Clin Med GUT Women's health Anat/Radiology Part 2 Flashcards
Anatomy of the KUB:
-Note location of the Kidneys, ureters and bladder
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Hysterosalpingogram=
an X-ray procedure that is used to view the inside of the uterus and fallopian tubes. It often is used to see if the fallopian tubes are partly or fully blocked.
-synechiae-adhesions
Does VUR cause Renal Damage?
VUR= vesicoureteral reflux
answer: not necessarily!
VUR:
-genetic disposition? Primary vs Secondary
- Primary= (genetic predisposition to short ureteral tunnel through bladder) – small chance of renal damage from VUR
- Secondary (to bladder and/or urethral dysfunction, ie neurogenic bladder or posterior urethral valves)
VUR:
Primary or secondary cases have more problems?
Secondary cases have the most problems and have increased chance of renal damage from VUR
Vesicoureteral Reflux (VUR):
- Predisposition to UTIs (yes or no?)
- demographic?
- VUR does NOT predispose to UTIs if there is no stasis of urine in the GUT
- A Hydronephrosis found on prenatal US requires a followup eval after birth to determine etiology.
- **30-40% of children <5 yrs with UTIs have VUR
Febrile UTIs, or VUR plus UTIs have increased chance of ____
**renal scarring
Surgery to reimplant ureters and/or prophylactic antibiotics do not necessarily prevent:
UTIs and/or renal damage
VUR:
-Greater grade of reflux associated with increased chance of ______
**renal damage
Bottom line: for VUR and UTIs
**both require individual evaluation and treatment as these are complex entities with still evolving knowledge of their associations
VUR grading
Grade I-V (Grade 4-5 =SEVERE)
VUR work-up should include:
**VCUG (=voiding cystourethrography) or Isotope Cystogram and a Radionuclide DMSA Renogram
-You are evaluating renal parenchyma and presence of reflux.
VUR:
Reflux is of 2 types:
Type 1 is due to–>
**1) Due to immaturity with a short ureteral tunnel in the bladder. If reflux is present with a UTI, pyelonephritis and renal damage can result. Immature short tunnel usually resolves with age.
VUR:
Reflux is of 2 types:
Type 2 is due to–>
2) Due to a congenital anomaly at the UV junction, ie no tunnel, adjacent bladder diverticulum, or displaced orifice. If reflux is present with a UTI, pyelonephritis and renal damage can result.
VUR:
With Posterior Urethral Valves OR a Neurogenic Dysfunctional Bladder, reflux:
**does not necessarily occur if the ureteral tunnel is normal. If the tunnel is abnormal, reflux occurs.
When prenatal fetal hydronephosis occurs OR the patient has documented pyelonephritis, What must be done?
*a work up – VCUG or Radionuclide Cystogram – is indicated to determine if underlying anatomic or functional abnormalities are present. If so, depending on findings, treat.
Hydronephrosis can occur 2/2 _____
ureteral obstruction
Pyelosinus backflow of urine usually occurs through infractions of the calyceal fornices from ______
obstruction
1 case that witwer mentioned regarding pyelosinus backflow 2/2 pressure:
=> ruptured renal collecting system w/ pyelosinus backflow
Bilateral collecting system=
- how are most diagnosed?
- associated w/ ?
= an unusual renal tract abnormality
- most are incidentally seen
- associated w/ GU abnormalities
Cystitis=
=inflammation of the urinary bladder, often caused by infection and is usually accompanied by frequent painful urination (dysuria)
16 YO patient with recurrent UTIs. Thickened bladder wall and
tubular structure that turned out to be a blind ureter, on
Retrograde Pyelography–> dx?
think Cystitis**
Polycystic Ovary Disease (PCOD)=
**Enlarged ovaries with thick sclerotic capsules and an abnormally high number of follicles
on imaging: Increased central stroma with multiple small subcapsular follicles
Stein-Leventhal Syndrome= (what Sx are assoc. with this syndrome**)
**amenorrhea, infertility, hirsutism and enlarged polycystic ovaries
Imaging findings revealed:
- Large ovary with large follicles
- Large ovary without demonstrable Doppler flow
Most likely dx= ?
*ovarian torsion
Ectopic Pregnancy:
-If the Pt’s beta-HCG level is >_____ IU/mL (2IS Standard) OR >_____ IU/mL (IRP standard), an intrauterine gestational sac SHOULD be identifiable on a transvaginal sonogram
> 1000 IU/mL (2IS Standard) or >2000 IU/mL (IRP Standard)
An intrauterine gestational sac should be present by __ weeks and also show embryonic cardiac activity by ___ weeks on a Transvaginal Sonogram when the sac is at least 16mm long or embryonic crown rump length is at least 5mm.
