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2011-12-11 12:41:49
39 Normal anatomy physiology female pelvis

Normal anatomy and physiology of the female pelvis
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  1. bony pelvis bones
    • 4bones
    • 1. two innominante (coxal)bones
    • ilium,ischium, pubis
    • 2. sacrum
    • 3. coccyx
  2. iliopectineal line
    • plane of division from superior sacrum to superior pubis symph
    • separated true and false pelvis
  3. False pelvis
    aka greater or major pelvis above the brim
  4. True pelvis
    lesser or minor pelvis below the brim, pelvic cavity
  5. muscles of pelvic cavity
    • posteriolateral=piriformis and coccygeus muscles
    • anteriolateral=obturator internus
    • pelvic floor= levator ani coccygeus
  6. abdominal wall
    • xiphoid process to symphasis pubis
    • paired rectus abdominis muscles anterior
    • external oblq , internal oblq, transversus abdominis antero laterally
  7. muscles of false pelvis
    psoas major and iliacus muscles to form iliopsoas muscles (do not enter true pelvis)
  8. psoas major
    originates at transverse process of lumbar vert and descend to pelvic side walls
  9. iliacus muscle
    false pelvis from pelvic side wall joins with psoas to form iliopsoas
  10. iliospoas
    • anterior to the hip and inserts into lesser trochanter on posterior femur
    • does not enter true pelvis
    • echogenic center due to nerves, vessles, lymphatics
  11. True pelvis muscles
    • piriformis
    • obturator internus
    • pelvic diaphragm muscles
  12. piriformis muscle
    flat triangular muscles from aterior sacrum and pass through greater sciatic notch to superior greater troochanter on femur
  13. obturatir internus muscle
    • triangular sheets of muscle that go from anteriolateral pelvic wall pass out of pelvic cavity to superior greater trochanter of femur
    • supports bladder
    • forms lateral side walls of pelvis
  14. levator ani
    • 3 muscles like a hammock across pelvic floor
    • coccygeus
    • piriformis
  15. ureters
    • run anterior and medial
    • aterior to psoas major muscle
    • enter bladder at trigone
    • anterior to internal illiac arteries
    • posterior to ovarian/uterine arteries
  16. vagina size
    • anterior wall 9cm
    • posterior wall 10cm
    • 90 degree angle with cervix
    • mucosal lining
  17. fornicies
    arch like recess at upper portion of vaginal canal, blind pockets, ring shaped space
  18. uterine size
    • 6-8cm x 3-5 x 3-5
    • fundus body cervix
    • cornua- where fallop. tubes attach
  19. uterine layers
    • serosa or perimetrium
    • myometrium
    • endometrium
  20. uterine supported in midline by
    • broad
    • round
    • uterosacral
    • cardinal
  21. broad ligament
    • double folds of peritoneum that drape over fallopian tubes, uterus, and ovaries
    • lateral side walls of uterus to pelvis walls
    • contains uterine blood vessles and nerves
  22. mesosalpinx
    upper fold of broad ligament that encloses fallopian tubes extends from cornua of uterus
  23. mesovarium
    posterior portion of broad ligamentthat encloses the ovaries
  24. round ligament
    • fibrous cords below in layers of broad ligament
    • insert into labia majora
    • hold fundus and body forward
  25. cardinal ligament
    • holds cervix to pelvic walls
    • spoke wheel shaped
  26. uterosacral ligament
    • holds cervix to pelvic side walls
    • cord like ligament
  27. anteverted
    • 90 degrees
    • most common
  28. anteflexed
    less than 90 degrees
  29. retroverted
    180 degrees
  30. retroflexed
    greater than 180 degrees
  31. cervix size
    3cm legnth
  32. prolapse
    loss of support allows uterine cervix to drop into vagina
  33. menstural phase
    • uterine
    • from day 1 of mensturation
    • average 3-5 days
    • FSH increasing causing follicular develop wich produces estrogen
  34. proliferative phase
    • days 5-14
    • corresponds with follicular phase
    • estrogen increases as follicle develp
    • estrogen makes uterine lining regenerate
  35. uterine
    • day 5 or completion of menst. or when there is enough estrogen to shut off FSH
    • dominant follicle
  36. secretory phase
    • uterine
    • day 15-28
    • corresponds to luteal phase
    • under influence of progesterone (corp lut) the endomet is edematous
    • estrogen shuts off prior to ovulation causing FSH and LH surge
    • LH causes follicle to rupture at day 14
    • 14 days later is menstruation
    • anovulatory women never experience this phase
  37. Ischemic phase
    • uterine
    • day 22-28
    • occurs if no fertilization
    • progesterone and estrogen low
    • FSH on the rise
  38. Ovary layers
    cortex- outermost layer- ova develops- horomone production

    medulla- innermost layer with blood vessles connective tissue nerves and lymphatics
  39. follicular phase
    • ovarian
    • follicle develops under influence of FSH
  40. luteal phase
    • ovarian
    • LH causes mature follicle to rupture at day 14
    • egg survives 6-9 hrs after ovulation
    • sperm survive 36-72 hours after ejac
  41. hypothalamus secreted horomones
    • LRH- luetinizing releasing horomone
    • GRH- gonadotrophin releasing horomone
  42. anterior pituitary glad horomones
    • FSH- follicle stimulating horomone
    • LH- luetinizing horomone
    • prolactin
  43. estrogen and FSH
    • when one is high the other is low
    • negative feedback system
  44. ovarian ligament
    • cord like ligament that anchors ovaries
    • runs from lateral to posterior portion of uterus to lower pole of ovary
  45. salpingoopherectomy
    removal of fallopian tubes and ovaries
  46. follicular development
    • occurs in inner cortex and migrate out
    • theca cells- outter
    • granulosa cells- inner
    • at birth 100,000-600,000 primary follicles, 500 will mature
  47. infundibular ligament
    • suspensory
    • superior extension of broad ligament
    • runs from upper pole of ovary to pelvis sidewalls
  48. space of retzius
    potential space anterior to bladder and posterior to pubic symphasis bone
  49. culdocentesis
    aspiration of fluid from posterior cul de sac via puncture of posterior fornix of vagina
  50. anterior cud de sac
    • vesicouterine pouch
    • potential space located anterior to uterus and posterior to urinary bladder

    hematomas post c-section
  51. metorrhagia
    bleeding between periods
  52. nude ovary
    no peritoneal covering
  53. suspensory ligament (infundibulopelvic)
    support ovaries laterally from infundibulum of fallop tube
  54. ovaries on broad ligament
    attach to posterior via mesovarium
  55. internal illiac feeds..
    • bladder
    • uterus
    • vagina
    • rectum
  56. oligomenorrhea
    • short light periods
    • PCOS
  57. polymenorrhea
    menstration intervals less than 21 days