GYN registry review Flashcards
Boney boundaries of female pelvis
Sacrum, Coccyx, Ilium, Ischium, Pubic Symphysis
TRUE pelvis
Deep and below linea terminalis, structures only seen in transvaginal imaging
Organs of the TRUE pelvis
Bladder
Small bowel
Ascending/Descending colon
Rectum
Uterus
Ovaries
Fallopian Tubes
Internal Iliac
4 muscles
4 muscles of the TRUE pelvis
Levator ani
Coccygeus
Obturator internus
Piriformis
Hammock shaped muscles that support pelvic organs
Levator ani and coccygeus
Result of weakened levator ani and coccygeous muscles
Uterine prolapse
Muscles found in the adnexas
Obturator internus (lateral to bladder)
Piriformis (posterolateral)
Iliopsoas (anterolateral)
Broad ligaments
A double fold of the peritoneum, laterally attached to the walls of the pelvis, supports pelvic organs
Round ligaments
Found BETWEEN the folds of the broad ligament, superiorly supports the fundus of the uterus
Cardinal ligaments
Contains vasculature of uterus
Space of Retzius (retropubic space)
Space anterior to the bladder
Adnexa
Lower quadrants of abdomen, lateral spaces of uterus. Contains ovaries (illiacs are landmarks)
Anterior Cul De Sac (vesicouterine pouch)
Space between anterior uterus and bladder
Pouch of Douglas (rectouterine pouch/posterior cul de sac)
Space between posterior uterus and rectum
Uterine arteries
branches of internal iliac arteries
Arcuate arteries
Periphery of myometrium
Radial arteries
Deeper into myometrium
Straight arteries
Feeds basal layer of endometrium
Spiral arteries
Feeds functional layer of endometrium
Ovarian (gonadal) arteries
Originate at aorta
Ovarian blood supply
Receive blood from ovarian artery and uterine artery
Uterine vein
Drains into internal iliac veins
Right ovarian vein
Drains into IVC
Left ovarian vein
Drains into left renal vein
*longest pelvic vessel
Uterus
A retroperitoneal organ, developed from fusion of paired Mullerian ducts. Sits between rectum and bladder with broad ligaments bound bilaterally
Uterine fundus
Most superior and widest part of uterus, fallopian tubes attach at uterine cornu
Uterine corpus
Body of uterus, largest area
Uterine Isthmus
Lower uterine segment during pregnancy
Cervix
Internal and external os
External os
Opens into most inferior part of vaginal canal, surrounded by vaginal fornix
Perimetrium (serosa layer)
Outermost layer of uterus (organ fascia)
Myometrium
Muscular layer of uterus
Endometrium
Mucosal layer of uterus– consists of basal layer and functional layer
Basal layer
Deep endometrial layer
Functional layer
Superficial endometrial layer that SHEDS during menses
Neonatal uterus size and shape
Prominent uterus due to maternal hormone stimulation.
Enlarged cervix (double size of body)
Prepubertal uterus size and shape
Tubular shape.
Body size=cervix size
Puberty uterus size and shape
Increased fundal diameter (pear shape)
6-8cm during reproductive years
Menopausal uterus size and shape
Decreased size, 4-6cm
Anteverted
Body of uterus TILTS forward at 90 degree angle with cervix
Anteflexed
Body of uterus FOLDS forward coming in contact with the cervix
Retroflexed
Body of uterus FOLDS back coming in contact with the cervix
Retroverted
Body of uterus TILTS back without a bend, no contact with uterus
Detroflexed
Flexed to the right
Levoflexed
Flexed to the left
Fallopian tubes (salpinges)
7-12cm tubes extending from cornu of uterus within the broad ligaments to the adnexa.
