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118 and 119 > Chapter 41- Normal Pelvis > Flashcards

Chapter 41- Normal Pelvis Flashcards

1
Q

The bony pelvis has 2 innominate/coxal bones. What are they?

A

Sacrum and Coccyx

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2
Q

The true and false pelvises are divided by an imaginary line. List all 3 names of this line.

A

pelvic brim, iliopectineal, or linea termialis

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3
Q

Which pelvis (true or false) is SUPERIOR to the pelvic brim?

A

The False Pelvis

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4
Q

Where is the Vesicouterine Pouch, also called the Anterior Cul-de-sac

A

anterior to uterine fundus, between uterus and bladder

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5
Q

Where is the rectouterine pouch (also called the posterior cul-de-sac and pouch of Douglas) ?

A

posterior to uterus and cervix

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6
Q

Where is the retropubic space, also called the space of Retzius?

A

between the bladder and symphysis pubis

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7
Q

what is the sonographic appearance of muscle?

A

hypoechoic with striations

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8
Q

which muscles make up the pelvic floor?

A

the levator ani and coccygus muscles

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9
Q

where is the vagina

A

posterior to bladder, anterior to rectum. at a 90 degree angle with cervix

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10
Q

What is the measurement for the vagina

A

9cm in length

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11
Q

the cervix projects into the vaginal canal. what are the two parts of the cervix?

A

Endocervix and Exocervix

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12
Q

a “Fornix” is a little pocket in a canal.
What does the fornix of the vagina create?

A

Shadowing

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13
Q

List the parts of the uterus

A

fundus (most superior portion), body, and cervix

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14
Q

Where do the fallopian tubes meet the uterine fundus?

A

the cornua

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15
Q

What are the three layers of the uterus?

A

Perimeteium, Myometrium, Endometrium

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16
Q

What is the perimetrium?

A

the serous outer layer of the uterus

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17
Q

What is the myometrium?

A

the thickest layer of the uterus, made of muscle

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18
Q

What is the endometrium?

A

the inner mucous membrane and the glandular part of the body of the uterus.

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19
Q

What is the Functional Layer of the Endometrium?

A

the superficial layer that sheds with menses. Contains glands and stroma.

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20
Q

What is the Basal Layer of the Endometrium

A

the deep layer that regenerates after menses.

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21
Q

Broad Uterine Ligament

A

connects the lateral aspect of uterus to the pelvic sidewall

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22
Q

Mesovarium ligament of Uterus

A

attached to posterior fold of broad ligament and enclosed the ovary.

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23
Q

mesosalpinx ligament of Uterus

A

attaches to the upper fold of the broad ligament and encloses the fallopian tube.

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24
Q

round ligament of Uterus

A

connects fundus to anterior pelvic sidewalls

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25
Q

Cardinal ligament of Uterus

A

extends across pelvic floor laterally

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26
Q

uterosacral ligament of Uterus

A

extends downward from uterine ithsmus to sacrum

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27
Q

suspensory ligament of Uterus

A

extends from lateral aspect

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28
Q

Where is the ovarian ligament of Uterus located?

A

extends medially from ovary to uterine cornua

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29
Q

what are the 2 most common uterine positions?

A

anteverted and anteflex

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30
Q

what does an anteverted uterus look like?

A

the cervical canal forms a 90 degree angle with the vaginal canal

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31
Q

what does an anteflexed uterus look like?

A

the body and fundus of uterus are bent forward to the cervix

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32
Q

what does a retroflexed uterus look like?

A

the entire uterus is tilted posteriorly

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33
Q

what does a retroverted uterus look like?

A

the fundus and body of uterus are bend backward toward cervix

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34
Q

Define uterine agenesis

A

absence of uterus

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35
Q

Define an arcurate uterus

A

mild separation of the superior endometrium

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36
Q

Define a bicornuate uterus

A

there are 2 uteri and 2 endometrial canals

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37
Q

Define uterus didelphys

A

there are 2 uteri, 2 cervixes, and a possible separated or duplicated vagina

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38
Q

Define a unicornate uterus

A

one uterine horn

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39
Q

Define a subseptus of the uterus

A

one uterus with a septated or divided endometrial canal

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40
Q

What are the four segments of the fallopian tubes (not shown on ultrasound) called?

