female pelvis Flashcards
1
Q
what passively develops into female organs?
A
paramesonepheric duct (mullerian duct)
2
Q
paramesonepheric ducts develop into? (4)
A
- fallopian tubes
- uterus
- cervix
- upper vagina
3
Q
lower part of vagina develops from the?
A
urogenital sinus
4
Q
Development of the Ovary?
A
Ovaries – dual function
Gonads – contain egg cells (oocytes)
Endocrine glands - produce hormones
- There are several million oocytes in a developing ovary
- By birth 1 million left
- By menarche less than half million left.
5
Q
Neonatal pelvis is examined for three main reasons?
A
- pelvic/abdominal mass
- ambiguous genitalia
- prenatally detected abdominal/ pelvic cyst
6
Q
young girls reason for sono exam?
A
- vaginal bleeding
2. pelvic pain or mass
7
Q
neonate- 6 years old ovarian volume?
A
1.0ml
8
Q
6-11 years ovarian volume?
A
up to 2.5ml
9
Q
after puberty ovarian volume?
A
up to 10ml
10
Q
neonate female pelvis?
A
- endometrium is prominent
- follicles >9mm
11
Q
Ovaries and uterus are larger in a newborn compared to 1-2 yrs old girls T or F?
A
true
12
Q
neonatal uterus fundus/cervix ratio and shape?
A
ratio: 1:2
shape: spade
13
Q
prepubertal uterus fundus/cervix ratio and shape?
A
ratio: 1:1
shape: tubular
14
Q
pubertal uterus fundus/cervix ratio and shape?
A
ratio: 3:1
shape: pear
15
Q
Pathology of Pediatric Pelvis? (5)
A
Uterine malformations Genital tract obstruction Pediatric Pregnancy Ambiguous genitalia PID
16
Q
3 uterine malformations?
A
- arrested development of mullerian ducts
- failure of fusion of millerian ducts
- failure of reasoption of median septum
17
Q
arested development of MD 2 catagories?
A
bilateral: uterine agesnisis/ hypoplasia
unilateral: uterus unicornis unicollis
18
Q
bilateral arrested development?
A
agenesis:
- Mayer-Rokitansky-Kuster-Hauser syndrome
– complete agenesis of uterus and vagina
Hypoplasia:
- symptoms vary by a degree of hypoplasia
19
Q
unilateral arrested development s/s?
A
Uterus unicornis unicollis:
- One mullerian duct fails to develop
- Rudimentary horn may be present
- Poor pregnancy outcomes
20
Q
2 categories of failure of fusion of MD bicornuate uterus?
A
complete
incomplete
21
Q
complete failure of fusion
A
22
Q
complete failure of fusion of MD bicornuate uterus involves?
A
- uterus didelphys
- 2x uterus, cervix, vagina, endometrium
23
Q
incomplete failure of fusion of MD bicornuate uterus involves?
A
- uterus bicornis bicollis
- uterus bicornis unicollis
- uterus arcuatus
24
Q
failure of fusion of MD is associated with?
A
vaginal septa (25%)
25
complete failure of fusion of MD?
Didelphys:
- Two hemiuteri
- No communication with other side
- Each side has tube, ovary, endo, upper vagina
26
incomplete Failure of Fusion of MD?
- U. bicornis bicollis
- U. bicornis unicollis
- Arcuate U.
- Mild indentation of endo at fundus
- Poor pregnancy outcomes.
27
failure of resorption of median septum?
duplication of the uterine cavity without duplication of the horns
1. complete uterus septus
2. incomplete uterus subseptus
28
what is failure of resorption?
- complete fusion of MD
- median septum fails to resorb
- 2 uterine cavities form
- most common malformation of uterus
- poor pregnancy outcomes
- treatment: resection of septum
29
U. unicornis unicollis
30
reasons for genital tract obstruction? (3)
1. imperforate hymen
2. transverse vaginal septum
3. vaginal atresia or stenosis
31
Genital tract obstruction can result in? (6)
```
Hydrocolpos
Hydrometracolpos
Hematocolpos
Hematometracolpos
Pyocolpos
Pyometracolpos
```
32
Hydrocolpos?
- Premenstrual vaginal secretions trapped
SONO:
- large distended anechoic vagina
- Fluid can become infected -pyocolpos (pus)
33
Hydrometrocolpos?
extension of hydrocolpos to uterine cavity
34
Hematometrocolpos?
- After puberty, blood in the endo and vagina
| - If infected -pyometracolpos
35
genital tract obstruction clinical presentation?
