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Pelvic > Quiz 2 > Flashcards

Quiz 2 Flashcards

1
Q

what are the congenital anomalies of the uterus?

A
  • arrested development
  • failure of fusion
  • failure of resorption
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2
Q

arrested development

A
  • bilateral

- unicornuate unicollis

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3
Q

failure of fusion

A

mullarian ducts fail to fuse

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4
Q

what can failure of fusion result in?

A

depends where failure occurs

  • bicornuate unicollis
  • bicornuate bicollis
  • dideplhsys
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5
Q

is bicornuate unicollis one or two uteri?

A

defect is lower but still one uterus, more difficult to distinguish from didelphsys

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6
Q

is didelphsys one or two uteri?

A

2 separate uterus and cervix, sometimes results in 2 separate vaginas

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7
Q

describe bicornuate

A
  • uterus exterior is indented where did not fuse

- failure of fusion happens more superiorly

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8
Q

is bicornuate or didelphsys more common?

A

bicornuate

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9
Q

what is the difference between unicollis and bicollis?

A

where failure of fusion occurs

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10
Q

can you become pregnant with bicornuate uterus?

A

yes but

  • preterm delivery because of growth restrictions
  • caesarean section
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11
Q

is didelphsys common or rare?

A

rare

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12
Q

can you become pregnant with a didelphsys uterus?

A

yes but rare

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13
Q

failure of resorption

A
  • median septum does not get resorbed
  • normal exterior uterine contour
  • differing degrees of resorption (septate, sub septate)
  • arcuate (slight dip)
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14
Q

septate uterus is the most common____________

A

“Mullerian Duct Anomaly”

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15
Q

what is failure of resorption associated with?

A
  • spontaneous abortions

- fertility issues

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16
Q

How do we tell if there is an Anomaly with 2D Ultrasound?

A

Should see endometrium dividing when scanning transversely through the uterus

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17
Q

what is the treatment for anomaly of uterus?

A

hysteroscope laser the septum

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18
Q

what may be a reason for miscarriages?

A

failure resorption

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19
Q

when would you plan for early delivery?

A

failure of fusion

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20
Q

when would be the best time to scan for a UTERINE ANOMALY?

A

secretory phase

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21
Q

Diethylstilbestrol (DES)

A

Associated with Uterine anomalies

  • drug taken by mother discontinued in 1971
  • given in 1st trimester had direct effect on Mullerian system of fetus (crosses placenta)
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22
Q

what may an ultrasound of the uterus show if a mother had taken DES?

A
  • diffuse decrease in uterine size

- irregular T-shaped uterine cavity

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23
Q

what are some uterine abnormalities?

A
  • leiomyoma (fibroids)
  • lipomatous uterine tumors
  • leiomyosarcoma
  • adenomyosis
  • arteriovenous Malformations
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24
Q

what is a fibroid or leiomyoma?

A

benign solid tumor of the uterus

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25
Q

what is a fibroid or leiomyoma composed of?

A

smooth muscle cells and fibrous connective tissue

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26
Q

what is the most common neoplasm of the uterus?

A

leiomyoma or fibroid

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27
Q

what is the most common cause of enlargement of non pregnant uterus?

A

leiomyoma or fibroids

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28
Q

what do fibroids depend on?

A

estrogen (this is why they usually decrease in menopause)

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29
Q

what are symptoms of fibroids?

A

-pain
-uterine bleeding
(frequently asymptomatic)

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30
Q

what are the 3 classifications of fibroids?

A
  • intramural
  • submucosal
  • subserosal
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31
Q

what is the most common fibroid?

A

intramural

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32
Q

intramural fibroid

A

confined to the myometrium

completely surrounded by myometrium

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33
Q

submucosal fibroid

A
  • projecting into uterine cavity (distorting or displacing endo)
  • produce symptoms associated with infertility
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34
Q

Subserosal (pedunculated subserosal & subserosal) fibroid

A
  • projecting outward from myometrium

- distort outer contour of uterus

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35
Q

intraligamentous

A

Pedunculated Subserosal fibroid can project between leaves of broad ligament

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36
Q

______ of all fibroids are located in cervix

A

8%

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37
Q

what kind of fibroid would a cervical fibroid be?

