female pelvic anatomy - medicinska fakulteten | medicinska ... · female pelvic anatomy. 1. 2 ......
TRANSCRIPT
1
2
The Lig. Infudibulo‐pelvicum
contains
the ovarian
vessels, lymphatics
and
nerves
(1)
The two
uterine
tubes
(2) lie on each
side
of the uterus in the upper
margin
of the broad ligament (3)
(mesosalpinx).
The internal
iliac
atery
devides
into
an
anterior
and posterior
trunk. The
anterior
trunk branches
in the
superior
and inferior
vesical
artery,
the middle
rectal
artery
, the vaginal
artery
(4), the obturator
artery
and
uterine
artery
(5).
The uterine
veins
form a plexus
in the
parametrium
below
the uterine
arteries, draining
into
the internal
iliac
veins
The Lig. Infudibulo‐pelvicum
contains
the ovarian
vessels, lymphatics
and
nerves
(1)
The two
uterine
tubes
(2) lie on each
side
of the uterus in the upper
margin
of the broad ligament (3)
(mesosalpinx).
The internal
iliac
atery
devides
into
an
anterior
and posterior
trunk. The
anterior
trunk branches
in the
superior
and inferior
vesical
artery,
the middle
rectal
artery
, the vaginal
artery
(4), the obturator
artery
and
uterine
artery
(5).
The uterine
veins
form a plexus
in the
parametrium
below
the uterine
arteries, draining
into
the internal
iliac
veins
3
4
5
1
4
5
2
The broad ligament (1) is a double
fold
of
peritoneum
extendingfrom
the uterus
towards
the pelvic
side‐
wall
(2).
The hilum
of the ovary
arises
from its
posterior
surface
(3).
Between
the leaves
of this fold, the uterine
and ovarian
blood
vessels
form an
anastomotic
loop.
The ovarian
ligament connects
the cornu
of
the uterus to the medial pole
of the ovary
(4).
The cardinal
ligaments (5+6) provide
support to the internal
genital organ and
consists
of connective
tissue
around
the
vessels
and nerve
plexuses
They
are fused
with the fascia
surrounding
the cervix
and upper
part of the vagina (7).
The broad ligament (1) is a double
fold
of
peritoneum
extendingfrom
the uterus
towards
the pelvic
side‐
wall
(2).
The hilum
of the ovary
arises
from its
posterior
surface
(3).
Between
the leaves
of this fold, the uterine
and ovarian
blood
vessels
form an
anastomotic
loop.
The ovarian
ligament connects
the cornu
of
the uterus to the medial pole
of the ovary
(4).
The cardinal
ligaments (5+6) provide
support to the internal
genital organ and
consists
of connective
tissue
around
the
vessels
and nerve
plexuses
They
are fused
with the fascia
surrounding
the cervix
and upper
part of the vagina (7).
1 2
34
56
7
The main
blood
supply
of the uterus is
from the uterine
arteries. Each
passes
medially
in the base
of the broad
ligament above
the ureter, and ascends
along
the lateral aspect
of the uterus
The descending
ureters
(1+2) are narrow
muscular
tubes
which
cross into
the
pelvis
close
to the bifurcation
of the
common
iliac
arteries. They
lie
immediately
under the peritoneum.
Approaching
the bladder, the ureters
pass medially
in front of the upper
vagina, and enter
the bladder base
obliquely
at the upper
angles
of the
trigone.
The main
blood
supply
of the uterus is
from the uterine
arteries. Each
passes
medially
in the base
of the broad
ligament above
the ureter, and ascends
along
the lateral aspect
of the uterus
The descending
ureters
(1+2) are narrow
muscular
tubes
which
cross into
the
pelvis
close
to the bifurcation
of the
common
iliac
arteries. They
lie
immediately
under the peritoneum.
Approaching
the bladder, the ureters
pass medially
in front of the upper
vagina, and enter
the bladder base
obliquely
at the upper
angles
of the
trigone.
1
2
The endometrium
(1) is the
epithelial
lining
of the cavity. The
surface
consists
of a single
layer
of
columnar
ciliated
cells.
Picture shows an intracavitär
myom
(3)
The smooth
muscle
fibres
of the
uterine
wall
form the Myometrium
(2), a myoma
located
in this layer
is
called
a intramural
myoma
(4)
The posterior
surface
of the uterus is
completely
covered
by peritoneum.
Anteriorly
the peritoneum
is
reflected
off
the uterus at a much
higher
level
A myoma
located
directly
under the
peritoneum
is
called
a
subserös
one
(5)
The endometrium
(1) is the
epithelial
lining
of the cavity. The
surface
consists
of a single
layer
of
columnar
ciliated
cells.
