Asstr Uterus
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Здесь вы найдете исчерпывающую информация о работе органов женской репродуктивной системы, а также о профилактике, диагностике и лечении заболеваний половых органов.
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Будет создан фармакологический раздел, где вы найдете описания фармакологических препаратов, используемых в гинекологии. Показания, противопоказания, безопасность при беременности и кормлении грудью. Сравнение их эффективности и приблизительная стоимость в аптеках.
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Original Author(s): Louisa Thompson
Last updated: May 12, 2019
Revisions: 52
Original Author(s): Louisa Thompson
Last updated: May 12, 2019
Revisions: 52
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The uterus is a secondary sex organ. Secondary sex organs are components of the reproductive tract that mature during puberty under the influence of sex hormones produced from primary sex organs (the ovaries in females and the testes in males).
They are responsible for the maintenance and transportation of gametes.
In this article, we shall look at the composition and clinical significance of the uterus. Its vasculature, lymphatic supply and innervation will be covered.
Fig 1 – Overview of the female reproductive tract.
The uterus is a thick-walled muscular organ capable of expansion to accommodate a growing fetus. It is connected distally to the vagina, and laterally to the uterine tubes.
Fig 2 – The three anatomical divisions of the uterus.
The exact anatomical location of the uterus varies with the degree of distension of the bladder. In the normal adult uterus, it can be described as anteverted with respect to the vagina, and anteflexed with respect to the cervix:
Thus, the uterus normally lies immediately posterosuperior to the bladder, and anterior to the rectum.
Fig 3 – Sagittal section of the female pelvis, showing the anatomical relations of the vagina.
In some individuals, the uterus may not lie in an anteflexed and anteverted position. The three most common dispositions are:
These abnormal arrangements do not inherently cause any medical problems. However, the retroverted uterus is positioned directly above the vagina. Thus in instances of increased abdominal pressure, the uterus is more likely to prolapse into the vagina.
Uterine prolapse is particularly prevalent in those with a history of pelvic floor damage.
Fig 4 – The normal, anteverted, retroverted and retroflexed positions of the uterus.
The fundus and body of the uterus are composed of three tissue layers;
The tone of the pelvic floor provides the primary support for the uterus. Some ligaments provide further support, securing the uterus in place.
Fig 5 – Overview of the uterus and fallopian tubes, and associated ligaments
The blood supply to the uterus is via the uterine artery. Venous drainage is via a plexus in the broad ligament that drains into the uterine veins.
Lymphatic drainage of the uterus is via the iliac, sacral, aortic and inguinal lymph nodes.
Fig 6 – Posterior view of the arterial supply to the female reproductive tract.
A hysterectomy is the surgical removal of the uterus, usually as a result of cervical or uterine cancer.
When performing a hysterectomy, a good knowledge of regional anatomy is needed to prevent accidentally damaging other structures in the pelvic region.
The uterine artery crosses the ureters approximately 1 cm laterally to the internal os. Care must be taken not to damage the ureters during clamping of the uterine arteries during a hysterectomy. The relationship between the two can be remembered using the phrase ‘water under the bridge’. Water refers to the ureter (urine), and the uterine artery is the bridge.
Sympathetic nerve fibres of the uterus arise from the uterovaginal plexus. This largely comprises the anterior and intermediate parts of the inferior hypogastric plexus.
Parasympathetic fibres of the uterus are derived from the pelvic splanchnic nerves (S2-S4).
The cervix is largely innervated by the inferior nerve fibres of the uterovaginal plexus.
The afferent fibres mostly ascend through the inferior hypogastric plexus to enter the spinal cord via T10-T12 and L1 nerve fibres.
Endometriosis is the presence of ectopic endometrial tissue at sites outside the uterus, most commonly the ovaries and the ligaments of the uterus. Ectopic tissue is still responsive to oestrogenic stimuli therefore cyclic proliferation and bleeding occur, often forming a cyst. The condition is associated with dysmenorrhoea and/or infertility.
Fibroids are benign tumours of the myometrium which affect 20% of menopausal women. They are oestrogen dependent, enlarging during pregnancy and with use of the contraceptive pill but regressing after the menopause. Most fibroids are asymptomatic, but if large enough the uterine mass can cause symptoms including menorrhagia, pelvic pain and infertility.
Endometrial carcinoma is the most common malignancy of the female genital tract, most often found during, or after, the menopause, and characterised by abnormal uterine bleeding.
Which of the following describes anteversion of the uterus?
Try again to score 100%. Use the information in this article to help you with the answers.
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Asstr Uterus
