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Thread: Uterus (Embryolog-Anatomy-Histology)

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    Default Uterus (Embryolog-Anatomy-Histology)

    Embryological development
    * It arises from Mullerian duct.

    Description

    Site: in the pelvis between urinary bladder anteriorly & rectum posteriorly.
    Size:
    · Dimensions:
    In nullipara : 1 × 2 × 3 inches.
    In multipara : 1.5 × 2.5 × 3.5 inches.
    · Ratio between corpus & cervix:

    corpus cervix
    Infantile 1 2
    Adolescent 1 1
    Childbearing period 2 1


    Shape: pyriform.
    Weight :
    Nullipara : 50 gm.
    Multipara : 75 gm.
    Supports:
    1) Cervical ligaments.
    2) Ligaments of body.
    3) Anteversion of uterus.
    Parts:
    1)Uterine body (corpus):
    · Forms the main bulk of uterus.
    · Fundus: above the level of uterine tubes.
    · Cornu: * area of insertion of each fallopian tube.
    * attached to it:
    1. Fallopian tube: centrally.
    2. Round ligament: anteriorly.
    3. Ovarian ligament: posteriorly.
    2)Isthmus: (5 mm)
    · Situated between cervix & body.
    · Extends from the anatomical internal os above, to
    the histological internal os below.
    · Lined by modified endometrium (?).
    · Expands during pregnancy forming LUS during last trimester.
    · Hormonal effect?!!!!!
    3) Cervix: (2.5 cm)
    · Elongated lower most part of uterus.
    · Demarcated from the body by the isthmus.
    · 2 parts: *supravaginal part.
    *vaginal part (portiovaginalis).
    · Cervical canal is spindle-shaped.
    · Upper opening is internal os.
    · Lower opening is external os: *pin hole in nullipara.
    *slit in multipara.
    Position: with empty bladder anteverted anteflexed:
    · Anteverted: the cervix nearly at right angle with the vagina.
    · Anteflexed: the uterus is bent forwards on the cervix making an angle about 160.
    · This position is maintained by:
    A. Rapid growth of posterior uterine wall > anterior uterine wall.
    B.Weight of intestine & ↑intra-abdominal pressure pushing body downwards.
    C. Round ligaments pull the fundus forwards.
    D.Tone in uterosacral ligament pulls cervix backwards.
    [B]N.B.: in 15% of normal women, RVF is present.
    Peritoneal covering:
    ·Posteriorly: completely covered by peritoneum.
    ·Anteriorly: covered with peritoneum except anterior surface of cervix.
    ·On both sides: peritoneum forms the broad ligament.

    Uterus (Embryolog-Anatomy-Histology) attachment.php?attachmentid=3202&d=1499549588

    Relations:

    i. Of the body:
    · Anteriorly: UB and vesico-uterine pouch.
    · Posteriorly: Douglas pouch with loops of intestine.
    · Laterally: broad ligament & uterine vessels.
    ii. Of the supravaginal portion of cervix:
    · Anteriorly: Urinary bladder located in front.
    · Posteriorly: It is anterior wall of Douglas pouch.
    · Laterally: ½ inch lateral to internal os crossing of uterine artery above ureter.

    Structure (Histology):
    A) Histology of body(3 layers):
    1) Endometrium:
    · Endometrial tubular glands formed of single layer of columnar epithelium.
    · Under effect of steroids ,this layer is differentiated into:
    i. Superficial compact layer sheds with menses.
    ii. Middle spongy layer sheds with menses.
    iii. Basal compact layer: regenerates again.
    · Endometrial thickness varies according to phases of menstrual cycle from 1-8 mm.
    2) Myometrium: arranged into 3 layers:
    · Outer longitudinal layer.
    · Middle interlacing fibers: in criss-cross fashion forms figure 8 around blood
    vessels leading to controls bleeding during menses & 3rd
    stage of labour, so called living ligature.
    · Inner circular.
    3) Peritoneal coat:
    · Peritoneum covers the body of uterus:
    · Anteriorly: reflected on the UB to form utero-vesical pouch.
    · Posteriorly: reflected on the rectum to form Douglas pouch (Cul de sac).
    · Peritoneum covers supravaginal portion of cervix.
    · The serous coat is firmly adherent to subserous layer except laterally to
    form broad ligament.
    B) Histology of the cervix(3 layers):
    1) Endocervix:
    · Lined by simple columnar epithelium.
    · Thrown into folds, so called compound racemose glands.
    · Secretes alkaline cervical mucus.
    · Liable to chronic infection (WHY?!!!!!).
    2)Muscle layer: outer longitudinal & inner circular.
    3) Ectocervix: covered by stratified squamous epithelium.

    Blood supply
    A) Arterial :
    I. Uterine artery:
    Arises from the anterior division of internal iliac artery.
    It supplies most of the uterus.
    II. Ovarian artery:
    Branch from aorta at level of L2.
    It supplies the fundus uteri.
    B) Venous:
    Starts as pampiniform venous plexus between the 2 layers of broad ligament:
    - Uterine vein: drains into internal iliac vein.
    - Ovarian vein: *Right ovarian vein: drains into IVC directly.
    *Left ovarian vein: drains into left renal vein which drains into IVC.

    Nerve supply
    Via branches of inferior hypogastric plexus
    - Uterus is sensitive to distension (stretch).
    - Cervix is sensitive to dilatation (stretch).
    - Both are insensitive to touch, cutting & burning.

    Lymphatic drainage
    1. Fundus: Para-aortic lymph nodes via ovarian lymphatics.
    2. Cornu: superficial inguinal L.Ns within inguinal canal via lymphatics of round ligament.
    3. Body: internal iliac L.Ns then external iliac L.Ns via uterine blood vessels.
    4. Isthmus: has the same drainage as cervix.
    5. Cervix:
    A. Primary group:
    · Paracervical & parametrial L.Ns.
    · Obturator, internal iliac & external iliac L.Ns.
    B. Secondary group:
    · Lateral sacral L.Ns.
    · Common iliac L.Ns.
    · Para-aortic L.Ns.











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    Last edited by Dr.Galal Baligh; 07-08-2017 at 09:39 PM.

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