Test 1 Flashcards
what are the portions of the fallopian tube from medial to lateral?
- cornual (interstitial)
- isthmus
- ampulla
- infindibulum
what is another name for rectouterine pouch?
posterior cul-de-sac
puch of douglas
what is the location of the rectouterine pouch?
- anterior to the rectum
- posterior to the uterus
what is the most inferior part of the pelvic cavity?
rectouterine pouch
what is the significance of the rectouterine pouch?
most common site for fluid to collect
what is another name for the space of retzius?
- retropubic space
- prevesical space
what is the location of the space of retzius?
- anterior to urinary bladder
- posterior to symohysis pubis
what is another name for the vesicouterine pouch?
anterior cul-de-sac
what is the location of the vesicouterine pouch?
- anterior to uterus
- posterior to urinary bladder
what does the uterosacral ligament support?
cervix
how is the length of the uterus measured?
from fundus to the external cervical os
how is the height (thickness) of the uterus measured?
perpindicular to the length of the widest portion of the uterine body
how is the width of the uterus measured?
widest portion of the uterine body in short axis
what is the size of the uterus for a premenarche?
2-4cm length
0.5-1 cm height
1-2 cm width
(cervix as long as uterus)
what is the size of a menarche uterus?
- nulliparous-6-8.5cm x 3-5cm x 3-5cm
- parous-8-10.5cm x 3-5cm x 5-6cm
what is the size of a postmenopausal uterus?
3.5-7.5cm x 2-3cm x 4-6cm
what is the hypoechoic area around the endometrium?
outer basal layer
what should the endometrium not exceed?
14mm
what are the ovaries composed of?
almond-shaped intraperitoneal endocrine organs that are composed of cortical and medullary tissue covered by epithelium
what is the site of follicular development?
ovarian cortex
where is the vascular core of the ovary?
medulla
what are the 2 blood sources that supply the ovary?
- ovarian artery arising from the aorta
- ovarain branch of the uterine artery
what is the function of the ovary?
produce ova
what are the hormones of the ovary?
- estrogen = secreted by follicle
- progesterone = secreted by corpus luteum
what are the measurments if the menarche ovary?
- 2.5-5cm length
- 1.5-3cm wide
- 0.6-2.2 cm height
what does ovarian volume vary with?
- age
- menstraul status
- body habitus
- pregnancy status
- phase of menstrual cycle
what is the volume of a menarche ovary?
9.8 cm3
what is the volume of a postmenopausal ovary?
5.8 cm3
what is the primary hormone that reflects the activity of the ovaries?
estradiol
what does estrodiol do during pregnancy?
levels will steadily rise
where are small amounts of estradiol located?
adrenal cortex and arterial walls
what are the normal estrogen levels?
5-100 ug/24 hours
what is the primary female sex hormone?
estrogen
what is estrogen primarily produced by?
developing follicles and the placenta
what stimulates the production of estrogen in the ovaries?
- FSH
- LH
what organs produce a small amount of estrogen?
- breasts
- liver
- adrenal glands
what are the functions of estrogen?
- it promotes formation of female secondary sex characteristics
- accelerates growth in height and metabolism
- reduces muscle mass
- stimulates endometrial growth and proliferation
- increases uterine growth
what is the function of FSH (follicle stimulating hormone)?
initiates follicular growth and stimulates the maturation of the Graafian follicles
where is FSH secreted?
anterior pituary gland
what are the levels of FSH in the ages of life?
normally low in childhood and slightly higher after menopause
what are the levels of FSH in the cycle?
levels decline in the late follicular phase and demonstrate slight increase at the end of the luteal phase
what hormone is essential in both males and females for reproduction?
LH
where is LH secreted from?
anterior pituituary gland
what stimulates LH production?
increasing estrogen levels
what triggers ovulation?
a surge in LH levels and initiates the conversion of the residual follicle into a corpus luteum
what does the corpus luteum do?
produces progesterone to prepare the endometrium for possible implantation
how long does the LH surge typically last?
