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Ob/Gyne 2 > Module 3 : Extra Pelvic Pathology > Flashcards

Module 3 : Extra Pelvic Pathology Flashcards

1
Q

10 common metastatic sites for ovarian cancer

A
  • pleura
  • diaphragm
  • liver
  • serial bowel implants
  • colon
  • nodes
  • ovaries
  • omentum
  • stomach
  • pelvic peritoneal implant
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2
Q

vaginal hymen

A
  • septum remains in the lumen of the vagina between the ureogenital sinus and upper vagina
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3
Q

imperforate hymen

A
  • occurs if the hymen does not rupture causing hydrocolpos or hematocolpos
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4
Q

hydrocolpos

A
  • fluid in vagina
  • occurs before puberty
  • retention of vaginal secretions
  • less severe
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5
Q

hydrometrocolpos

A
  • before menses or after menopause (stenotic cervix)
  • secretions in uterus and vagina
  • more severe
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6
Q

hematocolpos

A
  • after puberty (should be getting menstual cycle but no blood)
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7
Q

hematometra

A
  • retention of blood in uterus
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8
Q

hematometrocolpos

A
  • blood in uterus and vagina
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9
Q

sonographic appearances of hemato and hydrocolpos

A
  • identify level of obstruction
  • evaluate the echogenicity
    + hypo echoic = fluid
    + hyperechoic and debris = blood
  • look for fluid fluid levels
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10
Q

gartner duct cysts

A
  • cysts along the vagina
  • mesonephric duct remnants
  • single or multiple
  • lateral or anterolateral
  • asymptomatic and incidental
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11
Q

vaginal carcinoma

A
  • not used in diagnosis
  • used to help stage
  • assess pelvic spread or distal metastasis
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12
Q

nabothian cysts

A
  • retention cysts
  • common
  • multiple
  • entrapped cervical secretions
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13
Q

carcinoma of the cervix

A
  • Dx clinically = Pap smear
  • cancer of cervix may cause obstruction
    + uterus = hematometra
    + renal = hydronephrosis
  • sonography to help stage
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14
Q

cervical cancer risk factors

A
  • infection from HPV
  • early sexual activity
  • multiple sexual partners
  • low socio-economic status
  • smoking
  • use of oral contreceptives
  • weakened immune system
  • DES in utero
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15
Q

sonographic findings of cervical carcinoma

A
  • hematometra from cervical stenosis
  • multiple cystic areas within a solid cervical mass
  • bulky cervix
  • irregular cervical borders
  • mass extending from cervix to pelvic sidewalls
  • tumor invasion of bladder
  • hydronephrosis
  • liver mets and para-aortic nodes
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16
Q

incompetent cervix

A
  • may cause preterm labor or delivery
  • cervical effacement (shortening) in 2nd or 3rd trimester
  • best assessed translabial or EV
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17
Q

causes of incompetent cervix

A
  • trauma
  • DES - t shaped uterus
  • idiopathic
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18
Q

two types of adnexal pathology

A
  • endometriosis
  • pelvic inflammatory disease (PID)
    + acute and chronic
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19
Q

what is endometriosis

A
  • growth of endometrial tissue outside uterine cavity
  • cyclical tissue will shed with menstraution causing incredible pain
  • only found in reproductive age group (hormones stimulating)
  • can cause adhesions (bad bad)
20
Q

two types of endometriosis

A
  • internal
    + adenomyosis
  • external
    + endometriosis
21
Q

4 places endometriosis usually occurs

A
  • ovaries
  • fallopian tubes
  • broad ligament
  • pouch of Douglas
  • FIRST PLACE IN RECTOVAGINAL CCANCAL
22
Q

symptoms of endometriosis

A
  • dysmenorrhea
  • dysparunia
  • infertility
  • menorrhagia
  • may have palpable mass
    + endometrioma
  • fixed retroverted uterus
  • no free fluid
23
Q

sonographic appearance of endometriosis

A
  • usually difficult to see

- may have endometrioma (chocolate cyst)

