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External Carotid Artery

December 28, 2012, 5:29 am
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Lumbar Plexus

December 29, 2012, 8:48 am
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Bones of the Thoracic Wall

January 31, 2013, 7:52 am
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Sternoclavicular Joint

January 31, 2013, 7:59 am
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Sternum

January 31, 2013, 8:05 am
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Sternal Angle

January 31, 2013, 8:10 am
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Muscles of the Thoracic Wall

February 2, 2013, 7:15 am
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Right Atrium

February 10, 2013, 5:38 am
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Right Ventricle

February 10, 2013, 5:41 am
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Pelvic Floor

February 10, 2013, 5:46 am
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Part 1 – Pelvic Diaphragm

 

Part 2 – Perineal Membrane and Deep Perineal Pouch

About this video
This tutorial was creating using the BioDigital Human web application. If you are having trouble viewing this, try the YouTube links: Part 1 Part 2 

 

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Left Atrium

April 4, 2013, 7:41 am
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Left Ventricle

April 4, 2013, 7:43 am
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Please Help to Improve AnatomyZone (1 minute survey!)

July 12, 2013, 4:50 am
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I would really appreciate some feedback on the tutorials and the website so that I can work on improving it and making the tutorials as useful as possible.

It would be a great help if you could fill out this very short survey, which should take no more than 1-2 minutes!

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Self-assessment: External Carotid Artery

March 22, 2013, 4:07 pm
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External Carotid Artery

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Self-assessment: Bones of the Shoulder

March 22, 2013, 4:08 pm
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Bones of the shoulder

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Self-assessment: Clinical Female Reproductive Anatomy

July 22, 2013, 8:36 am
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Introduction to Female Reproductive Anatomy

July 22, 2013, 12:28 pm
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Part 1 – The Basics

 

Part 2 – Ligaments

 

Part 3 – Blood Supply and Axes of the Uterus

 

Part 4 – External Genitalia

About this video
This tutorial was creating using the BioDigital Human web application. If you are having trouble viewing this, try the YouTube links: Part 1 Part 2 Part 3 Part 4 

Click here to view tutorials on clinical anatomy relating to the female reproductive tract.

 

Test yourself!

Click here to test yourself on these tutorials!

 

Part 1 – The Basics

  • Ovaries
    • Primary sex organ, responsible for producing the egg cells (ovum), which are released each month in a process called ovulation
    • Intraperitoneal – egg is released into the peritoneal cavity and directed into the fallopian tubes
  • Fallopian/uterine tubes
    • Fimbriae – at the distal end of the fallopian tubes are finger-like projections which waft the egg released from the ovary into the tube
    • Four parts (distal to proximal):
      • Infundibulum
      • Ampulla – most common site for fertilisation
      • Isthmus – narrowest part of tube
      • Intrauterine part
  • Uterus
    • Fundus – portion of uterus above the point where the fallopian tubes join
    • Body – bulk of the uterus
    • Cervix– neck of the uterus
      • Protrudes into the vagina
      • Internal os – where cervix opens into uterine cavity above
      • External os – where cervix opens into vagina below
      • Fornices – recesses formed around the margin of the cervix where it protrudes into the vagina
        • 2 lateral fornices
        • Anterior fornix
        • Posterior fornix
    • Layers of the uterus
      • Perimetrium – outer serous connective tissue layer
      • Myometrium – thick smooth muscle layer
      • Endometrium – lining of the uterus
  • Vagina
    • Fibromuscular tube which runs between the vaginal orifice and the external os
    • Vaginal vault – superior internal end of vagina
    • Layers
      • Outer connective tissue layer
      • Middle muscular layer
      • Internal mucosa
  • Broad ligament
    • Sheet of peritoneum which drapes over the pelvic viscera
    • Forms “pouches”
      • Anteriorly: vesico-uterine pouch
      • Posteriorly: recto-uterine pouch (pouch of Douglas)

 

Part 2 – Ligaments

Fascia which lines the pelvic cavity, viscera and vessels condenses to form ligaments:

  • Uterosacral ligament – extends posteriorly from cervix to sacrum
  • Transverse cervical/cardinal ligament – extends laterally from cervix to pelvic side walls
  • Pubocervical ligament – extends anteriorly to pubic symphysis

Together with the levator ani muscle, these ligaments are crucial in supporting the uterus

