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Ultrasound - (spring)
Gyn - pelvic anatomy
151
Medical
Professional
01/18/2010

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Cards

Term
what is the word pelvic derived from? what does it mean?
Definition
derived from Latin and Greek and means dish or bowl
Term
where is the pelvic girdle located, positioned, supports, rests on?
Definition

is the central section of the axial skeleton

positioned between the lower end of the spine,

supports the spine

rests upon the lower extremities

Term
what bones comprise the bony pelvis?
Definition

sacrum - posterior

coccyx - posterior

2 innomiate bones (which consists of the fusion of the ilium, ischium and the pubis - anterior & lateral

Term
where does the imaginary plane run from?
Definition
imaginary plane running from the sacral prominence to the upper margin of the pubis symphsis
Term
which are the 2 regions that divide the pelvic cavity
Definition

false pelvis (pelvis major)

true pelvis (pelvis minor)

Term
where does the false pelvis lie?
Definition
sits abvoe the imaginary plane and is bound by the iliac wings. It is a broad shallow cavity that supports the abdominal viscera
Term
where does the true pelvis sit? what is it further divided into?
Definition
sits below the imaginary plane and is further divided into pelvic inlet and pelvic outlet
Term
_______ pelvis is larger, incompletely enclosed cavity between the upper parts of the ilia. This basin is incomplete because it lacks an anterior wall. It sits on top of the true pelvis
Definition
false pelvis
Term
________ pelvis is the smaller, completely enclosed cavity within the pelvis
Definition
true
Term
How is the pelvic inlet horizontally oriented?
Definition
bound by the pubic bones anteriorly & the sacral promontory posteriorly
Term
how is the pelvic outlet verically oriented?
Definition
bound by the ischial tuberosities laterally and the coccyx posteriorly
Term
Where is the bladder, uterus, ovaries, fallopian tubes and adnexa situated in the absence of masses in the nongravid patient
Definition
in the true pelvis
Term
what are the pelvic ligaments which can be classified as those which bind the pelvic bones together?
Definition

osseous

 

Term
what are the pelvic ligaments which can be classified as those which support the uterus and ovaries ?
Definition
suspensory
Term
What are the 2 categories of suspensory ligaments?
Definition

uterine

ovarian

Term
name the uterine ligaments?
Definition

cardinal

uterosacral

round

broad

Term
which uterine ligament arise superiorly and laterally from the uterus and inferiorly from the vagina to provide primary support for the uterus?
Definition
cardinal
Term
which uterine ligaments extends posterolaterally from the cervix, encircles the rectum, and inserts onto the fascia over the sacrum
Definition
uterosacral
Term
which uterine ligaments are situated anterior and inferior to the broad ligaments and fallopian tubes & attach the uterine cornu to the anterior pelvic wall
Definition
round ligament
Term
which uterine ligament extend from the laeral aspects of the uterus and attach to the lateral pelvic side walls
Definition
broad
Term

the ________ ligament maintain the forward bend of the uterine

the _______ & _________ ligament hold the cervix back and upward

Definition

round

cardinal & ureterosacral ligament

Term
what is a double fold of periotneum that extends from the uterine cornua to the lateral pelvic walls?
Definition
broad ligament
Term
which ligament provides minimal support for the uterus?
Definition
broad ligament
Term
what are the features of broad ligament?
Definition
arise from the lateral aspect of the uterus on each side contain fat vessels and nerves between layers of periotneum. Divides the true pelvis ino anterior and poserior compartments. Ovaries attached to posterior surface of the broad ligament
Term
The spaces within the peritoneal cavity located posterior to the broad ligaments is called ______
Definition
the adnexa
Term
what is the name of the ligament seen extending from the lateral aspects of the uterus?
Definition
broad
Term
what attaches the inferior ovary to the uterione cornu, posterior to the fallopiean tube on each side?
Definition
ovarian ligaments
Term
which ligament is continuous issue that connects the ovary to the wall of the pelvis. It contains blood and lymph vessels passing to and from the ovary?
Definition
suspensory aka infundibulopelvic
Term
a short peritoneal fold connecting the anterior border of the ovary with the posterior layer of the borad ligament of the uterus
Definition
mesovarium
Term
what are the groups of pelvic musculature?
Definition