A

Infundibulum, ampulla, isthmus, and interstitial portion

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41
Q

What is the length of the fallopian tubes

A

10-12 cm

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42
Q

The fallopian tubes recieve blood supply from…

A

ovarian arteries and veins

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43
Q

Ovaries have dual blood supply. From what arteries is this blood supplied?

A

Ovarian and Uterine Arteries

44
Q

What do the Right and Left Ovarian veins drain into?

A

The R Ovarian vein drains into the IVC, the L Ovarian vein drains into the L Renal Vein.

45
Q

What part of the ovary secretes estrogen?

A

The follicles

46
Q

What part of the ovary secretes progesterone?

A

The corpus luteum

47
Q

The ovary produces reproductive cells called..?

A

Ovum

48
Q

The ovarian ligaments support the ovary from which direction?

A

Medially

49
Q

The ovary is supported laterally by which ligament?

A

The Suspensory or Infundibulopelvic Ligament

50
Q

The ovary is attached to the posterior aspect of which uterine ligament?

A

The broad ligament

51
Q

A normal ovary, measured sagittally has a volume of..?

A

0.523

52
Q

Pelvic vascularity is evaluated using what methods of ultrasound?

A

Real-time and Doppler

53
Q

Describe dopplar imaging

A

allows vessels to be located easily and allows the sonographer to assess waveforms.

54
Q

Salpin- is a prefix that refers to what structure of the pelvis?

A

Fallopian Tubes

55
Q

What is the Mesometruim?

A

The portion of the broad ligament that surrounds the body of the uterus.

56
Q

Where do eptopic pregnancies occur? Why that location?

A

They occur in the ampulla, becuase that is where fertilization takes place.

57
Q

The uterus and vagina are derived from two mullarian ducts during which phase of pregnancy?

A

The first trimester, around weeks 7-12

58
Q

congenital abnormalities of the uterus/kidneys often are caused by..?

A

The mullarian ducts not fusing correctly or completely.

59
Q

Define premenarche

A

Pre-puberty. Typically before the age of 11

60
Q

Define Menarche

A

Menstruation occuring approximately every 28 days. Usually begins around 11-13 years.

61
Q

Define menopause

A

Cessation of menses. Starts around the age of 50

62
Q

Define polymenorrheic

A

When a cycle occurs at an interval of less than 21 days and a person has too many periods.

63
Q

Define oligomenorrheic

A

When a cycle is prolonged past 35 days and a person has too few periods.

64
Q

Explain Ovulation: the Follicular Phase

A

During menarchal years, ovum are released about once each month by one of the ovaries. This typically occurs around day 14 of the cycle.

65
Q

At what stage of life does a person begin to develop their ova (eggs)?

A

Embryonic development. Each ovary contains about 200,000 oocytes at the time of birth. These oocytes remain immature until menarche begins around age 11.

66
Q

The process of ovulation is regulated by the hypothalamus. What does the hypothalamus begin to release during puberty?

A

Gonadotropin-releasing hormones. These hormones stimulate the anterior pituitary gland to secrete gonadotropins.

67
Q

The anterior pituitary gland secretes Follicle-Stimulating Hormone during the first 14 days of the menstrual cycle. What does FSH do?

A

It causes the ovarian follicles to develop so they can be released with ovulation.

68
Q

A mature ovarian follicle is known as a Graafian Follicle. How many cm in size do they reach before ovulation?

A

2 cm

69
Q

Between 5 and 8 preantral follicles begin to develop each month. How many of these reach maturity?

A

One.

70
Q

Ovulation is the explosive release of an ovum from a graafian follicle. What hormone(s) spike to stimulate this release?

A

Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (FH)

71
Q

After ovulation, the ovary enters the Luteal Phase and begin the process of luteinization. What happens during Luteinization?

A

Cells in the lining of the ruptured follicle will multiply and create the Corpus Luteum. The Corpus Luteum starts secreting progesterone.

72
Q

9-11 days after ovulation, the Corpus Luteum degenerates. The progesterone level declines causing what event?

A

With the decline of progesterone levels, menstruation occurs and the cycle starts over.

73
Q

If fertilization occurs, the zygote will produce Human Chorionic Gonadotropin. Instead of degenerating, the Corpus Luteum does what?

A

The Corpus Luteum will remain to secrete progesterone until the placenta takes over. This takes about 3 months.

74
Q

Are Functional Cysts abnormal?

A

No. They are the result of the ovary functioning as normal. They are a common cause of enlarged ovaries in young women.