A

any of the three

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38
Q

sonographic appearance of a fibroid

A
  • hypoechoic
  • heterogenous echotexture
  • areas of attenuation
  • frequently distort the external contour of uterus
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39
Q

what do we mention when describing fibroid location

A
  • type of fibroid

- location(anterior/posterior wall, fundal, cervical)

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40
Q

what do we do if their are multiple fibroids?

A

measure the 3 largest

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41
Q

what is an US role for fibroids?

A
  • location
  • size
  • is it a fibroid?
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42
Q

how do we know if fibroid is attached to the uterus?

A

turn on colour and put pressure

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43
Q

when can post menopausal fibroids increase in size?

A

if on HRT or Tamoxifen

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44
Q

Fibroids and postmenopausal women

A

rarely develop
usually decrease in size
become calcified

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45
Q

when may fibroids increase in size?

A
  • pregnancy

- anovulatory cycles (unopposed estrogen)

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46
Q

which fibroid would we measure if we saw one?

A

submucosal because it would be the one to cause bleeding

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47
Q

what problems could occur with fibroid and pregnancy?

A

location
-check if in cervix
size
-it gets larger with pregnancy

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48
Q

what are the complications associated with fibroids?

A
  • may outgrow blood supply
  • degenerating or necrotic fibroids when outgrow blood supply
  • pedunculated fibroids
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49
Q

which colour flow is usually represented with fibroids?

A

peripheral flow????

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50
Q

transabdominal for fibroids

A
  • larger FOV
  • Better assessing large fibroids
  • can be missed if just using TVP
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51
Q

transvaginal for fibroids

A
  • good at detecting small fibroids
  • origin of large pedunculated, subserosal fibroids vs. adnexal mass
  • fundal fibroids on retroverted uterus
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52
Q

what is the treatment of symptomatic fibroids?

A
  • uterine artery embolization
  • surgical treatment (hysterectomy)
  • medical treatment
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53
Q

are Lipomatous Uterine Tumors or Lipoleimyomas bengin or malignant?

A

benign

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54
Q

what do Lipomatous Uterine Tumors or Lipoleimyomas consist of?

A
  • mature lipocytes
  • smooth muscle
  • fibrous tissue
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55
Q

what does Lipomatous Uterine Tumors or Lipoleimyomas look like sonographically?

A
  • highly echogenic
  • absence of color flow within
  • usually asymptomatic
  • make sure within uterus
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56
Q

what can Lipomatous Uterine Tumors or Lipoleimyomas be confused with?

A

ovarian dermoid

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57
Q

Leiomyosarcoma

A
  • rare
  • malignant
  • may arise from leiomyoma
  • asymptomatic or uterine bleeding
  • same symptoms and appearance “fibroid”
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58
Q

what is the clue to Leiomyosarcoma?

A

rapid growth and post menopausal growth

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59
Q

Adenomyosis

A

endometrial glands and stroma within myometrium

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60
Q

what are the 2 forms of Adenomyosis?

A
  • diffuse

- nodular

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61
Q

Adenomyosis diffuse

A
  • more common

- widely scattered adenomyosis foci within the myometrium

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62
Q

Adenomyosis nodular

A

composed of adenomyomas (circumscribed nodules)

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63
Q

what is the clinical presentation of Adenomyosis?

A

Nonspecific

  • Uterine enlargement
  • Pelvic pain
  • Dysmenorrhea
  • Menorrhagia
  • Seen more in women who have had children
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64
Q

which probe is better for looking at adenomyosis?

A

transvaginal

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65
Q

sonographic features of adenomyosis?

A

Diffuse ut enlargement

  • Diffusely heterogeneous myometrium
  • Asymmetrical thickening of myometrium
  • Inhomogeneous hypoechoic areas
  • Myometrial cysts
  • Poor delineation of endo-myometrial border
  • Focal tenderness with transvaginal transducer
  • Subendometrial echogenic linear striations
  • Subendometrial echogenic nodules
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66
Q

what can be confused with adenomyosis?

