GYN Flashcards
ovarian ligament
extends from cornua of the uterus to the medial aspect of the ovary
round ligament
arises in the cornua of the uterus and extends to the pelvic sidewalls
what forms the posterior boundary of the false pelvis?
iliac bones and base of sacrum
functional layer of the endo-
is the echogenic inner lining of the endo- that sheds during menses
(only this layer is included in measurement)
basal layer of endo-
the hypoechoic fluid layer within endo- (NOT included in endo measurement)
asherman syndrome
intrauterine adhesions ablating the endometrial lining caused by previous endo- infection or D&C
cystic teratoma
dermoid tumor of the ovary; typically found superior to the UT fundus; arises from the wall of a follicle; may contain fat, hair, skin, and teeth
leimyoma
uterine fibroid; most common uterine mass; intramural (most common location), submucosal (causes bleeding), and subserosal
serous cystadenoma
epithelial neoplasm; 2nd most common benign tumor of the ovary; typically contains septations
adenomyosis
benign invasive growth of endometrium into the myometrium;
RISK FACTORS: multiparity, elevated estrogen levels, and D&C
stromal tumors
Fibroma (rare)
Thecoma (produces estrogen)
dysgerminoma
malignant germ cell neoplasm; most common ovarian malignancy in childhood
Related to: precocious puberty, pelvic pain, assoc, with AFP and hCG levels
endometrium measurements with the phases
secretory phase: 7-14 mm
late proliferatory phase: 6-10 mm
early menstrual phase: 4-8 mm
graafian follicles
mature follicle that secretes estrogen
corpus luteum
yellow body formed from the graafian follicle after ovulation
produces estrogen and progesterone
menopause hormone levels
follicular stimulating hormone is slightly elevated, progesterone and estrogen is decreased
ovarian follicular phase coincides with what phase of the endo?
proliferation phase
failure of the mullerian ducts to develop
results in uterine agenesis
hematometra
an abnormal accumulation of blood in the endometrial cavity in a premenarche pt.
what is a dysgerminoma
most common ovarian malignancy in childhood and is a possible cause for precocious puberty
symptoms of adenomyosis
uterine tenderness (esp. during menstruation), pelvic pain, menorrhagia, dysmenorrhea, uterine enlargement, and cramping
intramural
myometrial location
most common site for fibroids
submucosal
endometrial location
least common site for fibroids
most likely location to cause symptoms
uterine arteries arise from
hypogastric arteries
uterine corpus
the upper muscular portion of the UT
cervix to corpus ratio during postmenopause
1:1 (equal in size)
what do the ovaries attach to
mesovarian portion of the broad ligament
ovarian volume
lowest during the luteal phase
highest during the periovulatory phase
blood supply to endometrium
spiral arteries (which arise from the radial arteries, that branch off of arcuate arteries)
uterosacral ligaments
extend from the superior cervix to the lateral margins of the sacrum
round ligaments
arise in the uterine cornua, extending from the fundus to the pelvic sidewall
junctional zone
the innermost layer of the myometrium
estradiol
reflects the activity of the ovaries
steadily rise during pregnancy
important when monitoring ovulation induction therapy
luteinizing hormone
secreted by the anterior pituitary gland to stimulate ovulation
helps form the corpus luteum
cumulus oophorus
“daughter cyst”
a hyperechoic focus within a mature follicle
ovulation generally will occure within the next 36 hrs after visualiztion of the cumulus oophorus
hypothalamus
produces luteinizing hormone releasing factor
theca lutein cysts
results from increased levels of hCG
occur in pts with hyperstimulation, or pregnancy
hormone dependent
secretory phase
demonstrates the greatest endometrial thickness (fluid-filled endo-)
ovarian luteal phase coincides with what endometrial phase
secretory phase
what are the endometrial phases
menstrual
proliferation
secretory
menoxenia
defines any abnormality relating to menstruation
brennor tumor
benign tumor arising from fibroepithelial tissue
estrogenic in nature
associated with Meig’s syndrome
meigs syndrome
a term used to describe a combination of pleural effusion, ascites, and an ovarian mass
krukenberg tumors
metastatic lesions most commonly resulting from primary gastric carcinoma
Other primary structures: breast, large intestines, and appendix
peritoneal inclusion cysts
caused by adhesions trapping normal secretions produced by the ovary
Symptoms: lower abd. pain and palpable mass, septated fluid collections surrounding ovary
straight arteries
“basal arteries”
branch of radial arteries
basal layer
spiral arteries
“coiled arteries)
branch of radial arteries
decidual layer (can slough)
left ovarian vein
drains into the left renal vein (not IVC)
round ligaments
support uterine fundus
uterine cornua to labia majora b/t the folds of the broad ligament
fossa of waldeyer
ovarian fossa
mesovarian ligament
connects the ovaries to the broad ligament
germinal epithelium of waldeyer
outer layer of the ovary
cortex that contains the follicles
cryptomenorrhea
monthly symptoms of menstruation without bleeding
metrorrhagia
irregular menstrual bleeding between periods
causes of dysfunctional uterine bleeding (DUB)
fibroids, adenomyosis, endometrial polyps, endo- hyperplasia, and endo- carcinoma
co-existing congenital anomalies along with the UT
kidneys/urinary co-existing anomalies
what is adenomyosis
invasion of endo- tissue into the myometrium
1. Focal “Adenomyoma”
2. Diffuse
affects older, multiparous women
menometrorrhagia
heavy and prolonged bleeding between periods
leiomyosarcoma
malignant counterpart of the leimyoma
more common in peri/post-menopausal women
precocious puberty
pubertal dev’t before the age of 8
- True: assoc. with intracranial tumors or idiopathic
- Pseudo: linked with ovarian, adrenal, and liver tumors
sex-cord stromal tumors
ovarian tumors that arise from the gonadal ridges
estrogen producing tumors
Includes: thecomas, granulosa cell tumors and fibromas
Assoc. with Meig’s Synd.