48 hours
when does FSH releasing facotor become active?
before puberty
where is FSH produced?
by the hypothalmus
what is the path of FSH?
FSH is released into the bloodstream, reaching the anterior pituitary gland
what stimulates FSH production?
low levels of estrogen
what is LH produced by?
hypothamus
what ages is progesterone low?
childhood and postmenopause
where is progesterone produced?
adrenal glands
corpus luteum
brain
placenta
when is progesterone produced to increased amounts?
during pregnancy
what are the functions of progesterone?
preparing the endometrium for possible implantation or starting the next menstrual cycle
descrive menstrual phase
- days=1-5
- functional layer necroses
- decreased estrogen and progesterone
describe early proliferation
- days 6-9
- thin echogenic endometrium
- increasing estrogen
- coincides with follicular phase of the ovary
describe late proliferation
- days 10-14
- preovulatory
- triple line appearance
describe secretory phase
- days 15-28
- post ovulatory or premenstrual phase
- functional layer thickens
- progesterone increases
how is ovulation regulated?
by the hypothalmus within the brain
when does LH usually reach its peak?
10-12 hours before ovulation
what triggers ovulation?
a surge in LH accompained by a smaller FSH surge
describe early follicular phase
- days 1-5
- 5-11 small follicles
descrive late folliciaular phase
- days 6-13
- before ovulation
- graafian follicle: 2-2.4 cm
- estrogen levels increase
describe ovulatory phase
- day 14
- rupture of graafian follicle
- pelivc pain-mittelschmerz
what happens in the ovarian phases?
graafian follicle
-some vascularity at periphery
describe early luteal phase
- days 15-18
- post ovulation
- corpus luteum secretes estrogen and progesterone
- free fluid in cul-de-sac
when does the corpus luteal cyst regress if fertlization does not occur?
late luteal
when is menopaue defined?
cessation of menstration for 12 months
Approximately________ of cases will demonstrate a simple ovarian cyst with post menopause
15%
Simple ovarian cysts less than ____ in diameter are most likely benign
5 cm
what does hormone replacement therapy include?
both estrogen and progesterone
what should the endometrium measire in post menopause?
under 8mm
what should endometrium thickness not exceed in post menopausal women?
should not excees 8mm in asymptomatic patients or 5mm in patients with vaginal bleeding
what can decrease in estrogen in post menopausal women do to pelvic organs?
shorten the vagina and decrease cervical mucous
what are oral contraceptives?
inhibit ovulation, endometrium has a thin echogenic line
what is depot-medroxprogesterone?
inhibits ovulation, endometrium has a thin echogenic line
what is levonorgestrel implant?
thin capsule is placed under the skin for 5 years, endometrium is thin
what do intrauterine devices do?
ovulation and corpus luteum continue
what are types of intrauterine devices?
paraguard (copper T)
mirena (hormone releasing)
what is the 3rd most common gynecological malignancy?
cervical carcinoma
cervical carcinoma is an __________ neoplasm
epithelial
what occurs with a cervical carcinoma?
- intermenstrual or postcoital bleeding
- hypoechoic or heterogenous retrovesical mass
- endometrial fluid collection
what are nabothian cysts?
obstructed inclusion cysts in cervix
what may cause nabothian cysts?
chronic cervicitis
are nabothian symptomatic or asymptomatic?
asymtomatic
what do nabothian cysts look like?
- multiple or solitary anechoic structures <2cm
- may contain internal echoes
what is another name for leiomyomas?
myoma
fibroid
what is the most common pelvic tumor?
leiomyoma (fibroid)
what is the leading cause of hysterectomy?
leiomyoma
what are the most common leiomyoma?
myometrial
when may leiomyomas be painful?
when they degenerate
what are the fibroid locations?
