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RRPA Anatomy II > GUT Women's Health Anatomy & Radiology Part 2 (& Commentary) > Flashcards

GUT Women's Health Anatomy & Radiology Part 2 (& Commentary) Flashcards

1
Q

Know the structures on the slide

A
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2
Q

What is a a hysterosalpingogram and what is it used for?

A
  • Injection of radiographic contrast goes into the cervical os to see the uterine cavity and if the fallopian tubes are open (normally open to the peritoneal cavity)
  • For fertility studies
  • Open uterine cavity means a chance for successful implantation of fertilized egg
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3
Q

Abnormalitites of the tubes and uterus can cause infertility such as?

A
  • scarring in the uterus
  • masses in the uterus
  • scarring in the tubes 2/2 PID
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4
Q

Does VUR cause renal damage?

A

Not necessarily!

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5
Q

What is primary VUR?

A
  • Genetic predisposition to short ureteral tunnel through the bladder
  • Small chance of renal damage from VUR
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6
Q

What is secondary VUR?

A
  • To the bladder and/or urethral dysfunction ie: neurogenic bladder or posterior urethral valves
  • Have the most problems and have increased chance of renal damage
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7
Q

If there is no stasis of urine in the GUT does VUR predispose a patient to UTIs?

A

NO - VUR does not predispose if there is no stasis of urine

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8
Q

What is required if a Hydronephrosis is found on prenatal US?

A

Requires a f/u evaluation after birth to determine etiology

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9
Q

What percentage of children <5 y/o with UTI’s have VUR?

A

30-40%

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10
Q

What conditions increase the chance of renal scarring?

A
  • Febrile UTIs
  • VUR plus UTIs
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11
Q

T/F: Surgery to reimplant ureters and/or prophylactic ABX do not necessarily prevent UTIs and/or renal damage

A

True

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12
Q

Greater grade of reflux is associated with ___ chance of renal damage

A

increased

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13
Q

What is the bottom Line of VUR and UTIs?

A

They require individual evaluation and tx as these are complex entities with still evolving knowledge of their associations

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14
Q

Grading of VUR

A
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15
Q

What should a workup of VUR include? What are you evaluating?

A
  • VCUG or Isotope Cystogram and a Radionuclide DMSA Renogram
  • Evaluating renal parnchyma and presence of reflux
  • In utero US evaluation is important to ID prenatally the presence of hydronephrosis and/or kidney size
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16
Q

What are the 2 causes/types of Vesicoureteral Reflux?

A
  1. Due to immaturity with a short ureteral tunnel in the bladder
  2. Due to a congenital anomaly at the UV junction
    1. no tunnel, adjacent bladder diverticulum, or displaced orifice
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17
Q

What happens in VUR if reflux is present with a UTI and the cause is a short ureteral tunnel?

A
  • Pyelonephritis and renal damage can result
  • An immature short tunnel usually resolves with age
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18
Q

What happens in VUR if reflux is present with a UTI and the cause is a congenital anomaly at the UV junction?

A

Same thing as a short ureteral tunnel - pyelonephritis and renal damage can result

*If reflux of any etiology is present with a UTI, pyelonephritis & renal damage can occur

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19
Q

Posterior Urethral Valves or a Neurogenic Dysfunctional Bladder does not necessarily occur if the ureteral tunnel is ___?

A

normal

*if the tunnel is abnormal, reflux occurs

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20
Q

When prenatal fetal hydronephosis occurs or the patient has documented pyelonephritis, VCUG or Radionuclide Cystogram, is indicated to determine what?

A
  • If underlying anatomic or functional abnormalities are present
  • If so, depending on findings, treat
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21
Q

In Hydronephrosis what will you see on VCUG or Cystomgram secondary to ureteral obstruction?

A

Dilated urinary collecting systems, calyces, infundibula, renal pelvis, ureters

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22
Q

High pressure in the urinary collecting system 2/2 to obstruction can cause?

A

rupture of the collecting system

*this is not a concern & spontaneously resolves

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23
Q

Bladder stone (bladder calculi) 2/2 to bladder urinary stasis and contributes to ___?

A

infection

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24
Q

What defects in the ureter and bladder indicate malignancy?

A

Filling defects

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25
Q

What is the key clinical finding in urinary tract transitional cell malignancy?

A

Painless hematuria!

*renal cell CA can cause hematuria as well

26
Q

In what disease does a patient have enlarged ovaries with thick sclerotic capsules and an abnormally high number of follicles?

A

Polycystic Ovary Disease (PCOD)/ Stein-Leventhal Syndrome (PCOS)

27
Q

What sx will you see in patients with Stein-Leventhal Syndrome?

A
  • ammenorrhea
  • infertility
  • hirsutism
  • enlarged polycystic ovaries
28
Q

What would you expect to see on US in a PCOD patient?

A

Increased central stroma with multiple small subcapsular follicles

29
Q

What is on your DDx for Pelvic or Low Abdominal Pain in a female patient?