thecoma
benign sex-cord stromal tumor
assoc. with meigs syndrome
most often found in postmenopausal women
granulosa cell tumors
most common estrogenic tumor (sex-cord stromal tumor)
more common in postmenopausal women
have malignant potential
fibroma
benign sex-cord stromal tumor
assoc. with meigs syndrome
most common in middle age women
brenner tumor
“transitional cell tumor”
rare and benign
small, solid, hypoechoic unilateral tumors
endometrioma
“chocolate cyst”
blood containing tumor that forms from the implantation of ectopic endo- tissue (endometriosis)
most often found on the ovary
most often seen in reproductive years
serous cystadenocarcinoma
most common malignancy
may have elevated CA-125
mucinous cystadenocarcinoma
assoc. with “pseudo-myxoma pertonei” —> intraperitoneal extension of mucin
often resembles ascites
krukenberg tumor
malignant ovarian tumor that metastasized from the GI tract
bilateral
assoc. with ascites
sertoli-leydig cell tumor
“androblastoma”
malignant sex-cord stromal tumor
assoc. with hirsutiusm and abnormal menstruation
women
dysgerminoma
most common germ cell tumor
women
yolk sac tumor
2nd most common malignant germ cell tumor
poor prognosis
femailes
hormone replacement therapy increases the risk of
endo- carcinoma breast cancer HTN thromboembolism possible diabetes
endometrial atrophy
most common cause of post-menopausal bleeding
endometrial hyperplasia
“an enlargement”
occurs in post-meno women and reproductive age women
presents as a thick endo > 8mm
what is endometrial carcinoma linked to?
hormone replacement therapy nulliparity obesity stein-leventhal syndrome (PCOS) estrogen producing ovarian tumors use of tomoxifen
asherman syndrome
presence of intrauterine adhesions within the uterine cavity that results from scar formation after a D&C
doesn’t allow implantation
adhesions may cause amenorrhea, pregnancy loss, or infertility
fitz-hugh curtis syndrome
extensive form of PID that also affects the stomach, liver, and diaphragm
conditions causing female infertility
PID congenital uterine malformations endometriosis PCOS tubal causes asherman syndrome fibroids
mullerian anomalies
congenital uterine malformations unicornuate bicornuate septate didelphys
stein-leventhal syndrome
PCOS
amenorrhea
hirsutiusm
obesity
androblastoma
sertoli-leydig cell tumor
malignant sex-cord stromal tumor
assoc. with hirsutuism and abnormal menstruation
women
luteal phase deficiency
endometrial causes of infertility
endometrium may not develop appropriately in the luteal phase of the cycle as a result of decrease progesterone production by the ovary
clomid
drug used to stimulate the pituitary gland to secrete increased amounts of FSH, which encourages the dev’t of multiple follicles on the ovaries
increased risk of torsion
which of the following neoplasms is most likely associated with meigs syndrome
fibroma
which hormone is responsible for inducing ovulation during a normal menstrual cycle
luteinizing hormone
obturator internus muscle
are adjacent to the lateral walls of the urinary bladder
iliopsoas muscles
lateral landmarks of the true pelvis lying lateral and anterior to the obturator internus muscle
suspensory ligaments
extend from lateral aspect of the ovary to the pelvic sidewalls
broad ligaments
extend from the lateral aspect of the UT to the pelvic sidewalls
contain the blood vessels and nerves
failure of the mullerian ducts to fuse
will result in uterine didelphys
partial failure of the mullerian ducts to fuse
result in bicornuate UT
blood supply to ovaries
ovarian and uterine arteries
cervix to corpus ratio during premenarche
2:1
dextroflexion
uterine body is displaced to the right of the cervix
levoflexion
uterine body is displaced to the left of the cervix
muscles that form the pelvic floor
levator ani and piriformix muscles
muscles located laterally in the true pelvis
obturator internus and iliopsoas muscles
obturator internus muscles
border the lateral walls of the urinary bladder
levator ani muscles
lie lateral to the vagina
ureterocele
prolapse of the distal ureter into the bladder
tunica albuginea
outer covering of the ovary
septate UT
vs.
