parts Role in fertilization Blood supply Lymphatic drainage Nerve supply Contrast study Clinical aspects.

Peritoneal reflections & topographical relations.The parietal peritoneum from anterior abdominal wall urinary bladder vesical surface and the fundus of uterus forming--uterovesical pouch intestinal surface of the uterus supravaginal part of the cervix upper part of vagina(posterior fornix). Then the peritoneum reflects backwards onto the upper part of the rectum forming rectouterine pouch.

Pouch of Douglas--- close proximity to the posterior Douglas--fornix is a direct access to peritoneal cavity.

OVARIAN Function will be dealt with in other lectures.