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Reproductive Sonography > Ovarian Pathology > Flashcards

Ovarian Pathology Flashcards

1
Q

What is the order of follicle formation

A

Primordial follicle
Primary Follicle
Secondary follicle
Graafian Follicles
Ovulation
Corpus Luteum
Corpus Albican

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2
Q

What are the 3 characteristics of an ovarian cyst

A

Thin, smooth walls
Anechoic
Posterior enhancement

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3
Q

Maj11ority of ovarian masses are

A

Simple cysts

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4
Q

What are functional ovarian cysts

A

Benign, cystic masses that respond to cyclic hormonal stimulation

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5
Q

What is the most common cause of ovarian enlargement in young women

A

Functional ovarian cysts

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6
Q

What are the 3 types of functional cysts

A

Follicular cyst
Corpus luteum cyst
Theca-lutein cyst

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7
Q

True or False
Functional cysts regress by themselves without any type of intervention

A

True

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8
Q

Fluid accumulation in the posterior cul-de-sac is due to

A

Physiology

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9
Q

What are the complex cystic masses (Benign ovarian neoplasm)

A

Serous cystadenoma
Mucinous cystadenoma
Brener tumor
Dermoid cyst
Fibroma
Endometrioma

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10
Q

Theca lutein cysts happen

A

Bilaterally

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11
Q

What is the most common type of ovarian cyst

A

Follicular cyst

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12
Q

Follicular cysts occur when a

A

Dominant follicle fails to ovulate and remains mature

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13
Q

Signs and symptoms of follicular cyst

A

Asymptomatic
Dull adnexal pressure
Fullness/bloating
Pain on side of cyst
May lead to menstrual irregularities
Surgery may be needed

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14
Q

True or False
Follicular cysts are smaller than dominant follicles

A

False - Larger than

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15
Q

Follicular cysts can be become ___ and can ___

A

Large and can rupture

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16
Q

What is the sonographic apperance of follicular cysts uni or bi

A

Unilateral

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17
Q

What are the risk factors for follicular cysts

A

Women of reproductive age

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18
Q

What are the differentials of follicular cysts
What are they?

A

Serous cystadenoma:
Epithelial tumor
Hydrosalpinx:
Fluid-filled fallopian tube

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19
Q

Type of functional ovarian cyst that occurs when corpus luteum fails to regress
How long do they last?

A

Corpus luteum cysts
14 days

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20
Q

What would happen to corpus luteum cyst if pregnancy occurs

A

Produces progesterone and will sustain the early stage of pregnancy, becomes corpus luteum of pregnancy

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21
Q

What is the most common pelvic mass encountered during 1st trimester of pregnancy

A

Corpus luteum cyst

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22
Q

True or False
Corpus luteum does not always indicate pregnancy

A

True

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23
Q

How does a corpus luteum cyst of menstruation forms from

A

Normal 2-3 cm dominant cyst/Graafian follicle ruptures

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24
Q

As corpus luteum cyst of menstruation regresses it becomes

A

Corpus albicans

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25
Q

Internal hemorrhage occurs into functional cysts of the ovary
Occurs most commonly in

A

Hemorrhagic corpus luteum cyst
Corpus luteum cyst

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26
Q

What are the signs and symptoms of a hemorrhagic corpus luteum cyst

A

Asymptomatic
Pelvic pain
Enlarged and tender ovary
Irregular menstrual cycle
Nausea/vomiting

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27
Q

What are the sonographic findings of corpus luteum cyst

A

Anechoic
Unilateral
Fluid in cul-de-sac or adjacent to ovary
Ovarian artieral flow-low resistant pattern

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28
Q

If a hemorrhage occurs with a corpus luteum cyst it will have what type of apperance

A

Fishnet apperance

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29
Q

Produces progesterone to support early pregnancy maintaining the decidualized endometrium

