Module 3: Extra Pelvic Pathology Flashcards
What is the hymen?
A septum that remains in the lumen of the vagina between the urogentital sinus and the upper vagina
What is an imperforate hymen?
Occurs when the hymen does not naturally rupture.
What is Hydrocolpos?
The retention of fluid secretions in the vagina before puberty due to an imperforate hymen.
What is Hydrometrocolpos?
The retention of fluid secretions in the vagina and uterus before menses or after menopause due to an imperforate hymen.
What is Hematocolpos?
The retention of blood trapped in the vagina after puberty due to an imperforate hymen.
What is Hematometra?
The retention of blood trapped in the uterus.
What is Hematometrocolpos?
The retention of blood trapped in the uterus and vagina .
What things do you look for sonographically when assessing the retention of fluid due to an imperforate hymen?
- Identify level of obstruction
- Evaluate the echogenicity (clear = hydro, debris = blood)
- Look for free fluid levels
What are cysts in the vagina called and what are they?
Gartner’s Duct Cysts
Small cysts along the vagina wall that are usually asymptomatic and found incidentally.
Where do Gartner duct cysts originate from?
They are mesonephric duct remnants that are usually on the lateral or anterolateral wall.
How is US used in the diagnosis of vaginal carcinoma?
Not used to diagnose but used to help stage and assess pelvic spread or metastasis.
What are cysts in the cervix called and what are they?
Nebothian cysts
Common retention cysts due to entrapped cervical secretions.
How do you document multiple nebothian cysts?
Document at least one in two planes with measurments and doppler.
How is carcinoma of the cervix Dx?
Clinically with a PAP smear, US used to stage
What obstructions can Ca of the cervix cause?
Hematometra in the uterus or hydronephrosis in the kidneys.
What factors increase the risk of cervical cancer? (8)
- HPV
- Early sexual activity
- Multiple partners
- Low socioeconomic status
- Smoking
- Oral contraceptives
- Weakened immune system
- DES in utero
Sonographic findings of cervical cancer? (8)
- Hematometra from cervical stenosis
- Multiple cystic areas within a solid cervical
mass - Bulky cx
- Irregular cervical boarders
- Mass extending from cervix to pelvic sidewall
- Tumor invasion of the bladder
- Hydronephrosis
- Liver mets and Para-aortic nodes
What are the stages of cervical cancer? (4)
- Confined to cervix
- Extends beyond cervix to the upper two thirds of vagina or parametrial tissue
- Extends to pelvic wall or lower 3rd of vagina
- Extends beyond true pelvis or involves bladder or rectal mucosa
What may happen to the ureters in the presence of Cervix Ca?
Hydroureters (dilated uteters).
What is an incompetent cervix?
A cervix that causes preterm labor (cervical effacement) in the 2nd or early 3rd trimester.
What are the causes of incompetent cervix?
- Trauma
- DES - T shaped uterus
- Idiopathic
What is the best was to assess incompetent cervix?
Translabial/transvaginal
What is DES?
Prescription drug discontinued in 1971
Look at cervix trans labial images
….
What is Endometriosis?
Growth of endometrial tissue outside uterine cavity
What are the 2 types of endometriosis?
- Internal (adenomyosis)
2. External (endometriosis)
What is adenomyosis?
When endometrial tissue grows into the myometrium of the uterus
What is endometriosis?
When endometrial tissue grows through the fallopian tubes and seeds itself outside the uterus
Where does endometriosis commonly occur?
- Ovaries
- Fallopian tubes
- Broad ligament
- Pouch of Douglas
Why is endometriosis only present in the reprouctive age group?
Because the endometrial tissue responds to the hormones during the menstrual cycle.
How is endometriosis usually diagnosed?
Laparoscopy
What are the symptoms of endometriosis? (5)
- Dysmenorrhea
- Dysparunia
- Infertility
- Menorrhagia
- May have palpable mass (endometrioma)
What is Dysmenorrhea?
Painful menstruation
What is Dysparunia?
