Pelvic Powerpoints (PID, Infertility, Abnormal Uterine Bleeding, and Ovarian Masses) Flashcards
What is endometriosis and what is it caused by?
endometrial tissue that is infiltrating outside of the uterus
caused by hormones.
What is the most common location of endometriosis?
The ovaries
What are the symptoms of endometriosis?
pain, abnormal uterine bleeding and dysmenorrhea.
What is an endometrioma and what is it caused by?
mass or lesion caused by accumulation of endometrial tissue
What is the nickname for an endometrioma?
chocolate cyst
Can we always diagnose an endometrioma or endometriosis?
not always.
What will an endometrioma look like on ultrasound?
well-define thin walls, anechoic, enhancement, avascular.
What are some differentials for an endometrioma?
hemorrhagic cysts, simple cyst, dermoid, or a fibroid.
Is polycystic ovarian disease an endocrine or exocrine disease process and how is it diagnosed?
endocrine
diagnosed from lab values
What disease causes anovulation?
polycystic ovarian disease
30% of polycystic ovarian disease are obese.
T/F
TRUE
What will the ovaries look like with a patient with polycystic ovarian disease?
bilateral ovaries w/ multiple follicles measuring 2-10 mm without a dominant follicle
What ovarian disorder will have the sign “string of pearls?”
polycystic ovarian disease
Bicornuate uterus’ will have _ vaginas, _ - _ cervixes, and __ uterus’.
( how many )
1 vagina, 1-2 cervix, and 2 uterus’
A didelphys uterus will have _ uterus, _ cervix and _ vaginas
COMPLETE separation (think di is 2 so two separate uterus’)
2 uterus, 2 cervix, 2 vaginas
With a septate uterus, there is a septum dividing the endo and a patient can get pregnant in one endo and not the other
t/f
TRUE
What is ovarian hyperstimulation caused by an what will it look like on ultrasound?
caused by infertility treatments and will have multiple large ovarian cysts.
What is PID (the dirty girl disease)
its a type of a sexually transmitted disease and can also be associate with abortions or childbirth
What are the syptoms of PID?
pain, fever/chills/ increased WBC, N/V, vaginal discharge and bleeding.
How is PID typically diagnosed and what labs will be elevated?
usually diagnosed though lab tests urine and vaginal secretions, and will have increased WBC
What are a few complications of PID?
chronic PID, infertility, ectopic pregnancy, chronic pain, and peritonitis
What will you see on Ultrasound with PID?
Salpingitis, pyosalpinx, hydrosalpinx, TOA, and endometritis
What is salpingitis?
infection of the tubes
Salpingitis includes thickened walls measuring greater than ___ mm. increased blood flow, and fluid in culdesac
5 mm
What is pyosalpinx and what can we do to distinguish between bowel and pyosalpinx?`
pyosalpinx is echogenic debri within tubes. The walls will be thickened
We can distinguish from bowel by watching for peristalsis
What is a tuboovarian complex?
bacteria from infection that reaches the ovaries.
What is a tuboovarian abscess
an abscess containg air or gas that is accompanied by pain, fever, discharge an bleeding.
MUST BE DRAINED
What’s the difference between a Tuboovarian abscess and a tubo ovarian complex?
a tuboovarian abscess makes the ovaries and tubes unrecognizable whereas the tuboovarian complex, you can still distinguish both the ovary and tubea
What is a peritoneal inclusion cyst and what is it caused by?
normal fluid released by ovary trapped in peritoneum.
Appears as irregular or loculated fluid around ovary.
Caused by trauma, surgery or TOA
What is the clinical indications for an ovarian mass?
pelvic pain or fullness, palpable mass, history of ovarian or breast cancer.
What are a few sex cell ovarian tumors?
fibromas, thecomas, ganulosa cell tumors, and sertoli-leydig cell tumors
What is a fibroma?
a sex cell tumor that does not produce hormones and will be asymptomatic
What is a thecoma tumor and what does it cause?
a sex cell tumor that produces estrogen and causes Meig’s with pleural effusion and ascites.