Means for fertilization and transportation to uterus
Fallopian tube cilia
Tiny, hair like structures inside tubes that move back and forth to aid the movement of the fertilized ovum
Interstitial segment
Most proximal segment of fallopian tube, where tube attaches to uterus cornu
Isthmus segment
“Bridge” that connects the interstitial segment to the ampulla segment of the fallopian tube
Ampulla segment
Longest and most tortuous segment of the fallopian tube
most common location of fertilization and ectopics
Infundibulum segment
Distal and widest portion of fallopian tube with fimbria at the end
Fimbria
Fingerlike extensions of infundibulum that draw unfertilized egg into tube
Ovaries
Paired, intraperitoneal ENDOcrine organs
Supported laterally of uterus by ovarian ligaments and laterally of pelvic walls by suspensory ligaments
Hormones produced by ovaries
Estrogen and Progesterone as response to FSH (follicle stimulating hormone) and LH (luteinizing hormone)
Outer cortex of ovaries
Site of oogenesis/follicles
Medulla of ovaries
Site of vasculature and lymphatics
Ovarian response to FSH
Follicles develop–> Graafian follicle matures–> thecal cells of follicle produce estrogen–> ovum found inside cumulus oophorus of dominant follicle–> ovulation in 36 hours
Ovarian response to LH
Graafian ruptured and replaced by corpus luteum–> corpus luteum releases progesterone–> corpus luteum regresses and replaced with corpus albicans
Hormone release order during menstrual cycle
Gonadotropin releasing hormone (via hypothalamus) stimulates anterior pituitary gland –> anterior pituitary gland releases FSH –> FSH (via pituitary) stimulates ovaries to develop and mature dominant follicle –> follicles produce estrogen –> dominant follicles mature leading to peak in estrogen –> LH surge released (via pituitary) –> stimulates rupture of dominant follicle (AKA ovulation) –> ruptured follicle = corpus luteum and releases PROGESTERONE and some estrogen
Estrogen affect on endometrium
Thickens endometrium
Progesterone affect on endometrium
Maintains and prepares endometrium for implantation
NO pregnancy affects on endometrium
Endometrium slough off and menses begin due to drop in progesterone levels
Follicular phase days 1-14
-FSH stimulates follicle development
-Dominant follicle matures to ~2.5-2.7cm until ovulation
-Follicles release estrogen
Menstrual phase days 1-5
Menses and shredding of endometrium
Early proliferative phase days ~6-10
-Immediately following menses
-Thin, echogenic endometrium
-Endo no more than 4mm
Late proliferative phase days
~10-14
-Endo will reach 6-10mm
-“Three line sign” (echogenic basal layer surrounding hypoechoic functional layer)
Ovulation day 14
-LH surge ruptures dominant follicle releasing ovum
-FF possibly seen in post CDS
occurs 14 days prior to start of next menstrual cycle
Luteal phase days 15-28
-Graafian follicle becomes corpus luteum producing progesterone to maintain endo thickness
NO fertilization by day 28 = regression of CL cyst
Secretory phase
-Progesterone maintains thickness for implantation
-Endo thick and echogenic 7-16mm
-Progesterone drop = begin menses
Gravida
Total number of pregnancies
Para
Total number of pregnancies carried to term
Mittelschmertz
Middle pain, pain in the middle of cycle near ovulation
Primary amenorrhea
Failure to have menses by age 16; never reached menarche
Secondary amenorrhea
Menses stopped
C-section scar/defect
Fluid or separation of c-section scar
C-section dehiscence
Myometrial walls are separating
Dehiscence
A partial or total separation of previously approximated wound edges, due to a failure of proper wound healing
Intrauterine device (IUD)
-Device that prevents implantation of fertilized ovum
-Echogenic linear echo with posterior shadowing or reverberation within endometrial cavity
Postmenopausal asymptomatic endometrium measures
NO bleeding
< or equal to 8mm
Postmenopausal symptomatic endometrium measures
YES bleeding
< equal to 5mm
Postmenopausal HRT endometrium measures
Variable/premenopausal appearance
Early proliferative endometrium measures
4-6mm
Late proliferative endometrium measures
6-10mm
Secretory endometrium measures
< equal to 16mm
Amenorrhea
Without menses
Hypomenorrhea
Decreased menses
High resistance doppler
Less diastole, less volume flow
Lower resistance doppler
More diastole, more volume flow
Ovarian doppler during menstrual and early proliferative phase
High resistive, demands for blood are low
*most accurate time especially in presence of mass
Ovarian doppler during mid cycle and luteal
Lower resistance
Non-gravida uterus doppler
Normally high resistance
*decreased resistance can be found in cancer and traumatic AVM
