Handouts Flashcards
What are the 4 regions of the Uterus?
Fundus
Corpus
Isthmus
Cervix
What is the most common uterine position?
Anteverted and Anteflexed
What is the 3 tissue layers of the uterus?
Perimetrium
Myometrium
Endometrium
What are the 4 portions of the fallopian tubes?
Interstitial (Intramural)
Isthmic
Ampullary
Infundibulum
What is the widest portion of the fallopian tubes?
Ampullary
*check with Amy
What are the bones of the pelvis?
Coccyx, sacrum, 2 innominate bones (ilium, ischium, & pubis)
What is the only abdominal organ NOT covered by peritoneum?
Ovaries
What produces hormones and gametes?
Ovaries
Where will free fluid collect first in the pelvic cavity?
Posterior Cul de sac (pouch of douglas)
What phase of the menstrual cycle typically lasts from 1 - 5 days?
Menstrual phase
What phase of the menstrual cycle typically lasts from 6 - 14 days?
Proliferative phase
If the endometrium measures 7mm in this phase is it normal?
No
*check with Amy
What hormone is the most influential in this phase? (proliferative)
Estrogen
What phase of the menstrual cycle typically lasts from 15-28 days?
Secretory Phase
What hormone causes ovulation to occur?
Luteinizing Hormone (LH)
What phase begins at ovulation and is also called the luteal phase?
Around the 14th day - Secretory phase
What phase is mainly under the influence of estrogen and is regrowth of endometrium?
Proliferative phase
During what phase does the endometrium degenerate?
Menstrual Phase
What secretes Gonad Releasing Hormone (GnH)?
Hypothalamus
The rise in GnH causes what organ to release follicle stimulating hormone (FSH)?`
Anterior Pituitary
A rise in LH (Lutenizing Hormone) causes what to occur?
Ovulatory Phase
What is the dominant follicle known as?
Graafian Follicle
What is polymenorrhea?
Frequent regular cycles but less than 21 days
What is oligomenorrhea?
Irregular cycles greater than 35 days apart
What menorrhagia?
(hypermenorrhea) Abnormal, heavy and long menstruation
What is dysmenorrhea?
Painful or difficult menstruation
What is Amenorrhea?
Absence of menstruation
What is Mittelschmerz pain?
Sudden sharp pain on one side of lower abdomen occuring on same side as ovulation. “Mid Cycle Pain”
Oral Contraceptives limit the release of what?
FSH and LH
Corpus Luteum Cysts produce what?
Progesterone
What is the normal measurement of an ovary?
2.5 x 1.5 x 0.6
Gravidity refers to what?
The # of times a women has been pregnant
Nulligravida refers to what?
Never been pregnant
Know sizes of uterus - nulliparous and multiparous uterus
Nulliparous - 8cm L, 5.5 cm W, 3cm in AP
Parity - 7.5 - 9cm L, 4.5 - 6cm W. 2.5 - 4cm AP
Which hormone causes ovulation to occur?
Luteinizing Hormone (LH)
What are all the ligaments?
Cardinal
Uterosacral
Round
Broad
Cardinal ligament
Anchor Uterine Corpus and Cervix to lateral pelvic wall
Uterosacral ligament
Anchor uterine cervix to sacrum
Round ligament
Anchor uterine fundus anteriorly
Broad ligament
Part of peritoneum that divides true pelvis into ANT and POS positions
What are the bones of the Pelvis?
Sacrum
Coccyx
2 Innominate ( ilium, ischium, pubic) x2
Know size of ovaries
2.5-5cm L, 1.5 - 3cm W, 0.6 - 2.2cm AP
(LxWxH)/2 = vol cm^3
Corpus luteum cyst - what is it, what hormone does it produce?
A Corpus luteum cyst is a type of ovarian cyst which may rupture about the time of menstruation
Produces Progesterone
What hormones are produced by the hypothalamus?
Gonadotropin-releasing hormone (GnRH)
What hormones are released by the Anterior Pituitary gland?
FSH LH GH Prolactin TSH Adrenocorticotropic hormone
WHat hormones are released by the Posterior Pituitary gland?
ADH
Oxytocin
DES what is it and what are the effects of it?
Diethylstilbestrol (DES) is a synthetic form of the female hormone estrogen. It was prescribed to pregnant women between 1940 and 1971 to prevent miscarriage, premature labor, and related complications of pregnancy
Responsible for CC vaginal carcinoma, Uterine hypoplasia, and “T” - shaped uterus
Hematometra
retention of blood in uterine cavity
Hematocolpos
Accumulation of menstrual blood in vagina
Hematometrocolpos
Accumulation of blood in uterus and vagina as a result of obstruction or imperforate hymen
Adenomyosis
Uterine condition in which endometrial glands and stroma are located in the myometrium proximal to the basalis layer of endometrium
Where are leiomyomas located?
