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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
What are cervical cancer risk factors? 8
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
26
What are sonographic findings of cervical cancer? 8
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
27
Incompetent cervix may cause what?
Preterm labor or delivery
28
In terms of incompetent cervix, cervical effacement happens when? (In pregnancy)
2nd or early 3rd trimester
29
What are causes of incompetent cervix? 3
1. Trauma 2. DES - t shaped uterus 3. Idiopathic
30
What is the best way to assess incompetent cervix?
Translabial or transvaginal
31
What are some examples of Adenexal pathology? 2
1. Endometriosis 2. Pelvic inflammatory disease (PID) both acute and chronic
32
What is endometriosis?
Growth of endometrial tissue outside uterine cavity
33
What are the two types of endometriosis?
1. Internal (Adenomyosis) 2. External (Endometriosis)
34
Where does endometriosis occur? 4 (organs and locations)
1. Ovaries 2. Fallopian tubes 3. Broad ligament 4. Pouch of Douglas
35
Endometriosis only occurs in which age group?
Reproductive
36
What kind of transmission does endometriosis have?
Retrograde tubal transmission
37
Endometriosis can cause what?
Adhesions
38
Endometriosis are usually only diagnosed by what?
Laparoscopy
39
What are some symptoms of endometriosis? 7
1. Dysmenorrhea 2. Dyspareunia 3. Infertility 4. Menorrhagia 5. Painful urination, defecation 6. Chronic pelvic pain 7. May have palpable mass (endometrioma)
40
How easy is it to DX endometriosis on u/s?
Difficult
41
What are some things to look for during endometriosis? 3
1. Negative sliding sign 2. Kissing ovaries 3. Endometrioma
42
Why does endometriosis only affecting reproductive age group?
Because it is at this time that the endometrium is affected by hormones
43
What is negative sliding sign? 2
1. With pressure, sliding of the uterus not observed 2. Ovaries do not move with pressure
44
What is kissing ovaries?
Ovaries touching each other in the posterior cul de sac
45
How does endometrioma present? 4
1. Well defined 2. Predominately cystic ovarian mass 3. Low level echoes 4. May see fluid- fluid levels
46
What is another name for endometrioma?
Chocolate cyst
47
What is the DDX for endometrioma? 3
1. Hemorrhagic ovarian cysts 2. Ovarian cysts Adenoma 3. Turbo-ovarian abscess
48
What are treatment options for endometriosis? 3
1. Drug 2. Hysterectomy and oophorectomy 3. Laser surgery
49
What is pelvic inflammatory disease?
Infection of the female genital tract
50
What are the causes of Pelvic inflammatory disease? 2
1. STI 2. Pyogenic
51
What are 4 causes of pyogenic?
1. IUCD 2. Surgery 3. Postpartum 4. Crohn’s disease
52
How many stages of Pelvic inflammatory disease?
Three
53
What are the three symptom stages of pelvic inflammatory disease?
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
What is two things we see with fitzhugh Curtis syndrome? (S/S)
1. Perihepatitis - inflammation of the liver capsule 2. Small abscesses on liver capsule - may lead to adhesions
55
Where/how do we feel pain in fitzhugh Curtis syndrome? 2
1. On inspiration 2. RUQ pain
56
Fitzhugh Curtis syndrome may increase what?
Liver enzymes
57
How many patients with fitzhugh Curtis syndrome have PID?
5-10 have PID
58
What is scalpingitis?
Walls become thickened and edomatous
59
During salpingitis, if the tubes block what happens?
Pyosalpinx occurs
60
Once salpingitis is treated what happens to the affected material?
Infected material is reabsorbed and the chronic result is hydrosalpinx
61
What are the three stages of PID?
1. Endometritis 2. Pyosalpinx 3. TOA
62
How many stages of acute PID?
3
63
How does endometritis during acute PID look like? 4
1. Thick endometrium 2. Fluid in endometrial canal 3. Or normal endometrial canal 4. Difficult to DX on US
64
What does pyosalpinx look like with acute PID sonographically? 2
1. Hypoechoic S shaped fallopian tubes with low level echoes 2. Fallopian tube walls are smooth
65
What does TOA look like with acute PID? 3
1. Multiocular mass 2. Irregularly boarders 3. Fluid- fluid levels within mass, make sure the cystic loops do not move (bowel with peristalsis
66
What does chronic PID look like sonographically? 2
1. Distended S shaped tubes 2. Thin walls
67
What is the DDX for chronic PID?
Difficult to differentiate from ovarian cysts or small cystadenomas
68
What is the PID treatment method? 2
1. Heavy doses of antibiotics 2. Abscess drainage or salpingectomy
69
What is fallopian tube carcinoma?
Serous intraepithelial tubal carcinoma
70
What is fallopian tube carcinoma usually referred to as?
STIC
71
In terms of fallopian tube carcinomas, it is thought that many ovarian cancers begin where?
The fimbriae of the fallopian tubes
72
Most fallopian tube caricinomas are what type?
Adenocarcinomas
73
Minority of fallopian tube carcinomas are what?
Endometriosis and clear cell adenocarcinoma
74
What does tubal carcinoma look like sonographically? 5
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
Ambiguous genitalia is seen in how many cases of babies?
1 in 50,0000
76
Isolated occurrences of intersex occurs in how many?
1 in 1000 but more commonly associated with other anomalies
77
What is the sonographic evaluation of hermaphroditism/ intersex? 3
1. Assess retroperitoneum and labia for gonads 2. Assess pelvis for Müllerian structures 3. Assess adrenal garlands and kidneys to exclude associated anomalies
78
What is a true hemaphrodite?
Possessing both male and female sex trait
79
What is a pseudohermaphrodite?
Possessing chromosomes of one sex but develop sex traits of the opposite sex
80
For hermaphroditism/ intersex what studies are run parallel to u/s? 2
Hormonal and chromosomal
81
What is a male pseudo hermaphrodite?
46XY, genetically male (testes) but have female characteristics (breasts, lack facial hair, and have underdeveloped external genitalia). May lack androgens
82
What is a female pseudo hermaphoraodite 46XX
Genetically female (ovaries) but have male characteristics (penis, scrotum, hirsuitism). May be due to excessive androgens or congenital adrenal hyperplasia (CAH)
83
What do we do with sonography with pelvic masses? 5
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
What do we evaluate with sonography with pelvic masses? 5
1. Size 2. Echogenicity 3. Contour of the masses 4. Vasculature 5. Consistency
85
Remember to look beyond the pelvis if pathology is seen, what do we look at? 4
1. Kidneys for obstruction 2. Liver for metastatic disease 3. Lymphadenopathy 4. Free fluid/ ascites
86
What is this image represent?
Hematometra
87
What does this image represent?
Hematocolpos
88
What does this demonstrate?
Gartner's duct cyst
89
What does this image demonstrate?
Nabolthian cysts
90
What does this image demonstrate?
Carcinoma of the cervix
91
What does this image demonstrate?
Kissing ovaries
92
What does this image demonstrate?
Endometritis or pyometritis
93
What does this image demonstrate?
Stage 2 pyosalpinx
94
What does this image demonstrate?
Tubo ovarian abscess
95
What does this image demonstrate?
Chronic PID on sonography
96

DMST 315 OBGYN 3 (21 decks)

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