A

fibroid

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67
Q

Lieomyomas

A
  • usually well defined

- peripheral vascularity

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68
Q

Localized Adenomyomas

A
  • ill defined borders

- internal vascularity

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69
Q

Arteriovenous malformations (AVM’s)

A

Vascular plexus of arteries and veins with no capillary network

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70
Q

what are the most cases for Arteriovenous malformations (AVM’s)?

A
  • pelvic trauma
  • surgery
  • gestational trophoblastic neoplasia
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71
Q

what is the symptom for AVM’s?

A

severe vaginal bleeding

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72
Q

when is AVM usually diagnosed?

A

post abortion and postpartum periods

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73
Q

what is the sonographic appearance of AVM’s?

A
  • multiple tortuous anechoic structures
  • subtle myometrial heterogenicity
  • myometrial or endometrial mass
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74
Q

what does colour look for AVM’s?

A

coloured mosaic pattern

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75
Q

what does spectral doppler look for AVM’s?

A
  • high velocity
  • low resistance arterial flow
  • high venous velocity (like an artery)
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76
Q

Differential Diagnosis of AVM’s

A
  • retained products of conception (RPOC)
  • GTN (gestational trophoblastic neoplasia)
  • subinvolution of placental bed
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77
Q

what help to distinguishing differential diagnosis of AVM’s?

A

negative hCG

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78
Q

what is the treatment for AVM’s?

A

-Wait to see if resolve (maybe not AVM)
-severe bleeding immediate treatment
(embolization)

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79
Q

Monckeberg’s Arteriosclerosis

A

Form of arteriosclerosis

-Hardening of the vessels or calcification of blood vessels

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80
Q

what is found in Monckeberg’s Arteriosclerosis?

A

calcium deposits are found in the muscular middle layer of the walls of arteries (the tunica media)

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81
Q

where does Monckeberg’s Arteriosclerosis occur?

A
  • peripheral
  • coronary arteries
  • GENITAL ORGAN ARTERIES
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82
Q

what is the cause of Monckeberg’s Arteriosclerosis?

A

unknown

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83
Q

what is Monckeberg’s Arteriosclerosis associated with?

A
  • Diabetes
  • Chronic kidney disease
  • Lupus
  • Chronic inflammatory conditions
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84
Q

what are sonographic features of adenomyosis?

A

Diffuse ut enlargement

  • Diffusely heterogeneous myometrium
  • Asymmetrical thickening of myometrium
  • Inhomogeneous hypoechoic areas
  • Myometrial cysts
  • Poor delineation of endo-myometrial border
  • Focal tenderness with transvaginal transducer
  • Subendometrial echogenic linear striations
  • Subendometrial echogenic nodules
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85
Q

is it normal to have fluid in the endo?

A

small amount

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86
Q

when measuring endo, do we include the fluid in our measurement?

A

NO

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87
Q

what are the indications for pelvic ultrasound specific for endometrium?

A

Bleeding

  • irregular
  • heavy
  • spotting
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88
Q

what are causes for endometrial thickening?

A
  • pregnancy
  • retained products of conception
  • fibroids (submucosal)
  • endometritis
  • adhesions
  • hyperplasia
  • polyps
  • carcinoma
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89
Q

when can endometritis occur?

A
  • postpartum
  • after D&C
  • associated with PID
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90
Q

what is the sonographic appearance of endometritis?

A
  • thick or irregular
  • may or may not contain fluid
  • gas with acoustic shadowing
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91
Q

what are some causes of abnormal bleeding from the endometrium?

A

especially in post menopausal women

  • hyperplasia
  • polyps
  • endometrial carcinoma
  • atrophy
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92
Q

what is endometrial hyperplasia?

A

overgrowth of endometrial glands

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93
Q

what are the 2 types of endometrial hyperplasia?

A

hyperplasia

cystic hyperplasia

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94
Q

what is the most common reason for hyperplasia?