**5 weeks
5+ weeks
IF none of the above are evident (ie no intrauterine gestational sac present at 5 weeks, or embryonic cardiac activity by 5 weeks OR beta-HCG levels >1000 or >2000 and no identifiable gestational sac) –> strongly suspect ectopic pregnancy.
-Additional criteria for ectopic pregnancy are:
- If no intrauterine gestational sac is seen at all
- If a live, extrauterine embryo is identified
- There is free fluid in the pelvis or peritoneum
- There is an adnexal mass
- There is a hematosalpinx
(MEMORIZE)
PID is associated with ____ abscess
**tuboovarian
Dermoid Cyst of the Ovary:
-contains ______
skin tissue, and hair, fat tissue, can have mandibles (ie can have teeth in it)–> diagnosis made by removing it and send to pathologist
Serous Cystadenoma of the Ovary:
-size?
often very large
Endometrioma=
a type of cyst formed when endometrial tissue (the mucous membrane that makes up the inner layer of the uterine wall) grows in the ovaries
(Endometrioma contains blood tissue (endometrial tissue aka it’s very vascularized)
–the blood will be brown because it’s old= termed a “chocolate” cyst )
Endometriosis=
presence of endometrial glands and tissue OUTSIDE of the uterus.
-Women with endometriosis may have problems with fertility
(remember: endometrial tissue is sensitive to the hormonal environment) this is common and can be VERY painful
Uterine Leiomyomata/Fibroids:
-very common
=noncancerous growths of the uterus that often appear during childbearing years. Also called leiomyomas, uterine fibroids aren’t associated with an increased risk of uterine cancer and almost never develop into cancer
Uterine Adenomyosis= occurs when ______
the tissue that normally lines the uterus (endometrial tissue) grows into the muscular wall of the uterus
(on imaging: Note Thickened Myometrium )
.
**Echogenic mass within the Uterine Cavity replacing the endometrial stripe=
**endometrial carcinoma
Post menopausal woman with vaginal bleeding. What MUST you R/O?
**r/o endometrial carcinoma (cancer)
Supporting and Stabilizing Structures of the uterus – (Experts differ):
-structures associated with the Pelvic Diaphragm (=pelvic floor)=
-Others?
- Pelvic Diaphragm (Pelvic Floor): (consists of)
- -Levator Ani
- -Coccygeus Muscle
- -And associated fascia
- Urogenital Diaphragm/Perineal membrane
- Perineal Body
T/F: the Broad Ligament, Round Ligament, suspensory ligament of the ovary, and peritoneal folds associated with the uterus are not considered to be true uterine support stuctures
true
“Ligamentous Supporting” Structures of the Uterus
-List the 3 Supporting/Stabilizing Structures aka Major Ligaments of the uterus:
- Cardinal (Transverse cervical, Mackenrodt)= fibromuscular fascia from either side of cervix to the pelvic walls
- Uterosacral ligaments=>from posterior cervix to the sacrum–comprised of the Recto-uterine folds – comprised of fibrous tissue and muscular fibers attached to front of sacrum
- Anterior Pubocervical ligament => from the uterus to the pubic symphysis
- MEMORIZE*
Cardinal ligament= aka ______ ______ ligament
*transverse cervical
Condensations of _____ form Ligaments
fascia
Peritoneal folds associated with the Uterus:
List:
**Broad Ligament, Mesovarium, Mesosalpinx, & Round Ligament
Folds of Peritoneum form Pouches:
-list ex’s
- Note the Urachus and Umbilical folds
- Note Vesicouterine pouch
- Note Rectouterine Pouch (Douglas)
Pouch of Douglas =
–this is a deep pouch, located ______
- *Rectouterine or Rectovaginal Pouch or Space
- **This is a deep pouch posterior to the uterus and anterior to the rectum
Mesovarium= a fold of peritoneum off of the _____
** Broad Ligament
Suspensory Ligament of Ovary= a fold of peritoneum from _______
**superiolateral pelvic wall and contains arteries, veins, lymphatics
Ligament of the Ovary is continuous with the ______. Attached to ______
- *Round Ligament of Uterus.
- lower pole of ovary to Uterus
Describe how a cystocele occurs
-**The Pubocervical Fascia
supports the bladder
-When the Pubocervical Fascia weakens, often 2/2 child birth, then the support of the Bladder weakens and Cystocele (Prolapse) occurs
Urachus=
a hollow canal connecting the fetal urinary bladder to the umbilical cord**
Normally the urachus is obliterated during ______ to become _______
**development to become the Median Umbilical Ligament or Fold
The **Medial Umbilical Ligament is different, this is the obliterated ________
**Umbilical Artery that during fetal development connected to the Internal Iliac Artery
IF the lumen remains open (ie patent urachus (aka urachus stays open) a communication can occur between the urinary bladder and _______, OR a _____ can form
**If the lumen remains open, a communication can occur between the Urinary Bladder and Umbilicus or a Urachal Cyst can form.
