Female Pelvis Flashcards
Clinical history protocol of imaging the female pelvis
- symptoms
- LMP (1st day of reproductive age)
- gravida/parity (if beyond puberty)
- surgeries (on UT or OV)
- previous imaging
If the patient is 50-65 years old, what should you ask when it comes to LMP?
Ask if they still get periods
If the patient is 17+ years old, what should you ask when it comes to gravida/parity?
ask if they have ever been told they are pregnant (b/c miscarriages count)
How should you ask the patient about past pregnancies?
“Counting this pregnancy, how many times have you been told you are pregnant and how many times have you delivered?”
What effects uterine size?
age & parity
Other than the date, what else do we need to know about LMP?
if they are normal
menarche
- first menstrual period
- pre-/post-
menopause
- end of menstrual periods
- peri-/post-
amennorhea
- w/o periods
- primary = never had a period
- secondary = had periods & they stopped (ex. pregnancy)
dysmennorhea
- difficult period
- pain, duration, bleeding
menorrhagia
heavy/excessive periods
menometrorrhagia
- heavy bleeding w/ & w/o period
- bleeding in btwn. periods
oligomenorrhea
- too few of periods
- longer cycles
Gravida
- G = actual pregnancies
- twins = 1 pregnancy
Parity
- P = actual deliveries beyond 20 weeks
- twins = 2 deliveries
G_TPAL
- Gravida, term, preterm, abortus, living children
- ex. G3 P1112
Parity types
- T = term deliveries (>36 weeks)
- P = preterm deliveries (<36 weeks)
- A abortions (spontaneous/elective/ectopic)
- L = living children (twins reflected)
Key terms for G & P
- multi-/Nulli-/Primiparous-Gravid
- nulli = none
- primi = 1
Patient pain
- acute vs. chronic
- pattern
Patient bleeding
cyclic vs. intermittent
Other reasons for exam
- F/U
- new symptoms
- MD concern
- labs
- medications (hormones, OCP’s)
Other pertinent clinical history
- possibly pregnant? (ask before scan only)
- previous conditions (esp. before surgeries)
- degree or severity of pain/bleeding
- did pt fill bladder before exam?
Patient education do’s
- ask questions carefully
- maintain pt modesty
- ask for permission to perform TV exam
- have a sonographer present for TV exam
Patient education don’ts
- making suggestions may create pt’s condition
- ask about pregnancy after starting exam
- refer to ‘probe’ when discussing TV exam
Lab values for female pelvis
- Gonadotropic hormones
- estrogen & progesterone
- non-gravid uterus
Gonadotropic hormones
- FSH/LH
- hCG (Human Chorionic Gonadotropin)
FSH/LH lab values
- controlled by GnRH (releasing hormone from the hypothalamus)
- levels may be monitored in suspected cases of infertility
hCG (Human Chorionic Gonadotropin) lab values
- qualitative = is pt pregnant?
- quantitative = how pregnant is the pt?
- values double every 48-72 hours
How can quantitative hCG be determined?
- rise proportionately in first 8 weeks of pregnancy
- correlate w/ sonographic appearance of UT/gestational sac
- only determined through blood sample
What could be happening if hCG values are not increasing enough, staying the same, or decreasing?
pregnancy may not be viable
Estrogen & progesterone lab values
may be monitored for infertility purposes
Non-gravid uterus lab values
- WBC (white blood cell count) - increases w/ infection (PID - pelvic inflammatory disease)
- vaginal/cervical/endometrial (ex. smears, biopsies, cultures, malignancies, STD’s)
Correlation
the process of establishing a relationship or connection btwn. 2 or more measures
Assessing the patient’s age/LMP/G/P
- look at size of UT
- appearance of UT/OV
When considering the type of pain the patient is experiencing, what should we be prepared to see?
pathology
If the patient is asymptomatic for an abnormality detected by the physician, do we still need to focus on it during the exam?
yes
What is the goal of hormonal medications?
- return a postmenopausal patient to near normal appearance
- OCP’s suppress normal cycle
Labs correlation
- detect infectious processes (in any pelvic structure)
- detect pregnancy
Why is it important for us to ask the patient about previous surgeries on UT/OV?
we don’t want to look for something that isn’t there
If the pelvic ultrasound is normal, what else could cause the symptoms?
- GI
- GU
- Vascular
- Musculoskeletal
