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Reproduction > 11.1 Imaging Of The Reproductive Tract > Flashcards

11.1 Imaging Of The Reproductive Tract Flashcards

1
Q

How is the prostate often imaged?

A

Trans rectal ultrasound

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2
Q

Why is CT not commonly used to image the reproductive system?

A

Poor tissue differentiation, cant see lobes of prostate

Ovaries and testis are very sensitive to radiation - constantly doing CTs can cause malignancy in these tissues

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3
Q

What imaging method is most commonly used in the female reproductive system?

A

Ultrasound

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4
Q

How do we do ultrasound of the female pelvis?

A

Trans abdominal approach

Trans vaginal approach

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5
Q

Before a trans abdominal ultrasound to view the uterus is done, what should the patient do?

A

Not go to the toilet. Good to have a full bladder as it gives a better window to view the uterus through

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6
Q

What imaging is used in assessment of female sub fertility?

A

Hysterosalpingogram - HSG

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7
Q

What is the purpose of a histrosalpingogram?

A

A assess reproductive system tubal patency

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8
Q

How is a HSG done?

A

2 ways

  1. Putting contrast into the uterus, which will pass out into the Fallopian tubes and peritoneal cavity.
  2. Ultrasound contrast
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9
Q

If contrast does not travel through the Fallopian tubes in a HSG, what does this indicate?

A

Indicates the Fallopian tubes arent patent, have scarring (previous STI/PID)

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10
Q

What imaging method is used to view the male pelvis?

A

MRI

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11
Q

What is being examined in a male mri of pelvis?

A

Prostate

Penile cancer

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12
Q

How are testicles imaged?

A

Ultrasound

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13
Q

How are biopsies of the prostate taken?

A

Trans rectal ultrasound biopsy

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14
Q

What are the different types of cysts found on the ovaries?

A 
Simple cysts
Haemorrhaging cysts
Endometrioma 
Mature cystic teratoma 
Malignant cysts
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15
Q

What are grafiaan follicles?

A

a fluid-filled structure in the mammalian ovary within which an ovum develops prior to ovulation. 10 develop at the start of each menstrual cycle, only 1 matures to become the dominant follicle

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16
Q

After releasing the oocyte, what happens to the dominant follicle?

A

dominant follicle collapses, and the granulosa cells in the inner lining proliferate and swell to form the corpus luteum of menstruation

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17
Q

What is the corpus albincans?

A

Regressed form of the corpus luteum. As the corpus luteum is being broken down by macrophages, fibroblasts lay down type I collagen, forming the corpus albicans

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18
Q

What is a follicular cyst?

A

A dominant Graafian follicle sometimes fails to ovulate and does not involute. When it becomes larger than 3 cm, it is called a follicular cyst. Follicular cysts are usually 3-8 cm, but may become much larger. Follicular cysts will usually resolve spontaneously on follow-up.

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19
Q

How does a follicular cyst look on an ultrasound?

A

On ultrasound follicular cysts present as simple unilocular, anechoic cysts with a thin, smooth wall

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20
Q

What is a corpus luteum cyst?

A

A corpus luteum may seal and fill with fluid or blood, forming a corpus luteum cyst. The characteristic circular Doppler appearance is called the ‘ring of
fire’.

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21
Q

Who is most at risk of developing a corpus luteul cyst?

A

Women using fertility drugs that induce ovulation, have increased chance of developing corpus luteum cysts

22
Q

Who should not be able to develop a corpus literal cyst?

A

Women on birth control pills - as prevent ovulation so usually wont be able to form a corpus luteum. If a women on birth control has a blood filled cyst in the ovary, should consider other pathology

23
Q

What is meant by the ring of fire circular Doppler appearance of a corpus luteum?

A

A highly vascular ring of Doppler flow surrounding a slightly complex cystic abnormality?

24
Q

What is a Doppler ultrasound?

A

A test that uses high-frequency sound waves to measure the amount of blood flow through arteries and veins

25
Q

What are haemorrhaging cysts?

A

When bleeding occurs into follicular cysts or corpus literal cysts. Appear on ultrasound as cyst with lots of echo debris within it. Should resolve

26
Q

What is hyperandrogenic anovulation?

A

Chronic anovulation syndrome associated with androgen excess. Causes ovulation dysfunction, clinical and/or biochemical hyperandrogenism, and PCOS

27
Q

How does PCOS present on ultrasound?

