hello all this is dr alsup and in this video we will be discussing specifically the internal
pelvic viscera associated with an individual assigned female at birth and you will see the
abbreviation AFAB which is going to be short for assigned female at birth so those physical
attributes in the form of viscera which have more traditionally been referred to as biologically
or genetically female viscera now i want to note that the terminology that you will hear throughout
the curriculum will vary and concepts of sex and gender merit much more than what we we're going
to discuss here our anatomy team understand that neither sex or gender may be divisible by narrowly
and we hope to use terminology that is the most inclusive and appropriate we are
always learning and always appreciative of respectful and constructive feedback
all right so let's get right into our mission which is to best understand the gross anatomy
but also the relationships of the internal pelvic viscera and the important fascial and peritoneal
ligaments in this region so this is going to be a little bit longer of a video so we have much to
cover let's get started and we're going to start with the uterine tubes very very often referred to
as the fallopian tubes note anatomical terminology has moved away from using eponyms particularly for
viscera associated with the reproductive system but it often persists in other disciplines
and we will always present those that are particularly persistent like the fallopian
tube so make sure you understand that uterine tubes and fallopian tubes are the same thing
the uterine tubes are a bit what they sound like they are a tube that is going to provide a pathway
from the ovary to the uterus for the oocytes so they'll be released from the ovaries and then
they will move into the uterine tubes note uterine tubes are actually intraperitoneal as is most of
the internal pelvic viscera in this region and that's something that's very often forgotten
is that peritoneum will extend this inferiorly regions like the bladder and the rectum will be
more subperitoneal but the uterine tubes the ovaries the uterus will be intraperitoneal
there are four major parts of the uterine tube starting laterally there is the infundibulum
which is going to be this general region right here the infundibulum is supposedly trumpet
shaped and this opens into the abdominopelvic cavity via what is called the abdominal osteum
and it's through this region that the OSI will enter the uterine tubes with guidance
from these mucosal finger shape folds which you can see kind of throughout this illustration here
and these are going to be attached to the distal end of the infundibulum i always kind
of think of these gently moving and directing the oocyte into the uterine tube the next portion is
going to be the longest and widest even though it doesn't look particularly so in this illustration
and that is going to be the um that's going to be the ampulla and if fertilization occurs it is
most likely to occur in the lumen of the ampulla this is going to be continuous with the isthmus
which is the narrowest part it appears kind of rounded and firm in this portion
and of course as its name would suggest the uterine part is going to be the portion that
actually lies in the myometrium of the uterus leading into the uterine cavity
if there is going to be some type of occlusion uh or closing of this region that's referred to as
tubal ligation sometimes you hear it referred to as tubes tied that prevents passage of the oocyte
all right very closely related to the infindibulum and the lateral pelvic walls are the ovaries
which are gonads that develop oocytes as well as have an endocrine function specifically
secreting estrogen and progesterone the ovaries are going to be composed of the cortex medulla
and interstitial cells the cortex contains the ovarian follicles at various stages of development
all right next let's discuss the uterus which is located medial to both the uterine tubes
and the ovaries and it's going to be this very prominent thick walled muscular organ
it's going to be located intermediate in position between the bladder and the rectum
there are two major parts the upper third is going to be referred to as the body of the uterus and
note this part of the body that's actually superior to where those uterine tubes enter
so this region right here is actually referred to as the fundus of the uterus the lower third of the
uterus is referred to as the cervix and it's going to be narrower it's going to be less muscular and
more fibrous in terms of composition the upper end of the cervix communicates with the uterine body
via the internal os and the lower end of the cervix opens into the vagina at the external us
the superior border of the uterus is covered with peritoneum and peritoneal folds actually
extend laterally from the uterus and surrounding structures as the broad ligament and so the broad
ligament is a very prominent structure in this region we'll talk more about that in a moment
the surgical removal of the uterus is referred to as a hysterectomy
the vagina is a fibromuscular tube that extends from the cervix
all the way to the vestibule of the vagina at the vaginal orifice sometimes you see it referred to
as the osteum of the vagina the superior portion of the vagina is going to surround
the protrusion of the cervix into the vagina so you can see that a bit right here
and this creates a recess between the cervix and the vagina referred to as the fornix and the
different parts are given the different parts of the fornix are given different or separate names