A

unopposed estrogen stimulation in peri/post menopausal women

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95
Q

what are risk factors for hyperplasia?

A
  • Anovulatory cycles
  • Polycystic ovarian disease
  • Obese women (increase in estrogens)
  • Estrogen producing tumors
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96
Q

what does hyperplasia cause?

A

common cause of abnormal bleeding

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97
Q

what is the sonographic appearance of hyperplasia?

A

thick
echogenic
well defined endometrium
may have cystic areas

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98
Q

what are the differential diagnoses for hyperplasia?

A
  • diffuse polyps
  • endo carcinoma
  • endometrial atrophy that is displaying cystic components (makes look thick)
99
Q

describe endometrial polyps

A
  • benign
  • growth projecting into cavity
  • pedunculated or broad based
  • common
  • increase in peri-postmenopausal women
  • mostly asymptomatic or bleeding
  • single/multiple
100
Q

what is the sonographic appearance of endometrial polyps?

A
  • echogenic focal area within endo
  • endometrial thickening
  • same echogenicity as the endometrium
101
Q

what is the differential diagnosis for polyps?

A
  • hyperplasia
  • endometrial cancer
  • submucosal fibroid
102
Q

what is a good imaging modality for differentiating a polyp vs fibroid?

A

sonohysterography

103
Q

what is shown on US with the endometrium in a polyp?

A

polyp seen arising from endo

104
Q

what is shown on US with the endometrium with a fibroid?

A

normal layer endo is seen overlying

105
Q

what is the treatment of polyps?

A
  • Dilation and Curettage

- hysteroscopy recommended if still bleeding and endo is over 8mm

106
Q

what is the most common gynecologic malignancy in north America?

A

endometrial carcinoma

107
Q

is endometrial carcinoma curable?

A

highly curable

108
Q

who does endometrial carcinoma mostly occur in?

A

postmenopausal women

109
Q

what is the most common clinical presentation of endometrial carcinoma?

A

uterine bleeding

110
Q

what is the sonographic appearance of endometrial carcinoma?

A
  • heterogenous echotexture
  • irregular or poorly defined margins
  • can cause obstruction blocks the cervix (hydrometra or hematometra)
111
Q

what is the differential diagnosis of thickened endometrium in peri or post menopausal women

A

-hyperplasia
-polyps
-cancer
need biopsy for diagnosis

112
Q

what is the role of sonography for pre operation endometrial cancer?

A
  • determine myometrial invasion

- intact sub endometrial halo (inner layer of myometrium)

113
Q

what are some uterine sarcomas?

A 
-leiomyosarcomas
arise from endo
-carcinosarcomas
-endometrial stromal sarcoma
-adenosarcomas
-undifferentiated sarcomas
114
Q

what is found in majority of women with PMB?

A

endometrial atrophy

115
Q

what does endometrial atrophy look like sonographically?

A
  • usually thin (less than 5mm)

- homogenous

116
Q

what is normal measurement of a symptomatic postmenopausal women with endometrial bleeding?

A

5mm or less ( greater than this is considered abnormal)

117
Q

what is the normal measurement of an asymptomatic patient with no bleeding?

A

8mm or less

118
Q

what is the effect on the endometrium in postmenopausal women on HRT?

A
  • unopposed estrogen linked increase risk of endo cancer and hyperplasia
  • usually on continuous combined
  • sequential (get menses) endo similar appearance pre menopausal women
  • increased thickness
119
Q

what is tamoxifen?

A

-nonsteroidal
-antiestrogen
used in therapy with breast cancer

120
Q

what is the effect of tamoxifen on premenopausal women?

A

-decreases estrogen

121
Q

what is the effect of tamoxifen on postmenopausal women?

A

increase estrogen therefore increase risk of endo cancer

122
Q

what is the sonographic appearance of tamoxifen?

A
  • cystic changes

- polyps

123
Q

Asherman’s Syndrome

A

formation of intrauterine adhesions

124
Q

when can ashermans syndrome occur?

A

posttraumatic or post surgical

125
Q

what can asherman’s syndrome cause?

