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Uncomplicated retroversion does not cause infertility gastritis diet tomatoes order florinef 0.1mg mastercard, and in the absence of incarceration it will not cause miscarriage gastritis diet 7 up buy cheap florinef 0.1 mg online. If pregnancy occurs atrophic gastritis symptoms diarrhea buy generic florinef 0.1 mg online, the uterus nearly always rises up into the abdomen in the normal way at about 12th week, and after delivery it resumes its retroverted position. Peritoneal Attachments of Uterus Broad ligament: this is a double fold of peritoneum, which covers the uterus and continues up to the lateral pelvic wall. The broad ligament, similar to the round ligament has no supporting function to the uterus. This part of the broad ligament is known as the mesosalpinx, whereas the part adjacent to the uterus is called the mesometrium. Besides the uterine tube, the broad ligament contains connective tissue (the parametrium), the uterine and ovarian vessels, the round and ovarian ligaments, and some embryonic remnants. The posterior layer of the broad ligament adjacent to the ovaries forms the mesovarium. Round ligament: this is a fibrous band attached to the uterus immediately below the entrance of the uterine tube. From here, it extends laterally and anteriorly, hooks around the inferior epigastric artery, travels in the inguinal canal, and eventually ends in the labium majus. The round ligament is usually accompanied in the foetus by a process of peritoneum, the processus vaginalis. Supporting Ligaments of the Uterus There are various ligaments, which support the uterus and are derived from the condensation of the parametrial tissues. On the other hand, ligaments formed as a result of peritoneal reflection and/or folding have minimal role in supporting the uterus. Transverse cervical ligament: the visceral pelvic fascia on the lateral aspect of the cervix is thickened in form of the lateral (or transverse) cervical (or cardinal) ligament. Peritoneal Relations of the Uterus the uterus (except for the cervix) is covered anteriorly and superiorly by the peritoneum. Anteriorly, the uterine body is separated from the urinary bladder by the vesicouterine pouch where the peritoneum is reflected from the uterus onto the posterior margin of the superior surface of the bladder. Posteriorly, the peritoneum is reflected from the posterior aspect of the body of the uterus, cervix and the vaginal fornix on to the anterior surface of the rectum (rectouterine pouch). The relations of the uterus can be summarised as follows: Anterior relation: the uterus is anteriorly related to the vesicouterine pouch and the superior surface of the bladder. The supravaginal part of the cervix is directly related to the Parts of the Uterus Uterine Corpus the uterine corpus forms the superior two-thirds of the uterus. Its muscular walls contract during labour to push the baby out through the cervix and the vagina. The uterine corpus includes the fundus of the uterus, the rounded part of the uterus, which lies superior to the uterine cornu. The remaining part of the body lies between the two layers of broad ligament and is freely movable. After menopause, the reverse is true and the cervix is twice as long as the uterine corpus. The uterine cavity is slit-like, which is approximately 6 cm in length and extends from the external os to the walls of the fundus.