75
Q

What is the proliferative phase?

A

Days 1-14 of the cycle where the ovarian follicles develop and estrogen increases. Menstruation typically is days 1-4 of this phase.

76
Q

Define Polymenorrhea

A

Too many periods. Menstrual cycles with an interval of <21 days.

77
Q

Define Oligomenorrhea

A

Too few periods. Menstrual cycles prolonged >35 days

78
Q

Define Menorrhagia

A

Abnormally heavy or long periods

79
Q

Define Dysmenorrhea

A

Abnormally painful periods

80
Q

Define Amenorrhea

A

Absence of menstruation

81
Q

How does the endometrium appear on ultrasound?

A

The functional layer appears with a hyperechoic halo. The basalis layer is a thin darker line on the outside of it. The endometrial cavity is inside the functionalis layer.

82
Q

The endometrium is thin during the proliferative phase. How thin?

A

6 mm

83
Q

How thick is the endometrium from day 10-14, before ovulation

A

10 mm

84
Q

The endometrium is its thickest during the secretory phase as the functional layer becomes idoechoic with the basalis layer. How thick is the endometrium?

A

7-14 mm.

85
Q

What happens during the secretory phase from days 15-28?

A

The ruptured follicle becomes the corpus luteum which secretes progesterone. If there is no pregnancy, estrogen and progesterone decrease.

86
Q

What does the postmenopausal endometrium look like sonographically? What factor could change this?

A

It is thin and measures less than 5mm. However, a patient taking Hormone Replacement may have a thick endometrium up to 8mm.

87
Q

What are the requirements for a transabdominal ultrasound? Why?

A

A full bladder is required for an acoustic window. A filled bladder will tilt the uterus posteriorly and move the bowel out of the way.

88
Q

What are the requirements for a transvaginal ultrasound?

A

An empty bladder and higher frequency transducer are required. This gives a more detailed image, but with a limited range and depth.

89
Q

When would you NOT use a transvaginal ultrasound.

A

When the patient is a minor who has not been sexually active.

90
Q

What are the steps to prepare the transducer for a transvaginal ultrasound

A

Apply gel to the end of probe. Cover with a sterile, non-latex probe cover. Make sure there are no air bubbles between the probe and cover. Apply gel to the top layer for insertion.

91
Q

Explain a translabial approach as an alternative to transvaginal imaging.

A

A linear or curvilinear probe is prepared with the same steps as a transvaginal transducer. Scanning is performed externally at the vaginal canal.

92
Q

Explain a Sonohysterography

A

A saline infused endometrium allows for the evaluation of the inner portation of the endometrium.

93
Q

What is 3D Imaging used to evaluate?

A

Congenital malformations of the uterus such as Endometrial Polyps

94
Q

What two hormones spike before Ovulation?

A

Lutenizing hormone and Follicle-Stimulating Hormone

95
Q

At the base of the follicle is a small cluster of cells that projects from the follicular wall. What is this called?

A

Cumulus Oophorus

96
Q

One of two muscles in the pelvic diaphragm, what muscle supports the Coccyx?

A

Coccygeus Muscle

97
Q

What triangular muscle covers the iliac fossae and forms the lateral wall of the pelvis?

A

The illacus muscle

98
Q

What is the iliopectineal line?

A

A bony ridge on the inner surface of the ilium and pubic bones. It divides the true and false pelvis.

99
Q

What does the obturator inturnus muscle do? and where does it attach?

A

it rotates and abducts the thigh. the muscle originates from the pelvic wall and connects to the femur

100
Q

Which muscle stretches across the pelvic floor and supports the pelvic organs?

A

Levator Ani

101
Q

What is the pyramid shaped muscle that attaches to the anterior sacrum and the femur?

A

The Piriformis Muscle

102
Q

What does the Psoas Major muscle do? and where is it located?

A

It flexes the thigh toward the pelvis. Originates at the lumbar vertebrae and unites with the iliacus muscle

103
Q

If pregnancy does not occur, the corpus luteum degenerates and turns into

A

corpus albicans

104
Q

The 3-line sign of the endometrium is found in which phase?

A

Proliferative phase

105
Q

What is the average length of the uterus?

A

6-8 cm

106
Q

Which ligament is located on the lateral wall of the uterus

A

The suspensory ligament

107
Q

What ligament holds the uterus in an anteverted position

A

Round ligament

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