Normal GYN

What is the collection of the Pelvic bone called?

Pelvic Girdle

What is the Pelvic Girdle made up of?

True/Minor pelvis

False/Major pelvis

What does the True pelvis contain?

Contain the bladder and pelvic organ

What is contained in the False pelvis?

Bowel and extend to the Umbilicus

What are the 5 muscles in the pelvis?

Levator Ani

Oburator Internus

Iliopsoas

Coccygeus

Piriformis

What does the Levator Ani muscles form?

Form the Pelvic flood

Inf to vagina

Considered to be Hammock shaped

Describe the Oburator Internus muscle?

Triangle shaped

Contains the Ant and Lat pelvic sidewalls

What is the iliopsoas muscle?

Continous to the Psoas Muscle

Large strap muscles

Best seen in Long

Most lateral landmark of the pelvis

Describe the Coccygeus muscle?

Is lateral and Post to cervix

Forms the Post Pelvic floor

If muscle fails it can cause uterine prolapse

Seperate the pelvis from peritoneum

Describe the Piriformis muscle?

Is lat and Post to uterine body

How can we visualize the Obturator Internus?

Tranabdominal or Transvaginally

Hypoechoic

Ovoid

Lateral to the Bladder

What muscle is this showing?

OBTURATOR INTERNUS

What is the Levator Ani muscle?

post and inf to Obturator Internus

Best seen in Transabdominal

Has a curved comma shape

What muscle is this?

Levator ANI

Describe the Broad Ligament?

-Not a true ligament

-Looks like a peritoneal fold on either side of Uterus

-Surrounds FT,Ovaries,Ovarian and UT vessels

Describe the Round Ligament?

-BEgins at UT horn

-goes through the Inguinal canal ends at mons pubis,labia majora

-helps hold UT in forward position

Describe the Ovarian Ligament?

-Attach to the Inf Med part of ovary

-Lateral wall of outer uterus

Describe the Uterosacral Ligment?

-Support UT at base

-Determine if UT is Anteflexed or Retroflexed

Describe the Cardinal Ligament?

-Support UT at cervix

Extend from side wall of Pelvis

When are most ligaments seen?

Not well seen Unless there is Ascites or Free Fluid

Lable this image

1-Round

2-Ovarian

3-Broad

4-Cardinal

5-Uterosacral

Describe the Urinary bladder?

-Landmark as a window

-Holds 500mL of urine

-Uses the Uterus away to see ovaries more clearly(Full)

Describe the anatomy of Bladder?

Post to rectus abdominus and Pubic bone

Ant to Uterus,cervix,vagina,rectum

How does the Uterus Run?

Anterior to Internal Ilaic artery and Posterior to Ovaries

Describe the Uterus?

Not visible on Pelvic U/S

We see bladder jets filling bladder

Lable this image?

Uterus

Internal Iliac vessels

What are the Pelvic spaces?

Anterior cul de sac

Posterior Cul de sac

Space of REtzius

Describe the Anterior Cul de Sac?

-Called Uterovesical or Vesicouterine pouch

-Seperate the Ut and Bladder

-Normally empty but can have small fluid

Describe the Posterior Cul De Sac?

-Called pouch of douglas and Rectouterine pouch

-Seperate posterior UT and REctum

-very common place for fluid to collect

Describe the Space of Retzius?

-Between the Ant Bladder and Post Pubic Symphasis

-Uncommon for fluid to collect here

Describe the Pelvis Arterial Vasculature?

Aorta→Iliac→External & Internal Iliac Arteries

-Uterine arteries branch off Internal ILiac Arteries

Where does the Ovarian arteries originate?

From the aorta then anastomoses with Uterine Arteries at Ut Cornua

-Ut artery then branch into and becomes Arcuate Artery

Describe the Venous Pelvic Vascular Flow?

Internal and External Iliac veins→IVC

-Internal drains→Ut and Pelvic muscles

-External drains→legs

Where does the Ovarian veins drain?

Rt Ov vein- drains directly into IVC

Lt OV vein- drains into LRV

Lable this image?

