Chapter 41- Normal Pelvis Flashcards
The bony pelvis has 4 bones. What are they?
Sacrum and Coccyx and 2 innominate hip bones
The true and false pelvises are divided by an imaginary line. List all 3 names of this line.
pelvic brim, iliopectineal, or linea termialis
Which pelvis (true or false) is SUPERIOR to the pelvic brim?
The False Pelvis
Where is the Vesicouterine Pouch, also called the Anterior Cul-de-sac
anterior to uterine fundus, between uterus and bladder
Where is the rectouterine pouch (also called the posterior cul-de-sac and pouch of Douglas) ?
posterior to uterus and cervix
Where is the retropubic space, also called the space of Retzius?
between the bladder and symphysis pubis
what is the sonographic appearance of muscle?
hypoechoic with striations
which muscles make up the pelvic floor?
the levator ani and coccygus muscles
where is the vagina
posterior to bladder, anterior to rectum. at a 90 degree angle with cervix
What is the measurement for the vagina
9cm in length
the cervix projects into the vaginal canal. what are the two parts of the cervix?
Endocervix and Exocervix
a “Fornix” is a little pocket in a canal.
What does the fornix of the vagina create?
Shadowing
List the parts of the uterus
fundus (most superior portion), body, and cervix
Where do the fallopian tubes meet the uterine fundus?
the cornua
What are the three layers of the uterus?
Perimeteium, Myometrium, Endometrium
What is the perimetrium?
the serous outer layer of the uterus
What is the myometrium?
the thickest layer of the uterus, made of muscle
What is the endometrium?
the inner mucous membrane and the glandular part of the body of the uterus.
What is the Functional Layer of the Endometrium?
the superficial layer that sheds with menses. Contains glands and stroma.
What is the Basal Layer of the Endometrium
the deep layer that regenerates after menses.
What connects the lateral aspect of uterus to the pelvic sidewall
The broad ligament
The mesovarium ligament of the uterus is attached to posterior fold of broad ligament. What does it do?
Encloses the ovary.
mesosalpinx ligament of Uterus
attaches to the upper fold of the broad ligament and encloses the fallopian tube.
round ligament of Uterus
connects fundus to anterior pelvic sidewalls
Which uterine ligament extends across pelvic floor laterally
The cardinal ligament
uterosacral ligament of Uterus
extends downward from uterine ithsmus to sacrum
Which ligament extends from the lateral aspect of the uterus
The suspensory ligament
Where is the ovarian ligament of Uterus located?
extends medially from ovary to uterine cornua
what are the 2 most common uterine positions?
anteverted and anteflex
what does an anteverted uterus look like?
the cervical canal forms a 90 degree angle with the vaginal canal
what does an anteflexed uterus look like?
the body and fundus of uterus are bent forward to the cervix
what does a retroflexed uterus look like?
the entire uterus is tilted posteriorly
what does a retroverted uterus look like?
the fundus and body of uterus are bend backward toward cervix
Define uterine agenesis
absence of uterus
Define an arcurate uterus
mild separation of the superior endometrium
Define a bicornuate uterus
there are 2 endometrial canals
Define uterus didelphys
there are 2 endometrial canals, 2 cervixes, and a possible separated or duplicated vagina
Define a unicornate uterus
one uterine horn
Define a subseptus of the uterus
A uterus with a septated or divided endometrial canal
What are the four segments of the fallopian tubes (not shown on ultrasound) called?
Infundibulum, ampulla, isthmus, and interstitial portion
What is the length of the fallopian tubes
10-12 cm
The fallopian tubes recieve blood supply and drain into which vessels?
ovarian arteries and vein
Ovaries have dual blood supply. From what arteries is this blood supplied?
Ovarian and Uterine Arteries
What do the Right and Left Ovarian veins drain into?
The R Ovarian vein drains into the IVC, the L Ovarian vein drains into the L Renal Vein.
What part of the ovary secretes estrogen?
The follicles
What part of the ovary secretes progesterone?
The corpus luteum
The ovary produces reproductive cells called..?
Ovum
The ovarian ligaments support the ovary from which direction?
Medially
The ovary is supported laterally by which ligament?
The Suspensory or Infundibulopelvic Ligament
The ovary is attached to the posterior aspect of which uterine ligament?
The broad ligament
A normal ovary, measured sagittally has a volume of..?
0.523
Pelvic vascularity is evaluated using what methods of ultrasound?
Real-time and Doppler
Describe dopplar imaging
allows vessels to be located easily and allows the sonographer to assess waveforms.
Salpin- is a prefix that refers to what structure of the pelvis?
Fallopian Tubes
What is the Mesometruim?
The portion of the broad ligament that surrounds the body of the uterus.
Where do eptopic pregnancies occur? Why that location?
They occur in the ampulla, becuase that is where fertilization takes place.
The uterus and vagina are derived from two mullarian ducts during which phase of pregnancy?
The first trimester, around weeks 7-12
congenital abnormalities of the uterus/kidneys often are caused by..?
The mullarian ducts not fusing correctly or completely.
Define premenarche
Pre-puberty. Typically before the age of 11
Define Menarche
Menstruation occuring approximately every 28 days. Usually begins around 11-13 years.
Define menopause
Cessation of menses. Starts around the age of 50
Define polymenorrheic
When a cycle occurs at an interval of less than 21 days and a person has too many periods.
