Uterus and Adnexal Diseases

19 Uterus and Adnexal Diseases



Anatomy of the Uterus, Adnexa, and Vagina



image

Uterus and Adnexa



Uterus



• Derived from fusion of paired embryonic paramesonephric (müllerian) ducts: basis for divided, asymmetrical, or bifid (didelphic) uteruses

• Endometrium: highly vascular and glandular uterine lining; thickness or state varies with menstrual cycle

• Myometrium: dense, fibrous connective tissue and smooth muscle, derived from embryonic splanchnic mesoderm

• Mesometrium: peritoneal covering of the uterus, continuous with peritoneum of broad, transverse (cardinal), uterosacral, and suspensory (infundibulopelvic) ligaments

• Fundus: dome superior to uterine tube orifices

• Body: superior 2/3

• Cervix: inferior 1/3; inferior aspect opens into vagina

• Isthmus: surface narrowing marking transition from body to cervix

• Uterine ostia: internal orifices of uterine tubes

• Uterine cavity: typically conical, apex down when not gravid

• Internal os: superior opening of cervical canal

• External os: inferior opening of cervical canal


Position of the Uterus and Pouches



• Typical, nongravid position: body anteflexed, lies against bladder

• Cervix between rectum and inferior bladder

• Nongravid uterus is thus anteverted relative to the vaginal canal and anteflexed on its own axis.

• Rectouterine pouch (of Douglas): posterior, pre-rectal peritoneal recess

• Vesicouterine pouch: anterior peritoneal recess between bladder and uterine fundus; also uterovesical


Uterine (Fallopian) Tubes (Ducts)



• Fimbriae: fringe around infundibular orifice

• Infundibulum: initial, funnel-like section proximal to fimbriae

• Ampulla: middle, wide portion proximal to infundibulum

• Isthmus: narrower portion approaching uterine wall

• Uterine portion: tube within uterine wall


Ovaries



• Normally almond-shaped and -sized

• Lie laterally and posterior to the broad ligament, attached near its upper borders via a peritoneal mesovarium

• Attached to body of uterus via ovarian ligaments running within broad ligament

• Contain follicles embedded in germinal epithelium and stroma
image Primary, secondary and mature (Graafian) ovarian follicles

image Corpus luteum (postovulatory follicle of current cycle)

image Corpus albicans (scar of degenerated corpus luteum)

• Granulosa cells surround an oocyte in its follicle.

• Theca interna and externa cells enclose the mass of granulosa cells and ovum.

• Interna layer differentiates into theca lutein cells of corpus luteum, which secrete estradiol.

• Vascularized stroma surrounds follicles.

• Thin surface epithelium (tunica albuginea) of fusiform cells in connective tissue

• Originally smooth surface epithelium becomes progressively scarred by ovulation.


Vagina



• Fibromuscular tube extending from cervix to vestibule between labia minora

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Aug 12, 2016 | Posted by in ANATOMY | Comments Off on Uterus and Adnexal Diseases

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