A

infertility or reccurent pregnancy loss

126
Q

what usually happens to women who have had several dilatation and curettage procedures?

A

ashermans syndrome

127
Q

what is the affect of asherman’s syndrome on a patient?

A
  • infertility
  • painful periods
  • miscarriages
  • absence of period
  • pelvic pain
128
Q

what may adhesions cause?

A
  • amenorrhea
  • repeated miscarriages
  • infertility
129
Q

what are the sign and symtoms of adhesions? (asherman’s syndrome)

A
  • menstrual irregulataries
  • cyclic pelvic pain
  • amenorrhea
  • repeated miscarriages
  • infertility
130
Q

what is the sonographic appearance of asherman’s syndrome?

A
  • Hyperechoic uterine lining - scar tissue in uterine cavity

- May be seen as hyperechoic bands traversing through the endometrial cavity.

131
Q

what is the treatment for asherman’s syndrome?

A
  • hysteroscopy done
  • estrogen therapy
  • sometimes a balloon or stent placed within endo until it is healed
132
Q

what kind of treatment would you use if it is focal?

A

hysteroscopy with directed biopsy

133
Q

what kind of treatment would you use if it is diffuse?

A

blind-nondirected biopsy

134
Q

what is a sonohysterography?

A

sterile solution into endometrial cavity under ultrasound guidance

135
Q

when is sonohysterography usually preformed?

A
  • days 4 & 7 of cycle

- postmenopausal women at anytime

136
Q

when would we not do a sonohysterography?

A
  • if patient may be pregnant

- acute pelvic inflammatory disease

137
Q

what are treatments for symptomatic patients?

A
  • endometrial ablation

- IUCD

138
Q

what is the treatment for irregular bleeding in perimenopausal women?

A

endometrial ablation

139
Q

what are the complications of post endometrial ablation?

A
  • Cornual hematometra or central hematometra
  • cause pain
  • Postablation tubal sterilization syndrome
140
Q

what is the Ultrasounds role post ablation?

A
  • Fluid can be absorbed by the body so fluid collections not evident
  • should be scanned when symptomatic
141
Q

what can help with irregular bleeding?

A

mirena

142
Q

what does mirena do?

A

secretes progesterin (progesterone) no estrogen

143
Q

what are the causes of a thick endometrium?

A
  • PREGNANCY
  • POLYPS
  • CARCINOMA
  • HYPERPLASIA
  • retained products of conception
  • Fibroid (makes it look thick)
  • endometriosis
  • adhesions
144
Q

what are causes of uterine bleeding in peri/post menopausal women?

A
  • hyperplasia
  • polyps
  • endometrial carcinoma
  • atrophy
  • fibroid
145
Q

sonographic appearance of polyp

A
  • thick endometrium
  • hyperechoic
  • homogenous
  • well defined
  • focal or diffuse
146
Q

sonographic appearance of carcinoma

A
  • thick endometrium
  • irregular border
  • invading myometrium
147
Q

sonographic appearance of hyperplasia

A
  • thick endometrium
  • hyperechoic
  • homogenous
  • well defined
  • cystic changes within
148
Q

sonographic appearance of atrophy

A
  • thin endometrium

- homogenous

149
Q

what is the sonographic appearance of a fibroid vs polyp-submucosal fibroid

A
  • hypoechoic
  • heterogenous
  • endometrium going over fibroid (displaces endometrium)
150
Q

what is the sonographic appearance of a fibroid vs polyp-polyp

A
  • hyperechoic
  • stalk (arterial pedicle)
  • homogenous
  • arises from endometrium
151
Q

what does PMB stand for and what is it?

A

post menopausal bleeding IT IS A SYMPTOM

152
Q

what is the most likely cause of PMB?

A

endometrial atrophy-could be cancer

153
Q

What is considered an abnormal endometrial measurement associated with PMB?

A

over 5mm

154
Q

How can a sonographer tell if it is endometrial cancer?

A

we cannot tell if its cancer (biopsy can)

155
Q

What endometrial measurement is considered normal in an asymptomatic patient?