Neonates present with an abdominal mass
After puberty - amenorrhea and cyclical pain
36
genital tract obstruction sono?
- Pear-shaped cystic mass arising out of the pelvis containing fluid
- Hydronephrosis due to obstruction from the mass
37
Pediatric Pregnancy?
Must always be considered in the differential diagnosis of a pelvic mass in girls 9 years of age or older
38
pediatric pregnancy increased complications? (5)
```
Toxemia
Preeclampsia
Placental abruption
Cesarean section
Prematurity and perinatal mortality
```
39
definition of Ambiguous Genitalia?
If a child born with a micropenis with no palpable gonads or only one palpable gonad
- one of the main indications for US of neonate
40
Ambiguous Genitalia- role of ultrasound?
- Determine the presence of the uterus
- The presence of the uterus and ovaries will point to a virilized female
- Identify the gonads.
- The presence of testis palpable and seen in the scrotum or lower inguinal canal will rule out virilazation of female infant
- R/o CAH and renal anomalies
41
what is Pelvic Inflammatory Disease ?
infection of the upper genital tract usually caused by gonorrhea or chalmydia
42
Pelvic Inflammatory Disease can result in?
- chronic pelvis pain
- ectopic pregnancy
- infertility
43
whats at higher risk for Pelvic Inflammatory Disease ?
- adolescent females
| - sexually active females presenting with pelvic pain
44
Pelvic Inflammatory Disease infections spreads from?
vagina-cervix-uterus-fallopian tubes-ovaries-peritoneal cavity
45
PID endometritis stage- sono findings?
- Pelvic anatomy appears normal or
- Uterus may be enlarged, more
hyperechoic, small amount of fluid in the endometrial canal
- fallopian tubes (not usually seen) become thick-walled and filled with purulent material
46
PID pyosalpinx sono features?
dilated, occluded tube that contains purulent material
47
PID hydrosalpinx sono features?
dilated tube with anechoic fluid
48
A complication of PID?
gonococcal or chlamydial perihepatitis (localized peritonitis)
49
hematocolpos
50
ambiguous genitalia
51
higher incidence of larger cysts is mother had?
- toxemia
- diabetes
- Rh isoimmunization
52
4 types of cysts?
- follicular
- corpus luteal
- theca lutein
- paraovarian
53
what is a follicular cyst?
clear or serous fluid
54
what is a corpus luteal?
- serous or hemorrhagic fluid
55
theca lutein cyst is caused by?
- GTD or
| - clomiphene/ clomid
56
what is a paraovarian cyst?
- rare
| - in broad ligament or fallopian tubes
57
ovarian cysts: complications?
- torsion
- hemorrage
- rupture
58
ovarian cysts symptoms?
- pain
- tenderness
- N & V
59
what is torsion?
- partial or complete roatation of the ovary on its vascular pedicle
- compromised arterial and venous flow
- hemorrhagic infarction
60
torsion is often caused by?
- ovarian cyst or tumor
| - prepubertal girls can be predisposed (excessive mobility of the adnexa)
61
torsion symptoms?
- acute onset of abdominal pain
- N & V
- leukocytosis
62
torsion on ultasound?
- unilateral ovarian enlargement
- fluid in PCDS
- cyst or tumor
- twisted vascular pedicle
63
absence of flow is a reliable criteria for torsion T or F
False- it is not a reliable source
64
target or whirlpool sign on doppler is associated with?
torsion
| - twisted vascular pedicle
65
ovarian torsion
66
hemorrhagic cyst
67
hemorrhagic cyst on u/s?
- heterogenous mass
- anechoic with hypoechoic material
- increased TT
- thick walls
- septations
- fluid in cul-de-sac
68
PCOD aka?
stein-leventhal syndrome
69
PCOD clinical features?
- hirsutism
- irregular menstrul bleeding
- associated with obesity and diabetes
- high incidence of endoetrial carcinoma
- infertility
70
PCOD on u/s?
- bilateral enlarged rounded ovaries
- ovarian vol.= 14cc
- increased number of developing follicles (0.5-0.8cm)
71
PCOD
72
most ovarian neoplasms occur when?
most occur at puberty
73
ovarian neoplasms usually present with?
- abdominal pain
- abdominal or pelvic mass
- pain from torsion or hemorrhage
- pain from torsion or hemorrhage into tumor
73
ovarian neoplasms usually present with?
- abdominal pain
- abdominal or pelvic mass
- pain from torsion or hemorrhage
- pain from torsion or hemorrhage into tumor
74
ovarian neoplasm with acites?