A

Corpus luteum of pregnancy

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30
Q

Sonographic apperance of corpus luteum of pregnancy - uni or bi

A

Unilateral

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31
Q

Caused by high levels of hormone, human chorionic gonadotropin

A

Theca Lutein cyst

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32
Q

Theca lutein cyst is a large ____

A

Functional cyst

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33
Q

Theca lutein cyst is associated with

A

Gestational trophoblastic disease
Normal pregnancy
Infertility drugs

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34
Q

Occurs when a sperm cell fertilizes an empty egg or 2 sperm cells fertilize normal egg cell

A

Gestational trophoblastic disease

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35
Q

What are the sonographic findings of theca lutein cyst

A

Bilateral
Multiloculated
Very large
Complications with hemorrhage, rupture, or torsion

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36
Q

Post surgical residual

A

Ovarian remnant syndrome

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37
Q

What are the signs and symptoms of ovarian remnant syndrome

A

Pelvic pain
Pelvic mass
Absence of menopause after oophorectomy

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38
Q

What is the sonographic apperance of ovarian remnant syndrome

A

Simple to complex
Thin rim
Free fluid

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39
Q

Paraovarian cysts arise from

A

Gartner’s duct remnant or Hydatid of Morgagni

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40
Q

Paraovarian cysts are most commonly found within the
Lies ___ to ovary and is separate from ___
Is a non___ cyst

A

Broad ligaments
Lies adjacent to ovary, separate from ovary
Non-functional cyst

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41
Q

What are sonographic findings of paraovarian cyst

A

Thin walled
Anechoic
Posterior enhancement
Small to 15 cm

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42
Q

Predominantly in patients with a history of previous abdominal surgery

A

Peritoneal inclusion cyst

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43
Q

Peritoneal inclusion cyst is a result of

A

Trauma
PID
Endometriosis

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44
Q

In peritoneal inclusion cysts if peritoneal adhesions present with accumulation of fluid it will

A

Entrapped in ovaries

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45
Q

What is the main source of peritoneal fluid in women

A

Ovaries

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46
Q

What is the sonographic apperance of peritoneal inclusion cyst

A

Anechoic fluids may containing echoes
Fluid & septations surround an intact ovary

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47
Q

Development of uterine’s inner lining tissue outside of the uterus

A

Endometriosis

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48
Q

Endometriosis is found in which 2 cavities

A

Abdominal and pelvic

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49
Q

What are the main symptoms of endometriosis

A

Pain
Menstrual irregularities w/ excessive bleeding
Bloating/nausea
Infertility

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50
Q

Dysmenorrhea

A

Painful period

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51
Q

Dyspareunia

A

Pain during intercourse

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52
Q

What are the causes of endometriosis

A

Retrograde menstruation
Surgical scar implantation
Immune system disorder

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53
Q

What are the risk factors of endometriosis

A

Never giving birth
Menses at early age
High levels of estrogen
1+ relative with endometriosis

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54
Q

What are the treatment options of endometriosis

A

Hormones
Excision surgery

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55
Q

Endometrioma is also known as

A

Chocolate cyst

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56
Q

Cystic mass filled with blood in the ovary as

A

Endometrioma or chocolate cyst

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57
Q

Endometriomas are a result of

A

Localized endometriosis

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58
Q

Endometriomas are most common in

A

Women of reproductive age

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59
Q

Endometriomas may be classified as what 2 types

A

Diffuse or localized

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60
Q

Most common form of endometriosis

A

Diffuse endometriosis

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61
Q

Endometrial tissue on one or both ovaries

A

Localized endometriosis

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62
Q

In endometrioma the ovarian tissue may be

A

Partially or completely replaces by endometrial tissue

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63
Q

Internal content of endometrioma may consist of

A

Old blood
Fresh
Hemorrhage
Clots

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64
Q

What are the signs and symptoms of endometriomas

A

Dysmenorrhea
Dyspareunia
Metromenorrhagia
Infertility

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65
Q

What is the sonographic apperance of endometriomas

A

Well defined
Homeogenous
Thought to represent cholesterol deposits

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66
Q

Ovarian torsion is also known as

A

Adnexal torsion or tubo-ovarian torsion

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67
Q

Partial or complete rotation of the ovarian pedicle on its axis

A

Ovarian torsion

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68
Q

Mobile adnexal structures allow torsion at the

A

Mososalpinx

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69
Q

In ovarian torsion there is a decrease in

A

Lymphatic and venous drainage

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70
Q

Ovarian torsion has the rotation of the ___ and portion of the ___ on supplying ___ pedicle