A

Enlarged follicular cysts, that appear pale and surround peripheral of ovary. At least 20

28
Q

What are mature cystic ovarian tumours?

A

Encapsulated tumours with mature tissue or organ components. They are composed of well differentiated derivations from at least two of the three germ cell layers (i.e. ectoderm, mesoderm, and
endoderm). Contain developmentally mature skin complete with hair follicles and sweat glands. Sometimes luxuriant clumps of long hair, and often pockets of sebum, blood, fat (93%), bone, nails, teeth, eyes, cartilage, and thyroid tissue

29
Q

What causes ovarian hyperstimulation?

A

Caused by hormonal overstimulation by hCG (usually due to hormonal therapy for fertility treatment) and is therefore usually bilateral. Hormonal overstimulation can occur in gestational throphoblastic disease, PCOS or in patients receiving hormonal therapy.

30
Q

How does ovarian hyperstimulation present on ultrasound?

A

Enlarged ovaries contained large simple cysts

31
Q

What is PID?

A

Pelvic inflammatory disease is defined as an acute clinical syndrome associated with ascending spread of micro-organisms, unrelated to pregnancy or surgery.

32
Q

How do we assess a malignant ovarian lesion?

A

ultrasound and MRI
Plus Ca125 marker
- used to assess risk of malignancy and then decide best treatment

33
Q

What is ca125?

A

Cancer antigen 125. A protein that can be tested for in blood. Tested for in suspected ovarian cancer

34
Q

Once a lesion in the ovary has been confirmed as cancerous, how is it staged?

A

Contrast enhanced CT

Also used to look for metastasis elsewhere

35
Q

What is a krukenberg tumour?

A

A tumour of the ovary that has metastasised from a primary site, classically the GI tract

36
Q

How are ovarian cysts categorised for likelihood of malignant changes?

A

Low risk = premenopausal and no other riskfactors

High risk = post menopausal or other risk factors such as:

  • personal or family history of breast or ovarian cancer
  • BRCA-1 or 2 carriers
  • Lynch-II HNPCC
  • Ashkenazi descent
37
Q

What is endometriosis?

A

Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. It is mainly found in the abdominal cavity, most commonly on the surface of the ovaries. It is an estrogen-dependent disease, occurs in women of reproductive age.

38
Q

What are the symptoms of endometriosis?

A

The most common symptoms are dysmenorrhea, dyspareunia, pelvic pain, and infertility - although it may also be asymptomatic

39
Q

How is endometriosis seen on an ultrasound?

A

Complex cysts with nodules

Hemorrhage into ovaries

40
Q

What is superficial endometriosis?

A

Superficial peritoneal endometriosis is when endometrial tissue attaches to the peritoneum. This is the least severe form. Difficult to identify

41
Q

What is deep infiltration endometriosis?

A

Endometriosis that implants or/and extends into other pelvic organs (ligaments/bladder, even up to diaphragm)

42
Q

What is frozen pelvis?

A

An uncommon complication of deeply infiltrating endometriosis. Sometimes a lot of scar tissue can bond organs so they become stuck in place.

43
Q

How do we assess deeply infiltrating endometriosis?

A

Bimanual trans vagina ultrasound - checking for adhesions, seeing the mobility of the uterus

44
Q

Where is deeply infiltrative endometriosis commonly seen?

A

Back of uterus (torus uterinus)
Rectum
Bladder
Caesarean section scars

45
Q

What is a characteristic sign of a patient with endometriosis in the bladder?

A

Haematuria every month during menstration

46
Q

What is the kissing ovary sign?

A

Ovaries pulled over the uterus by strong pelvic adhesions

47
Q

Why is a pelvic floor mesh used?

A

To treat female pelvic floor dysfunction / stress urinary incontinence

48
Q

Why are pelvic floor meshes controversial?

A

As can leave females in agonising pain. Bad side effects

49
Q

Why are scans done in testicles?

A

Pain in testicle (not acute as indicates torsion)
Inflammation
Testicular lumps

50
Q

Nice no longer recommended biopsies for first line prostate cancer investigation, what is now recommended?

A

MRI - assess with PI-RADS scoring system

51
Q

What is PSA density?

A

A comparison of PSA value and prostate volume
PSA density = PSA volume / prostate volume
Better indicator of cancer than PSA value alone

Reproduction (11 decks)

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