Professional Documents
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District I ACOG
Medical Student Education Module 2011
Gynecologic Viscera
Uterus: thick, muscular organ
Derived from the fusion of the paramesonephric
(mullerian) ducts.
These ducts also form the upper 2/3 of the vagina
and the fallopian tubes.
Cardinal Ligament:
Found at the base of the broad ligament.
Provides the main support for the uterus and
cervix.
It attaches to the cervix and extends laterally,
connecting to the endopelvic fascia.
Ligamentous Support
Uterosacral Ligaments:
Ovarian veins:
Left ovarian vein drains into the left renal vein
Right ovarian vein drains directly into the
inferior vena cava.
Lymph Drainage
Cervical Cancer:
Drains 1st to the parametrial nodes -->
obturator nodes --> pelvic nodes --> para-aortic
Uterine Cancer:
Drains 1st to the pelvic nodes or para-aortic.
Ovarian Cancer:
Can metastasize to either the pelvic or para-
aortic nodes.
Pelvic Support
Pelvic diaphragm is retroperitoneal
and supports all the viscera.
Composed of the:
Levator ani group: puborectalis,
pubococcygeus, and ileococcygeus.
Coccygeous muscles
Question #1
In a CT scan of the pelvis, the uterus
is located:
A) Posterior to the bladder and rectum
B) Posterior to the bladder and anterior
to rectum
C) Anterior to the bladder and rectum
D) Anterior to the bladder and posterior
to the rectum
Answer
B) Posterior to the bladder and
anterior to the rectum.
Question #2
A 27 year-old woman is examined by her
gynecologist. Upon rectal examination, a
firm structure, directly in front of the
rectum, in the midline, is palpated through
the anterior wall of the rectum. The
structure is:
A) Bladder
B) Body of uterus
C) Cervix of uterus
D) Pubic symphysis
E) Vagina
Answer
C) Cervix of uterus
The cervix of the uterus is anterior to the
rectum
Since the cervix is the inferior part of the uterus
that is protruding into the vagina, it should feel
like a firm structure upon palpation
Although the vagina is directly anterior to the
rectum, it would not feel like a distinct and firm
structure upon palpation.