false pelvis muscles (abdomino pelvic)

true pelvis muscles

Term
which are the false pelvis muscles?
Definition

rectus abdominis

transverse abdominis

iliopsoas

Term
which muscle form the anterior margin of the abdominal & pelvic spaces. it extends from the xiphoid process to the symphsis pubis
Definition
rectus abdominis
Term
the rectus abdominus muscles, which are paired, are intersected transversely by the _________ ________ muslces that are wrapped in a sheath
Definition
transversus abdominis
Term
which muscles resemble a corset insofar as they wrap around the trunk from back to front
Definition
transversus abdominus
Term
The sheath along with the transversus abdominis muscles fuse and form the ________ ______
Definition
linea alba
Term
which muscles are prominent paired muscles that originate at the lower thoracic vertebrae and extends lateral and anterior as it courses through the lower abdomen, along the pelvic side wall to eventually insert on the lesser trochanter
Definition
psoas muscles
Term
Just inferior to the iliac crest the psoas major muscle merges with the iliacus muscle creating the _______ ________
Definition
iliopsoas muscle
Term
what muscle forms part of the lateral margins of the pelvic basin?
Definition
iliopsoas
Term

what connects the lumbar spine to the femur?

what connects the iliac crest to the femur?

Definition

psoas

iliacus

Term
what are the 2 layers of the true pelvis muscles? and what is the primary purpose of the true pelvis muscles?
Definition

the perineum

the deep

primary purpose of the true pelvis muscles is to hold the pelvic organs in place

Term
which are the true pelvic muscles?
Definition

obturator internus

piriformis

pelvic diaphragm

Term
Which is the triangular muscle arising from the antero-lateral wall of the pelvic. It extends from the brim of the true pelvis and exits through the lesser sciatic foramen to insert on the greater trochanter of the femur
Definition
obturator internus
Term
what is the muscle group which lines the lateral walls of the true pelvis
Definition
obterator internus muscle
Term
which is the muscle that arises from the sacrum, passes laterally through the greater sciatic notch, and inserts on the greater  trochanter of the femur?
Definition
piriformis
Term
which muscles that make up the pelvic diaphragm?
Definition

levator ani

coccygeus

Term
which muscles make up the levator ani muscles?
Definition

pubococcygeus, iliococcygeus & puborecalis muscles

(pip)

Term
which muscles provide primary support to the pelvic viscera and aid in the contraction of the vagina and rectum
Definition
levator ani muscles
Term
which muscles are the most posterior muscles pair of the pelvic diaphragm, which extend from the ischial spine to the sacrum & coccyx
Definition
coccygeus muscles
Term

which of the following muscles do not lie within the true pelvis?

piriformis

levator ani

iliacus

obturator internus

Definition
iliacus
Term
what are the muscles that make up the pelvic diaphragm?
Definition

pubococcygeus

iliococcygeus

puborectalis

coccygeus

Term
collectively what do we call the pubococcygeus, the iliococcygeus and the puborectalis muscles?
Definition
levator ani muscles
Term
Pelvic spaces is also known as
Definition
peritoneal recesses
Term
what are the different pelvic spaces
Definition

space of retzius

anterior cul-de-sac

posterior cul-de-sac

Term
what is space of retzius aka?
Definition
pre-vesical or retropubic space
Term
where is the space of retzius located? what is it filled with?
Definition
this space separates the anterior bladder wall from the symphysis pubis and is filled with extraperiotoneal fat
Term
how will the bladder be displaced if there is a mass in the space of retzius?
Definition
posteriorly
Term
anterior cul-de-sac aka?
Definition
vesicouterine pouch
Term
where is the anterior cul-de-sac / vesicouterine pouch located at?
Definition
anterior to the lower uterus and posterior to the urinary bladder
Term
posterior cul-de-sac is aka?
Definition

