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DMST 315 OBGYN 3 > Extra Pelvic Pathology > Flashcards

Extra Pelvic Pathology Flashcards

1
Q

What is the hymen?

A

A septum that remains in the lumen of the vagina between urogenital sinus and upper vagina

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2
Q

Imperforate hymen occurs if what? What does it cause?

A

If the hymen does not rupture causing hydrocolpos or hematocolpos

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3
Q

Vaginal septum, congenital or acquired obstructive lesions can also cause what? 2

A
  1. Hydrocolpos
  2. Hematocolpos
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4
Q

What is hydrocolpos? 2

A
  1. Fluid in the vagina
  2. Retention of vaginal secretions
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5
Q

What is hydrometrocolpos?

A

Secretions in uterus and vagina

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6
Q

When can hydrocolpos and hydrometropcolpos take place?

A

Before menarche or after menopause

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7
Q

What is hematocolpos?

A

Blood trapped in the vagina

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8
Q

Hematometra is what?

A

Retention of blood in uterus

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9
Q

What is hematometrocolpos?

A

Blood in uterus and vagina

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10
Q

When does hematocolpos, hematometra, hematometrocolps occur?

A

After menarche, or before menopause

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11
Q

How do we spot hematocolpos sonographically? 3

A
  1. identify the level of obstruction
  2. Evaluate the echogenicity
  3. Look for fluid fluid levels
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12
Q

What are gartner’s duct cysts?

A

Cysts along the vagina

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13
Q

What is the gartner’s duct cysts a remnant of?

A

Mesonephric duct

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14
Q

How many gartner’s duct cysts can someone have?

A

Single or multiple

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15
Q

Gartner’s duct cysts are usually in which walls?

A

Lateral or anterolateral walls

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16
Q

How are gartner’s duct cysts found?

A

Incidentally

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17
Q

Are gartner’s ducts asymptomatic or symptomatic?

A

Asymptomatic

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18
Q

Are vaginal carcinomas used for diagnosis?

A

No

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19
Q

What is sonography used for in terms of vaginal carcinoma? 2

A
  1. Used to help stage
  2. Used to assess pelvic spread or distal metastasis
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20
Q

What are nabothian cysts in the cervix? 2

A
  1. Retention cysts
  2. Entrapped cervical secretions
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21
Q

How common is nabothian cysts?

A

Common

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22
Q

How many nabothian cysts do we have at one time?

A

Multiple

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23
Q

How do we diagnose carcinoma in the cervix?

A

PAP smear

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24
Q

Carcinoma of the cervix may cause what?

A

obstruction

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25
Q

What are cervical cancer risk factors? 8

A
  1. Infection by HPV
  2. Early sexual activity
  3. Multiple sexual partners
  4. Low socioeconomic status
  5. Smoking
  6. Use of Oral contraceptives
  7. Weakened immune system
  8. DES in utero
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26
Q

What are sonographic findings of cervical cancer? 8

A
  1. Hematometra from cervical stenosis
  2. Multiple cystic areas within a solid cervical mass
  3. Bulky cervix
  4. Irregular cervical boarders
  5. Mass extending from cervix to pelvic sidewall
  6. Tumor invasion of the bladder
  7. Hydronephrosis
  8. Liver Mets and para- aortic nodes
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27
Q

Incompetent cervix may cause what?

A

Preterm labor or delivery

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28
Q

In terms of incompetent cervix, cervical effacement happens when?

A

2nd or early 3rd trimester

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29
Q

What are causes of incompetent cervix? 3

A
  1. Trauma
  2. DES - t shaped uterus
  3. Idiopathic
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30
Q

What is the best way to assess incompetent cervix?

A

Translabial or transvaginal

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31
Q

What are some examples of Adenexal pathology? 2

A
  1. Endometriosis
  2. Pelvic inflammatory disease (PID) both acute and chronic
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32
Q

What is endometriosis?

A

Growth of endometrial tissue outside uterine cavity

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33
Q

What are the two types of endometriosis?

