female pelvic visceral organs

Lecturer: Dante Roel Fernandez RT, M.D.

Hollow pear shaped muscular organ in which the fertilized ovum is implanted until the fetus is fully developed.

3 inches in length, 2 inches in width across its free end, gradually diminishing to an inch inferiorly, with a thickness of 1 inch

Parts:1.Fundus- the rounded

free upper end above the attachment of the fallopian tubes.

2.Body- main part of the uterus.

3.Cervix- cylindrical shaped organ about one inch long that is connected to the vagina, separated from the body above by a faint groove called the isthmus.

Uterine tubes. Ligament of the

ovary. Round ligament

It is located in the middle of the pelvis, posterior at the upper surface of bladder, inferior to the intestines.

It usually leans towards the right, with the cervix and the upper part of the vagina being tilted towards the left.

It is usually dextrorotated. The myometrium is thick and firm. Cervix has more fibrous tissue and is more firm. Mostly covered with peritoneum. In most women, the long axis of the uterus is

bent forward on the long axis of the vagina to an angle of 90 degrees, a position called anteversion, to internal os is 170 degrees a position is called anteflexion.

Inferior surface: the cervix is inserted into the vagina through the uppermost part of the anterior wall, and nearly one half of the cervix is within the cavity of the vagina.

Anterior surface: it is related to the bladder, nearly flat, with occasional loop of intestine. Covered in peritoneum

Posterior surface: distinctly convex. Separated with the rectum by the upper portion of the rectouterine pouch.

Lateral borders: attachment to both layers of the broad ligaments.

Two and one half inch long and is divided into the cavity and the body of the cervix.

Uterine cavityo Triangular in shapeo Uterine tubes enter

via the angles of the fundus.

o Continuous with the canal of the cervix

Cervical canal Spindle shaped, its

upper end opens into the cavity of the body and is referred to as the internal os.

The lower ends open into the vagina and is called the external os uteri.

Supplied by the uterine arteries and partially ovarian arteries; drained by similar veins.

Vessels enlarged during pregnancy.

Uterine vessels cross over the ureter adjacent to the cervix.

1. Serous (perimetrium)- peritoneal covering.

2. Muscular (myometrium)- consists of plain muscle with fibrous and elastic tissue abundant in the cervix. About half an inch in thickness

3. Mucous (endometrium)- innermost lining of the uterus. Attached to the muscular coat without a submucous layer. Layer undergoing cyclic changes during menstruation.

1. Broad ligaments- dual layered peritoneal fold stretching transversely from the lateral margin of the uterus to the lateral pelvic wall.

Extensions:1. Mesovarium- peritoneal

fold attaching ovary to upper part of posterior layer of broad ligament.

2. Suspensory ligament of ovary- (infundibulopelvic ligament.

Parts of broad ligament

1.Mesosalphinx- encloses the fallopian tube.

2.Mesometrium- part below attachment of mesovarium.

Contents 1.Round ligament of

uterus.2.Uterine and

ovarian vessels.3.Uterine tubes.4.Ovarian ligaments.5.Epoophoron and

paraophoron.6.Lymphatics and

nerves

Ligamentum teres uteri

A long slender band of muscle mixed with fibrous tissue.

Represents the lower part of the embryonic gubernaculum ovary. Goes toward the deep inguinal ring. Traverses the inguinal canal.

Utero-sacral ligament (sacrocervical ligament)- markedly thicked bands of subserous fascia running from the sacral periosteum and fascia to the cervix.

Cardinal ligament ( transverse cervical, ligament of mackenrodt)- thickened subserous fascia coming from the lateral pelvic wall and attached on either side of the lower part of the cervix and upper part of the vagina. Strogest ligament of the uterus.

Pubocervical ligament- pass to the cervix from the posterior surface of the pubis.

Almond shaped Has a smooth and pink surface in young women,

later becomes puckered due to repeated discharge of ova.