1-Ov Arteries

2-UT arteries

3-Internal Iliac Arteries

4-Vaginal Arteries

Describe the Embryology timeline?

Week 5→2 gestational ridges develop form gonadals

Early Week 6→Primitive germ cells becomes egg and sperm travel to yolk sac. Ridges develop into sex cords

Second Half week 6→Y chrosomes activated,female mechanism develop

Week 7→Grow more and cell differenciates

Week 8→Sex cords degenerate into either Mularian or Wolfian Ducts

Describe the Mullerian Ducts

-Called Paramesonephric Duct

-Leads toFemale Reproductive organ

-Female(originate Kidney)

-degenerate in Men

-fuse formin Vagina and UT

-Unfused part become Fallopian Tube

Describe the Wolffian Duct?

-Called Mesenteric Duct

-Found in men(originate kidney)

-Degrade in women

-Remnats in Women(Gartner duct cyst, Hydatoid Cyst,Paraovarian Cyst)

What are the parts of the Uterus?

Vagina

Cervix

Uterus

Endometium

Fallopian Tube

Lable this image

1-FT

2-UT

3-CV

4-Vag

5-Myometrium

6-Endometrium

7-Ovary

Describe the Vagina?

-Opening extend from vulva to Cervix

-Fibromuscular tube measure 9cm

-Vag Cervix located in upper part of vag at external os of cervix

-Fornices called pelvic spaces

Lable this image?

1-Uterine Cavity

2-Peritoneum

4-Posterior Fornix

5-Vagina

6-Anterior Fornix

7-Cervix

9-External OS

10-Lateral Fornix

11-Cervical canal

12-Uterine Cavity

Describe the Cervix?

-Narrowing of the lower end of Uterus

-Opening of vag=external os

-Opening in the Uterus=internal os

-Also called birthing canal

Lable this Cervical image?

1-Internal Os

2-External OS

3-Ectocervix

4-Endocervical Canal

Describe the Uterus?

-Is muscular organ

-Sole purpose is for gestatation

-divided into 4 segemnts[Cervix,Insthmus,Ut Body,Fundus]

Lable this Uterine image?

1-Fundus

2-Uterus

3-Isthmus

4-Cervix

Describe the Uterus based on age?

-largest organ in the pelvis

-Length=6-8 cm

-Ap=3-5

-Ut volume considered enlarge=>120ml

What are the 3 layers of the Uterus?

Serosa/Peri,etrium=outer

myometrium=middle

Endometriusm=Inner

Lable the Uterine Layers?

1-serosa

2-Myometrium

3-Endometrium

Describe the Endometrial layer

-Innermost layer

-Has 2 layers(Zona Funtionalis,Basalis)

What is the Zona Functionalis?

Superficial layer

Made of gland and stroma tissue

Stretches with menses

What is the Zona Basalis?

Thinner deeper layer

Connect Endometrial canal to myometrium

Regenerates

Describe the Vasculature of Endometrium?

-Arcuate Artery branch into myometrium then become radial artery

-Radial Artery branch into straight artery supply zona basalis

-Becomes larger and supply zona basalis

-Blood from spiral arteries shed in menses

What are the positions of the Uterus?

Anteverted

Anteflexed

Retroverted

Retroflexed

Describe Anteverted or Anteflexed?

most common

bend foward

Describe retroverted or Retroflexed?

normal

Ut bend post to rectum

What does it mean the Uterus is Dextroflexed or levorted?

Bent Lt or RT

What is version refer to to as?

anteverted-angled anteriorly

Retroverted-angled posteriorly

What is Flexion?

Bend of the Fundus

Anteflexed-Fundus bent anteriorly

Retroflexed-Fundus folds posteriorly

What are the Fallopian tubes called?

Oviducts

Describe the Fallopian tubes?

-Muscular tube that connects to the UT at cornus

-Open at the peritoneal cavity and curve over ovary

What is the length of the Fallopian tube?

10-12 cm long

1-4 cm diameter

How does the Fallopian tube lies?

lies superior to utero-ovarian and round ligament

Are the Fallopian tubes be seen on the scan?