- ascites is less common than in adults
| - presence of ascites suggests malignancy
75
ovarian neoplasms- role of sonographer?
- site of orgin
- solid/ cystic
- fluid in POD
- ascities
- lymphadenopathy
- mets
76
3 primary ovarian neoplasms?
- germ cell
- epithelial cell
- stromal cell
77
germ cell tumors? (5)
```
Benign teratoma
Dysgerminoma
Embryonal carcinoma
Endodermal sinus tumors
Choriocarcinoma
```
78
epithelial cell tumors? (3)
Serous cystadenoma
mucinous cystadenoma
serious cystadenocarcinoma
mucinous cystadenocarcinoma
79
stromal cell tumors? (3)
Granulosa theca cell tumor
Arrhenoblastoma
Gonadoblastoma
80
Mets (non-primary) ovarian neoplasms?
- leukemia
- lymphoma
- neuroblastoma
- colon cancer
81
germ cell tumors- benign teratoma sono apperance?
- Predominantly cystic with or without mural nodule
- Solid masses
- Complex lesions with fat-fluid or hair-fluid levels
- Calcifications
82
benign teratoma
83
what is Dysgerminoma?
Malignant
Large, solid, encapsulated
Rapidly growing
Hypoechoic areas from hemorrhage, necrosis
84
Embryonal carcinoma, Endodermal sinus tumors, and Choriocarcinoma
Less common
Rapidly growing
Highly malignant
Solid
Spread by direct extension to opposite adnexa and retroperitoneal LNs
Cause peritoneal seedings, mets to liver, lung, bone, mediastinum
85
granulosa theca cell tumor?
- Associated with feminizing effects and precocious puberty (estrogen producing)
- Most are benign
- Solid, non-specific US appearance
86
Arrhenoblastoma may result in?
- rare
| - may result in virilazation
87
gonadoblatoma?
- most are benign
| - composed of gonadal elements (germ, stromal, and sex cord cells)
88
Neoplasms of uterus and vagina?
- Uncommon in children
- If present, more likely malignant
- Vagina is more common site than uterus
89
types of neoplasms of the uterus and vagina?
- rhabdomyosarcoma
- endodermal sinus tumor
- carcinoma of vagina
90
endodermal sinus tumor?
- highly malignant gern cell tumor of vagina
91
what is carcinoma of the vagina from?
- from in utero exposure to DES
92
what is Rhabdomyosarcoma?
- Malignant
- Arise from uterus or vagina
- Most often from anterior wall of vagina near cervix
- May directly extent to bladder
93
clinical presentation of Rhabdomyosarcoma?
- 6-18 months old
- vaginal bleeding
- protrusion of polyploid cluster of masses
94
Rhabdomyosarcoma on u/s?
- solid tumors
- homogenous mass that filled the vaginal cavity
- enlargeent of uterus with irregular contour
95
Rhabdomyosarcoma
96
Endocrine abnormalities with primary amenorrhea? (4)
- Gonadal dysgenesis (m/c form – Turner’s syndrome)
- Chromosomal abnormalities
- Decreased hormonal states
- Testicular feminization
97
Endocrine abnormalities with primary amenorrhea role of sonographer?
- assess uterine size, shape, maturity
| - ovarian development
98
Turner’s syndrome?
- 45, XO karyotype
- Delayed or absent puberty
- Short statue, webbed neck
- Renal and CV problems
99
turner's syndrome on u/s?
- ovaries may not be seen
- streak ovaries
- prepubertal uterus
100
Testicular feminization?
- Sex-linked recessive abnormality
- End-organ insensitivity to androgens
- Phenotypic females with 46,XY karyotype
- Absent uterus and ovaries
- Ectopic testes
101
Endocrine abnormalities: Precocious Puberty?
- Development of secondary sexual characteristics, gonadal enlargement, & ovulation before age 8 yrs
102
Endocrine abnormalities: Precocious Puberty clinical presentation?
- Uterus enlarged with postpubertal shape
- fundus/cx ratio - 2:1 to 3:1
- Prominent endometrium
- Ovarian volume > 1cc, with functional cysts
103
percocious puberty- central type?
- true precocious puberty
- gonadotropin dependent
- increases FSH, LH, and estrogen
104
causes of percocious puberty- central type?
- idiopathic
| - intracranial tumor
105
percocious puberty- peripheral type?
- pseudoprecocious puberty
- gonadotropin independent
- increased estrogen
- decreased FSH, LH
106
causes of percocious puberty- peripheral type?
Ovarian tumor
Granulosa techa cell tumor
Dysgerminoma
Choriocarcinoma
