Adnexal Path and infertility Flashcards
Endometriosis
- ectopic location of functional endo tissue
- attaches to fallopian tubes, ov, colon and bladder
Endometriosis clinical findings
- asymptomatic
- dysmenorrhea
- pelvic pain
- irrgular menses
- dyspareunia
- infertility
endometriosis sono findings
- difficult to vis w/ U/S
- obscure organ boundries
- fixation of ov posterior to UT
- endometrioma
endometrioma
- focal collection of ectopic endo tissue
“chocolate cyst”
endometrioma clinical findings
- asymptomatic
- metromenorrhagia
- dysmenorrhea
- dyspareunia
- palpable pelvic mass
- infertility
endometrioma sono findings
- hypo homo adnexal mass
- thick well defined wall margins
- diffuse low level echos w/ or w/o solid components
- avascular mass
- fluid
- mass w/ not regress in size on serial sonogram
krukenberg tumor
- metastatic lesions
- primary lesion from gastic carcinoma
- other primary structures include large intestine, breast, or appendix
krukenberg tumor clinical findings
- asymptomatic
- abd pain
- bloating
krukenberg tumor sono findings
- bilat adnexal or ov mass
- oval or lobulated margins
- hypo areas w/in mass
- posterior enhancement
- ascities
paraovarian cyst
- mesothelial in origin
- typically located in broad ligaments
- not assoc with hx of PID, surgery or endometriosis
paraov cyst clinical findings
- asymptomatic
- pelvic pain
- palpable pelvic mass
para ov cyst sono findings
- round or ovoid anechoic adnexal mass
- separate from ipsilateral ov
- thin smooth wall margins
0 stable size on serial sonograms
PID
- bacterial infection
- diverticulitis
- appendicities
PID clinical findings
- abd pain
- fever
- vag discharge
- urinary frequency
PID sono findings
- normal pelvic appearence
- thick and hypervascular endo
- complex tubular adnexal mass
- ill defined multilocular adnexal mass
carcinoma of tubes
- dysplasia
- carcinoma in situ
carcinoma of tubes clinical findings
- pelvic pain
- abnormal bleeding
- pelvic pain
carcinoma of tubes sono findings
- sausage shaped complex adnexal mass
- papillary projections
hydrosalpnix
- PID
- endometriosis
- postoperative adhesion
hydrosalpnix clinical findings
- asymptomatic
- pelvic fullness
- infertility
hydrosalpnix sono findings
- tuboovarian abscess
- loops of bowel
pyosalpnix
- bacterial infection
- pus in fallopian tubes
pyosalpnix clinical findings
- asymptomatic
- low grade fever
- pelvic fullness
pyosalpnix sono findings
- complex tubular adnexal mass
- wall thickness >5 mm
- irregular margins
- mass attenuates the sound
salpingitis
inflammation of tubes
salpingitis clinical findings
- pelvic pain
- fever
- dyspareunia
- leukocystosis
salpingitis sono findings
- nodular, thick tubular adnexal mass
- complex adn mass
- posterior enhancement
tuboovarian abscess
- pelvic infection
- STD
tuboovarian abscess clinical findings
- severe pelvic pain
- fever
- leukocytosis
- nausea/ vomiting
tuboovarain abscess sono findings
- complex multilocular adn mass
- ill defined wall margins
- total breakdown or normal adnexal anatomy
Infertility is suggested when coneption doesnt occur w/in
1 year
infertility is caused by
male or female reproductive abnormalities
most common cause of female infertility is
ovulatory disorder
- PCOS
- luteinizing unruptured follicle syndrome
- luteal phase inadequacy
Other causes of female infertility
oviduct disease, congenital ut anomalies, endo pathology, cx mucus abnormality, nutritional factors, metablic disorder and synechiae
fibroids are responsible for what percent of infertility cases
15
Ovarian Induction Therapy
medications are injected to stimulate follicular development
Ovarian induction therapy stimulates
pituitary gland to increase secretion of FSH
Ovarian Induction Therapy follicular growth is monitored by
periodic US exam
Ovarian Induction Therapy estrodial levels are monitored for
timing of intramuscular injection of hCG
In Vitro Fertilization
mature ova are aspirated with US guidance
In Vitro Fertilization is accumplished in what setting
laboratory
In Vitro Fertilization endo is prepared to accept
embryo
In Vitro Fertilization embryos are transferred into
endo
Gamete Intrafollicular Transfer requires
ovulation stimulation and retrieval of oocyte
Gamete Intrafollicular Transfer oocytes are mixed with
sperm and then transferred into tubes
Zygote Intrafallopian Transfer
zygote is transferred into fallopian tubes
What type of uterus has a high incidence of infertility
septae
Endo thickness >8 mm is assoc with a
decrease in infertility
Full luteal function is expected with an endo thickness of 11 mm or greater during mid ____ phase
luteal
Baseline study before therapy, assess for the presence of an
ov cyst or follicle
During induction therapy, monitor the
size and number of follicles per ov
count and measure only the follicles greater than
1 cm
Optimal follicle size before ovulation is
1.5 - 2 cm
Correlate estradiol level with
size and number of follicles
Ectopic pregnancy
more common in patients with hx of infertility
Mutliple gestations are most common with
IVF 25%
Ovarian Hyperstimulation Syndrome is caused by
high hCG levels
Ovarian Hyperstimulation Syndrome clinical findings
lower abd or back pain, abd distention, nasuea/ vomiting, hypotension and leg edema
Ovarian Hyperstimulation Syndrome multicystic enlargement measures
> 5 mm
Ovarian Hyperstimulation Syndrome additional sono findings include
ascites and pleural effusion
