2. Acquired Flashcards
Salpingitis Isthmica Nodosa (SIN)
This is a nodular scarring o f the fallopian tubes
involves the proximal 2/3 of the tube
Salpingitis Istiimica Nodosa (SIN) is strongly associated with =
infertility and ectopic pregnancy
Uterine AVM
Congenital or acquired (more common)
“serpiginous and/or tubular anechoic structures within the myometrium with high velocity color Doppler flow”
Causes of Uterine AVM
previous dilation and curettage
therapeutic abortion
caesarean section
just multiple pregnancies.
This is scarring in the uterus, that occurs secondary to injury: prior dilation and curettage Tmost commonI surgery, or pregnancy.
Intrauterine Adhesion (Ashermans)
Intrauterine Adhesion (Ashermans)
(a) non filling of the uterus, or
(b) multiple irregular linear filling defects (lacunar pattern), with inability to appropriately distend the endometrial canal.
MRI would show a bunch of T2 dark bands.
Intrauterine Adhesion (Ashermans) clinically can result to =
Infertility
This is in the spectrum o f PID. You often see it 2-5 days after delivery, especially in women with prolonged labor or premature rupture.
Endometritis
fluid + thickend endoemtrial cavity
Gas in the cavity (not specifitc in a postpartu woman)
Endometritis can progress to =
pyometrium
Expansion + pus
3 functional compartments of the pelvic floor
Anterior
Middle
Posterior
The anterior pelvic compartment
Bladder
Urethra
Middle pelvic comparment
Vagina
Cervix
Uterus
Adnexa
Posterior pelvic compartment
Anus
Rectum
Supports the Anterior and middle comparments
Endopelvic fascia (buncha ligaments)
Main muscular component of the pelvic floor
Levator ani
The levator ani is composed of:
Puborectalis
pubococcygeus
ileococcygeus
This muscle groups constant contraction maintains the pelvic floor height.
Levator ani
This is the most caudal or superficial musculofascial structure.
Uroganital diaphragm
Anatomic landmark used in the classification of urethral injury
Urogenital diaphragm
Pelvic floor relaxation has two components
- Pelvic floor descent
- Widening
rawn from inferior margin of the symphysis pubis to the junction between the first and second coccygeal elements.
Pubococcygeal line
drawn from the inferior margin of the symphysis pubis to the posterior aspect of the puborectalis muscle sling.
H line
shortest distance between the posterior aspect of the puborectalis muscle sling and the PCL
M line
Hiatal enlargement (H line) =
> 6 cm
Pelvic floor descent (M line) =
> 2 cm
Bladder Descent > 1 cm below the pubococcygeal line.
Cystocele
Horizontally rotated urethra
Urethral hvpermobility
Anal fistula
loss of the normal “H shaped” vagina or direct defects / asymmetric thinning in the muscular sling
Axial image through the Ischioanal space (Triangle of fat lateral and caudal to the levator ani
Descent of the cervix or posterior vaginal fornix > 1 cm below the pubococcygeal line.
Uterine prolapse
A big turd can prop up the uterus - so it is best to measure them with an empty rectum (post defecation phase
Axial images could show the vagina lose its normal “H” shape - hanging low like the sleeve of a wizard (or the tongue of a tired dog).
RIsk factore of uterine prolapse
Hysterectomy
Abnormal rectal bulging (typically anteriorly).
Due to weakening of the rectovaginal fascia
Rectocele
Rectocele risk factors
Vaginal Surgery
Hysterectomy
Chronic constipation
Being old as dirt