A

8mm or less

156
Q

What measurement would they biopsy and why?

A

Over 11mm it correlates with a person who’s bleeding, may be cancer

157
Q

Name an ultrasound procedure that is ordered to provide more information regarding the endometrium.

A

Sonohysterography-inject saline into endometrial cavity

158
Q

Name 2 types of endometrial biopsy’s and reason for doing one over the other?

A

Directed and nondirected (blind) biopsy-to distinguish focal from diffuse abnormalities

159
Q

When is the best time to evaluate a menstruating women’s endometrium and why?

A

early proliferative

Because the endometrium is thin and fibroid/polyp/e.t.c can be seen best

160
Q

what are indications for ovarian pathology?

A
  • pain
  • palpable mass
  • irregular bleeding
  • fam history of ovarian tumor/cancer
161
Q

what are we looking for in an ovarian scan?

A
  • ectopic pregnancy
  • cysts
  • tumors
  • inflammatory bowel disease
  • appendicitis
162
Q

what is transvaginal good at looking at?

A

ovaries

163
Q

what is the most common cause of “ovarian enlargement” in young women?

A

nonneoplastic lesions “functional cysts”

164
Q

what are the types of nonneoplastic lesions “follicular cysts”?

A
  • follicular
  • corpus luteal
  • theca luteal
165
Q

when is a normal follicle found?

A

1st half of menstrual cycle

166
Q

what do the normal follicles usually measure?

A

up to 2.5 cm at maturity

167
Q

when do follicular cysts form?

A

mature follicle fails to ovulate and it develops if fluid in a nondominant follicle fails to resorb

168
Q

what is the sonographic appearance of a follicular cyst?

A
  • anechoic
  • thin walled
  • posterior enhancement
  • known as a simple cyst
  • measures equal or over 3cm
169
Q

what are some follicular cyst facts?

A
  • larger than follicle
  • unilateral
  • asymptomatic
  • incidentally found on US
  • usually resolve on their own
170
Q

when do corps luteal form?

A

after ovulation failure of absorption or excessive bleeding into corpus luteum

171
Q

how big are corpus luteal cysts?

A

larger than 4-5 cm

172
Q

what are corpus luteal cysts compared to follicular cysts?

A
  • less common
  • more symptomatic
  • larger
173
Q

are corpus luteal cysts unilateral or bilateral?

A

unilateral

174
Q

what are corpus luteal cysts more prone to?

A

more prone to rupture or hemorrhage

175
Q

what is a major symptom of corpus luteal cyst?

A

pain

176
Q

what is a differential of diagnosis corpus luteal cyst?

A

ectopic pregnancy (if positive B-hCG and no intrauterine pregnancy)

177
Q

sonographic appearance of corpus luteum

A
  • Small ,<4cm
  • Hypoechoic
  • isoechoic
  • Cyst with low-level internal echoes
  • Usually thicker wall than a follicle
  • Crenulated appearance
  • Peripheral rim of Color (Ring of Fire)
  • Involutes before menstruation
178
Q

sonographic appearance of corpus luteal cyst

A

> 4cm

If hemorrhage differing U/S appearances due to variable appearance of blood

179
Q

what is the largest of functional ovarian cysts?

A

theca luteal cysts

180
Q

what is theca luteal cysts associated with?

A

high levels of hCG

181
Q

when do theca luteal cysts mostly occur?

A
  • gestational trophoblastic disease

- ovarian hyperstimulation syndrome

182
Q

are theca luteal cysts unilateral or bilateral?

A

BILATERAL

183
Q

sonographically luteal cyst sonographically

A
  • bilateral
  • multilocular
  • +++large
184
Q

what are complication in functional cysts?

A
  • hemorrhage
  • enlargement
  • rupture
  • torsion
185
Q

what does complications in functional cysts equal?

A

ACUTE PAIN!!

186
Q

where can internal haemorrhage occur?

A

functional cysts

187
Q

what is the most common hemorrhagic cyst?

A

corpus luteal cyst

188
Q

what is the symptom of hemorrhagic cysts?