Picture shows an intracavitär
myom
(3)
The smooth
muscle
fibres
of the
uterine
wall
form the Myometrium
(2), a myoma
located
in this layer
is
called
a intramural
myoma
(4)
The posterior
surface
of the uterus is
completely
covered
by peritoneum.
Anteriorly
the peritoneum
is
reflected
off
the uterus at a much
higher
level
A myoma
located
directly
under the
peritoneum
is
called
a
subserös
one
(5)
2
1
3
4
5
The uterus is in the middle
of the pelvic
cavity
The uterus is mobile and moves
under
pressure of the full bladder or full rectum
anteriorly. Increased
intra
abdominal
pressure pushes
it downwards.
Under normal circumstances
the
suspensory
part keeps
the uterus in
anteflexion
and anteversion
It is important
to distinguish
retroversion
from anteversion
before
introducing
a sond
or similar
instrument into
the uterine
cavity,
to avoid
perforation of the uterine
wall.
The uterus is in the middle
of the pelvic
cavity
The uterus is mobile and moves
under
pressure of the full bladder or full rectum
anteriorly. Increased
intra
abdominal
pressure pushes
it downwards.
Under normal circumstances
the
suspensory
part keeps
the uterus in
anteflexion
and anteversion
It is important
to distinguish
retroversion
from anteversion
before
introducing
a sond
or similar
instrument into
the uterine
cavity,
to avoid
perforation of the uterine
wall.
Position of uterus:”Retroverted”: Tipped
backward
"Anteverted": Tipped
forward
Position of fundus:"Anteflexed": Fundus
is pointing
forward
relative to the cervix
Retroflexed": Fundus
is pointing
backwards
relative to Cervix
The picture
shows the bimanual
palpation of an anteverted
and
anteflexed
livmoder
Position of uterus:”Retroverted”: Tipped
backward
"Anteverted": Tipped
forward
Position of fundus:"Anteflexed": Fundus
is pointing
forward
relative to the cervixRetroflexed": Fundus
is pointing
backwards
relative to Cervix
The picture
shows the bimanual
palpation of an anteverted
and
anteflexed
livmoder
Picture 1: First step of abdominal Hysterectomy: The round ligament is
grasped
and divided
with ligation
or
electrocautery. After cutting
this
ligament,
the posterior
leaf
of the broad ligament
(x) can
be incised
giving
access to the
retroperitoneal
space.
It is important
to identify
the ureter
in
the Retroperitoneum.
Picture 2: The anterior
part of the broad
ligament is cut
in order to reach
the
vesico‐uterine
junction
(x1). At this
point
the peritoneum
is incised
to free
the bladder.
Picture 1: First step of abdominal Hysterectomy: The round ligament is
grasped
and divided
with ligation
or
electrocautery. After cutting
this
ligament,
the posterior
leaf
of the broad ligament
(x) can
be incised
giving
access to the
retroperitoneal
space.
It is important
to identify
the ureter
in
the Retroperitoneum.
Picture 2: The anterior
part of the broad
ligament is cut
in order to reach
the
vesico‐uterine
junction
(x1). At this
point
the peritoneum
is incised
to free
the bladder.
1
x
2x1
Laparoscopic
resection
of an
intramural
myoma.
In the picture
the serosa
of the
uterus has already
been
incised
and gives view
over the myoma
lying
under the surface.
Subserös and intramural
myoma
can
be easily
removed
with a minimal
invasiv
laparoscopic
operation
Laparoscopic
resection
of an
intramural
myoma.
In the picture
the serosa
of the
uterus has already
been
incised
and gives view
over the myoma
lying
under the surface.
Subserös and intramural
myoma
can
be easily
removed
with a minimal
invasiv
laparoscopic
operation
The term vulva generally
encompasses
all the external
female
genitalia, i.e. the mons pubis, the labia
majora
and minora, the clitoris, and
the structures
within
the vestibule
–
the external
urinary
meatus
and the
hymen.
External
borders
of the vulva:
‐Anterior: The mons pubis
(x)
‐Lateral: The labia
majora
‐Posterior: The perineum
Internal
border:
‐Hymenal
ring
The term vulva generally
encompasses
all the external
female
genitalia, i.e. the mons pubis, the labia
majora
and minora, the clitoris, and
the structures
within
the vestibule
–
the external
urinary
meatus
and the
hymen.
External
borders
of the vulva:
‐Anterior: The mons pubis
(x)
‐Lateral: The labia
majora
‐Posterior: The perineum
Internal
border:
‐Hymenal
ring
Perineum
x
mons pubis