Chapter 28 Neonatal And Pediatric Pelvis

Question 0

Surface epithelium gives rise to ________ ________ ________or _________ _________.

Answer 0

secondary sex cords; cortical cords

Question 1

Primary sex cords converge to form network of canals called the ______ _______.

Answer 1

rete ovarii

Question 2

Oogonia multiply rapidly by ________.

Answer 2

mitosis

Question 3

Before birth all oogonia enlarge to form what?

Answer 3

oocytes

Question 4

________ remain in arrested state until puberty.

Answer 4

Ovaries

Question 5

Male/female reproductive organs develop from the same source. ________ ________ grow to form primary sex cords.

Answer 5

gonadal ridges

Question 6

By what week of gestation is the external genitalia fully formed?

Answer 6

12th week

Question 7

_________ ________ form most of the female reproductive system.

Answer 7

Müllerian ducts

Question 8

_________ _________ form most of the male reproductive system.

Answer 8

Wolffian ducts

Question 9

Uterus and upper third of the vagina are derived from what?

Answer 9

The Müllerian ducts

Question 10

Ducts elongate - internal lumens at how many weeks gestation?

Answer 10

7-12 weeks

Question 11

Fusion of the Müllerian ducts begins _______ and progresses _______. Starts with _______ and progresses to ________.

Answer 11

caudally, cephalically; vagina, fallopian tubes

Question 12

Fused caudal ends of the Müllerian ducts form what?

Answer 12

vagina, cervix, uterus

Question 13

Unfused cranial ends form what?

Answer 13

Fallopian tubes

Question 14

Fusion ________ can occur throughout the process.

Answer 14

anomalies

Question 15

To image the pediatric pelvis you need to have the child do what?

Answer 15

Fill bladder

Question 16

How should an infant/toddler fill their bladder?

Answer 16

have parent keep child well hydrated

Question 17

How should you have a potty trained child fill their bladder?

Answer 17

drink 2 glasses of fluids 1 hour prior - hold bladder

Question 18

How should you have a young teen fill their bladder?

Answer 18

drink 3-4 glasses of fluids 1 hour prior

Question 19

What type of walls should the pediatric bladder have?

Answer 19

Smooth thin wall

Question 20

What should the wall thickness of the bladder be when it is full?

Answer 20

1.5-3mm

Question 21

What should the wall thickness of the bladder be when it is empty or partially filled?

Answer 21

< 5mm

Question 22

When using bladder jets with color doppler, ureters should be dilated. True or false?

Answer 22

False. Ureters should not be dilated

Question 23

Should fluid be visualized in the neck and urethra?

Answer 23

no fluid should be visualized

Question 24

What should the newborn uterus look like?

Answer 24

- Prominent - maternal hormones - Pear shaped - Length - 3.5 cm - Fundus/cervix ratio-1:2

Question 25

At 2-3 months what should the uterus look like?

Answer 25

- Teardrop shape - tubular configuration - Length - 2.5-3 cm (prepuberty) - Fundus/cervix ratio- 1:1 - No discernible endometrial stripe

Question 26

What should the uterus look like at age 7?

Answer 26

Begins to increase in size and take on pear shape

Question 27

What should the uterus look like at puberty/post puberty?

Answer 27

- Dramatic changes in shape and size - Length 5-7 cm - Fundus/cervix ratio- 3:1

Question 28

To image the vagina, a _______ _______ is needed.

Answer 28

full bladder

Question 29

The vagina is a _______ structure posterior to bladder, and has continuity with ________.

Answer 29

tubular, cervix

Question 30

The vagina has a ______ central echo.

Answer 30

bright

Question 31

How should you measure the ovary?

Answer 31

Use volume measurement

Question 32

Where should you find the ovaries?

Answer 32

anywhere between lower pole kidneys to true pelvis

Question 33

What is size of the ovary up to 5 years old?

Answer 33

.75-.86 cm cubed

Question 34

What is the appearance of the ovary in neonatal?

Answer 34

heterogeneous secondary to tiny cysts

Question 35

What is the appearance of the ovary as there is an increase in age?

Answer 35

homogeneous, maybe small cysts

Question 36

Describe congenital anomalies of the uterus and ovaries.

Answer 36

Developmental abnormality, interference with blood supply or distortion of uterine cavity may cause infertility or spontaneous abortion

Question 37

Congenital anomalies occur in what percentage of females?

Answer 37

approximately .5%

Question 38

Congenital anomalies of the uterus and ovaries have a very high association with what?

Answer 38

renal anomalies

Question 39

Müllerian abnormalities include what?

Answer 39

improper fusion, incomplete development of one side, incomplete vaginal canalization

Question 40

If Müllerian anomalies are detected, what should you do?

Answer 40

You should ALWAYS check kidneys

Question 41

What are the six groups of Müllerian anomalies?