A

acute onset of pelvic pain

189
Q

What is the appearance of an Acute Hemorrhagic Cyst?

A
  • hyperechoic (blood when old-can go back to anechoic)
  • reticular pattern (thin septations)
  • mimic a solid mass
  • smooth posterior wall
  • posterior enhancement
  • diffuse low level echoes may be seen
190
Q

Why are there so many different sonographic appearances of hemorrhagic cysts

A

blood changes as it ages (new is anechoic and it hoes to echogenic back to anechoic)

191
Q

Does Colour Doppler help with diagnosis?

A

no flow within clot but demonstrate peripheral vascularity because clots move-normally no blood flow in a cyst

192
Q

What could free fluid in the pelvis indicate?

A

confirms diagnosis of leaking or ruptured hemorrhagic cyst

193
Q

differential diagnosis of hemorrhagic cyst

A
  • corpus luteal cyst
  • endometrioma
  • ectopic (positive B-hCG)
194
Q

when do functional cysts resolve?

A

within 1-2 menstrual cycles

195
Q

when do we follow up for a functional cyst?

A

in 6 wks

196
Q

when does ovarian remnant syndrome occur?

A

patient has undergone bilateral oophorectomy

197
Q

what can ovarian remnant syndrome cause?

A
  • pain

- compression of distal ureter

198
Q

sonographic appearance of ovarian remnant syndrome

A

Small to large cysts
Simple to complex
Thin rim of ovarian tissue

199
Q

Surface Epithelial Inclusion Cysts

A

Nonfunctional cysts
Usually in postmenopausal
periphery

200
Q

Surface Epithelial Inclusion Cysts sonographic appearance

A

Tiny, sometimes punctate foci
Can grow to several cms
not likely to hemorrhage

201
Q

Extraovarian Cysts

A

Paraovarian Cysts & Paratubal Cysts

202
Q

Peritoneal Inclusion Cysts

A

fluid accumulates within adhesions separate from ovary

203
Q

Paraovarian Cysts & Paratubal Cysts

A

Mostly asymptomatic
Typically small
Found in Broad Ligament
Ipsilateral ovary close to but separate from cyst

204
Q

Paraovarian Cysts & Paratubal Cysts sonographic appearance

A

anechoic
internal echoes within
do not change with cycle

205
Q

Peritoneal Inclusion Cysts

A
  • Benign cystic mesothelioma or benign encysted fluid
  • Extraovarian origin
  • Premenopausal women
206
Q

you can get a Peritoneal Inclusion Cysts if you have a history of what?

A
  • abdominal surgery
  • trauma
  • PID
  • endometriosis
207
Q

what is the main producer of peritoneal fluid?

A

ovary

208
Q

what is the treatment of Peritoneal Inclusion Cysts

A
  • suppression with oral contraceptives

- fluid aspiration

209
Q

Peritoneal Inclusion Cysts sonographic appearance

A
  • Multiloculated cystic adnexal masses
  • Bizarre shape
  • “presence of an intact ovary amid septations and fluid”
210
Q

what are the differential diagnosis of peritoneal inclusion cysts?

A
  • paraovarian

- hydrosalpinx (fluid in fallopian tubes)

211
Q

paraovarian

A
  • usually round or ovoid
  • not associated with surgery, infection, or trauma
  • separate from ovary
212
Q

Hydrosalpinx (fluid within fallopian tubes)

A
  • tubular or ovoid structure
  • visible folds
  • ovary is outside
213
Q

what are Pregnancy-Associated Ovarian Lesions?

A
  • hyperstimulated ovaries-theca luteal cysts
  • ovarian hyperstimulation syndrome
  • hyperreatio luteinalis
  • luteoma (rare)
214
Q

Theca Luteal Cysts

A

Largest of functional cysts

Bilateral, multilocular ++large

215
Q

Hyperstimulated Ovaries- theca luteal cysts

A
  • response to increased levels of hCG

- usually associated ovulation induction

216
Q

what is Hyperstimulated Ovaries- theca luteal cysts?

