The adnexa of the uterus is the space in your body occupied by the uterus, ovaries, and fallopian tubes.

An adnexal mass is defined as a lump in the tissue located near the uterus or pelvic area (called the
adnexa of uterus).

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.

The uterus has three parts;

Fundus – top of the uterus, above the entry point of the uterine tubes.

Body – usual site for implantation of the blastocyst.

Cervix – lower part of uterus linking it with the vagina. This part is structurally and functionally different
to the rest of the uterus. See here for more information about the cervix.

OVARY
The ovaries are paired, oval organs attached to the posterior surface of the broad ligament of the
uterus by the mesovarium (a fold of peritoneum, continuous with the outer surface of the ovaries).

Neurovascular structures enter the hilum of the ovary via the mesovarium.

The main functions of the ovaries are:

• To produce oocytes (female gametes) in preparation for fertilisation.

• To produce the sex steroid hormones oestrogen and progesterone, in response to pituitary

gonadotrophins (LH and FSH).

The ovary has three main histological features:

1. Surface – formed by simple cuboidal epithelium (known as germinal epithelium). Underlying this
layer is a dense connective tissue capsule.

2. Cortex – comprised of a connective tissue stroma and numerous ovarian follicles. Each follicle
contains an oocyte, surrounded by a single layer of follicular cells.

3. Medulla – formed by loose connective tissue and a rich neurovascular network, which enters via
the hilum of the ovary.

Two peritoneal ligaments attach to the ovary;

• Suspensory ligament of ovary – fold of peritoneum extending from the mesovarium to

the pelvic wall. Contains neurovascular structures.

• Ligament of ovary – extends from the ovary to the fundus of the uterus. It then continues from
the uterus to the connective tissue of the labium majus, as the round ligament of uterus.

• The main arterial supply to the ovary is via the paired ovarian arteries. These arise directly from
the abdominal aorta (inferior the renal arteries). There is also a contribution from the uterine
arteries.

• Venous drainage is achieved by paired ovarian veins. The left ovarian vein drains into the left
renal vein, and the right ovarian vein drains directly into the inferior vena cava.

• The ovaries receive sympathetic and parasympathetic innervation from the ovarian and uterine
(pelvic) plexuses, respectively. The nerves reach the ovaries via the suspensory ligament of the
ovary, to enter the ovary at the hilum.
 FALLOPIAN TUBE

• The uterine tubes (or fallopian tubes, oviducts, salpinx) are muscular ‘J-shaped’ tubes, found in
the female reproductive tract.

• They lie in the upper border of the broad ligament, extending laterally from the uterus, opening
into the abdominal cavity, near the ovaries.

• This article will look at the function, parts, vasculature and innervation of the fallopian tubes, as
well as any clinical relevance.

• The main function of the uterine tubes is to assist in the transfer and transport of the ovum
from the ovary, to the uterus.

• The ultra-structure of the uterine tubes facilitates the movement of the female gamete:

• The inner mucosa is lined with ciliated columnar epithelial cells and peg cells (non-ciliated

secretory cells). They waft the ovum towards the uterus and supply it with nutrients.

• Smooth muscle layer contracts to assist with transportation of the ova and sperm. Muscle is
sensitive to sex steroids, and thus peristalsis is greatest when oestrogen levels are high.

• The fallopian tube is described as having four parts (lateral to medial);

• Fimbriae – finger-like, ciliated projections which capture the ovum from the surface of the
ovary.

• Infundibulum – funnel-shaped opening near the ovary to which fimbriae are attached.
 • Ampulla – widest section of the uterine tubes. Fertilization usually occurs here.

• Isthmus – narrow section of the uterine tubes connecting the ampulla to the uterine cavity.

• The arterial supply to the uterine tubes is via the uterine and ovarian arteries. Venous drainage
is via the uterine and ovarian veins. 

• Lymphatic drainage is via the iliac, sacral and aortic lymph nodes.

APENDIX

The appendix is a narrow blind-ended tube that is attached to the posteromedial end of the cecum
(large intestine).

It contains a large amount of lymphoid tissue but is not thought to have any vital functions in the
human body.

In this article, we shall look at the anatomy of the appendix – its anatomical structure and relations,
neurovascular supply and lymphatic drainage.

Anatomical Structure and Relations

The appendix originates from the posteromedial aspect of the cecum. It is supported by the
mesoappendix, a fold of mesentery which suspends the appendix from the terminal ileum.

The position of the free-end of the appendix is highly variable and can be categorised into seven main
locations depending on its relationship to the ileum, caecum or pelvis. The most common position is
retrocecal. They may also be remembered by their relationship to a clock face:

Pre-ileal – anterior to the terminal ileum – 1 or 2 o’clock.

Post-ileal – posterior to the terminal ileum – 1 or 2 o’clock.

Sub-ileal – parallel with the terminal ileum – 3 o’clock.

Pelvic – descending over the pelvic brim – 5 o’clock.

Subcecal – below the cecum – 6 o’clock.

Paracecal – alongside the lateral border of the cecum – 10 o’clock.

Retrocecal – behind the cecum – 11 o’clock.

Neurovascular Supply
The appendix is derived from the embryologic midgut. Therefore, the vascular supply is via
branches of the superior mesenteric vessels.

Arterial supply is from the appendicular artery (derived from the ileocolic artery, a branch of
the superior mesenteric artery) and venous drainage is via the corresponding appendicular
vein. Both are contained within the mesoappendix.

Sympathetic and parasympathetic branches of the autonomic nervous system innervate the
appendix. This is achieved by the ileocolic branch of the superior mesenteric plexus. It
accompanies the ileocolic artery to reach the appendix.
Note: Of clinical relevance, the sympathetic afferent fibres of the appendix arise from T10 of
the spinal cord – thus explaining why the visceral pain of early appendicitis is felt centrally
within the abdomen.
Lymphatic Drainage
Lymphatic fluid from the appendix drains into lymph nodes within the mesoappendix and into
the ileocolic lymph nodes (which surround the ileocolic artery).

By TeachMeSeries Ltd (2021)

 PATHOPHYSIOLOGY

Developing an ovarian cyst is heightened by:

Hormonal problems. These include taking the fertility drug clomiphene (Clomid), which is used to cause
you to ovulate.
Pregnancy. Sometimes, the cyst that forms when you ovulate stays on your ovary throughout your
pregnancy.

Endometriosis. This condition causes uterine endometrial cells to grow outside the uterus. Some of the
tissue can attach to the ovary and form a growth.
A severe pelvic infection. If the infection spreads to the ovaries, it can cause cysts.
A previous ovarian cyst. If the patient had one, she’s likely to develop more.

Some women develop less common types of cysts that a doctor finds during a pelvic exam. Cystic
ovarian masses that develop after menopause might be cancerous (malignant). That’s why it’s important
to have regular pelvic exams.

Infrequent complications associated with ovarian cysts include:

Ovarian torsion. Cysts that enlarge can cause the ovary to move, increasing the chance of painful
twisting of your ovary (ovarian torsion). Symptoms can include an abrupt onset of severe pelvic pain,
nausea and vomiting. Ovarian torsion can also decrease or stop blood flow to the ovaries.

Rupture. A cyst that ruptures can cause severe pain and internal bleeding. The larger the cyst, the
greater the risk of rupture. Vigorous activity that affects the pelvis, such as vaginal intercourse, also
increases the risk.