- intramural (myometrial)
- subserosal
- pedunculated
- submucosal
what fibroid distorts the uterine contour?
subserosal
what fibroids cause abnormal uterine bleedng?
submucosal and intramural
what is adenomyosis?
glands and stroma from the basal layer of endometrium penetrate into the myometrium
adenomyosis is found in _______ of hysterectomy specimens
70%
what does adenomyosis cause?
dysmenorrhea and AUB
what is the sonographic appearance of adenomyosis?
- myometrial alterations
- trans vag may demonstrate poor defintion of the endometrial and junctional zone caused by endometrial tissue extending from the basal layer
what is endometrial hyperplasia?
an abnormal proliferation (growth) of the endometrium in responce to excess or unopposed estrogen
what does endometrial hyperplasia look like sonograhically?
endometrium is diffusely thickened although asymmetric or focal thickening may be present
what is the most common gynecologic cancer, affecting 1 in every 50 women?
endometrial adenocarcinoma
when are most cases of endometrial adenocarcinoma diagnosed?
post menopausal women
what is the most common clinical presentation for endometrial adenocarcinoma?
postmenopausal bleeding
what are the risk factors for endometrial adenocarcinoma?
- unopposed estrogen stimulation
- obesity, nulliparity, diabetis, hypertension
- tamoxifen therapy for breast cancer
- chronic anovulation
- presence of atypical endometrial hyperplasia
what does endometrial carcinoma look like sonographically?
- thickened endometrium >4mm in postmenopausal women
- heterogenous echotexturem hematometra, enlarged uterus
what is needed to differentiate between hyperplasia and a carcinoma?
biopsy
what are endometrial polyps?
bengin focal overgrowths of endometrial glands and stroma
where can polyps extend?
into the cervix or vagina
who is endometrial polyps more prevalent in?
perimenopausal and postmenopausal women
what can polyps cause?
- coital spotting
- intermenstrual bleeding
- menorrhagia
- menometrorrhagia
what is the sonographic appearance of a polyp?
- typically isoechoic to the surrounding endometrium causing the appearance of wither focal or global endometrial thickening
- cystic spaces within the polyp
- evidence of a vascular feeding vessel on color doppler
- well define by saline
why is tamoxifen given to cancer patients?
block estrogenic effects on breast tissue
what endometrial abnormalities can occur with tamoxifen?
- carcinoma
- hyperplasia
- polyps
what is ashermans syndrome?
adhesions from a previous deep curretage or endometrial infection
what are the clinical symptoms of ashermans syndrome?
- asymptomatic
- amenorrhea
- dysmenorrhea
- hypomenorrhea
- infertility
what is retained products of conception?
some of the gestational contents may remain within the uterine cavity and cause bleeding or infection
what do retained products of conception uaully consist of?
placetal tissue which can persist for months and result on AUB
what is the sonographic appearance post pardum?
uterus immediately is enlarged and typically returns to normal size and shape within 6-8 weeks after delivery
what are some immediate post pardum finsings with RPOC?
residual fluid and echogenic material=hemorrhage within the endometrial cavity
how do you rule out RPOC?
evaluate the endometrial cavity for a focal echogenic mass and assess endometrial thickness
what measurement shows RPOC is unlikely?
endometrial thickness is less than 10mm
when is RPOC likely?
an echogenic mass with vascularity is present
what may an echogenic mass without vascularity represent?
either RPOC or blood clots
what is a hematometra?
blood trapped in the endometrial cavity
what are the symptoms of hematometra?
pelvic pain
amenorrhea
hypomenorrhea
pelvic mass
what is hematometra caused by?
imperforated hymen
cervical stenosis
vaginal neoplasm
what is a gartner duct cyst?
small cysts within the vagina
what is hematocolpos?
blood accumulation in the vagina
what is hematometrocolpos?
blood accumulation in the uterus and vagina
what is a hydrosalpinx?
distally blocked fallopian tube filled with serous or clear fluid
is hydrosalpinx usually bilateral or unilateral?
bilateral
what may hydrosalpunx be caused by?
- old infection
- STD
- previous surgery
- adhesions
- endometriosis
what is a IUCD?
a flexible contraceptive device inserted through the vaginal canal into the endometrium
what is IUCD made of?