rectouterine pouch

or

pouch of douglas

Term
where is the posterior cul-de-sac / rectouterine pouch / pouch of douglas located?
Definition
posterior to the cervix and anterior to the rectum.
Term
what forms the lateral boundaries of the posterior cul-de-sac space?
Definition
the utero-sacral ligaments
Term
which is the most common location among the pelvic space where free peritoneal fluid is noted sonographically?
Definition
posterior cul-de-sac
Term
what are 2 other names for the psoterior cul-de-sac?
Definition

pouch of douglas

rectouterine pouch

Term
what is another name for the vesicouterine pouch?
Definition
anterior cul-de-sac
Term
what pelvic space do we see fluid in more often?
Definition

posterior cul-de-sac

pouch of douglas

rectouterine pouch

Term
what are the pelvic organs?
Definition

bladder

ovaries

vagina

uterus

fallopian tubes

Term
What is a muscular sac that receives and stores urine produced by the kidneys
Definition
bladder
Term
where does the ureters insert in the bladder?
Definition
in the inferior third of the osterior wall on either side
Term
what is the superior concavity of the bladder called?
Definition
dome
Term
what is the posterior wall area defined by the orifices of the 2 ureters and the urethra in the bladder?
Definition
trigone
Term
what are the walls of the bladder composed of?
Definition

inner mucosa

muscularis

submucosa

outer serosa

Term
where does the urethra arise? at this pointit is surrounded by thickened region of bladder wall called?
Definition

along the inferior middle portion of the bladder

internal urethral sphincter

Term
the bladder is _____, _____ whose size depends on the ____ of contained urine
Definition
hollow, symmetric, quantity
Term
what is the wall normal measurement of a distended bladder
Definition
3-6mm
Term
when is the bladder considered adequately full for trans abd ultrasound?
Definition
the bladder is adequately full for trans abd pelvic ultrasound when the dome of the bladder extends above the fundus of the uterus
Term
when is the bladder too full?
Definition
if the uterus looks flattened
Term
How are the ovaries shaped and what does it measure in a menarcheal female?
Definition

almond shaped

3 cm long

Term
where does the ovaries lie? where are they usually located?
Definition

on the posterior surface of the broad ligament

usually located medial to the external iliac vessels and anterior to the internal iliac vessels, with the internal iliac vein being the closest

Term
what are the only organs in the abdomino-pelvic cavity that is not lined by visceral peritoneum?
Definition
ovaries
Term
What is the outer layer of the ovaries called? what do they contain?
Definition

cortex

contains a large number of primordial follicles, the source of eggs at ovulation

Term
what is the inner layer of the ovaries called? what does it contain
Definition

medulla

essentially the blood vessels and connective tissues

Term
where is the hilum of the ovary, through which channel the ovarian vessels and nerves situated?
Definition
anterior surface of each ovary
Term
where does both the suspensory ligament of the ovary and the fimbriae of the fallopian tube attach to each ovary?
Definition
superior surface of each ovary
Term
what does the ovaries produce?
Definition

the ovum

2 hormones - estrogen & progestrone

Term
what secrets the estrogen & progestrone?
Definition

follicles

corpus luteum

Term
what are the hormones (estrogen and progestrone) responsible for?
Definition
producing and maintaining secondary gender characeristics, preparing the uterus for implantation of a fertilized ovum and development of the mammary glands in the female
Term
what is the size & volume of the ovaries during premenopausal?
Definition

3.5 x 2.0 x 1.5 cm

5.1 cm3 - 3.2cm3

Term
what is the size & volume of the ovaries during postmenopausal?
Definition

2.0 cm x 1.0 cm x 0.5 cm

 