A

Ovary, fallopian tube, vascular

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71
Q

For ovarian torsion has eventual loss of ___ perfusion and results in ___

A

Loss of arterial perfusion
Results in infraction

72
Q

Clinical findings of ovarian torsion

A

Sudden or severe pelvic pain
Nausea/vomiting
Palpable adnexal mass & tenderness
Surgical emergency

73
Q

What are the lab values of ovarian torsion

A

Elevated WBC

74
Q

The sonographic findings of ovarian torsion is variable on:

A

Variable on:
Duration
Degree
Existence of mass

75
Q

Other sonographic findings of ovarian torsion

A

Peripherally displaced follicles with hyperechoic central stroma
Free pelvic fluid
Ovary tender to transducer

76
Q

What are the Doppler findings of ovarian torsion

A

Decrease/absent blood flow
Absent/reversed diastolic flow
Whirlpool sign

77
Q

Poly-cystic ovary syndrome is also known as

A

Stein-leventhal syndrome

78
Q

A complex endocrinologic disorder resulting in oligomenorrhea and chronic anovulation

A

Polycystic ovary syndrome

79
Q

In polycystic ovary syndrome there is an imbalance in:
Resulting from:

A

LH & FSH
Due to abnormal estrogen and androgen production

80
Q

PCOS will have follicles but they may fail to

A

Regulary release eggs

81
Q

PCOS is most common in
PCOS is most common cause of

A

Women age 20-30
Infertility

82
Q

Signs and symptoms of PCOS

A

Polycystic & enlarged ovaries
Infertility
Oligomenorrhea or amenorrhea
Hirsutism

83
Q

Excess facial and body hair androgenism

A

Hirsutism

84
Q

Sonographic apperance of PCOS

A

Enlarged ovaries (> 10 cubic cm)
Multiple, small, peripheral follicles
Bilateral
12+ follicles (2-9mm)

85
Q

In PCOS the follicles located peripherally are known as the

A

String of perals

86
Q

Equation to calculate ovarian volume

A

0.5 x L x W x Thickness of ovary

87
Q

Cystic teratoma is also known as

A

Dermoid cyst

88
Q

Dermoid is composed of

A

Dermal and epidermal elements

89
Q

Termatomas composed of

A

Mesodermal and endodermal

90
Q

Cystic teratoma is most common in
Is the most common
Most common site is

A

Common in young women of repro age
Most common benign tumor
Site is level of superior to the uteruine fundus

91
Q

75% of all dermoid cyst are

A

Unilateral

92
Q

Germ cell that is retained within the egg sac

A

Cystic teratoma

93
Q

Cystic teratoma is filled with

A

Sebaceous material of hair, teeth, bone, thyroid, fibrous tissue and fluid

94
Q

What are the clinical findings of cystic termatoma

A

Mild-acute abdominal pain
Adnexal fullness
Pressure-like symptoms

95
Q

Sonographic findings of cystic termatoma

A

Posterior shadowing
“Tip of iceberg”
Cystic to complex

96
Q

Common solid masses

A

Solid teratoma
Brenner tumor
Fibroma
Dysgerminoma
Thecoma

97
Q

Rare, malignant, mainly in children and young adults

A

Solid teratoma

98
Q

Sono findings of solid teratoma

A

Unilateral
Poor prognosis

99
Q

Brenner tumor is also known as
Most common in
May be associated with

A

Transitional cell carcinoma
Postmenopausal women (50-60)
Meig’s syndrome

100
Q

Meig’s syndrome

A

Ascities and pleural effusion

101
Q

Clinical findings of Brenner tumor

A

Asymptomatic and found incidentally

102
Q

Solid, abnormal growth on the ovary

A

Brenner tumor

103
Q

Most Brenner tumors are ___
5% are ___

A

Benign
5% are malignant

104
Q

What are the sonographic findings of Brenner tumor

A

Solid
Confused with pendunculated fibroids
Hypoechoic
50% calcifications
Unilateral (Can be bilateral)
Small
Equal to or >10cm