What will both a fibroma and thecoma look like on US?
hypoechoic solid masses.
What is the age range for a granulosa cell tumor and what is it caused by?
What’s it look like on US?
mostly postmenopausal and caused from estrogen.
thickened enometrium and variable ovary appearance.
Can sertoli-leydig cell tumors be malignant?
yes..up to 20% are.
What is an endometroid tumor?
an epithelial originated, possibly malignant cystic mass with solid components
It is often bilateral and is associated with endometrial cancer.
When is mucinous cystadenocarcinoma typically diagnosed? (age range)
older populations.
What will mucinous cystadenocarcinoma look like on US?
thicker septations, solid areas, and vascularity
When is mucinous cystadenoma typically found and what will it look like on US?
younger populations, most are benign
sonographically it is multiloculated, internal echoes, thick septations, and papillary projections. VERY LARGE.
What age range is a serous cystadenoma (benign)found and will it need surgery to be removed?
40-50 years of age.
yes surgery is needed.
When age range is serous cystadenocarinoma (malignant) found and what lab value will be increased.
peri-post menopausal.
elevated CA125
What is a dermoid?
besides the nastiest thing ever?
it is a germ cell composed of teeth, bones, nails, fat and hair.
What are the clinical symptoms of a dermoid?
asymptomatic usually, possibly pelvic pain,
can be large and painful.
On ultrasound, what will a dermoid look like?
nasty.
vascularity around periphery, fat/fluid levels, echogenic material within, posterior portional will be shadowed making measurements difficult
A dermoid is associated with what sonographic sign?
tip of iceberg sign from echogenic material within.
What are the clinical symptoms of ovarian torsion?
severe pain, N/V, possible palpable mass
What are the sonographic finings of ovarian torsion?
large ovary with normal vascularity (venous flow is the first to go), cyst on ovary, and twisting of vessels outside ovary.
where does the paraovarian cysts originate from
broad ligament adjacent to ovary.
What is the normal follicle size?
3 cm
If someone has the BRCA1 or BRCA 2 gene, what are they more at risk for?
ovarian masses
What are some risk factors for endomentrial adenocarcinoma and what are the clinical symptoms?
hormone therapy, obesity, hypertension, diabetes, tamoxifen and nulliparity
clinical symptoms include abnormal uterine bleeding and post menopausual bleeding
What will endometrial carcinoma look like on US?
thickened irregular or illdefine endometrium, enlarged uterus, invasion of myometrium and increase blood flow
What does tamoxifen (used for breast cancer) do to the uterus?
it makes the endometrium heterogenous and thickened with cystic areas
What is a polyp of the endometrium and where are they typically found?
overgrowths of enometrial glands and stroma
it is attached blood floby a stalk with blood flow
uterus or cervix
What is hyperplasia of the endometrium and what causes it?
overgrowth of endometrial tissue
estrogen causing endometrium to constantly reproduce
What is adenomyosis and what is it cause by?
cells rom basal layer of endometrium migrating into myometrium
unknown cause
What are the symptoms of adenomyosis?
painful periods and abnormal uterine bleeding
What is the sonographic findings of adenomyosis?
heterogenous, hypoechoic striations and cyst like areas, increased vascularity, and thickened posterior wall.
Name the three locations of fibroids and their names.
Intramural-in myometrium
Submucosal- in endometrium
Subserosal-exophytic
Which of the locations of fibroids causes abnormal uterine bleeding?
submucosal –in endo.
What ethnicity is more at risk for fibroids?
african americans
These fibroids are fed by estrogen.
T/F
true
What are the symptoms of a fibroid?
calcify, pain, irregular bleeding, an feeling fullness.
What are the types of abnormal uterine bleeding?
menorrhagia (long and heavy, menometorrhagia (irregular and heavy), after intercourse, infrequent.
What are some causes of abnormal uterine bleeding?
Uterine-fibroids and adenomyosis
Endo- carcinoma, hyperplasia, and polyps
Reproductive tract- PID
Endocrine-hormone imbalance, PCOS, low weight, and thyroid condition, perimenopasual.