Broad ligament

  • Flat sheet of peritoneum which drapes over the pelvic viscera
  • Attaches from the sides of the uterus to the pelvic side walls
  • Contains
    • Fallopian tubes  
    • Ovaries – attached to posterior aspect of broad ligament (mesovarium)
    • Ligaments
      • Suspensory ligament of ovary (not really contained as such, but formed by a fold of the broad ligament)
        • Also called the “infundibulopelvic ligament”
        • Attaches to superior pole of ovary
        • Contains ovarian vessels and lymphatics
    • Ovarian ligament
      • Attaches to inferior pole of ovary
      • Connects ovary to uterus
      • Continues anteriorly on the uterus to form the round ligament:
    • Round ligament
      • Attaches laterally to the uterus and passes anteriorly in the broad ligament through the deep inguinal ring to enter the inguinal canal, terminating in the labium majus.
  • Vessels, lymphatics, nerves
    • Uterine and ovarian arteries

“Water under the bridge”

Beneath the broad ligament are the ureters. Above the ureters, the uterine arteries are carried within the broad ligament. The mnemonic “water under the bridge” can be used to remember this anatomical relationship, whereby the water flowing through the ureters runs underneath the bridge formed by the uterine arteries.

 

Part 3 – Blood supply and Axes of Uterus

  • Ovaries
    • Arterial supply: ovarian arteries
      • arise from abdominal aorta below renal arteries
    • Venous drainage: ovarian veins
      • Right ovarian vein – drains to inferior vena cava
      • Left ovarian vein – drains to left renal vein
    • Travel in suspensory (infundibulopelvic) ligament to superior pole of ovary
  • Uterus
    • Arterial supply: uterine artery
      • Arises from anterior division of internal iliac artery
      • Runs in base of broad ligament
      • Superiorly – forms anastomoses with ovarian arteries
      • Inferiorly – sends of branches to upper vagina and cervix
    • Venous drainage: uterine veins
      • Drain to internal iliac veins
      • Venous plexuses – networking of veins from vagina and bladder
  • Vagina
    • Arterial supply: branches of internal iliac artery
      • Vaginal, uterine, rectal, internal pudendal branches
    • Venous drainage: vaginal veins drain to venous plexuses, which drain to internal iliac veins

Axes of the uterus

  • Anteflexion: anterior flexion of the uterine body on the cervix at the internal os.
  • Anteversion: anterior angulation of the cervix with the vagina

Normal uterine position is anteverted and anteflexed.

Variation in uterine positions include:

  • Anteversion and anteflexion
  • Anteversion and retroflexion
  • Retroversion and anteflexion
  • Retroversion and retroflexion

 

Part 4 – External Genitalia

  • Labia majora
    • Run from mons pubis anteriorly (layer of adipose tissue lying over pubic symphysis) to perineum posteriorly (connected by posterior commissure)
  • Labia minora
    • Enclose an area called the vestibule
      • Vestibule contains the urethral orifice anteriorly, vaginal orifice (introitus) posteriorly
    • Anteriorly: labia minora bifurcate to form:
      • Lateral fold – join together in front of the clitoris, forming the prepuce (hood of the clitoris). Body of the clitoris lies deep to the prepuce.
      • Medial fold – join together behind the clitoris, forming the frenulum
    • Posteriorly: labia minora join to form the fourchette
  • Hymen
    • Thin membrane covering the vaginal orifice
    • In young girls this completely covers the vaginal orifice
    • Ruptured with first sexual intercourse/trauma, leaving remnants around orifice
  • Glands
    • Paraurethral glands – open either side of urethral orifice
    • Greater vestibular glands (Bartholin’s glands) – open either side of vaginal orifice
      • Secrete mucus which lubricates vagina

 


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Clinical Female Reproductive Anatomy

July 22, 2013, 12:29 pm
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Ovary and Fallopian Tubes

 

Uterus

 

Cervix

About this video
This tutorial was creating using the BioDigital Human web application. If you are having trouble viewing this, try the YouTube links: Part 1 Part 2 Part 3   

Click here to view tutorials on basic anatomy of the female reproductive tract.

 

Test yourself!

Click here to test yourself on these tutorials!