105
Q

Benign ovarian tumor of sex cords

A

Ovarian fibroma

106
Q

Fibromas arise from

A

Stroma and sex cords

107
Q

90% of fibromas are ___
Big as ___cm
Mainly found in
Most common tumor associated with

A

Unilateral
25cm
Postmenopausal or perimenopausal women (50-60)
Meig’s syndrome

108
Q

Clinical findings of fibroma

A

Small - Asymptomatic
Large - Pelvic pain
Pressure symptoms
Abdominal enlargement

109
Q

Sono findings of fibroma

A

Solid
Hyperechoic
Have torsion

110
Q

Rare maligant tumor and 75% occur between 10-30 years of age

A

Dysgerminoma

111
Q

Symptoms of dysgerminoma
90% __

A

Pelvic pain
Irregular vaginal bleeding
Unilateral

112
Q

Sono findings of dysgerminoma

A

Solid
Homogenous
Poor prognosis

113
Q

Thecoma is also known as
Are uni or bi
Most common in

A

Theca cell tumor
Unilateral
Menopausal or postemenopausal women

114
Q

Malignant thecomas are

A

Rare

115
Q

Clinical symptoms of thecoma

A

Pelvic pain
Pressure symptoms

116
Q

Sono findings of thecoma

A

Posterior shadowing
Foci or calcifications
Necrosis
Cystic degeneration

117
Q

Common adnexal masses

A

Cystadenoma (Serous & Mucinous)
Cystadenocarcinoma (Serous & Mucinous)
Brenner Tumor
Granulosa cell tumor

118
Q

Benign ovarian cystic tumor lined by a serous epithelium

A

Serous cystadenoma

119
Q

Most common epithelial tumor

A

Serous cystadenoma

120
Q

Second most common benign tumor of the ovary

A

Serous cystadenoma

121
Q

Serous cystadenoma has peak incidence in the

A

4th & 5th decades

122
Q

Signs and symptoms of serous cystadenoma

A

Nausea/vomiting/bloating
Fatigue
Low abdominal pain/pressure

123
Q

Sono findings of serous cystadenoma

A

Papillary projections
Unilateral

124
Q

Treatment for serous cystadenoma

A

Surgical excised

125
Q

Most common type of ovarian cancer

A

Serous cystadenocarcinoma

126
Q

Clinical manifestations of serous cystadenocarcinoma

A

Pain
Abdominal distension
Bowel obstruction
Nausea/vomiting
Easy satiety
Cachexia

127
Q

Sono findings of serous cystadenocarcinoma

A

Papillary projection
Thick septations
Irregular borders
Components and septations demonstrate blood flow

