Chapter 41 normal anatomy/physiology of the female pelvis

the bony pelvis consists of four bones:

Two innominate bones, the sacrum and the coccyx.

what makes up the innominate bones?

ilium, ischium, pubis

The bony pelvis is divided into two continuous compartments:

true and false pelvis

what is considered the pelvic cavity?

true pelvis

the true pelvis is situated:

inferior to caudal portion of parietal peritoneum

the anterior pelvic cavity is occupied by the

bladder, ureters, ovaries, fallopian tubes, uterus, vagina

the posterior pelvic cavity is occupied by the

rectum, colon, ileum

levator ani is made up of what three muscles:

pubococcygeus, iliococcygeus, puborectalis muscles

what are the muscles of the false pelvis:

psoas major and iliacus muscles

the psoas major and iliacus muscles come together and form the:

iliopsoas muscle

what two muscles create the pelvic floor (diaphragm)

levator ani and coccygeus muscles

what is the area below the pelvic floor?

perineum

collapsed muscular tube that extends from external genitalia to cervix of uterus

vagina

the vagina lies _______ to the urinary bladder and urethra

posterior

the vagina lies ______ to the rectum and anus

anterior

the vagina extends ____________ from the vulva

upward/backward

The vagina measures approximately _____ in length

9cm

what is the longest part of the vagina

posterior wall

the upper half of the vagina lies above the ________

pelvic floor

the lower half of the vagina lies within the________

perineum

the uterine cervix protrudes into the upper portion of the vaginal canal forming the:

fornices

Blind pockets formed by the inner surface of the vaginal walls and outer surface of the cervix.

fornices

hollow pear shaped organ

uterus

largest organ in the female pelvis when the urinary bladder is empty

uterus

the average menarcheal uterus measures in length:

6-8cm

premenarchal uterus measures:

1-3cm long

postmenopausal uterus measures:

3.5-5.5cm long

the average menarcheal uterus measures in AP/transverse:

3-5cm

the uterus consists of:

fundus, body, cervix

widest part and most superior portion of the uterus

fundus

at the lateral boarders of the fundus is the:

cornua

where the fallopian tubes enter the uterine cavity:

cornua

lies between the fundus and the cervix and is the largest portion of the uterus

body

Lower cylindrical portion of the Uterus that projects into the Vaginal canal?

cervix

the surface of the cervix is divided into:

endocervix and exocervix

the endocervix communicates with the uterine cavity by the:

internal os

the endocervix communicates with the vagina by the:

external os

__________ is continuous with the vagina

exocervix

serous outer layer of the uterus; serosa

perimetrium

muscular middle layer of the uterus composed of thick, smooth muscle supported by connnective tissue:

myometrium

inner mucous membrane, glandular portion of the uterine body

endometrium

the endometrium consists of two primarily layers:

functional and basal layer

layer of the endometrium that sheds with menses?

functional layer

thin layer of the blind ends of endometrial glands that regenerates a new endometrium after menses:

basal layer

a double fold of peritoneum that drapes over the fallopian tubes, uterus, and ovaries:

broad ligaments

the broad ligaments extend from the __________ sides of the uterus to the side walls of the pelvis

lateral

what ligament contains the uterine blood vessels and nerves and provides a small amount of support to the uterus

broad ligament

upper fold of the broad ligament; encloses the fallopian tube

mesosalpinx

posterior portion of the broad ligament; encloses the ovaries

mesovarium

fibrous cords that occur in front of and below the fallopian tubes between the layers of the broad ligament; holds uterus forward

round ligaments

extend across pelvic floor laterally; firmly supports cervix

cardinal ligament

extend from the uterine isthmus downward, along-side the rectum to the sacrum; firmly supports the cervix

uterosacral ligament

extends from lateral aspect of ovary to pelvic sidewall

suspensory ligament

extends medially from ovary to uterine cornua

ovarian ligament

uterine body tilts anteriorly

anteversion

uterine body tilts posteriorly

retroversion

uterine body folds forward possibly touching the cervix

anteflexion

Uterine body tilts back and touches cervix

retroflexion

uterus more towards right

dextroversion

uterus more towards left

levoversion

abnormal dropping of the uterus that occurs if the uterine ligaments and pelvic floor muscles are weak, allowing the uterus to protrude into the vagina:

uterine prolapse

coiled muscular tubes that open into the peritoneal cavity at their lateral end

fallopian tubes

Funnel-shaped lateral tube projects beyond broad ligament to overlie ovaries

infundibulum

widest part of the fallopian tube where fertilization occurs

ampulla

hardest part of the fallopian tube; lies just lateral to the uterus, most medial segment

isthmus

area of the fallopian tube that pierces the uterine wall at the cornua

interstitial portion

finger-like projections at distal end near ovary

fimbriae

length of fallopian tubes

10-12 cm

the ovaries have a dual blood supply from:

ovarian and uterine arteries

the ovaries consist of two layers:

cortex and medulla

______ consists of follicles in varying stages of development and is covered in a layer of dense connective tissue (tunica albuginea)

cortex

connective tissue containing blood, nerves, lymphatic vessels, and some smooth muscle at region of hilum

central medulla

the ovaries produce:

the ovum, estrogen and progesterone

what hormone is secreted by the follicles

estrogen

what hormone is secreted by the corpus luteum

progesterone

arteries that encircle the uterus in outer third of myometrium

arcuate

Branches of arcuate arteries that extend from myometrium to base of endometrium

radial

branches of radial arteries that supply zona basalis of endometrium

straight

branches of radial arteries that supply zona functionalis

spiral

When cycle occurs at intervals of less than 21 days

polymenorrhea

cycles prolonged and occur at intervals of greater than 35 days

oligomenorrhea

Ovulation normally occurs are on day ______ of a 28-day cycle

14

The process of ovulation is regulated by the:

hypothalamus of the brain

At puberty, hypothalamus begins pulsatile release of

GnRHs

GnRHs stimulate the ________________ to secret varying levels of gonadotropins

pituitary gland

Two gonadotropin hormones :

FSH (Follicle Stimulating Hormone) and LH (Luteinizing Hormone).

secretion of ________ causes the ovarian follicles to develop during the first half of the menstrual cycle

FSH

secretion of FSH day ______- _________

1-14

what phase begins with the first day of menstrual bleeding and continues until ovulation (day1-day14)

follicular phase

as ovarian follicles grow, the fill with fluid and secrete increasing amounts of ___________

estrogen

mature follicle:

dominant or graafian follicle

graafian follicle typically measures _______ right before ovulation

2cm

as estrogen levels rise the pituitary gland:

stops FSH production and begins secreting LH

LH levels will typically:

Increase rapidly (LH surge)

LH surge with smaller FSH surge triggers:

ovulation

release of ovum from ruptured graafian follicle:

ovulation

small amount of fluid within posterior cul-de-sac mid cycle:

physiological finding

midcycle dull ache on either side of lower abdomen lasting a few hours:

mittelschmerz

phase that beings with ovulation and usually last 14 days (day 14-day 28)

luteal phase

during the luteal phase: the cells in lining of ruptured ovarian follicle begin to multiply and create:

corpus luteum