A
  1. Internal (Adenomyosis)
  2. External (Endometriosis)
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34
Q

Where does endometriosis occur? 4

A
  1. Ovaries
  2. Fallopian tubes
  3. Broad ligament
  4. Pouch of Douglas
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35
Q

Endometriosis only occurs in which age group?

A

Reproductive

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36
Q

What kind of transmission does endometriosis have?

A

Retrograde tubal transmission

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37
Q

Endometriosis can cause what?

A

Adhesions

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38
Q

Endometriosis are usually only diagnosed by what?

A

Laparoscopy

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39
Q

What are some symptoms of endometriosis? 7

A
  1. Dysmenorrhea
  2. Dyspareunia
  3. Infertility
  4. Menorrhagia
  5. Painful urination, defecation
  6. Chronic pelvic pain
  7. May have palpable mass (endometrioma)
40
Q

How easy is it to DX endometriosis on u/s?

A

Difficult

41
Q

What are some things to look for during endometriosis? 3

A
  1. Negative sliding sign
  2. Kissing ovaries
  3. Endometrioma
42
Q

Why does endometriosis only affecting reproductive age group?

A

Because it is at this time that the endometrium is affected by hormones

43
Q

What is negative sliding sign? 2

A
  1. With pressure, sliding of the uterus not observed
  2. Ovaries do not move with pressure
44
Q

What is kissing ovaries?

A

Ovaries touching each other in the posterior cul de sac

45
Q

How does endometrioma present? 4

A
  1. Well defined
  2. Predominately cystic ovarian mass
  3. Low level echoes
  4. May see fluid- fluid levels
46
Q

What is another name for endometrioma?

A

Chocolate cyst

47
Q

What is the DDX for endometrioma? 3

A
  1. Hemorrhagic ovarian cysts
  2. Ovarian cysts Adenoma
  3. Turbo-ovarian abscess
48
Q

What are treatment options for endometriosis? 3

A
  1. Drug
  2. Hysterectomy and oophorectomy
  3. Laser surgery
49
Q

What is pelvic inflammatory disease?

A

Infection of the female genital tract

50
Q

What are the causes of Pelvic inflammatory disease? 2

A
  1. STI
  2. Pyogenic
51
Q

What are 4 causes of pyogenic?

A
  1. IUCD
  2. Surgery
  3. Postpartum
  4. Crohn’s disease
52
Q

How many stages of Pelvic inflammatory disease?

A

Three

53
Q

What are the three symptom stages of pelvic inflammatory disease?

A
  1. Asymptomatic or vaginal discharge and tenderness (endometritis)
  2. Febrile, acute pelvic pain, abnormal vaginal bleeding. may develop hydrosalpinx
  3. TOA stage - acute ABD pain, increased WBC ma even develop fitzhugh Curtis syndrome
54
Q

What is fitzhugh Curtis syndrome 2

A
  1. Perihepatitis - inflammation of the liver capsule
  2. Small abscesses on liver capsule - may lead to adhesions
55
Q

Where do we feel pain in fitzhugh Curtis syndrome? 2

A
  1. On inspiration
  2. RUQ pain
56
Q

Fitzhugh Curtis syndrome may increase what?

A

Liver enzymes

57
Q

How many patients with fitzhugh Curtis syndrome have PID?

A

5-10 have PID

58
Q

What is scalpingitis?

A

Walls become thickened and edomatous

59
Q

During salpingitis, if the tubes block what happens?

A

Pyosalpinx occurs

60
Q

Once salpingitis is treated what happens?

A

Infected material is reabsorbed and the chronic result is hydrosalpinx

61
Q

What are the three stages of PID?

A
  1. Endometritis
  2. Pyosalpinx
  3. TOA
62
Q

How many stages of acute PID?