128
Q

Second most common epithelia tumor
Benign or malignant

A

Mucinous cystadenoma
Benign

129
Q

Signs and symptoms of mucinous cystadenoma

A

Increase abdominal girth
Pelvic pressure
Bloating

130
Q

Sono findings of mucinous cystadenoma

A

Large
Low-level echoes
Thin septations
Unilateral

131
Q

Second most common epithelial ovarian cancer
Most common in

A

Mucinous cystadenocarcinoma
Menopausal women

132
Q

What are the clinical findings of mucinous cystadenocarcinoma

A

Pelvic pressure
Bloating

133
Q

Sono findings of mucinous cystadenocarcinoma

A

Similar to serous cystadenocarcinomas

134
Q

Rare type of ovarian cancer
Most common in
Uni or Bi

A

Granulosa cell tumor
Adults
Unilateral

135
Q

Most common sex cord-stromal tumor

A

Granulosa cell tumor

136
Q

Granulosa cell tumor does what to women

A

Higher than normal levels of estrogen

137
Q

Symptoms of granulosa cell tumor

A

Irregular menstruation cycles

138
Q

Treatment for for granulosa cell tumor

A

Fertility-sparing surgery

139
Q

Metastatic disease can affect the ovary from

A

Breast
GI Tract
Lymphatic spread
Other pelvic organs

140
Q

Metastatic malignancy of the ovary from stomach, biliary tract, GB, pancreas

A

Krukenberg tumors

141
Q

Sono findings of metastatic disease

A

Bilateral
Ascites
Complex
Necrotic
Solic
Hypoechoic

142
Q

Types of inflammatory Diseases

A

PID
Pyosalpinx
Hydrosalpinx
Chronic salpinitis
Tubo-ovarian abscess
Peritonitis

143
Q

2 types of PID consequences

A

Gonorrheal
Nongonorrheal

144
Q

Nongonorrheal PID consequences result from retained products of

A

Conception
Appendicitis
Sigmoiditis
Prolonged use of IUD

145
Q

PID may lead to

A

Parametritis

146
Q

Chronic PID

A

Widespread fibrosis and adhensions

147
Q

Associated with PID and use of IUD

A

Actinomycosis

148
Q

Conditions that mimic PID

A

Endometriosis
Ectopic pregnancy
Hemorrhagic cyst
Multicystic ovarian disease

149
Q

Clinical findings of PID

A

Fever
Leukocystosis
Rapid pulse rate
Vaginal discharge

150
Q

For PID sonographically you always look for

A

Peristalsis

151
Q

Inflammation of the fallopian tube that fills and swells with pus

A

Pyosalpinx

152
Q

Acute pyosalpinx is shaped like a

A

Sausage

153
Q

Clinical findings of pyosalpinx

A

Fever
Pelvic pain
Dyspareunia

154
Q

Lab values of pyosalpinx

A

Leukocytosis

155
Q

Sonographic findings of pyosalpinx

A

Distended fallopian tubes

156
Q

Post reabsorption of the inflammation the tube becomes weak and thin

A

Hydrosalpinx

157
Q

Clinical findings of hydrosalpinx

A

bhCG titers will prove difference
Colicky pain

158
Q

Sono findings of hydrosalpinx

A

Anechoic fluid filled
Sausage-shaped
Beads of string sign

159
Q

Adnesions and fibrosis may involve the peritoneal surfaces and bowel

A

Chronic salpingitis

160
Q

Clincial findings of chronic salpinitis

A

Painful defecation
Dyspareunia
Intermenstrual pain
Hysterosalpingoraphy

161
Q

Purulent material spills from Fallopian tube to the ovary

A

Tubo-ovarian abscess

162
Q

Tubo-ovarian abscess is one of many later complications of

A

PID

163
Q

Tubo-ovarian abscess can be life-threatening if the abscess

A

Ruptures and results in sepsis

164
Q

Consists of encapsulated or confined pocket of pus with defined boundaries that forms during an infection of a fallopian tube and ovary

A

Tubo-ovarian abscess

165
Q

Clinical findings of tubo-ovarian cyst

A

Nausea/vomiting
Abdominal & pelvic pain
Fever/chills
RUQ pain
Right sided pleuritic pain

166
Q

Fitz-hugh-curtis syndrome

A

RUQ pain, right sided pleuritic pain

167
Q

Lab values associated with tubo-ovarian abscess

A

High ESR

168
Q

Sono findings of tubo-ovarian abscess

A

Local areas of tubal distention with pus and debris
Multiple loculations
Septation
Difficult to identitfy ovary

169
Q

Inflammation of peritoneum

A

Peritonitis

170
Q

Peritoneum covers and supports most

A

Abdominal organs

171
Q

Peritonitis usually caused by

A

Infection from bacteria or fungi

172
Q

What can happen if peritonitis is left untreated

A

Spread into blood (Sepsis) and to other organs

173
Q

Peritonitis results in multiple

A

Organ failure and death

174
Q

First symptoms of peritonitis

A

Poor appetite
Nausea
Dull abdominal ache

175
Q

Other signs and symptoms related to peritonitis

A

Abdominal tenderness/distension
Chills/fever
Fluid in abdomen
Not/less passing urine
Difficult to pass gas/bowel movement
Vomiting

Reproductive Sonography (9 decks)

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