BASIC AND APPLIED ANATOMY Dr ankita
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