1.3 cm3

Term
what is the formula for ovarian volume?
Definition
length x width x AP (in cm) x 0.523
Term
what is a muscular tube approx 7-10 cm in length, extending from the external genitalia to the cervix?
Definition
vagina
Term
what forms the distal ortion of the birth canal?
Definition
vaginal canal
Term
what is the vaginal canal composed of?
Definition
smooth muscle, elastic connective tissue and stratified squamous epithelium which line the inner surface
Term
the vaigna angle towards the _____ always
Definition
sacrum
Term
What does the upper portion of the vagina attache to?
Definition
cervix approx half way up
Term
what does a ring like blind pouch which surrounds the cervix known as? what is it categorized as?
Definition

the vaginal fornix

categorized as - posterior fornix

  anterior fornix

lateral fornix

Term
what is a pear shaed muscular structure suspended by ligaments, and normally located in the mid sagittal plane in the true pelvis
Definition
uterus
Term
how is the uterus bordered?
Definition
anteriorly by the urinary bladder, and posteriorly by the rectosigmoid colon & rectum
Term
how is the uterus divided into?
Definition

fundus

body

isthmus

cervix

Term

what is the uterine length and AP measurement for 2-8 years old kid?

9- menarche

nulliparous

multiparous

postmenopausal

Definition

33mm x 7.5mm

43 mm x 13 mm

80 mm x 30 mm

90 mm x 40 mm

varied  - based on parity

Term
what is the widest and most superior portion of the uterus?
Definition
fundus
Term
at the lateral border of the fundus are the _______ where the fallopian tubes enter the uterine cavity
Definition
cornua
Term
what is the body of the uterus aka?
Definition
corpus
Term
what is the largest part of the uterus and contains the uterine cavity?
Definition
body
Term
the _______ of the uterus is predominantly muscular and widens superiorly as the fundus, above the insertion of the fallopian tubes
Definition
body / corpus
Term
what is the portion of the uterus between the body and the cervix?
Definition
isthmus
Term
what is the isthmus called in a gravid patient?
Definition
lower uterine segment
Term
what is located posterior to the angle of the bladder, and is comprised predominately of collagenous and elastic tissue
Definition
cervix
Term
what is more fibrous and less muscular than the body of the uterus?
Definition
cervix
Term

cervix is _____ than the uterine body

what does the cervix measure in length in the nulliparous female?

Definition

narrower

3-4 cm

Term
Where does the mucosal lined cervical canal extend from to where?
Definition
the mucosal lined cervical canal continues with the uterine cavity and extends 2-4 cm from the internal os (or opening) and joins the endomerial canal to the external os which projects into the vaginal vault
Term
what are the layers of the uterus?
Definition

mucosa (endometerium)

muscularies (myometrium)

serosa (perimetrium)

Term
what is the innermost ining of the uterus, which lines the cavity of the uterus?
Definition
endometrium or mucosa
Term
what varies in thickness in the pre-menopausal woman during the different stages of the menstrual cycle?
Definition
endometrium or mucosa
Term
what are the 2 layers of the endometrium?
Definition

superficial or functional

deep or basal

Term
this layer increases in size during the menstrual cycle and partially sloughs off at menses and are vascularized by the spiral arteries in the endometrium
Definition
superficial or functional
Term
this layer is not significantly influenced by the menstrual cycle in the endometrium
Definition
deep or basal
Term
Which is and extremely thick, homogeneous smooth muscle layer that is continuous with that of the fallopian tubes and vagina in the uterus?
Definition
myometrium or muscularis
Term
which layer in the uterus extends into the ovarian and round ligament?
Definition
myometrium or muscularis
Term
What is the most common position of the uterus?
Definition
anteverted
Term
describe anteverted uterus
Definition
in the presence of an empty urinary bladder, the fundus bends forward and tips anteriorly and rests over the lower uterine segment
Term
if the body and fundus of the uterus are bent at a greater anterior angle until the fundus is pointing inferiorly and resting on the cervix, this position is called ____
Definition
anteflexed
Term
the body and fundus are tipped posteriorly with a ________ uterus
Definition
retroverted
Term
if the body and fundus are bent at a greater posterior angle until the fundus is pointing inferiorly adjacent to the cervix, this position is called ________
Definition
retroflexed
Term
What are coiled, muscular tubes that extend from the uterine cornu laterally and open into the peritoneal cavity at their lateral end
Definition
fallopian tubes, or oviducts
Term
What is the length and diameter of the fallopian tubes?
Definition