It is atrophied in elderly women. Position and relation: Lies near the sidewall of the pelvis between the

broad ligament and the ureter and is attached to the upper layer of the broad ligament.

Extremities:1. Tubal end- immediately behind the external iliac

vein; the terminal part of the uterine tube curls around it.

2. Uterine end- provides attachment to the ligament of the ovary.

Surfaces:1. Medial surface- is overlapped by the tube and is

related to an intestinal loop and to the tip of the vermiform appendix.

2. Lateral surface- is separated by the peritoneum of the side wall of the pelvis from the umbilical artery, the obturator nerve and vessels and the obturator internus muscle.

Borders:1. Free border- is separated from the ureter by the

peritoneum.2. Mesovarian- projects into the broad ligament via

a slit in its upper layer, and is held in place by the mesovarium. The vessels and nerves enter and leave this border, which is called the hilum of the ovary.

Blood vessels:1.Ovarian artery- arises from the aorta

proximal to the renal artery and runs downwards over the posterior wall of the abdomen. Crosses the external iliac artery an inch below its origin and enters the infundibulo-pelvic ligament, descends to the ovary and divides into branches thaqt enter through the hilum.

2.Ovarian veins- issue through the hilum and form a pampiniform plexus around the artery .

Lymph vessels- emerge through the hilum and, joined by the lymph vessels from the fundus of the uterus and from the uterine tube.

Nerves- derived from the aortic and renal plexuses.

Ligaments:1. Ovarian ligament (round ligament of the ovary)- a

thin band of smooth muscle mixed with fibrous tissue; but is only an inch or an inch and a half in length; represents the upper part of the gubernaculum ovary.

2. Suspensory ligament of the ovary- also known as the infundibulo-pelvic ligament which runs from the tubal end of the ovary to the lateral pelvic wall. Contains ovarian blood vessels, lymphatics, and nerves.

Reproductive organs that convey discharged ovum from ovary to ujterus.

Length- 4 inches Width- ¼ inch but varies in width at different

parts. It pierces the wall of the uterus medially at the

junction of fundus with the side of the body and opens into the anterior angle of its cavity.

Divisions:1. Intramural- part embedded in the wall of the

uterus.2. Isthmus- proximal to the uterus, about an inch

long, almost straight, narrowest part.

3. Ampulla- the longest and widest part of the tube comprising 2/3 of the length, slightly sacculated and convulated, and it is bound loosely to the peritoneum, site of fertilization.

4. Infundibulum- funnel-shaped lateral end of the tube. Broken up into a conical fringe of finger-like processes called fimbrae. The longest fimbria is adherent to the ovary and is called the ovarian fimbria.

Blood vessels- branches of the uterine and ovarian arteries.

Lymph vessels- drain to aortic nodes with the lymph vessels from the ovary and the fundus of the uterus.

Canal extending from the vulva to the cervix. Function as organ of copulation and birth

canal. Parts:1.Pelvic portion- upper half lying above

urogenital diaphragm. Presents fornices which are found around the projection of the cervix into the vagina.

2.Perineal portion- lower half lying below urogenital diaphragm.

Relationships:1. Anteriorly- superiorly- touches the fundus of the

urinary bladder. inferiorly- adheres to posterior

wall of the urethra.2. Posteriorly- superiorly- related to the recto-

uterine pouch of douglas. inferiorly- perineal body.

3. Laterally- adheres to fibers of urogenital diaphragm.

Blood vessels: blood supply through branches of the internal iliac artery- vaginal, uterine, internal pudendal and middle rectal arteries. Venous drainage- tributaries of the same name as the arteries draining iliac veins.

Lymphatic drainage:1.Upper vagina- to the external and internal

iliac nodes.2.Middle vagaina- into the internal iliac nodes.3.Lower vagina- to the superficial inguinal

nodes. Nerve supply: arises from the uterovaginal

plexus.