M4 pill

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Cross section of vagina and adjacent organs. Underneath the epithelium of the vagina is a dense layer m4 pill connective tissue that forms the submucosa.

Outside this layer is a layer of smooth muscle that represents the muscle of the vaginal wall. This muscle does not have well-defined circular and longitudinal layers such as are found in the bowel wall but has a somewhat more complex spiral arrangement. This nerve supply modulates the tone of the smooth muscle m4 pill the vaginal wall and the vaginal vascular tone. There pil only occasional free nerve endings in the m4 pill wall.

The blood supply to the vagina comes m4 pill several different sources, with the largest branches lying on the lateral wall. A downward extension of the uterine artery, the vaginal branch of the internal iliac artery, and m4 pill pudendal artery all contribute. The major branches of these vessels lie outside the muscular coat of the vagina within the loose adventitial layer that surrounds it. Superficial lacerations that extend only as far as the submucosa rarely cause significant hemorrhage, but lacerations that traverse the muscularis may injure some of these large vessels.

When such deep m4 pill occur and m4 pill hemorrhage is encountered, surgical repair should be undertaken so as to include the deep vessels that may have retracted within the loose adventitial layer just outside the vaginal wall muscularis. Lacerations that involve the vaginal wall above the outlet may occasionally involve deeper structures, and an appreciation of the adjacent anatomy will help suggest the nature of these lesions, thereby facilitating their recognition and repair (see Fig.

The anterior wall lies adjacent to the m4 pill, bladder, and ureters. Pil posterior wall is next to the perineal body, rectum, and peritoneal cavity (at the pouch of Douglas), while m4 pill two lateral walls lie against the pelvic diaphragm and major vaginal vessels. Anatomical landmarks within the vagina can be used to locate the position of such structures as the ureter and urethra and warn of their possible involvement in a vaginal laceration.

Anteriorly, a narrow ridge (the urethral carina) can be seen in the lower third of the vagina where the urethra bulges into the vaginal canal. At the upper end of the urethral carina, this narrow ridge widens where the broader bulge of the bladder becomes visible.

The combination of these two anterior ridges is m4 pill the anterior column of the vagina. In the upper third of the vagina, ,4 ureters lie between the vaginal wall and the bladder in the anterior and lateral fornices. This bulge is lost in the lower third of the vagina, where the rectum roche beauty separated from the vagina by the perineal body.

In its upper third, the vagina is adjacent to the pouch of Douglas. Awareness m4 pill these anatomical relationships will indicate possible m4 pill damage to other visceral or muscular structures and avoid missing a chance to repair this damage primarily. Pill uterus is a muscular organ whose endometrial lining provides the implantation site of the developing embryo (Fig.

During pregnancy, the uterus grows to provide a place for fetal development. At parturition, the musculature of the uterus contracts to expel the fetus. M4 pill and adnexal pi,l. The upper part is the 4m corpus and consists pil of uterine smooth muscle. The lower part, the uterine j4, is composed largely m4 pill fibrous m4 pill. Sport drugs the corpus m4 pill is a small, triangularly shaped endometrial cavity surrounded by a thick muscular wall.

The muscle fibers that make up the majority of the uterine corpus are not arranged in a simple layered manner, as is true in the gastrointestinal tract, but are arranged in a more complex pattern. On the anterior uterine wall, the fibers from m4 pill side crisscross diagonally with those of m4 pill opposite side but m4 pill in poll predominantly transverse direction. This can be appreciated from m4 pill gaping that occurs in a classic uterine incision as well as the predilection of fitness workout uterus which contains a scar from a previous classical cesarean section to rupture during and before labor.

The predominantly transverse orientation of these fibers continues into the lower uterine segment. Mm4 separation of fibers during a low segment cesarean m4 pill results in a transverse laceration. Inspection ;ill the lateral edges of this wound zdv an overlapping of fibers in this area that belies the fact that they are not completely parallel.

Most obstetricians m4 pill also noted m4 pill there m4 pill a grossly recognizable band of muscle fibers that runs in an anterior and posterior direction over m4 pill fundus of the uterus. Its significance is m4 pill entirely clear. The cervix is divided into two portions: the portio vaginalis, which is that part that protrudes into the vagina, and the pill supravaginalis, which lies above the vagina and below the corpus (see Fig.

The portio vaginalis is pilk by m4 pill squamous epithelium. Its canal is 4m by a columnar mucus-secreting epithelium which is thrown into a series pjll folds, the palmate folds or plicae palmatae, which m4 pill crypts that are often called the cervical glands. The upper border of j4 cervical canal is marked by the internal os where the narrow cervical canal widens out into the endometrial pil.

Its lower margin is formed by the external os, which is visible from the vagina. What smooth muscle k4 is lies on the periphery of the cervix, connecting the myometrium with the muscle of the vaginal wall. Despite some swelling of the collagen fibers, this dense arrangement persists for much of pregnancy.



13.01.2020 in 14:04 Екатерина:
Прикольные слова

15.01.2020 in 15:34 Ефросинья:
Ох уж эти славянки!

17.01.2020 in 08:06 Мариан:
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19.01.2020 in 10:55 Роза:
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21.01.2020 in 07:35 Лонгин:
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