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Repro > Normal Pelvic Anatomy and Mullerian Anomalies > Flashcards

Normal Pelvic Anatomy and Mullerian Anomalies Flashcards

1
Q

What is the cervix?

A

The inferior most part of the uterus

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2
Q

What is the corpus?

A

The body of the uterus - between the cervix and the fundus

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3
Q

What is the fundus?

A

The superior most part of the uterus

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4
Q

What is the cornua?

A

Part of the uterus where the Fallopian tubes enter the uterine cavity

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5
Q

What do internal organs develop from?

A

Paramesonephritic (Mullerian) Ducts and Mesonephritic (Wolffian) Ducts

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6
Q

What do both Wolffian and Mullerian ducts lead to?

A

Formation of a cloaca in a urogenital sinus

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7
Q

What determines if Wolffian or Mullerian ducts develop?

A

Hormones

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8
Q

What determines the development/progression of Wolffian ducts?

A

Testosterone and DHT

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9
Q

What do Sertoli Cells produce that causes regression of Mullerian Ducts?

A

AMH - Anti Mullerian Hormone

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10
Q

What produces AMH?

A

Sertoli Cells

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11
Q

What leads to the development of external femal genitalia?

A

Nothing - absence of androgen/AMH all that is required

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12
Q

What develops from the Mullerian ducts?

A

Tubes, Uterus, Cervix, Upper 2/3 of the Vagina

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13
Q

What develops from the urogenital sinus?

A

Lower 1/3 of the Vagina

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14
Q

Where is the hymen located?

A

At the junction of the Upper 2/3 of the Vagina from the Mullerian Ducts and the Lower 1/3 of the Vagina from the Urogenital Sinus

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15
Q

When does fusion of the Mullerian Ducts begin?

A

8-9 weeks post gestation

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16
Q

What follows fusion?

A

Canalization

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17
Q

When is Canalization Complete?

A

20 weeks

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18
Q

What happens to any anomalies of canalization at 20 weeks?

A

They stay but aren’t easily seen on U/S

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19
Q

What forms male internal genitalia and parts of the external genitalia?

A

Wolffian duct

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20
Q

What does the Umbilical vein become in adults?

A

Falciform Ligament

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21
Q

What does the Umbilical Artery become in adults?

A

Lateral suspensory ligaments of bladder

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22
Q

Where do you insert the laparoscope?

A

Umbilicus

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23
Q

What do you inflate the abdominal wall with?

A

CO2

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24
Q

What do you inflate the abdominal wall with CO2?

A

CO2 will dissolve, and be exhaled

- Room air –> Air embolism

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25
Q

What can be seen during a laparoscopy?

A
  1. Fundus of uterus, ovaries, and tubes
  2. Retroperitoneal vessels
  3. Utero-ovarian ligament (contains a vessel)
  4. Uterine Ligaments
  5. Infundibulopelvic ligaments (AKA Suspensory Lifgament of ovary) at pelvic brim
  6. Other abdominal Organs
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26
Q

What do the pelvic organs look like during a laparoscopy?

A

Upside down as you are looking at them from above instead of from below

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27
Q

What does the infundibulopelvic ligament (suspensory ligament of the ovary) contain?

A

Ovarian Artery, Veins, and Nerves

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28
Q

What can PID lead to?

A

Fitz-Hugh-Curtis Syndrome

- Adhesion of liver to diaphragm

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29
Q

What is endometriosis?

A

Discolorization of all pelvic organs due to intra-pelvic bleeds (rust-colored)

30
Q

What is a hysteroscopy?

A

Used to look inside the uterus and to operate inside the uterus

31
Q

What do you fill uterus with during hysteroscopy?

A

Saline

  • Allows operations
  • NOT CO2
32
Q

What is the main etiology of Mullerian anomalies?

A

Environment + Genetics + Epigenetics

33
Q

What happens when you karyotype a woman with an Mullerian anomaly?

A

Karyotype is normal

34
Q

What are the classifications of Mullerian Anomalies?