Answer 41

Class I - incomplete vaginal canalization Class II - unicornuate uterus Class III - uterus didelphys Class IV - bicornuate uterus Class V - septate uterus Class VI - Diethylstibestrol (DES) exposure - "T" shape uterus C

Question 42

Class I - Segmental Mullerian agenesis-incomplete vaginal canalization

Answer 42

- transverse vaginal septum or vaginal atresia (not fully formed) - suspected when girl reaches puberty without menstruation

Question 43

``` Class I - Vaginal atresia hydrocolpus - hydrometrocolpus- hematometrocolpus- cervix may be _______ large _____ ______ ______ in neonatal period or _____ at puberty ________ ________. ```

Answer 43

hydrocolpus - fluid filled vagina hydrometrocolpus - fluid filled vagina and uterus hematometrocolpus - blood filled vagina and uterus cervix may be absent large cystic pelvic mass in neonatal period or diagnosis at puberty imperforate hymen

Question 44

Class II

Answer 44

- unicornuate uterus - complete unilateral arrest of Mullerian Ducts - may have small rudimentary horn if partial arrest - long, slender uterus (cigar shaped) - deviated to one side - frequently renal agenesis on contralateral side - small and laterally positioned uterus - infertility and pregnancy loss

Question 45

Class III

Answer 45

- uterus didelphys - complete nonfusion of Müllerian ducts - complete duplication of uterus, cervix, and vagina - not usually associated with infertility problems - no treatment - 2 endometrial echo complexes

Question 46

Class IV

Answer 46

- bicornuate uterus - partial nonfusion of the Müllerian ducts - duplication of uterus-common cervix - wide-spaced cavities - low incident of fertility complications - usually not treated - rudimentary cavity - at 12-16 weeks gestation, rupture of uterine cavity - 2 endometrial cavities visualized

Question 47

Class V

Answer 47

Septate uterus - 2 uterine cavities closely spaced - 1 fundus - possibly 2 cervical canals or vaginal septum - highest incidence of infertility problems - MOST COMMON UTERINE ANOMALY

Question 48

Class VI

Answer 48

- exposure to diethylstilbestrol (DES) in utero - synthetic drug used in 1970's during pregnancy to treat threatened and habitual abortion - drug causes vaginal malignancies in the daughters - uterus - normal shape and size - uterine cavity "T" shaped, irregular contour

Question 49

Ambiguous Genitalia | -hermaphroditism

Answer 49

- True - both ovarian and testicular tissue - Internal and external genitalia variable - 46, XX karyotype, or mosaics (46, XX/46, XY)

Question 50

Ambiguous Genitalia | -Female pseudohermaphroties

Answer 50

- 46, XX karyotype - increase production of androgens - masculinization of external genitalia (enlarged clitoris, abnormalities of urogenital sinus and partial fusion of the labia majora) - ultrasound used to determine presence or absence of uterus, vagina and ovaries

Question 51

Precocious Puberty | -true precocious puberty

Answer 51

ALWAYS isosexual (same sex) - development of secondary sexual characteristics and increasing size and activity of reproductive organs prior to normal puberty age-usually < 10 y/o - uterus enlarged, postpubertal configuration - 2:1 & 3:1 fundus/cervix ratio - ovarian volume enlarged > 1 cubic cm - functional cysts present

Question 52

Precocious pseudopuberty

Answer 52

- maturation of secondary sexual characteristics but not reproductive organs - no activation of hypothalamic-pituitary-gonadal axis - usually associated with increase steroidal release from adrenal glands-tumors - should always scan the liver and adrenal glands to r/o lesion

Question 53

Pathology of the Pediatric Ovary | -Ovarian cyst

Answer 53

- may form inutero, but spontaneously resolve - 3-7 mm cysts normal - higher incident in neonates of mothers with toxemia, diabetes, Rh isoimmunization - greater than normal release of placental chorionic gonadotropin - most common complications: hemorrhage, torsion - may rupture - Sono findings - anechoic structure adjacent to, or within ovary may have debris if hemorrhage - little or no color flow to ovary if torsion

Question 54

Pathology of the Pediatric Ovary | -Ovarian Torsion

Answer 54

- may occur at any age - sudden onset of severe pain** - more common associated with ovarian cyst/mass - arterial and venous blood flow compromised (venous first)** - enlarged and edematous ovary

Question 55

Pathology of the Pediatric Ovary | -Ovarian Teratomas

Answer 55

- uncommon in adolescent and neonate - 60% germ cell - benign or malignant - most common in pediatrics is benign mature teratoma or dermoid cyst - usually asymptomatic until gets very large - mmost frequent complication is torsion - 16-40%

Question 56

What is the sonographic appearance of ovarian teratomas?

Answer 56

- varied-complex, heterogeneous mass - frequently echogenic foci with acoustic shadowing-less shadowing in neonates - "tip of the iceberg"