Define oligomenorrheic
When a cycle is prolonged past 35 days and a person has too few periods.
Explain Ovulation: the Follicular Phase
During menarchal years, ovum are released about once each month by one of the ovaries. This typically occurs around day 14 of the cycle.
At what stage of life does a person begin to develop their ova (eggs)?
Embryonic development. Each ovary contains about 200,000 oocytes at the time of birth. These oocytes remain immature until menarche begins around age 11.
The process of ovulation is regulated by the hypothalamus. What does the hypothalamus begin to release during puberty?
Gonadotropin-releasing hormones. These hormones stimulate the anterior pituitary gland to secrete gonadotropins.
The anterior pituitary gland secretes Follicle-Stimulating Hormone during the first 14 days of the menstrual cycle. What does FSH do?
It causes the ovarian follicles to develop so they can be released with ovulation.
A mature ovarian follicle is known as a Graafian Follicle. How many cm in size do they reach before ovulation?
2 cm
Between 5 and 8 preantral follicles begin to develop each month. How many of these reach maturity?
One.
Ovulation is the explosive release of an ovum from a graafian follicle. What hormone(s) spike to stimulate this release?
Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (FH)
After ovulation, the ovary enters the Luteal Phase and begin the process of luteinization. What happens during Luteinization?
Cells in the lining of the ruptured follicle will multiply and create the Corpus Luteum. The Corpus Luteum starts secreting progesterone.
9-11 days after ovulation, the Corpus Luteum degenerates. The progesterone level declines causing what event?
With the decline of progesterone levels, menstruation occurs and the cycle starts over.
If fertilization occurs, the zygote will produce Human Chorionic Gonadotropin. Instead of degenerating, the Corpus Luteum does what?
The Corpus Luteum will remain to secrete progesterone until the placenta takes over. This takes about 3 months.
Are Functional Cysts abnormal?
No. They are the result of the ovary functioning as normal. They are a common cause of enlarged ovaries in young women.
What is the proliferative phase?
Days 1-14 of the cycle where the ovarian follicles develop and estrogen increases. Menstruation typically is days 1-4 of this phase.
Define Polymenorrhea
Too many periods. Menstrual cycles with an interval of <21 days.
Define Oligomenorrhea
Too few periods. Menstrual cycles prolonged >35 days
Define Menorrhagia
Abnormally heavy or long periods
Define Dysmenorrhea
Abnormally painful periods
Define Amenorrhea
Absence of menstruation
How does the endometrium appear on ultrasound?
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.
The endometrium is thin during the proliferative phase. How thin?
6 mm
How thick is the endometrium from day 10-14, before ovulation
10 mm
The endometrium is its thickest during the secretory phase as the functional layer becomes idoechoic with the basalis layer. How thick is the endometrium?
7-14 mm.
What happens during the secretory phase from days 15-28?
The ruptured follicle becomes the corpus luteum which secretes progesterone. If there is no pregnancy, estrogen and progesterone decrease.
What does the postmenopausal endometrium look like sonographically? What factor could change this?
It is thin and measures less than 5mm. However, a patient taking Hormone Replacement may have a thick endometrium up to 8mm.
What are the requirements for a transabdominal pelvic ultrasound? Why?
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.
What are the requirements for a transvaginal ultrasound?
An empty bladder and higher frequency transducer are required. This gives a more detailed image, but with a limited range and depth.
When would you NOT use a transvaginal ultrasound.
When the patient is a minor who has not been sexually active.
What are the steps to prepare the transducer for a transvaginal ultrasound
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.
Explain a translabial approach as an alternative to transvaginal imaging.
A linear or curvilinear probe is prepared with the same steps as a transvaginal transducer. Scanning is performed externally at the vaginal canal.
Explain a Sonohysterography
A saline infused endometrium allows for the evaluation of the inner portation of the endometrium.
What is 3D Imaging used to evaluate?
Congenital malformations of the uterus such as Endometrial Polyps
What two hormones spike before Ovulation?
Lutenizing hormone and Follicle-Stimulating Hormone
At the base of the follicle is a small cluster of cells that projects from the follicular wall. What is this called?
Cumulus Oophorus
One of two muscles in the pelvic diaphragm, what muscle supports the Coccyx?
Coccygeus Muscle
What triangular muscle covers the iliac fossae and forms the lateral wall of the pelvis?
The illacus muscle
What is the iliopectineal line?
A bony ridge on the inner surface of the ilium and pubic bones. It divides the true and false pelvis.
What does the obturator inturnus muscle do? and where does it attach?
it rotates and abducts the thigh. the muscle originates from the pelvic wall and connects to the femur
Which muscle stretches across the pelvic floor and supports the pelvic organs?
Levator Ani
What is the pyramid shaped muscle that attaches to the anterior sacrum and the femur?
The Piriformis Muscle
What does the Psoas Major muscle do? and where is it located?
It flexes the thigh toward the pelvis. Originates at the lumbar vertebrae and unites with the iliacus muscle
If pregnancy does not occur, the corpus luteum degenerates and turns into
corpus albicans
The 3-line sign of the endometrium is found in which phase?
Proliferative phase
What is the average length of the uterus?
6-8 cm
Which ligament is located on the lateral wall of the uterus
The suspensory ligament
What ligament holds the uterus in an anteverted position
Round ligament