A
  1. Hypoplasia/Agenesis
  2. Unicornuate
  3. Didelphus
  4. Bicornuate
  5. Septate
  6. Arcuate
  7. DES Drug Related
35
Q

Subclasses of Hypoplasia/Agenesis

A

a. Vaginal
b. Cervical
c. Fundal (aka uterine)
d. Tubal
e. Combined

36
Q

What is agenesis?

A

No fusion of Mullarian duct –> no development of female tract

37
Q

Presentation of Hypoplasia/Agenesis?

A

Primary amenorrhea w/ cyclic pain , normal secondary sex characteristics

38
Q

Possible anomalies in hypoplasia/agenesis?

A

No uterus
No uterus + no tubes
No uterus + no tubes + no cervix/upper vagina

39
Q

What is the etiology of unicornuate uterus?

A

Failure of one of the Mullerian Ducts to develop/elongate

40
Q

Subclasses of unicornuate uterus?

A

Communicating
Non-communicating
No Cavity
True Unicornuate Uterus

41
Q

What is a communicating unicornuate uterus?

A

Rudimentary horn w/ a cavity and its communicating with uncornuate cavity

42
Q

What is a non-communicating unicornuate uterus?

A

Rudimentary horn w/ a cavity but its not communicating with uncornuate cavity

43
Q

What is a No cavity unicornuate uterus?

A

Rudimentary horn w/o a cavity

44
Q

What is a true unicornuate uterus?

A

No rudimentary horn –> Very rare

45
Q

Etiology of Uterine didelphys?

A

Failure of Mullerian ducts to fuse –> two seperate uterine horns –> each with endometrial cavity and its own cervix

46
Q

Subclasses of bicornuate uterus?

A

a. Complete Septum

b. Partial Septum

47
Q

Etiology of bicornuate?

A

Incomplete fusion

- Walls of Mullerian ducts don’t fuse properly, so you end up with a kind of Y-shaped uterus

48
Q

How many cervices do you have in a bicornuate uterus?

A

One Cervix with two separate but communicating endometrial cavities

49
Q

What happens during pregnancy with a bicornuate uterus?

A

Increased incidence of preterm delivery

50
Q

Subclasses of Septate uterus?

A

a. Complete Septate Uterus

b. Partial septate (subseptate) uterus

51
Q

Etiology of Septate uterus?

A

Incomplete canalization

52
Q

Where in the uterus are bicornuate and septate uterus similar? different?

A

Inside the uterus

Outside the uterus

53
Q

What does the outside of the uterus look like in a septate uterus?

A

Normal

54
Q

What are the risk with septate uterus?

A

Infertility and early pregnancy loss

55
Q

How do you differentiate between a bicornuate uterus and a septate uterus?

A

Measuring depth of outside indentation

  • > 1 cm = bicornuate
  • <1 cm = septate
56
Q

How do you distinguish between arcuate uterus and septate uterus?

A

Measuring length of inside indentation

  • > 1 cm = septate
  • <1 cm = arcuate
57
Q

What does DES make the uterus look like?

A

T-Shaped Uterine Cavity

58
Q

DDx of agenesis?

A
  1. Meyer-Rokitansky-Kuster-Hauser (MRKH) Syndrome

2. Androgen insensitivity (AI) Syndrome

59
Q

How do you tell MRKH from AI?

A

Karyotype

  • MRKH = 46 XX
  • AI = 46 XY
60
Q

Genetics of MRKH?

A

46 XX

61
Q

Phenotype of MRKH?

A

Female

62
Q

What is absence in MRKH?

A

Vagina, Cervix, Uterus

63
Q

Do pts with MRKH have ovaries?

A

Yes - leads to normal pubetal secondary sex characteristic development

64
Q

Genetics of AI?

A

46 XY

65
Q

Phenotype of AI?

A

Female

66
Q

Why do pts with AI present as females?

A

Androgen receptors do not respond to androgen leading to no Wolffian duct development so they default to female external genetalia

67
Q

Do pts with AI produce AMH?

A

yes

68
Q

The production of AMH in pts with AI leads to what?

A

The regression of the Mullerian Ducts –> No vagina, uterus, cervix, fallopian tubes

69
Q

How to pts with AI go thru female puberty?

A

High levels of androgen get converted to estrogen via aromtase

70
Q

Do pts with AI have testes?

A

Yes

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