The Ovaries Anatomy: Situation, Shape, Length, Age Related Changes by NJE

0
154

The ovaries are paired female reproductive glands which are homologous with the testis of male.

Situation

In Nulliparous

Adult It is situated one on each side of the uterus below the pelvic brim in the ovarian fossa close to the lateral wall of lesser pelvis.

In Newborn

It is situated above the pelvic brim.

After Repeated Pregnancies.

 It may be prolapsed in the pouch of Douglas due to the relaxation of broad ligaments.

Boundaries of the Ovarian Fossa

Anteriorly

Obliterated umbilical artery.

Posteriorly

Ureter and the internal iliac artery.

Floor

Parietal peritoneum deep to it obturator vessels and nerve.

Shape

Almond-shaped (amygdaloid).

Measurements Length (vertical)

3 cm

Anteroposterior

1.5 cm.

Transverse

1 cm.

Axis of the Ovary 

In nulliparous women

It is in vertical so it has upper and lower poles.

In multiparous women

It is in horizontal axis so upper pole changes towards laterally and lower pole changes towards medially.

Characteristics 

1. It is an intraperitoneal organ.

 2. Its colour before puberty—Grayish pink aft er puberty—Gray.

 3. Its surfaces are smooth before puberty but aft er that become irregular due to repeated ovulations.

External Features

1. Poles/extremities 

2. Borders 

3. Surfaces.

Poles/extremities (in Nulliparous Women) 

1. Tubal (superior). 

2. Uterine (inferior).

Tubal (superior) pole

  1. It is broader than the inferior pole and directed upwards.

2. Uterine tube arches over it.

3. Attachments of the ovarian fimbria of uterine tube.

 4. Attachment of the suspensory ligament of the ovary.

Uterine (inferior) pole

 1. It is narrower than the superior pole and directed downwards towards the pelvic floor.

2. It is related to the pelvic floor.

3. It is connected to the lateral angle of the uterus, posteroinferior to the uterine tube by a rounded ligament called ovarian ligament.

 4. The ovarian ligament lies between the two layers of the broad ligament of the uterus.

5. The ovarian ligament contains some smooth muscle fibres.

Borders

1. Mesovarian (anterior).

2. Free (posterior). 

Mesovarian (anterior) border.

 1. It is straight border.

 2. Th is border attached with the posterior layer of broad ligament by a short peritoneal fold called Mesovarium.

 3. It is directed downwards towards the obliterated umbilical artery.

 4. Mesovarium conveys the ovarian vessels and nerves to reach the ovarian hilum.

Free (posterior) border 

1. It is convex border.

 2. This is directed towards the ureter.

Relations 

1. Uterine tube.

2. Ureter.

3. Internal iliac vessels.

Surfaces 

1. Medial surface 

2. Lateral surface.

i. Medial surface

Relations  

1. Uterine tube.

2. A peritoneal recess known as ovarian bursa between the mesosalpinx (upper part of the broad ligament) and the ovary.

ii. Lateral surface 

1. It is convex.

 2. Parietal peritoneum in the ovarian fossa.

 3. Deep to parietal peritoneum, extraperitoneal tissue, obturator vessels and nerve.

Peritoneal Relation of the Ovary

It is intra-peritoneal except along the mesovarian or anterior border where two layers of peritoneum are reflected on to the posterior layer of the broad ligament of the uterus.

Ligaments of the Ovary

Ovarian Ligament

1. This a rounded ligament lies in the broad ligament and contains some smooth muscle cells.

2. Attachments: From the uterine (inferior) pole of the ovary to the lateral angle of the uterus, posteroinferior to the fallopian tube.

Suspensory Ligament of the Ovary

1. This is a peritoneal ligament.

2. Attachments: From the tubal (superior) pole of the ovary and fallopian tube to the peritoneum on the psoas major posterior to the cecum on right side and descending colon on the left side.

3. Contains: Ovarian vessels and nerves.

Mesovarium

 1. It is a peritoneal fold.

 2. Attachments: From the anterior border of the ovary to the posterior layer of the broad ligament.

 3. Transmits: Ovarian vessels and nerves.

Arterial Supply

1. Ovarian artery branch of abdominal aorta, 

2. Some branches from the uterine artery.

Venous Drainage 

1. Veins form the pampiniform plexus which join to form ovarian vein.

2. Right ovarian vein drain in the inferior vena cava.

3. Left ovarian vein drain in the left renal vein.

Lymphatic Drainage

Lymphatics run along the ovarian vessels and drain into the lateral and preaortic group of lymph nodes. 


Nerve Supply

Sympathetic

T10 and T11 segments of the spinal cord.

Parasympathetic

Age Related Changes in the Ovary

The Pre-pubertal Ovary 

1. Measurements.

a. Length—13 mm 

b. Wide—6 mm 

c. Thick—4 mm. 

2. The cortex contribute about 35%.

3. The medulla contribute about 20%.

4. The interstitial cells up to 45%.

5. It gradually increases size with growth of the body and interstitial tissue decreases.

The Postmenopausal Ovary 

1. The ovulation ceases.

2. The stroma becomes denser, the tunica albuginea thickens and the surface epithelium becomes thin.

3. Many follicles persist in the cortex, some of them without oocytes, but others apparently normal.

4. Some abnormal follicles may become cystic as age advanced.

CLINICAL ANATOMY 

1. During excision of the ovary (ovariectomy) the ureter may injured when the ovarian vessels are tied off because these structures closely related each other where they cross the pelvic brim, where the ureter lies medial to the ovarian vessels.

2. Ovarian cyst

They are of two types: 

i. Follicular cyst: The follicular cysts are common which are originate from the unraptured graffian follicles, they rarely exceed 1.5 cm in diameter.

ii. Luteal cysts: They are formed in the corpus luteum where fluid is retained, they rarely exceed 3 cm in diameter.

3. Twisted ovarian cyst: It can be an emergency as ovarian pedicle obstructs the arterial supply and venous drainage of the cyst.

4. Prolapse of the ovaries: 

i. After repeated pregnancies the ovary may be prolapsed in the recto-uterine pouch (pouch of Douglas).

ii. In this case the ovary may be tender and cause discomfort on sexual intercourse (dyspareunia). 

iii. The ovary in the recto-uterine pouch may be palpated through the posterior fornix of the vagina.

5. Ectopic ovary: It is rare occasion where ovary may found in the inguinal canal or labium majus due to errors of descent.

6. Inflammation of the ovary may produce localized peritonitis of the ovarian fossa which causes irritation of the obturator nerve and results in persistent pain along the medial aspect of the thigh or at the knee joint.

7. Adrenal or thyroid tissue may be present in the ovary. Sometimes ovary contains cells that are capable of differentiating into various tissues like bone, cartilage, hair, etc. which may give rise to peculiar tumor called a teratoma.

LEAVE A REPLY

Please enter your comment!
Please enter your name here