OK so in this tutorial I would like to introduce you to some clinical aspects in relation to
the anatomy that I've discussed in the previous tutorials on the female reproductive anatomy.
So we'll start from the top and work our way down, so we'll being with the ovaries, and
look at some of the clinical aspects to consider in relation to the anatomy.
So there are three things I'm going to talk about in relation to the ovaries, so the first
is "ovarian cyst accidents".
So the ovaries can develop cysts within them, and an ovarian cyst is a fluid-filled sac.
And the problem with these cysts is that the cysts can rupture, or they can cause the ovary
to twist, which compromises its blood supply, and can lead to infarction and ultimately
necrosis and death of the ovary.
So remember that the ovaries are suspended in the peritoneal cavity by the mesovarium.
So I've just draw on an outline of a cyst on the ovary and you can get three things
that happen.
You can get haemorrhage into the cyst itself, you can get rupture of the cyst, so you'll
get rupture into the peritoneal space, or the cyst can become so big that it actually
causes the ovary to twist round on itself and you get a compromised supply of blood
to the ovary.
So another condition to do with ovaries is polycystic ovary syndrome, so in this condition,
the ovaries are stimulated to produce excessive male hormone, so predominantly testosterone.
And in this condition you get multiple enlarged follicles which are actually scattered underneath
the surface of the ovary, and they are themselves contained within an enlarged ovary.
So the syndrome isn't just related to the ovaries, it's an endocrine disorder.
And the criteria is obviously to have the polycystic ovaries themselves, which can be
detected on ultrasound, and you also get irregular periods, and as a result of the raised testosterone,
you get hirsutism, which is an excess of body hair, and you also get acne.
So in terms of ovarian malignancy, there are three main groups to think about.
So thinking about the histology of the ovary, you've got epithelial ovarian cells, which
is the outer layer of cells, and is called the germinal epithelium.
And then you've got the germ cells themselves, which are the cells which make the eggs in
the ovary.
And then you've got the connective tissue - the supportive tissue of the ovaries, so
you've got the granulosa and the thecal cells.
So ovarian cancer can arise from any of these three main groups of cells, but the most common,
the type of cancer which makes up 80-90% of all ovarian cancers, comes from the surface
epithelium, and this type of cancer is most common in older women, who are post-menopausal.
So there are several different types of epithelial cancers, but the most common is the serous
type.
Germ cell cancers are more common generally in younger women, and sex-cord stromal tumours
are quite rare.
So those are some clinical considerations in relation to the ovary.
So moving on to the fallopian tubes, remember how I said the ovum is released from the ovary,
and it's wafted into the end of the fallopian tube by the finger-like projections.
So what is happening is that the egg is actually released into the peritoneal space, and this
is important, because the fallopian tubes open directly into the peritoneal cavity and
this is the only direct communication with the intraperitoneal space.
So why is this important?
Well this is, this direct communication is a possible route for the spread of an ascending
infection, so sexually transmitted infections like gonorrhoea, or chlamydia can potentially
ascend and spread into the peritoneum.
So the fallopian tubes are also one of the most common sites for ectopic pregnancies
to occur.
So an ectopic pregnancy is where the blastocyst implants in a site other than the endometrium
of the uterine body.
So 95% of the time, the site will be in the fallopian tube, but the blastocyst can also
implant ectopically in the cornu of the uterus, in the cervix, even in the abdomen.
So the most common site within the fallopian tube itself for the ectopic pregnancies is
in the ampulla.
So remember you've got the infundibulum, the ampulla, the isthmus and the intrauterine
part.
So the fate of an ectopic pregnancy located in the fallopian tube is that it may abort
into the peritoneal cavity, or if it implants in the narrow isthmus section of the fallopian
tube, it's much more likely to lead to a rupture of the tube.
A ruptured ectopic pregnancy and internal haemorrhage is a life-threatening condition
and it needs to be treated immediately.
So hopefully that has given you an idea of some of the clinical conditions associated
with the ovaries and the fallopian tubes.
And next we'll take a look at the uterus and the associated clinical conditions.