A

ovarian blood vessels react abnormally to hCG and leak fluid

217
Q

Hyperstimulated Ovaries- theca luteal cysts sonographic appearance

A
  • Bilaterally Enlarged ovaries with multiple cysts
  • Usually resolve during pregnancy
  • Risk of torsion
218
Q

Mild OHSS

A

Ovaries enlarged but <5cm

Lower abd discomfort

219
Q

Moderate OHSS

A

Weight gain 5 to 10 lbs.
Ovaries measure btw 5 & 12 cm
May have nausea and vomiting

220
Q

Severe OHSS

A 
>10 lb. weight gain
Severe abd pain &amp; distension
Ovaries > 12cm in diameter, multiple large, thin walled cysts
Associated ascites and pleural effusions
LOOK in Morrisons Pouch
221
Q

what is the treatment for Ovarian Hyperstimulation Syndrome?

A
  • Conservative - replace fluids and electrolytes

- Resolves 2 to 3 weeks

222
Q

Hyperreactio Luteinalis (HL) aka theca luteal in later pregnancy

A

Abnormal response to circulating hCG
Patient had NO ovulation induction therapy
Mostly Occurs in 3rd trimester

223
Q

where is Hyperractio Luteinalis (HL) more likely to occur?

A

patient who has polycystic ovarian disease

224
Q

Sonographically HL

A

Bilaterally enlarged ovaries

Multiple cysts

225
Q

Difference btw HL and OHS

A

Occurs in 3rd trimester
Ovaries not as large
Resolves spontaneously

226
Q

Luteoma of pregnancy

A

Rare
Solid
Benign
Most asymptomatic
Luteinize stromal cells produce androgens
30% experience maternal virilization (male traits & mother)

227
Q

Luteomas Sonographically

A

Heterogeneous
Mostly hypoechoic mass
Can be Highly vascular

228
Q

what is the most common cause of maternal virilization?

A

luteomas

229
Q

which anomaly has a heart shaped uterus?

A

bicornuate

230
Q

what is the most common cause of ovarian enlargement?

A

functional cysts

231
Q

do labs

A

finnish

232
Q

primary infertility

A

couples who have not become pregnant after at least 1 year having unprotected intercourse

233
Q

secondary infertility

A

couples who have been able to get pregnant at least once, but now are unable

234
Q

3 causes of male infertility

A
  • low semen quality
  • obstruction of efferent ducts
  • ejaculation malfunction
235
Q

3 causes of female infertility

A
  • primary ovarian insuffiency
  • ovulation failure
  • tubal obstruction
236
Q

Name a common fertility drug administered to women who have anovulatory cycles.

A

clomid or pergonal

237
Q

Explain the following fertility treatment: IVF

A 
Follicular Aspiration
•	Needle inserted into follicle + suction to remove follicular fluid (hopefully including ovum)
•	done with U/S guidance
•	Several removed; quantified in lab
•	Sperm injected into egg (in-vitro)
•	Grown for 2-5 days
ET – Embryo Transfer
•	Transferred directly to uterine cavity via catheter
•	‘implantation’ stage
238
Q

ZIFT

A

ZIFT- Zygote Intra-fallopian Transfer

-transfers a fertilized egg into fallopian tubes

239
Q

GIFT

A

GIFT- Gamete Intra-fallopian Transfer

-transfers a mixture of sperm and ovum into the fallopian tubes

240
Q

what is a severe symptom of OHS?

A

shortness of breath

241
Q

why is shortness of breath associated with OHS?

A

blood clot in legs causes shortness of breath because a clot in the leg could break off and move to the pulmonary artery. Treatment would be blood thinners and compression socks

242
Q

when would you scan a women in her menstrual cycle?

A

patient is scanned from day 9 through to ovulation

243
Q

Explain the following fertility treatment: ovarian stimulation

A

Controlled ovarian hyperstimulation (COH) is a process in which the ovaries are stimulated by fertility medication to produce ovulatory follicle(s). Typically, a combination of oral fertility medication and injectible fertility hormones are used to stimulate the ovary to produce mature follicles.

Pelvic (5 decks)

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