Intramural - in myometrium Submucosal - below endometrium Sub- Serosal/ Serosal - at serosal surface of uterus Pedunculated - extras uterine Intracavity - Prolapsing from a cavity
Sonohysterogram - What is this procedure, what does it help to identify?
Injecting 25 - 30 mL of saline into the endometrial cavity to highlight polyps and other problems. It is also used to check for obstruction of the fallopian tubes
What are all the cysts?
Theca lutein
Graafian
Corpus luteum
Paraovarian
Theca lutein cysts
Largest functional cyst 3 - 20cm. Results from exaggerated corpus luteum response in patients with high levels of hCG. Associated with gestational trophoblastic disease such as hydatidiform mole, chorioadenoma, and choriocarcinoma. Multilocular and bilateral
Graafian cysts
Follicular Cysts - Result from either non- rupture of dominant follicle or failure of immature follicle to undergo atresia. 3 - 10cm. Usually resolves in 6 - 8 weeks can cause pelvic pain, hemorrhage to torsion or rupture
Corpus Luteum cysts
Failure of the follicular cyst. Corpora Lutea must be greater than 3 cm to be considered luteal cyst. Usually uniocular and unilateral. regresses usually after 3 menses cycles
Paraovarian cysts
Developed from vestigial wolffian duct structures or tubal epithelium uniocular, do not change w/ ovarian cycle.
What are the differential diagnosis of cervical carcinoma?
Leiomyoma involving cervix
Endometrial carcinoma involving cervix
Endometrial polyps prolapsed into vagina
What are Signs and symptoms of Uterus Leiomyomas?
Pelvic pain Menorrhagia Asymptomatic Bladder and rectum pressure Infertility Spontaneous Abortion
What are US appearance of uterus leiomyomas?
Wide variety of US appearance: whorled appearance, lobulated uterus, hypo - anechoic
What is Krukenberg tumor?
Malignant ovarian tumor that has most likely metastasized from G.I. or breast, signet - ring cells are key histologic sign.
US appearance: Moth eaten pattern
Meigs Syndrome
Presentation of Ascites, Pleural effusion and ovarian tumor (most commonly, fibroma)
Symptoms subside after removal of tumor
What is Ovarian Torsion?
Complete or incomplete rotation of ovary on its vascular pedicle
Ultrasound Appearance of Ovarian Torsion
On ultrasound, may appear as a large ovary with hypoechoic and hyperechoic areas
Ovarian Torsion occurs most commonly in what age group?
Most common in childhood or women < 30 years of age
Signs and symptoms of Ovarian Torsion?
- Acute onset of pelvic pain
- Nausea
- Vomiting
Stein Leventhal Syndrome is also known as?
Polycystic Ovaries
In Polycystic Ovaries, endocrine disorders result in?
High free serum testosterone
High LH or FSH
Ultrasound Appearance of Polycystic Ovaries
- Normal ovaries
- Bilaterally enlarged ovaries with multiple small follicles around periphery
What are the categories of benign Ovarian Neoplasms?
Epithelial tumors
Germ cell tumors
Stromal tumors
What is another name for Dermoid Tumor?
Dermoid Cyst or Benign Cystic Teratoma
Benign Cystic Teratoma
AKA: dermoid cyst, teratoma
- Common germ cell tumors
- Most common in premenopausal women
- Most common ovarian tumor for women less than 20 years of age
- Have little malignant potential
What are Functional Cysts?
OVARIAN FOLLICLES FOLLICULAR CYSTS CORPUS LUTEUM CYSTS THECA LUTEIN CYSTS PARAOVARIAN CYSTS
Ovarian Follicles
- LOCATED ON BOTH OVARIES
- SMALL ANECHOIC STRUCTURES
- USUALLY MULTIPLE
- DOMINANT FOLLICLE REACHES 2.0-2.5 CM BEFORE OVULATION OCCURS
Follicular Cysts
OVER DISTENSION OF A GRAAFIAN FOLLICLE THAT DID NOT RUPTURE FOLLICLE THAT DID NOT RESOLVE USUALLY UNILATERAL 1.0 - 10.0 CM IN SIZE FOLLOW UP MAY BE ORDERED MOST RESOLVE OR CHANGE IN SIZE
Corpus Luteum Cysts Menstruation
- Corpora lutea forms after dominant follicle ruptures.. REACHES 3 CM IN SIZE
- Usually unilateral and simple.. CORPUS LUTEUM CYST MAY MEASURE 5-8 CM
- Hemorrhage and rupture may cause pain
- Usually resolves within 14 days
Corpus Luteum Cysts Pregnancy
- Remains if fertilization occurs
- Holds the pregnancy
- Produces progesterone
- Resolves between 10 and 16 weeks from LMP
- Rupture may cause pain
Theca Lutein Cysts
- Caused by high levels of human chorionic gonadotropin
- 50% Associated with gestational trophoblastic disease (MOLAR PREGNANCY).