Not easily visualized but can use color to distinguish

What are the segments of the Fallopian tubes?

Infundibulum

Ampulla

Isthmus

Interstitial

Describe the Infundibulum?

-Lateral part of tube

-Funnel shape over ovaries

-Finger like structures called Fimbriae

Describe the Ampulla?

-Middle

-Longest part of the Tube

-Where fertilization of egg occurs

Describe the Isthmus of FT?

Medial part of tube

Narrows and lies anterior to the Uterus

Describe the Interstitial portion of the FT?

-Narrowest part of tube

-connects and passes through the Uterine Cornua

Lable the portions of the Fallopian Tube?

1-Ampulla

2-Isthmus

3-Interstitial portion

4-Ovarian ligament

5-Fimbriae

6-Infundibulum

7-Mesosalpinx

Describe the Ovaries?

-Almond shaped

-Lateral and posterior to Uterus near cornua

-Volume over 10ml is abnormal

Where are the Ovarian ligaments suspended?

suspended by the posterior aspect of broad ligament

-medially supported by the Ovarian ligament

-laterally supported by the suspensory or infundibulumpelvic ligament

What is the primary role of the ovaries?

-produce the female reproductive cells

Ovum,estrogen(secreted by the follicles) and progesterone(secreted by the corpus luteum)

What are the layers of the Ovaries?

Cortex(outer)

Central Medulla(Medulla)

Describe the Cortex of the Ovaries?

-Outer portion

-Surrounds the medulla

-Consist of follicles

-Cortex is covered by 2 tissues (Tunica Albuginea,Germinal Epithelium)

describe the Medulla?

-Central part of the ovary

-Compuses of connective tissue

-Contains blood vessels,lymphatic vessels,smooth vessels

Describe the Menstrual Cycle?

-Typically begins at age 11-13

-likely end at age 50

Describe the 3 menstrual status?

Premenarche -prepuberty before menses

Menarche- Menses occur on a regular basis

Menopause- endo of the women Menstrual cycle

Describe the menstural cycle?

-Last 28 days

-Day 1 =bleeding

What is the Menstural cycle regulated by?

regulated by the Hypothalamus in the brain

releases estrogen and progesterone from the ovaries

What is the Ovulation cycle?

-Release of an egg each month

-Ovulation occurs mid cycle day 14

-Woman born with over 200,000 eggs

Write on white board

Slide 50

Describe the Follicular phase of the Ovarian cycle?

-Secretion of the FSH

-1st phase of menstural cycle

-continue until day 14 of cycle

-Follicles grow and fill with fluid and increase amount of estrogen

Describe the LH Surge & Ovulation?

5-8 follicles but only 1 reaches maturity

Mature follicles called Grafian Follicle

LH surges peak until the 10-12 hour before ovulation

Describe the Luteal Phase?

2nd phase of Menstural cycle 14 days after ovulation

Rupture follicle turn into Corpus Luteum and secrete Progesterone

Decline in progesterone causes cycle to begin

Describe the Menstral Cycle?

Endometrium changes through Menstral cycle

What are the 3 stages of the Endometrium during the menstrual cycle?

Menstrual

Proliferative

Secretory

Describe the Menstrual phase of the Menstural cycle

-Day 1-5 bleeding occurs

-Progesterone levels decline

-low levels of progesterone causes the spiral artery to constrict result in shedding of the Zona Functionalis of endometrium

-In association with the Early Follicular phase

-We can see fluid sometimes

What phase is this?

Menstural Phase

Describe the Proliferative phase?

-When the follicles grow the ovaries secrete estrogen

-Regeneration of the regrowth occurs in the Proliferative phase

Day 5-14

-endometrim usually measures 4-8mm (three line patterns)

-the endometriumis 6-10mm before ovulation

What part of the Menstral Cycle this patient is in?

Proliferative phase

Describe the Secretory phase?

-Right after ovulation

-Secrete progesterone form the corpus luteum

-Causes spiral arteries to swell

-Occurs day 15-28

-Normally in association with the Luteal phase

-thickest and most echogenic aroud 14mm

What phase of the cycle is this patient in?

Secretory phase