 

Ovaries and Fallopian Tubes

Ovaries

  • Ovarian Cyst Accidents
  • Polycystic Ovary Syndrome
  • Ovarian Cancer

Ovarian Cyst Accidents

Three things can happen with ovarian cysts:

  • Haemorrhage into the cyst
  • Rupture of the cyst into the peritoneal space
  • Ovarian torsion

Polycystic Ovary Syndrome

  • Endocrine disorder
  • Multiple enlarged follicles scattered underneath the surface of the ovary.

Features

  • Polycystic ovaries on ultrasound
  • Irregular menstruation
  • Raised testosterone leading to hirsutism and acne

Ovarian Cancer

There are three main groups of cells within the ovary:

  • Epithelial Ovarian Cells: outer layer of cells, also known as the germinal epithelium
  • Germ cells: cells which make the eggs in the ovary
  • Connective tissue: supportive tissue of the ovaries
    • Granulosa cells
    • Thecal cells

Ovarian cancer can arise from any of these three main groups of cells, however the most common type comes from the surface epithelium.

This constitutes 80-90% of all ovarian cancers and is more common in older, post-menopausal women.

Serous type is most common type of surface epithelial ovarian cancer.

Germ cell cancers are more common in younger women.

Sex-cord stromal tumours are quite rare.

 

Fallopian Tubes

This fallopian tubes open DIRECTLY into the peritoneal cavity – this is the only direct communication with the intraperitoneal space.

This direct communication is a possible route for the spread of an infection – a sexually transmitted infection such as gonorrhoea, or chlamydia could spread into the peritoneum.

Ectopic pregnancy

Blastocyst implants in the wrong place, i.e. not in the endometrium.

Locations of ectopic pregnancy:

  • Fallopian tubes – this is the most common sites for ectopic pregnancy
    • Ampulla is the most common site in the fallopian tube for ectopic pregnancy
  • Cornua of the uterus
  • Cervix
  • Ovaries
  • Abdomen

 

Uterus

Prolapse

Structures supporting the uterus:

  • Uterosacral ligament extending posteriorly from the cervix to the sacrum
  • Transverse cervical/cardinal ligament extending laterally to the pelvic side wall side wall
  • Pubocervical ligament extending anteriorly
  • Levator ani muscle

If these structures are weakened, then the pelvic organs can prolapse.

It is useful to think of the prolapses in terms of three different compartments:

Anterior Compartment

  • Urethrocele – urethra bulges into anterior wall of vagina.
  • Cystocele – bladder bulges  superiorly into anterior wall of vagina.
  • Urethrocele + cystocele = cystourethrocele.

Middle Compartment

  • Uterine prolapse
    • Graded from 1 to 3:
      • Grade 1: Prolapse contained within the vagina.
      • Grade 2: Further descent: cervix reaches level of introitus but the fundus stays inside the pelvis
      • Grade 3: the entire uterus is prolapsed outside the vagina – procidentia.
    • Causes of uterine prolapse are:
      • Previous vaginal delivery
      • Iatrogenic causes/previous pelvic surgeries
      • Low oestrogen levels in post-menopausal women
      • Obesity.
  • Enterocele – pouch of Douglas protrudes downwards.
  •  Vaginal vault prolapse –  Occurs after  a hysterectomy. The superior end of the vagina prolapses and the vagina inverts on itself.

Posterior Compartment

  • Rectocele

Benign Uterine Tumours

  • Fibroids
  • Intrauterine Polyps

Common causes for heavy menstrual bleeding (menorrhagia).

Fibroids

Uterine leiomyomata (leiomyoma = singular).

Benign tumours of smooth muscle and connective tissue differentiation, which affect the myometrium.

Three subtypes of fibroid:

  • Subserosal: just below the serous layer of the uterus
  • Intramural: directly within the wall of the myometrium.
  • Submucosal: underneath the mucosa.

Polyps

Benign tumours which grow into the cavity of the uterus

Usually endometrial in origin

These cause menorrhagia and intermenstrual bleeding.

 Endometriosis

Characterised by ectopic endometrial tissue (areas of endometrial tissue that is out of place)

This tissue is responsive to oestrogen, just like the endometrium and therefore changes in size during the menstrual cycle as hormone levels change.

Chronic, cyclical pelvic pain is a common symptom of endometriosis.