- Associated with drug therapy for infertility (ovarian hyperstimulation syndrome)
- Are bilateral, multilocular, and large (3-20 cm)
- May persist 2-4 months after evacuation of molar pregnancy
Paraovarian Cysts
- Found in broad ligament
- Difficult to determine if ovarian or paraovarian
- Can be small up to 15 cm
- Do not regress or change with time
- Can be complicated by hemorrhage, torsion, rupture or infection
Differential Diagnoses for Paraovarian Cysts
DIFFERENTIAL DIAGNOSES:
Serous cystadenoma
Endometrioma
What are the malignant Tumors of the Ovaries
Ovarian Carcinoma Epithelial Types: Epithelial Neoplasms Sex Cord Neoplasms Germ Cell Neoplasms Metastases to the the Ovary
What are the most common of the Sex Cord Neoplasms?
- GRANULOSA-THECA CELL TUMOR
- ANDROBLASTOMA (SERTOLI-LEYDIG CELL TUMOR)
Sex Cord Neoplasms: GRANULOSA-THECA CELL TUMOR
- 1-2% of all tumors
- Most common in postmenopausal patients
- Abnormal uterine bleeding (estrogen)
- Associated with endometrial hyperplasia or carcinoma
- Unilateral
- Solid and homogeneous
Sex Cord Neoplasms: SERTOLI-LEYDIG CELL TUMOR
AKA: androblastoma
- Rare (less than .5% of ovarian tumors)
- Most common in adolescence
- Present with virulization
- Almost always unilateral
- Usually solid
Sex Cord Neoplasms: SERTOLI-LEYDIG CELL TUMOR
AKA: androblastoma
- Rare (less than .5% of ovarian tumors)
- Most common in adolescence
- Present with virtualization
- Almost always unilateral
- Usually solid
Germ Cell Neoplasms:
3 Types
- Choriocarcinoma
- Teratocarcinoma
- Endodermal Sinus Tumor
Germ Cell Neoplasms: Choriocarcinoma
- Very rare as ovarian neoplasm
- Most common in infants and young children
- May cause precocious puberty
- Elevated serum hCG levels
- Usually unilateral
- Solid hemorrhagic tumor
- Aggressive
Germ Cell Neoplasms: Teratocarcinoma
- AKA: immature teratoma
- Occurs in children and young adults
- Composed of immature neuroepithelium
- Usually unilateral
- Variable US appearance, possible with cystic and highly echogenic components
Germ Cell Neoplasms: Endodermal Sinus Tumor
- AKA: yolk sac tumor
- 2nd most common malignant ovarian germ cell tumor
- Common in childhood, adolescence and young adults
- Elevated levels of AFP
- Usually unilateral
- Can be solid, or cystic and solid
Metastases to the Ovary
KRUKENBERG TUMOR
- Metastases to ovary from primary elsewhere
- Most common site of primary is GI tract, but can be breast, lung, pancreas, or lymphoma
- Usually bilateral
- May be cystic, mixed, or solid on ultrasound
- May demonstrate the “moth-eaten” sign
What is Pseudomyxoma Peritonei?
Mucinous Cystadenoma with a rupture
What are risk factors for development of Endometrial Carcinoma?
- OBESITY
- DIABETES
- HIGH BLOOD PRESSURE
- SHORT IN HEIGHT
- JEWISH
- AGE (postmenopausal)
- ESTROGEN USE AFTER MENOPAUSE
Signs and symptoms of Endometrial Carcinoma?
- BLEEDING OR DISCHARGE AFTER MENOPAUSE
- Pain
Endometrial Carcinoma: Where does it begin and where does it grow to?
- BEGINS IN THE ENDOMETRIUM
- GROWS TOWARD THE MYOMETRIUM
Endometrial Carcinoma: STAGING is based on?
Degree of tumor spread
Endometrial Carcinoma: GRADING is based on?
Degree of tumor differentiation
Dysfunctional Uterine Bleeding (DUB)
Vaginal Bleeding not related to menstrual cycle
HYPERmenorrhea
excessive volume during cyclic menstrual bleeding
HYPOmenorrhea
abnormally small amount of menstural bleeding
Polymenorrhea
Frequent menstrual bleeding less than 21 days apart
Oligomenorrhea
menstrual bleeding greater than 35 days apart
Menorrhagia
excessive bleeding in time and/or volume
Dysmenorrhea
painful uterine bleeding
Amenorrhea
absence of menstrual flow
Vaginal Agenesis
Absent vagina
Vaginal Atresia
Lack of vaginal development