The fibres of transversus abdominis gets inserted into the linea alba along with the aponeurosis of internal oblique lymphocytic gastritis symptoms treatment cheap florinef 0.1 mg with mastercard, and into the pubic crest and pecten pubis via the conjoint tendon symptoms of gastritis in babies order florinef paypal. Between the muscle fibres of internal oblique and transversus abdominis gastritis jaw pain order florinef 0.1 mg on-line, there is a neurovascular plane of the anterolateral abdominal wall, which contains the nerves and arteries supplying the anterolateral abdominal wall. Rectus Abdominis Muscle Rectus abdominis muscle belongs to the group of muscle, which runs vertically. These fibrous interruptions within the muscle help in firmly attaching it to the rectus sheath. These fibrous interruptions are usually confined to the region above the umbilicus, but sometimes can also be found below the umbilicus. When found below the umbilicus, the rectus sheath is attached firmly to the rectus muscle at the region of inscription. This may cause difficulty at the time of muscle separation during Pfannenstiel incision. Origin: this muscle takes its origin from the pubic symphysis and the pubic crest. Insertion: After taking their origin, the rectus muscle fibres run vertically to get inserted into the xiphoid process and the fifth, sixth, and seventh costal cartilages. The rectus muscle is surrounded by a sheath, comprising of the aponeuroses of the oblique muscles and the transversus abdominis. In most areas, the fibres of this muscle are perpendicular to the fibres of the external oblique, but in the lower abdomen, their fibres arch somewhat more caudally, and run in a direction similar to those of the external oblique. Transversus Abdominis Muscle the innermost of the flat muscles is the transversus abdominis and its fibres run more or less transversely. Insertion: Coursing transversely to the midline, the upper three-fourths of the transversus aponeurosis lies behind the rectus muscle. This muscle marks the midline and assists in the identification of the medial borders of the rectus muscle. Origin: A small, vestigial, triangular-shaped muscle, the pyramidalis, arises from the pubic symphysis. Insertion: It inserts on the anterior surface of the pubis and the anterior pubic ligament. It ends in the linea alba which is especially thickened for a variable distance superior to the pubic symphysis. The pointed insertion of the pyramidalis muscles into the linea alba can be used for locating the midline. Blood Supply to the Anterior Abdominal Wall the primary blood supply to the abdominal wall is from the superficial and deep blood vessels. The main blood vessels supplying the anterolateral abdominal wall are as follows: T Superior epigastric vessels and the branches of musculophrenic artery T Inferior epigastric and deep circumflex iliac arteries T Superficial circumflex iliac and superficial epigastric arteries T Posterior intercostal vessels of the 11th intercostal space and the anterior branches of the subcostal vessels. The superficial blood vessels originate from the femoral artery and include the superficial epigastric, the superficial circumflex, and the superficial external pudendal arteries. The deep vessels, on the other hand, originate from the external iliac and the internal thoracic artery.

Approach to the Diagnosis A thorough pelvic and rectal examination must be performed to rule out secondary causes such as ovarian cyst gastritis symptoms nausea cheap florinef 0.1mg with mastercard, uterine fibroids gastritis bad breath order 0.1 mg florinef otc, and ectopic pregnancy gastritis symptoms with back pain buy online florinef. A sonogram and pregnancy test should be performed if there is an adnexal mass, as well as a smear and culture for gonococcus and Chlamydia. Aortic aneurysms may precipitate bouts of meteorism by causing mesenteric vascular insufficiency. I-Inflammatory conditions cause meteorism, most notably peritonitis and pancreatitis. N-Neurologic conditions such as transverse myelitis, spinal cord trauma, and anterior spinal artery occlusion may cause meteorism. C-Congenital conditions that may cause this symptom are Hirschsprung disease and malrotation. A-Allergy would suggest food allergies such as sensitivity to chocolate, peanuts, and so forth. Autoimmune conditions such as granulomatous colitis and ulcerative colitis may produce meteorism. T-Trauma to the spinal cord has already been mentioned, but penetrating wounds, contusions, and intraperitoneal bleeding may cause meteorism. E-Endocrine disorders such as myxedema may cause gaseous distention of the bowel. A general surgeon or gastroenterologist may need to be consulted in the acute cases. The blood may be from the external or middle ear, and usually is caused by diseases of the skin or drum. Trauma is the most significant cause and is usually related to self-inflicted lacerations from digging at wax with hairpins or pencils, 581 for example, which may occasionally rupture the eardrum. External otitis and otitis media may cause a bloody discharge, but this is not common. Carcinomas of the skin of the external canal may cause a bloody discharge, and cholesteatomas will cause bleeding when they ulcerate through the tympanic membrane. Coagulation disorders rarely present with bleeding from the ear, in contrast to epistaxis and bleeding from the gums. V-Vascular would suggest the hemorrhagic disorders, especially hemophilia, thrombocytopenia, heparin and warfarin (Coumadin) therapy, and fibrinogenopenia, as in disseminated intravascular coagulopathy. In children, idiopathic thrombocytopenic purpura may present with bleeding gums and petechiae following an upper respiratory infection. I-Inflammatory includes acute gingivitis, dental abscesses, pyorrhea, actinomycosis, or syphilis. D-Degenerative disorders include aplastic anemia and deficiencies such as scurvy and vitamin K deficiencies. I-Intoxication recalls mercury, phosphorus, and diphenylhydantoin intoxication, in which the gums are usually severely hypertrophied as well. A-Autoimmune suggests thrombocytopenic purpura, Henoch purpura, and lupus erythematosus. E-Endocrine disorders are not likely to cause bleeding except secondarily, as in diabetes-induced pyorrhea or the alveolar bone degeneration or dysplasia (osteolytic) of hyperparathyroidism.

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