A
  • PID/Tubo-ovarian abscess
  • Ovarian torsion
  • Ectopic pregnancy
  • Appendicitis
  • Ruptured ovarian cyst
  • Diverticulitis
  • Endometriosis
  • Dysmenorrhea
30
Q

If you note a blue ovary 2/2 to obstruction of veins and/or arteries in the ovary and the Doppler US shows no blood flow to the ovary what Dx are you thinking of?

A

Ovarian torsion

31
Q

If a patient’s bHCG level is >1000 IU/mL (2IS Standard) or >2000 IU/mL (IRP Standard) what should be identifiable on a Transvaginal Sonogram?

A

intrauterine gestational sac

32
Q

An intrauterine gestational sac should be present by how many weeks?

A

5 wks

33
Q

An intrauterine gestational sac should show embryonic cardiac activity by 5+ weeks on a transvaginal when the sac is at least 16mm long or?

A

embryonic crown rump length is at least 5mm

34
Q

What are the criteria for an Ectopic Pregnancy?

A
  • 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 (blood in fallopian)
35
Q

T/F: PID can be anything from a mild inflammation to an extensive abscess within the tubes and ovaries (tuboovarian abscess)

A

True!

*may see fluid collections and pus on CT and US

36
Q

Why can there sometimes be both benign or malignant tumors including hair, teeth, fat, etc. in dermoid cysts of the ovary?

A

Because the ovary contains plenipotential cells (can develop into any type of organ)

37
Q

What type of ovarian tumor can be very large and is benign?

A

Cystadenoma

38
Q

Carcinoma of the ovary is a malginant tumor and on US could show?

A
  • complex cyst
  • thick walls
  • mixed mass and cystic changes
39
Q

Sister Mary Joseph Sign can be a sign of what type of tumor in females?

A

Carcinoma of the ovary

40
Q

Endometrial tissue is the tissue within the uterine cavity that develops during the ___ ___

A

Menstrual cycle

41
Q

In Endometriosis/Endometrioma, endometrial tissue can sometimes be located where?

A
  • Outside of the uterus
  • In the adnexa
  • Even on bowel

*responds to menstrual cycle and can be very painful

42
Q

What are uterine Leiomyomata/Fibroids?

A
  • Smooth muscle benign tumor
  • Very common - esp. in older pts
  • Can be painful, bleed
  • Can lead to infertility
43
Q

What is uterine adenomyosis?

A
  • endometrial tissue within the myometrium
  • similar but different than Endometriosis
44
Q

What are some sx of uterine adenomyosis?

A
  • Can be painful
  • Cramping
  • Uterine bleeding
  • Dyspareunia (painful intercourse)
  • Infertility

*Note thickening myometrium

45
Q

Painless, post-menopausal bleeding should be evaluated because?

A

It could be endometrial carcinoma!

46
Q

Risk factors for Endometrial Carcinoma

A
  • Obesity, DM
  • BRCA
  • Tamoxifen
  • Nulliparity
  • Inc age
  • Inc levels of estrogen
  • FHx, genetics
  • PCOS
47
Q

Risk factors and causes of Carcinoma of the Cervix (uterine neck)

A
  • Squamous carcinoma
  • HPV (90%)
  • Oral contraceptives
  • Multiple pregnancies
48
Q

Carcinoma of the Cervix can obstruct what structure and lead to a renal death?

A

ureters

49
Q

What is the supporting structure of the ovary that is a fold of peritoneum off of the Broad Ligament?

A

Mesovarium

50
Q

What supporting structure of the ovary is a fold of peritoneum from the superiolateral pelvic wall and contains arteries, veins, and lymphatics?

A

Suspensory Ligament of Ovary

51
Q

What supporting structure of the ovary is continuous with the Round Ligament of the uterus and attaches to the lower pole of the ovary?

A

Ligament of Ovary

52
Q

Weakness of the bladder supporting structures causes the posterior portion of the bladder to drop down forming a ___

A

Cystocele

53
Q

What fascia supports the bladder? What happens when this fascia weakens?

A
  • Pubocervical Fascia
  • When weakened, often 2/2 to childbirth, the support of the bladder weakens and a Cystocele (Prolapse) occurs
54
Q

When the support structures of the uterus and vagina weaken, the vagina and/or uterus can?

A

Prolapse (drop) out

*this can also occur when the rectal support structures weaken (rectocele)

55
Q

What are the 3 Levels of the Pelvic Support Structures?

A

Level 1: Cardinal, Uterosacral, and Anterior Pubocervical ligaments

Level 2: Levator ani and Arcus tendinous fasciae

Level 3: Urogenital diaphragm

56
Q

A Cystocele can manifest with stress incontinence and on PE you can feel a bulge in the ___ vaginal wall accentuated when the patient coughs

A

anterior

57
Q

What structure is a hollow canal connecting the fetal urinary bladder to the umbilical cord?

A

Urachus

58
Q

Normally the Urachus obliterates during development to become what?

A

The Median Umbilical Ligament or Fold

59
Q

What ligament is the obliterated Umbilical Artery that during fetal development connected to the Internal Iliac Artery?

A

Medial Umbilical Ligament

60
Q

If the lumen of the Urachus remains open, a communicatin can occur between the Urinary Bladder and ___

A
  • Umbilicus
  • Or a Urachal Cyst can form

RRPA Anatomy II (9 decks)

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