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Case1b: PelvicAnatomy & FemaleReproductive Histology Haleema CheemaLearning Agenda01.Pelvic bones Bony landmarks of ilium, ischium, pubis; joints; key terms 02. Gross anatomy of female reproductive organs 03. Histology Ovaries, uterine tubes, uterus and vagina01. PELVIC ANATOMY KEYTERMS: o Bony Pelvis: the 2 hip bones, the sacrum and the coccyx o Pelvic girdle: the two hip bones Functions of the pelvis: 1) Transfer of weight (from upper to lower skeleton) 2) Attachment site for ligaments and muscles 3) Protects viscera contained within it o Pelvic cavity: space between the pelvic inlet and outlet; contains pelvic viscera KEYTERMS: o False (greater) pelvis: superior part- above the pelvic inlet o True (lesser) pelvis: inferior part- below the pelvic inlet (pelvic cavity within; pelvic viscera contained in it) KEYTERMS: o Pelvic inlet: border between the greater and lesser pelvis Boundaries of the pelvic brim: sacral promontory AND sacral ala (posterior), pubic symphysis (anterior), arcuate line (border of ilium), pectineal line (border of superior pubic ramus) o Pelvic outlet: lower border of the pelvic cavity- Boundaries: pubic arch (anterior), tip of coccyx (posterior) & ischial tuberosities + inferior margin of sacrotuberous ligamentBONESOF THEPELVICGIRDLE(OS COXAE) A:ilium B:pubis C: ischium bones fuseatthe acetabulum (formshipjointwhenit articulateswiththefemur)BONESOF THEPELVICGIRDLE(OS COXAE) ILIUM: BONESOF THEPELVICGIRDLE(OS COXAE) Ischial tuberosities are what your weight falls ISCHIUM: on when sitting LIGAMENTS: Sacrospinous ligament –from the ischial spine to the sacrum, creates greater sciatic foramen (sciatic nerve passes) Sacrotuberous ligament –from the sacrum to ischial tuberosity, forming lesser sciatic foramen.BONESOF THEPELVICGIRDLE(OS COXAE) PUBIS: JOINTS OF THE PELVICGIRDLE Sacroiliacjoint Pubicsymphysis Joint connecting to sacrum and Between the pubic bodies of the the ilium two hip bones Synovial joint- fibrous joint capsule lined by synovial membrane Surfaceslined with HYALINE cartilage Sacrococcygeal symphysis Hip joint Joint betweenthe sacrum and the Joint betweenthe acetabulum and coccyx the femur Sacroiliacligaments Anterior sacroiliac ligament Posterior sacroiliacligament Interosseous sacroiliacligament Thickening of anterior Locatedposteriorly Between the ilium andsacrum; part of the joint thickest andstrongest capsule ligament SACRUMAND COCCYX Sacrum: 5 vertebrae Coccyx:4 vertebrae Fusedtogether02. FEMALE REPRODUCTIVE ORGANSRELATION/POSITION ORGANS (anterior to posterior): Bladder (urethra inferior to it) Uterus Rectum PERITONEAL POUCHES: Retropubic: behind the pubis and in front of the bladder Uterovesicle: between uterus and bladder Rectouterine (pouch of Douglas): between rectum and uterus (Check out the VR) LIGAMENTS 3 categories of ligaments: • Broad ligament – a sheet of peritoneum, covering both uterus and ovaries • Uterine ligaments – ligaments associated with the uterus • Ovarian ligaments – ligaments associated with the ovaries Ovarian ligament, suspensory ligament of ovary and round ligament of uterus is contained in the broad ligament LIGAMENTS OVARIAN LIGAMENTS UTERINELIGAMENTS BROAD LIGAMENT Extends from lateral pelvic walls, covering internal Ovarianligament: Round ligament: female genitalia attached to the ovary inferiorly, originates at the uterine horns (the anteriorly and connects the ovary to the side points at which the fallopian posteriorly of the uterus. tubes enterthe uterus), passes 3regions: joins uterus just inferior to through inguinal canal - • MESOVARIUM: attaches to the labia majora where uterine tubes attach projects from posterior surface of the broad