such as anterior right and left lateral and posterior vaginal fornices of particular clinical
importance is going to be the posterior vaginal fornix which you can see right in this region here
this will be the posterior vaginal fornix this is going to offer access to the recto uterine pouch so that's going to be that lowest extent or the most inferior extent
of the peritoneum in the pelvis so allowing access to the peritoneal cavity if necessary
excellent so those are the viscera that we needed to cover but it's also
important to review the peritoneal and fascial specializations in this region as they play
such an important role particularly in stabilization that is will also play a
role in terms of a route for neurovasculature to travel and the most prominent by far is going to
be the broad ligament and this illustration i think could even extend higher up into here
excuse me so this is going to extend laterally from the uterus to the lateral pelvic walls and
in essence dividing the true pelvis into anterior and posterior portions
and i really love this BlueLink image it's one of my favorite ones as it truly shows the expanse
of the broad ligament on this one side so you can see here this is going to be the uterus right here
so it's expanding all the way to the lateral wall there are three major parts of the broad ligament
that are continuous and these are named based on the visceral structure that is most closely
related to the most superior is going to be the mesosalpinx style pinks is an ancient
trumpet-like instrument and is describing the supposed trumpet shape of the uterine
tube particularly in the infundibulum part so the mesosalpinx is most closely associated with the
uterine tube and is so the most superior portion so it's any of this peritoneum that's covering
the uterine tubes here you can even see some of that fimbriae on the ends there the mesovarium
is the smallest portion of the broad ligament it is going to be the most posteriorly placed as well
that anterior border of the ovary is covered by the mesovarium so it's in this general region here
and then all of the rest of this so the largest the most inferior portion is going to be the
mesometrium portion of the broad ligament so it's going to be the part that's extending laterally
from the uterine body and the uterine arteries will actually pass between its two peritoneal
layers another peritoneal ligament is the suspensory ligament of o of the ovary which is
a very long name and it's also known by another long name the infundibulopelvic or IP ligament
so the suspensory ligament is going to extend from the general region of the
abdominal aorta and the inferior vena cava to the pole of the ovaries and the reason it has
such a long extent is because it's conducting the gonadal arteries and
veins specifically the ovarian and it will extend over the external iliac vessels and the ureter
so it's traveling all the way from kind of the abdominal region down towards the
ovaries and will actually be continuous with the mesovarium which you can kind of see right there
the ovarian ligament or ligament of the ovary attaches the lateral portion of the uterus
so this general region here to the inferior medial portion of the ovary the ovary is going
to be right in this general region so located posterior but inferior to the uterine tube
all right uh you can see that it lies in the broad ligament so it's very closely associated
with the broad ligament and it's going to be continuous with the round ligament of the uterus
both of which are remnants of the gubernaculum which were present during the descent of the gonad
now we've discussed the round ligament of the uterus in a previous session when we were
discussing the inguinal canal it is typically described as extending from the lateral uterus
through the deep inguinal ring which you can see a bit of that right here
and traverses the inguinal canal and ending in the labium majus although there are some studies
that show a high prevalence of the structure ending just distal to the superficial ring
nearer to the uterus which is the portion that we can see right here
in this image contains a notable amount of smooth muscle but this gradually diminishes
more distally and will appear more fibrous or like a collection of adipose tissue the more
distal that you get so the part that's associated with the inguinal canal heading to the labia majus
the transverse cervical or cardinal ligament is a condensation of endopelvic connective tissue
so it is not peritoneum and this will extend from the cervix so that's the key here it's
extending from the cervix to the lateral pelvic wall so it'll be inferior to the broad ligament
so not in this image here just kind of getting an idea of where it would be located
so and also of note not made of peritoneum so the transverse cervical ligament will radiate with
some other ligaments around the cervix providing support the uterine artery is transmitted or
travels adjacent to the base or the bottom of the broad ligament and it is right at that boundary
um between where the broad ligament ends and the transverse cervical ligament begins
that the ureter travels in close proximity to the uterine artery so you may hear
water under the bridge the ureter is as we know is going to transmit urine so that's the water
and it will travel under the bridge which is the uterine artery right at this level
excellent we have come to the summary slide so thank you for your time and attention here please
make sure to review and reach out if you have any questions i hope you have a great rest of your day