Within the pelvic cavity, the common sites for endometriosis are

  • Ovaries
    • Chocolate cysts (endometrioma): accumulations of blood which appear a dark brown colour.
  • Pouch of Douglas (rectouterine pouch)
  • Vesicouterine pouch
  • Uterosacral ligaments
  • Fallopian tubes

Also affects: rectum, vagina, bladder

Sites outside of the pelvic cavity can also be affected:

  • Umbilicus
  • Old wound scars
  • Pleura
  • Pericardium
  • CNS

Long-term, endometriosis can lead to pelvic adhesions, and to immobile pelvic viscera.

Adenomysosis

Ectopic endometrial tissue within the myometrium

Endometrial cancer

Most common malignancy of the female reproductive tract

Mostly adenocarcinoma

Prolonged exposure to unopposed oestrogen (oestrogen without the protective effects of progesterone) is the biggest risk factor

 

Cervix

Ectocervix

  • portion of the vagina which protrudes into the vagina
  • squamous epithelium

Endocervix

  • lines the endocervical canal
  • columnar epithelium

Squamocolumnar junction occurs where the squamous epithelium meets the columnar epithelium

During puberty and pregnancy, the cervix gets pushed out and the columnar cells of the endocervix are exposed to the acidic environment of the vagina.

This causes metaplasia of the columnar cells to squamous cells and this area of change is called the transformation zone.

At the transformation zone, the cervix is more susceptible to neoplastic change.

Cervical ectropion

Benign condition of the cervix where the cervix protrudes out, exposing the columnar cells of the endocervix.

Results in a red area around the external os and is a common cause of post-coital bleeding (bleeding after intercourse).

Normal finding in:

  • younger women
  • pregnant women
  • women using the combined oral contraceptive pill

Cervical intra-epithelial neoplasia (CIN)

Pre-malignant, pre-invasive stage of cervical cancer.

Atypical cells can be detected by a smear test

Smear test is a cytological test, which detects cellular changes, not histological changes.

The degree of cellular change (dyskaryosis) corresponds to the degree of CIN

Three grades of CIN:

  • CIN 1: mild dysplasia  – affects lower 1/3 of epithelium.
  • CIN 2: moderate dysplasia – affects lower 2/3 of epithelium.
  • CIN 3: severe dysplasia – full thickness. Carcinoma in situ

Cervical cancer

Most often occurs near the external os, at the transformation zone.

Most common cause is human papillomavirus (HPV)

Squamous cell carcinoma (SCC) is the most common type

Adenocarcinoma is the second most common type.

 

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Self-assessment: Female Reproductive Anatomy

July 22, 2013, 12:40 pm
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Please help me out by filling out this quick feedback form - it shouldn’t take more than 1 minute!

1.

Is the indicated structure intraperitoneal or retroperitoneal?

 
 

Question 1 of 12

2. Regarding the structure in the previous question, which of the following ligaments attaches to its superior pole:

 
 
 
 

Question 2 of 12

3.

What is this section of the fallopian tube called?

 
 
 
 

Question 3 of 12

4. Regarding the structure in the previous question:

True or false: This section of the fallopian tube is the most common location for fertilisation.

 
 

Question 4 of 12

5.

Identify the indicated structure:

 
 

Question 5 of 12

6. True or false: the transverse cervical ligament extends posteriorly from the cervix to attach to the sacrum.

 
 

Question 6 of 12

7.

Which vessel crosses above the indicated structure in the base of the broad ligament?

 
 
 
 

Question 7 of 12

8.

Where does this ligament terminate?

 
 
 
 

Question 8 of 12

9.

The vein draining this specific structure drains first to which vein:

 
 
 
 

Question 9 of 12

10. True or false: Anteversion refers to the forward angle of the cervix on the vagina

 
 

Question 10 of 12

11. True or false: The labia minora are joined posteriorly by the posterior commissure

 
 

Question 11 of 12

12. Regarding the labia minora:

The frenulum is formed by the union of the medial folds.

 
 

Question 12 of 12

 

 

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Feedback on New Reproductive Anatomy Tutorials

July 22, 2013, 1:58 pm
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Hi,

I would greatly appreciate any feedback on the new tutorials I have made on female reproductive anatomy. Even if you have just watched one or two of the videos, your feedback would be most welcome!

This is the last survey – I promise!

If you have not watched them yet, but would like to view them, click here for the basic anatomy tutorials and here for the clinical tutorials.

Thanks,

Peter

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