T-shaped made of plastic, wrapped in copper, and may or may not contain hormones
where shoudl all tyoes of IUD be located?
in the midline portion of the endometrial cavity
what does the ParaGuard IUD look like?
2 parallel hyperechoic linear echoes with intense posterior acoustic shadowing
what does the Mirena IUD look like?
a hypoechoic or mildly echogenic stem with thin echogenic “T-arms”
what does a lippes loop look like?
multple echogenic dots within the endometrial canal
what are abnormal or ectopic locations of IUD’s?
- migration from the superior fundal to the inferior portion of the endometrium or vaginal canal
- myometrial penetration
- perfration into the peritoneal cavity
what are some additional complications of an IUD?
- PID
- ectopic pregnancy
- a coexisting IUP
when does ecplusion of the IUD generally occur?
within the first year most commonly during the first few months after insertion
when is expulsion more likely to occur?
when inserted soon after childbirth or in women with a history of previous expulsion, nulliparity, or severe menorrhagia
what do women present with clinically with expulsion of IUD?
- aymptomatic
- complian of cramping
- vaginal discharge
- intermenstrual or postcoital bleeding
- spotting
- dyspareunia
what are the sonographic findings of expulsion of IUD?
absence of the IUD within endometrial cavity
what must be done when IUD is not visualzed in the pelvis?
film radiograph of the abdomen and pelvis should be ruled out perforation into the peritoneal cavity
when is an IUD abnormally located?
if it sits inferiorly within the endometrial cavity or if any part extends past the confines of the cavity into the uterus or cervix
what may be a result when an IUD is in an inferior location?
may result of migration or improper insertion of the device, and patients may experience pain or be asymtomatic
what does an inferior located IUD decrease?
the contraceptive effectiveness and is at risk for being expelled
what is required if the IUD is embedded in the myometrium?
operative hysteroscopy
what does myometrial penetration mean?
extension or penetration of the IUD through the basal layer of the endometrium into the uterine myometrium
what is the usual myometrial penetration location of the IUD?
generally the T portion of the IUD extends partially or completelly through the lateral and fundal portions of the endometrial layers embedding into the myometrium of the uterus
what are the symptoms of myometrial penetration?
women may be asymptomatic or experience pelvic pain or irregular bleeding
when does perforation occur?
almost always occurs during inserton and is associated with an inexperienced clinician, retroverted uterus, and congenital uterine anomalies
what is the principal clinical finding for perforation?
pelvic pain
what are complications with perforation?
damage and scarring of the surrounding organs and pelvic infection
when may infection occur with IUD?
bacteria may enter the endometrial cavity as the IUD is inserted through thee vaginal canal
what is a womens risk of infection strongly related to?
previous history of a sexullay transmitted disease and insertion technique
how can pelvic infection develop into a serious condition?
affect the:
- uterus
- fallopian tubes
- adnexa
- peritoneum
what may pelvic infection result in?
- endomyometritis
- pyosalpinx
- tubovaran abscess
what does in situ mean?
right place
what does the endometrium look lke with endomyometritis?
- the endometrium may appear thick and irregular, and the uterus may appear enlarged and inhomogenous
- hypervascular endometrium and myometrium may be evident with color doppler
when is the risk of pregnancy with an IUD in place the highest?
in the first year after IUD insertion
what are the complications with pregnancy in the presence of an IUD?
- most noted complication is ectopic pregnancy
- spontaneous abortion with an IUD that remains in situ is 40-50%
what are other rare complications with pregnancy and IUD?
- chorioamniotiis
- premature rupture of membranes
- preterm labour
- septic abortion
- maternal death
true or false? Using an IUD increases a womens risk for ectopic pregnancy
false
Using an IUD does not increase a woman’s risk for ectopic pregnancy
where are most ecoptic pregancies located?
in the ampulla segment of the fallopian tube
what is the treatment of an ectopic pregnancy?
medical therapy (methotrexate) or surgical intervention