24
Q

sonographic appearance of endomtrioma

A
  • well defined
  • predominantly cystic mass
  • low level echoes
  • may see fluid-fluid levels
25
Q

differential diagnosis of endometrioma

A
  • hemorrhagic ovarian cyst
  • ovarian cyst adenoma
  • tuba-ovarian abscess
26
Q

treatment of endometriosis

A
  • drugs (hormones)
  • laser surgery
  • hysterectomy and oophrectomy
27
Q

pelvic inflammatory disease

A
  • infection of female genital tract
28
Q

causes of PID

A
  • STI = gonorrhea or chlamydia
  • pyogenic
    + IUCD
    + surgery
    + postpartum
    + crohns disease
29
Q

symtoms in stage 1 PID

A
  • asymptomatic or vaginal discharge and tenderness

- endometritis

30
Q

symptoms in stage 2 PID

A
  • FEBRILE
  • acute pelvic pain
  • abnormal vaginal bleeding
  • may develop hydrosalpinx
31
Q

symptoms in stage 3 PID

A
  • TOA stage (tubal ovarian abscess)
  • acute and pain
  • INCREASED WBCS
  • could develop Fitzhugh Curtis syndrome
32
Q

Fitzhugh Curtis syndromes

A
  • perihepatitis- inflammation of liver capsule
  • pain on inspiration
  • RUQ pain
  • small accesses on liver capsule - may lead to adhesons
  • increased liver enzymes
33
Q

salpingitis

A
  • walls become thickened and oedematous
  • if tubes are blocked PYOSALPINX (pus) occurs
  • once treated infected material resorbed and chronic result is HYDROSALPINX
34
Q

acute PID sonographic appearance stage 1

A
  • endometritis
  • thick endo
  • fluid in canal
  • or normal cancel
  • difficult to DX on US
35
Q

acute PID sonographic appearance stage 2

A
  • pyosalpinx
  • hypo echoic s shaped Fallopian tubes with low level echoes
  • Fallopian tube walls are smooth
36
Q

acute PID sonographic appearance stage 3

A
  • multilocular mass
  • irregular borders
  • fluid-fluid levels air within mass, make sure cystic loops do not move
37
Q

chronic PID on ultrasound

A
  • distended s shaped tubes

- thin walls

38
Q

DDX of chronic PID

A
  • difficult to differentiate from ovarian cyst or small cyst adenomas
39
Q

hermaphroditism

A
  • possessing both male and female sex traits +/- ambiguous genitalia
  • two types
    + true
    + pseudo
40
Q

true hermaphrodite

A
  • POSSESSING BOTH OVARIAN AND TESTICULAR TISSUE
  • infertile
  • increased risk of cancer in gonads
  • due to fusion of 2 heterozygous twin zygotes right after fertilization
41
Q

pseudo hermaphrodite

A
  • possessing chromosomes of one sex but develop sex traits of opposite sex
  • male and female
42
Q

male pseudo hermaphrodite

A
  • genetically male (testes)
  • female characteristics
  • may be due to lack of androgens
43
Q

female pseudo hermaphrodite

A
  • genetically female (ovaries)
  • male characteristics
  • due to excessive androgens
44
Q

other areas to look when pelvic pathology is identified

A
  • kidneys for obstruction
  • liver for metastatic disease
  • lymphadenopathy
  • free fluid/ascites
45
Q

fallopian tube carcinoma

A
  • serous tubal intraepithelial tubal carcinoma
  • STIC
  • thought many ovarian cancers begin in the fimbriae of Fallopian tube
  • most are adenocarcimonas
  • minority are endometroid and clear cell
46
Q

sonography of tubal cancer

A
  • very similar to ovarian cancers
  • complex largely solid mass with cystic components
  • highly vascular
  • sausage shaped
  • most cases ovary is not seen

Ob/Gyne 2 (19 decks)

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