OB review- abnormal female pelvis Flashcards
what is the 3rd most common gyneclogical malignancy?
cervical carcinoma
what is cervical carcinoma?
- epithelial neoplasm
- intermestrual or post coital bleeding
- hypoechoic or heterogenous retrovesical mass
- endometrial fluid collection
nabothian cyst on u/s?
- cyst in the cervix
- multiple or solitary anechoic structures <2cm
- may contain internal echoes
what are nabothian cysts caused by? How do they present?
- chronic cervicitis
- typically asymptomatic
Leiomyomas aka?
- myomas
- fibroids
what are leiomyoma’s?
- benign smooth muscle tumors
- most common pelvic tumor
what is the leading cause of hysterectomy?
leiomyomas
leiomyoma risk factors?
- african american women
leiomyoma on u/s?
- may be multiple and vary in size
- may cause pain if they degenerate
where are fibroids most commonly seen?
myometrial
4 locations of leiomyomas (fibroids)?
- intramural (myometrial): most common
- subderosal
- pedunculated
- submucosal
what kind of fibroid distorts the uterine contour?
suberosal
what type of fibroid grows off a stalk?
pedunculated
what type of fibroids cause abnormal uterine bleeding? (2)
- submucosal
2. intramural
what kind of fibroid is this?
subserosal
What kind of fibroid is this?
peduculated
what kind of fibroid is this?
submucosal
what is an adenomyosis?
glands and stroma from the basal layer of enometrium penetrate into the myometrium
clinical presentation of adenomyosis?
- smooth muscle becomes hyperplastic
- enlarged uterus
- may be diffuse or focal
adenomyosis is found in what % of hysterectomy specimens?
70%
adenomyosis causes? (2)
- dysmenorrhea
- abnormal uterine bleeding
sono apperance of adenomyosis?
- myometrial alterations
- poor definition of endometrial and junctional zone caused by endometrial tissue extending form the basal layer
what is endometrial hyperplasia?
- abnormal proliferation (growth) of the endometrium in response to excess or unopposed estrogen
endometrial hyperplasia on u/s?
- endometrium is diffusely thickened
- asymmetric or focal thickening may be present
what is the most common gynecologic cancer?
endometrial adenocarcinoma
who does endometrial adenocarcinoma affect?
1 in 50 women
most cases of endometrial adenocarcinoma get diagnosed when?
in postmenopausal women
what is the most common clinical presentation of endometrial adenocarcinoma?
postmenopausal bleeding
risk factors of endometrial adenocarcinoma? (5)
- unopposed estrogen stimulation
- obesity, nulliparity, diabetes, hypertension
- tamoxifen therapy for breast cancer
- chronic anovulation
- presence of atypical endometrial hyperplasia
endometrial carcinoma on u/s?
- endometrium >4mm in postmenopausal women
- heterogenous
- hematometra
- enlarged uterus
why is a biopsy needed with endometrial carcinoma?
to differentiate between hyperplasia and carcinoma
what is an endometrial polyp?
- benign focal overgrowth of endometrial glands and stroma
size of endometrial polyp?
variable- some are 1mm, others fill endometrial canal
where might an endometrial polyp extend to?
- cervix or vagina
who are endometrial polyps most prevenlent in?
- perimenopausal
- postmenopausal
what can polyps cause? (4)
- coital spotting
- intermenstrual bleeding
- menorrhagia
- menometrorrhagia
polyp on u/s?
- isoechoic to surrounding endometium
- gives apperance of focal or global endometrial thickening
- cystic spaces between polyp
- vascularity feeding vessel
- well- defined
what is tamoxifen?
- drug administered to women with brest cancer to block estrogenic effects on breat tissue
what can tamoxifen cause and why?
can stimulate cell gorwth and proliferation in endometrial tissue, enhanching the risk of:
- carcinoma
- hyperplasia
- polyps
what is asherman syndrome?
- adhesions froma pervious deep curretage or endometiral infection
clinical presentation of asherman syndrome?
- asymptomatic
- amenorrhea
- dysmenorrhea
- hypomenorrhea
- infertility
ashermans syndrome on u/s?
- inability to distinguish an endometrial cavity
- may have bright echoes in endometrial cavity
what does retained product of conception (RPOC) typically contain?
- placental tissue
- can persist for months causing abnormal utererine bleeding
sono findings of RPOC (enlarged uterus)?
- enlarged uterus- typically returns to normal size and shape within 6-8 weeks after delivary
immediate postpartum findings of RPOC?
- Residual fluid and echogenic material
- hemorrhage within the endometrial cavity
How to rule out RPOC?
- evaluate endometrial cavity for focal echogenic mass and asses endometrial thickness
if endometrial thickness is less than ___mm, RPOC is unlikely
10mm
RPOC is likely if what is seen?
if an echogenic mass with vascularity is present
an echogenic mass without vasularity may represent what?
- RPOC
- blood clots
RPOC
what is hematometra?
Blood trapped in endometrial cavity
hematometra s/s? (4)
- pelvic pain
- amenorrhea
- hypomenorrhea
- pelvic mass
hematometra is caused by? (3)
- impoerforated hymen
- cervical stenosis
- vaginal neoplasm
3 vaginal abnormalities?
- gartner duct cyst
- hematocolpos
- hematometrocolpos
what is a gartner duct cyst?
- small cyst within vagina
what is a hematocolpos?
blood accumulation in the vagina
what is hematometrocolpos?
- blood accumulation in uterus and vagina
hematometra
gartner duct cyst
hematometrocolpos
hydrosalpinx
what is hydrosalphinx?
- distally blocked fallopian tube
- filled with serous or clear fluid
hydrosalphinx on u/s?
- sausage shaped
- often bilateral
- colour doppler helpful to R/O varix
causes of hydrosalphinx? (5)
- old infection
- STD
- previous surgury
- adhesions
- endometriosis