bicornuate, unicornuate and didelphys UT
displays a normal uterine contour with separation in endometrial cavity
vs.
demonstrate an abnormal contour to the fundus
mullerian ducts
the UT is derived from the fused caudal portion of the paired mullerian ducts
max. endo measurement during menarche
14 mm
progesterone
hormone produced by the corpus luteum
increases during the endometrial secretory phase and ovarian luteal phase
increases after ovulation
during what phases is the endometrial lining the thinnest?
early proliferation or late menstrual phase
blastocyst
implants into the endo
the trophoblastic tissue of the blastocyst secretes hCG
hematocolpos
abnormal accumulation of blood within the vagina in premenarche pts.
subserosal
perimetrial uterine fibroid location
on the serosal surface of the UT
polycystic ovarian syndrome
PCOS
“string of pearls”
result from endocrine imbalance — causes chronic anovulation/infertility
Findings: irregular menses, hirsutuism, obesity, and infertility)
mucinous cystadenoma
epithelial neoplasm
typically multilocular
can become very large
contains internal debris generally
perimetrium
the external or serosal layer of the UT
endometriosis
a condition occurring when active endometrial tissue invades the peritoneal cavity
endometriomas
“chocolate cysts”
collectionsf of extravasted endo tissue
GIFT
ZIFT
IVF
“Gamete Intrafallopian Transfer” —> mixes oocytes with sperm added to the fallopian tube
ZIFT places a zygote in the fallopian tube
IVF placles embryos in the endometrium
uterine arteries
branches of right and left internal iliac arteries
supplies UT, fallopian tube, and ovaries
course along lateral aspect of UT (w/i broad ligament)
Branches: arcuate, radial, and straight and spiral arteries
hypogastric artery (uterine blood supply)
4 branches:
obturator, umbilical, uterine-vaginal, superior vesicle arteries
internal iliac artery (uterine blood supply)
gives rise to the uterine and ovarian arteries
corpus
uterine body
adenomyosis
ectopic endometrial tissue within the myometrium
internal iliac veins (uterine blood supply)
drain the pelvic organs and muscles
ovarian hyperstimulation syndrome
generally seen in pts. undergoing fertility treatments
ascites and pleural effusion may also be found
right ovarian vein
drains directly into the IVC
vesicouterine pouch
anterior cul de sac
anterior to the UT
broad ligaments
supports UT, tubes, and ovaries
suspends the UT anteriorly,posteriorly, and laterally
located at the lateral aspect of UT to the side walls of the pelvis
suspensory ligament
infundibulopelvic
supports ovaries and tubes
cardinal ligament
supports the cervix
uterosacral ligament
supports the UT
cumulus oophorus
a group of closely associated granulosa cells in which the ovum is contained (w/i the graafian follicle)
may resemble a daughter cyst
menorrhagia
abnormally heavy and prolonged menstruation
mullerian ducts develop what structures
UT, vagina, and fallopian tubes
hematometra
an accumulation of blood within the UT
most commonly caused by an imperforate hymen
hydrocolpos
vagina is distended with simple, anechoic fluid
more often seen in neonatal period
hydrometrocolpus
collection of fluid from the vagina that extends into the UT
theca lutein cysts
largest and least common of fun’tal cysts
found in increased levels of hCG
common concurrent conditions = gest. trophoblastic disease and ovarian hyperstimulation syndrome
bilateral and multilocular
cystic teratoma
“dermoid”
most common benign ovarian tumor
results from retention of an unfertilized ovum that differentiates into 3 germ cell layers
contains thyroid tissue, bone, hair, sebum, fat, cartilage, and teeth
“tip of the iceberg”
serous cystadenoma
benign tumor of ovary
women in 40s/50s
bilateral
contains septations
mucinous cystadenoma
larger than serous cystadenoma (can reach up to 50 cm)
internal debris
benign tumor within the ovary
which side does ovarian torsion typically occur?
right side
most common cause is ovarian cyst/mass)
postmenopausal endometrium
normal = 5 mm
on hormone replacement therapy = 8 mm
endometrial carcinoma
most common female genital tract malignancy
PMB is the most common clinical presentation
most common form of adenocarcinoma
tubo-ovarian complex
vs.
tubo-ovarian abscess
fusion of the ovaries and dilated tubes ovary and tube are still distinguishable
vs.
unable to distinguish between ovary and tube
which endometrial phase demonstrates the greatest dimension?
early secretory
which vessel provides the best imaging landmark for locating the ovaries?
internal iliac arteries
pt. with hx of dysmennorhea and UT tenderness. The uterine myometrium appears diffusely inhomogeneous, it is indicative for what?
adenomyosis
a localized hypoechoic adnexal mass is present on serial sonograms with bilateral ovarian cysts of different sizes, is indicative of what?
endometrioma
which rare benign ovarian neoplasm occurs most often in post-meno women?
thecoma