A

3

63
Q

How does endometritis during acute PID look like? 4

A
  1. Thick endometrium
  2. Fluid in endometrial canal
  3. Or normal endometrial canal
  4. Difficult to DX on US
64
Q

What does pyosalpinx look like with acute PID sonographically? 2

A
  1. Hypoechoic S shaped fallopian tubes with low level echoes
  2. Fallopian tube walls are smooth
65
Q

What does TOA look like with acute PID? 3

A
  1. Multiocular mass
  2. Irregularly boarders
  3. Fluid- fluid levels within mass, make sure the cystic loops do not move (bowel with peristalsis
66
Q

What does chronic PID look like sonographically? 2

A
  1. Distended S shaped tubes
  2. Thin walls
67
Q

What is the DDX for chronic PID?

A

Difficult to differentiate from ovarian cysts or small cystadenomas

68
Q

What is the PID treatment method? 2

A
  1. Heavy doses of antibiotics
  2. Abscess drainage or salpingectomy
69
Q

What is fallopian tube carcinoma?

A

Serous intraepithelial tubal carcinoma

70
Q

What is fallopian tube carcinoma usually referred to as?

A

STIC

71
Q

In terms of fallopian tube carcinomas, it is thought that many ovarian cancers begin where?

A

The fimbriae of the fallopian tubes

72
Q

Most fallopian tube caricinomas are what type?

A

Adenocarcinomas

73
Q

Minority of fallopian tube carcinomas are what?

A

Endometriosis and clear cell adenocarcinoma

74
Q

What does tubal carcinoma look like sonographically? 5

A
  1. Very similar to ovarian cancer
  2. Complex, large solid mass with cystic components
  3. Highly vascular
  4. Sausage shaped
  5. Most cases ovary is not seen separately
75
Q

Ambiguous genitalia is seen in how many cases of babies?

A

1 in 50,0000

76
Q

Isolated occurrences of intersex occurs in how many?

A

1 in 1000 but more commonly associated with other anomalies

77
Q

What is the sonographic evaluation of hermaphroditism/ intersex? 3

A
  1. Assess retroperitoneum and labia for gonads
  2. Assess pelvis for Müllerian structures
  3. Assess adrenal garlands and kidneys to exclude associated anomalies
78
Q

What is a true hemaphrodite?

A

Possessing both male and female sex trait

79
Q

What is a pseudohermaphrodite?

A

Possessing chromosomes of one sex but develop sex traits of the opposite sex

80
Q

For hermaphroditism/ intersex what studies are run parallel to u/s? 2

A

Hormonal and chromosomal

81
Q

What is a male pseudo hermaphrodite?

A

46XY, genetically male (testes) but have female characteristics (breasts, lack facial hair, and have underdeveloped external genitalia). May lack androgens

82
Q

What is a female pseudo hermaphoraodite 46XX

A

Genetically female (ovaries) but have male characteristics (penis, scrotum, hirsuitism). May be due to excessive androgens or congenital adrenal hyperplasia (CAH)

83
Q

What do we do with sonography with pelvic masses? 5

A
  1. Confirm the presence of a mass
  2. Determine where the mass is originating from
  3. Evaluate
  4. Demonstrate the involvement of other organs
  5. Document if ascites or other metastatic lesions are present
84
Q

What do we evaluate with sonography with pelvic masses? 5

A
  1. Size
  2. Echogenicity
  3. Contour of the masses
  4. Vasculature
  5. Consistency
85
Q

Remember to look beyond the pelvis if pathology is seen, what do we look at? 4

A
  1. Kidneys for obstruction
  2. Liver for metastatic disease
  3. Lymphadenopathy
  4. Free fluid/ ascites
86
Q

What is this image represent?

A

Hematometra

87
Q

What does this image represent?

A

Hematocolpos

88
Q

What does this demonstrate?

A

Gartner’s duct cyst

89
Q

What does this image demonstrate?

A

Nabolthian cysts

90
Q

What does this image demonstrate?

A

Carcinoma of the cervix

91
Q

What does this image demonstrate?

A

Kissing ovaries

92
Q

What does this image demonstrate?

A

Endometritis or pyometritis

93
Q

What does this image demonstrate?

A

Stage 2 pyosalpinx

94
Q

What does this image demonstrate?

A

Tubo ovarian abscess

95
Q

What does this image demonstrate?

A

Chronic PID on sonography

96
Q
A

DMST 315 OBGYN 3 (21 decks)

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