Painful intercourse
What is Menorrhagia?
Abnormally heavy bleeding during menstruation
What is the medical term for chocolate cyst?
Endometrioma
What is an endometrioma?
Chocolate cyst
A well defined, mostly cystic mass with low level echoes
What sonographic markers indicate an endometrioma and why?
- Kissing ovaries
- Retroflexed uterus
- No free fluid in posterior cul de sac.
(Due to the adhesions that endometriosis causes)
What is the DDx for endometrioma?
- Hemorrhagic ovarian cyst
- Ovarian cyst adenoma
- Tubo-ovarian abscess (TOA)
What is the treatment for endometrioma?
- Drugs
- Laser surgery
- Hysterectomy and oophorectomy
What is PID?
Pelvic Inflammatory Disease
Infection of the female genital tract
What are the causes of PID?
- STI (Gonorrhoea or Chlamydia)
2. Pyogenic
From:
- IUCD
- Surgery
- Postpartum
- Crohn's disease
What are the stages of PID?
Stage 1 – Asymptomatic or vaginal discharge and tenderness (endometritis)
Stage 2 – Febrile, acute pelvic pain, abnormal vaginal bleeding.
Stage 3 – Tubular Ovarian Abscess (TOA) stage – Acute abd pain,
Increased WBC.
What may develop in stage 2 of PID?
Hydrosalpinx
What may develop in stage 3 of PID?
Fitzhugh Curtis Syndrome
What is Fitzhugh Curtis Syndrome?
A rare complication of PID that involves inflammation of the liver capsule
What are the signs/symptoms of Fitzhugh Curtis Syndrome? (4)
- Pain on inspiration
- RUQ pain
- Small abscesses on liver capsule may lead to adhesions
- Increase in liver enzymes
What % of people with Fitzhugh Curtis Syndrome have PID?
5-10 %
What is inflammation of the fallopian tubes called?
Salpingitis
What happens when someone has Salpingitis?
The walls of the fallopian tubes become thickened and edematous which can cause the tubes to block causing pyosalpinx.
What happens when pyosalpinx is treated?
The infected material is reabsorbed and the chronic result is hydrosalpinx
What is the sonographic appearnance of Stage 1 acute PID?
Endometritis
Can either appear normal or:
- Thick endometrium
- Fluid in endo canal
What is the sonographic appearnance of Stage 2 acute PID?
Pyosalpinx
Hypoechoic S-shaped fallopian tubes with low level echoes
What is the sonographic appearnance of Stage 3 acute PID?
Tubo-Ovarian Abscess
- Multilocular mass with irregular borders
- Fluid-fluid levels air within mass
How does chronic PID appear on US?
- Distented S-shaped tubes with thin walls
What is the DDX of chronic PID?
Ovarian cyst or small cystadenomas
What is hermaphroditism?
When a person possesses both male and female sex traits and ambiguous genitalia
What is a “true hermaphrodite” and how common are they?
10 % of hermaphrodite cases (rare)
Possessing both ovarian and testicular tissue
What may true hermaphroditism be due to?
The fusion of two heterozygous twin zygotes (an xx and xy) right after fertilization.
What health consequences result from true hermaphroditism?
- Infertile
2. Increased risk of cancer in gonads
What is a “Pseudo Hermaphrodite” and how common is it?
90 % of hermaphrodite cases
When a person possesses the chromosomes of one sex but develops the sex traits of another.
What type of hermaphrodite may result from a lack of androgens?
Male Pseudo
What type of hermaphrodite may result from an increase of androgens?
Female pseudo
What is a male pseudo hermaphrodite?
Genetically male (has testes) but also possesses female characteristics (breasts, no facial hair, underdeveloped genitals).
What is a pseudo female hermaphrodite?
Genetically female (has ovaries) but also has male characteristics (penis, scrotum, hirsutism).
What is mulit-locular?
Multiple small compartments
What is hirsutism?
Abnormal facial and body hair growth (usually on a woman)