7-12 cm long

1-4mm diameter

Term
what are the 4 anatomic portions?
Definition

infundibulum

ampulla

isthmus

interstitial or intramural

Term
the lateral segment that is often referred to as the fimbriated end of the fallopian tube because it contains fringelike extensions called fimbriae, which move over the ovary and directs the egg into the fallopian tube after ovulation
Definition
infundibulum
Term
The middle segment and the longest, most coiled portion of the fallopian tube
Definition
ampulla
Term
this lumen portion of the fallopian tube gradually increases in diameter to terminate as the trumpet shaped infundibulum, opening into the peritoneal cavity. this is the area where fertilization of the egg most often occurs becuase it is the most distensible region of the tube.
Definition
ampulla
Term
this portion of the fallopian tube is the narrowest portion where the tube is contained within the cornu of the uterus
Definition
interstitial or intramural
Term
where does the fallopian tube lie and what is its function?
Definition
lie within the broad ligament and provide nutrients for the ova and sperm
Term
what part of the fallopian tube is adjacent to the ovary?
Definition
the infundibulum or fimbria
Term
how do you measure an ovary
Definition

by volume

m1 x m2 x m3

Term
which major branches of the blood vessel provide blood supply to the pelvic viscera?
Definition
abdominal aorta
Term
The abdominal aorta bifurcates into the _____
Definition
right and left common iliac arteries
Term
the common iliac arteries bifurcates to form the
Definition
external and internal iliac arteries
Term
The external iliac arteries course throught the _____ pelvis, adjacent to the ______ muscle, and exit the pelvis through the _____ canals at the level of the _____ ligament
Definition
false, psoas, femoral, inguinal
Term
How does the internal iliac arteries course? what do they divide into?
Definition
the internal iliac arteries dive deep into the pelvis and divide into anterior and posterior trunks
Term
What are the branches that arise from the anterior branch of the internal iliac artery?
Definition
obturator, umbilical and superior vesicle, inferior vesicle, uterine, vaginal, inferior gluteal
Term
Where does the uterine artery course?
Definition
the uterine artery crosses the ureters on each side and at the cervix ascends the lateral aspect of the uterus within the broad ligament
Term
what anastomoses with the ovarian artery? at what location? which is the major supplier of the blood to the uterus?
Definition
the uterine artery anastomoses with the ovarian artery at the uterine cornu however the uterine artery is the major supplier of blood to the uterus
Term
as the uterine artery ascends the lateral uterus, multiple branches penerate the uterine wall and divide into -
Definition
anterior and posterior arcuate arteries
Term
What does the arcuate arteres give rise to and what organs does it supply?
Definition
the arcuates then give rise to numerous radial arteries and supply the deeper layers of the myometrium and the endometerium
Term
the uterine artery comes directly from what vessel?
Definition
internal iliac arteries
Term
where does the right and left gonadal veins empty the blood?
Definition

right empties into the IVC

left gonadal vein empties into the left renal vein

Term
what wave form is seen in uterine doppler?
Definition

high velocity

high resistance flow

Term
in which phase is a higher resistance flow seen
Definition
in the proliferative phase than in the luteal phase
Term
during which age is a higher resistance flow seen
Definition
higher resistance in post menopausal women rather than a women in the reproductive age
Term
in the follicular phase how is the flow doppler?
Definition
flow is often low velocity and high resistance
Term
what happens to the impedance during peri ovulatory phase and luteal phase
Definition
drops dramatically on the side with the dominant follicle
Term
what is the resistive index in post meopausal women and with increasing age
Definition
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