BASIC AND APPLIED ANATOMY

Dr ankita

Pelvis

Retroperitoneal space

Ureter

Blood vessels

Lymphatics

Pelvic organs

Uterus

Adnexa

Uterus

Pyriform muscular organ between bladder and rectum.

Normal uterine size: 7×5 cm at fundus

Gravid uterus: Hen’s egg 6 wks Cricket ball 8 wks Fetal head 12 wks

Uterus

Corpuso Funduso Body

Isthmus

Cervix.

Position and Angulation

• Angle of anteversion- 90˚• Angle of anteflexion- 125˚

Congenital malformations

Cervix Phase Body: cervix ratioAt birth Cervix very longPrepuberty 1:2Nulliparous 2:1Parous 3:1Menopausal 1:1

Ectocervix: squamousEndocervix:columnarOriginal squamocolumnar junctionNew squamocolumnar junctionTransformation Zone

Changes with phases of life!MOST COMMON SITE FOR ORIGIN OF CARCINOMA!!

PAP SMEAR

Adnexa

Ovary

Fallopian tube

Ovary

2.5-5 cm ×1.5 to 3 cm ×0.7 to 1.5 cm (reproductive life)

Normal volume: < 10 ccUpper limit in premenopausal women: 20 mlUpper limit in postmenopausal women: 10 ml

• Cortex

• Medulla

Variety of ovarian tumors

• 7 to 12 cm• Tubal ligation

Fallopian tubeAmpulla-70 % ectopic

pregnanciesExpandable

Isthmus-Easily

ruptured

Broad ligament

• ROUND LIGAMENT

• FALLOPIAN TUBE

• OVARIAN LIGAMENT

• Infundibulopelvic ligament

• Ovarian vessels• Ureter

Ovarian fossa

• Superiorly: external iliac artery and vein

• anteriorly : broad ligament of the uterus

• posteriorly: ureter, internal iliac artery and vein

• inferiorly: obturator nerve, artery and vein

True broad ligament fibroid

Pseudo broad ligament fibroid

Arises de novo in the broad ligament

Arises from uterus,Grows in between two leaves of broad ligament

Ureter can lie anywhere Ureter is lateral & belowLacks pseudocapsule Pseudocapsule present

High risk of ureteric injury!!

Supports of UterusUpperRound ligamentBroad ligament

MiddleTransverse ligamentPubocervical Uterosacral

LowerUrogenital diaphragmLevator ani, Perineal body

Vagina

Anterior cul-de-sac

• Vesicouterine pouch

• Caesarean section & abdominal hysterectomy

• Vaginal hysterectomy

• Culdocentesis• colpotomy

Posterior Cul-de-sac/ rectouterine pouch

Retroperitoneal structures of the lower abdomen

Ureters25 to 30 cm

Abdominal ureter: 12 – 15 cms

Pelvic brim

Pelvic ureter: 12 - 15 cm

Ureter dorsal to the infundibulopelvic ligament near or at the pelvic brim

Identification of the ureter is imperative prior to performing an oophorectomy

At the pelvic brim, ureter crosses from lateral to medial, as well as anterior to the bifurcation of

the common iliac arteries.

Ureter passes under uterine arteries (“water under the bridge”)

Skeletonization of uterine arteries

Ureter enters into paracervical tissues- Tunnel of wertheim

Common sites of ureteral injuries

Blood supply of ureter

Blood vessels

Internal iliac artery

Vaginal(inferior vesical)

Anterior division

Parietal branches•Obturator•Internal pudendal•Inferior gluteal

Visceral branches•Uterine•Superior vesical•Vaginal (inferior vesical)•Middle rectal

Internal iliac artery:Posterior division• Iliolumbar• Lateral sacral• Superior gluteal

Blood supply of genital tract

Blood supply of uterus

Important to know during ligation of blood vessels……The rich collaterals!!

Course of uterine artery

Uterine artery ligation

Ovarian artery ligation

Internal iliac artery ligation

Lymphatics

Follow the pelvic vessels

3 main group of lymph nodes:• Paraaortic• Pelvic• Inguinal

PparParaaortic lymph nodes

Pelvic lymph nodes

• Common iliac• External iliac • Internal iliac• Obturator• Medial sacral • Pararectal

Lymphatic drainage of the cervix

• Internal iliac• External iliac• Obturator• Sacral

Lymphatic drainage of uterus & vagina UterusFundus : ParaaorticCornu :superficial inguinalBody :external iliacAdjacent to cervix : cervical lymphatics

VaginaUpper2/3rd:cervical lymphaticsLower 1/3rd:superficial inguinal

Lymphatic drainage of fallopian tube & ovary

• Ovarian vessels- paraaortic LNs

• Broad ligament-pelvic LNs

• Round ligament-inguinal LNs

Lumbar LN

common iliac LN

External iliac LN Internal iliac LN

Deep inguinal LN Obturator LN Sacral LN

Superficial inguinal LN