ligament; attaches to the hilum of the ovary, does Suspensory ligament of not,, coversurface of the ovary. ovary: extends outwards from the • MESOSALPINX: ovary to the lateral pelvic superior to mesovarium, wall encloses uterine tubes contains the ovarian vessels and nerves (ovarian artery, • MESOMETRIUM surrounds uterus (largest vein, nerve plexus and subsection) runs laterally, lymphatic vessels) covering the external iliac vessels, also encloses proximal part of the round ligament of the uterus.PARTSOF THEUTERUS OVARIES The ovaries are pairedoval organs attachedto posterior aspect of the broad ligament; produce oocytesfor fertilisationandproduce oestrogenand progesterones ● ARTERIAL SUPPLY: paired ovarian arteries which arise from the abdominal aorta (some contribution from uterine arteries) ● VENOUS DRAINAGE: paired ovarian veins- right drains directly into inferior vena cava, left drains into left renal vein first ● INNERVATION: reach ovaries via suspensory ligament sympathetic- ovarian plexus parasympathetic- uterine plexus ● HISTOLOGY: - Surface: simple cuboidal epithelium - Cortex: connective tissue and ovarian follicles; follicles contain oocytes surrounded by a layer offollicular cells - Medulla:contains neurovascular supply (blood vessels run through) UTERINE TUBES Transport ovum from ovary touterus Four parts: • Fimbriae – finger like projectionswhich collectovumfromovary • Ampulla – widest part; where fertilisation usually occurs • Isthmus – narrowsection; connects to the uterus ● ARTERIAL SUPPLY: uterine and ovarian arteries ● VENOUS DRAINAGE: uterine and ovarian veins ● INNERVATION: sympathetic- ovarian plexus parasympathetic- uterine plexus ● HISTOLOGY: inner mucosa is lined with ciliated columnar epithelial cells and peg cells (non-ciliated secretory cells) Also has a smooth muscle layerwhich contracts to move the ovum ANTEVERTEDAND ANTEFLEXED! UTERUS Fundus, body and cervix ● ARTERIAL SUPPLY: uterine artery ● VENOUS DRAINAGE: uterine vein ● INNERVATION: sympathetic- uterovaginal plexus parasympathetic- pelvic splanchnic nerves (S2-S4) ● HISTOLOGY: three main layers of the uterus (fundus and body) Peritoneum –double layered membrane (known as the perimetrium) Myometrium – thick smooth muscle layer Cells undergo hypertrophy and hyperplasia during pregnancy in preparation for birth Endometrium– inner mucous membrane lining the uterus. It can be further subdivided into 2parts: Deepstratumbasalis: Changes little throughout the menstrual cycle and is not shed at menstruation. Superficial stratum functionalis: Proliferates in response tooestrogens, and becomes secretory in response to progesterone. It is shed during menstruation and regenerates from cells in the stratum basalis layer. CERVIX ● HISTOLOGY: ● Ectocervix: non keratinised stratified squamous epithelium ● Endocervix: simple columnar epithelium (secretes mucus) VAGINA ● ARTERIAL SUPPLY: uterine and vaginal (both branches of internal iliac artery) ● VENOUS DRAINAGE: vaginal venous plexus -> uterine vein -> internal iliac vein ● INNERVATION: mostly autonomic from uterovaginal nerve plexus (inferior 1/5 receives somatic innervation supplied by deep perineal nerve) HISTOLOGY: four layers (internal to external) Stratified squamous epithelium –provides protection; lubricated by cervical mucus (the vagina itself does not contain any glands). Elastic lamina propria – a dense connective tissue layerwhich projects papillae into the overlying epithelium. Fibromuscular layer –two layers of smooth muscle; inner circular and outer longitudinal Adventitia – fibrous layer DONE RESOURCES: - teach me anatomy - VIRTUAL RESOURCE! - Wrap ups - Histology: - Niggy’s lectures (much more detailed) (also has pictures) THANK YOU:)