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DMS 117 > Test 3 > Flashcards

Test 3 Flashcards

1
Q

Paired, almond-shaped structures situated on each
side of the uterus

A

ovaries

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2
Q

normal ovary measurements

A

Length: 2.0-5.0 cm
Average size: 3.0 x 1.5 cm

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3
Q

post menopausal ovary measurements

A

Length: 1.2-1.4 cm

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4
Q

Ovaries

VOLUME=

A

(Length X Width X Height) X .523

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5
Q

Ovarian Volume:

Premenopausal/ adolescent/ pregnant women
Not including any lesion

A

< 6cc but not more than
20cc

critical to know especially to rule out torsion

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6
Q

Ovarian Volume:

Post-menopausal

A

About 2cc, more than 8cc is
considered abnormal

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7
Q

How to get volume of ovaries with a cyst?

A

subtract cyst volume from ovarian volume

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8
Q

Location of ovaries

midline anteflexed uterus

A

ovaries are usually positioned lateral or posteriolateral to the uterus

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9
Q

Location of ovaries
Retroverted uterus:

A

Ovaries are usually positioned laterally and
superior to the uterine fundus.

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10
Q

2 regions of the ovary

A

cortex
medulla

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11
Q

region of ovary that contains follicles with oocytes

A

cortex

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12
Q

region of ovary that contains rich vascular bed, lymphatic vessels and nerve fibers within a loose connective tissue

A

medulla

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13
Q

outermost layer of ovary

A

germinal epithelium

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14
Q

(dense connective
layer) lies under epithelium

A

Tunica albuginea

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15
Q

4 ovary support structures

A
  1. Ovarian Ligaments
    2.Suspensory
    3.Broad
    4.Mesovarian
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16
Q

____________ anchors the ovary medially to the uterus

A

ovarian ligament

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17
Q
  • a peritoneal fold that “tents” over the uterus.
  • Extends from the lateral aspect of the uterus to
    the lateral pelvic sidewalls
  • contains the fallopian tube
A

broad ligament

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18
Q

The portion of the ligament that
extends from the infundibulum of the fallopian tube and upper pole of the ovary to the pelvic sidewall is called the _________

A

suspensory ligament

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19
Q

The __________ ligaments contain the ovarian vessels, lymphatics, and
nerves and is sometimes subject to twisting which results in ovarian torsion.

A

suspensory

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20
Q

The ovary is attached to the posterior layer of the broad ligament by the ________________

A

mesovarium

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21
Q

The __________ ligaments may be identified sonographically when they are outlined by free intrapertioneal fluid (ascites)

A

broad

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22
Q

The ________________________ ligaments
cannot be seen sonographically.

A

mesovarium and round

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23
Q

The ________________- ligament is also not seen
however, on occasion, the ovarian artery
within the ligament may be seen during
a transvaginal scan

A

suspensory

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24
Q

blood supple to ovaries

1
2

A

ovarian arteries
uterine arteries

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25
Q

The blood vessels reach the ovaries by
traveling through the ______________
ligaments.

A

suspensory

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26
Q
  • Common Iliac arteries - course
    anteriorly and medial to the psoas
    muscles; bifurcates at the level of the
    L5-S1 disk
    – External iliac arteries-course along pelvic
    brim and become the common femoral
    arteries.
    – Internal iliac arteries
    Supply blood to the pelvic
    visera.
A
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27
Q

Internal Iliac artery divides into ___________ and _________

A

anterior and posterior branch

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28
Q

What does the anterior branch of the internal iliac artery supply blood to?

A

pelvic viscera

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29
Q

What does the posterior branch of the internal iliac artery supply blood to?

A

body wall and thigh

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30
Q

Uterine Artery

  • runs anterior on levator ani to
    cervix
  • crosses ureter
  • ascends lateral to the uterus in
    the broad ligament to the
    junction of the fallopian tubes
    and uterus
  • courses laterally and joins
    with ovarian artery
  • branches anastomose
    extensively across midline
    (usually a high velocity, high
    resistance flow
A
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31
Q

Which artery????
-Arise from the lateral margin of the
aorta, slightly inferior to the renal
arteries
-Cross external iliac artery and courses
medially within suspensory ligament
of ovary

A

Ovarian artery

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32
Q

Where does the RT ovarian vein empty into???

A

into IVC just below renal vein

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33
Q

Where does the LT ovarian vein empty into?

A

left renal vein

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34
Q

Which vein makes up 80-90% of the OVT cases???

affected, commonly 2-15 days following delivery.

A

right ovarian vein

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35
Q

LYMPHATICS OF PELVIS

  • Common iliac - accompany artery
  • External iliac - accompany artery and vein
  • Internal iliac - surround internal iliac
    vessels
A
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36
Q

Onset of menstruation is called _________

A

menarche

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37
Q

Pain with ovulation is called ________________
meaning “middle pain”

A

mittelschmerz

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38
Q

3 phases of ovulatory cycle

A

3 phases:
1. Follicular Phase (before ovulation)- Days 1-13
Corresponds to proliferative endometrial stage
2. Ovulation- Day 14
3. Luteal Phase (after ovulation)- Days 15-28
Corresponds to secretory phase of endometrium

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39
Q

Days 1-13 of ovulatory cycle is which phase?

A

follicular phase (before ovulation)

Corresponds to proliferative endometrial stage

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40
Q

Day 14 of the ovulatory cycle is which phase?

A

ovulation

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41
Q

Day 15-28 of the ovulatory cycle is which phase?

A

Luteal phase (after ovulation

Corresponds to secretory phase of endometrium

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42
Q

Ovulatory Cycle is Influenced by gonadotrophins from the ____________

A

hypothalamus

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43
Q

What size does the dominant follicle reach by day 10 while the others regress?

A

2.0 - 2.5 cm

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44
Q

This dominant or mature follicle is called
a ____________

A

Graafian follicle

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45
Q

The other activated follicles that regress
are called _________

A

atretic

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46
Q

Which hormone surges around day 14 and causes the Graafian follicle to rupture and ovulation has occured?

A

luteinizing hormone

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47
Q

Following ovulation the granulosa cells of the
follicle are transformed into ______________ cells.

  • This enables the corpus luteum to produce
    progesterone.
A

secretory

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48
Q

A corpus lutem degenerates into a ____________ if fertilization doesn’t take place

A

corpus albicans

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49
Q

Gonadotropin releasing hormone (GnRH) (secreted by the hypothalamus) stimulates the anterior pituitary gland to release Follicular stimulating hormone(Day 1)

Follicular Stimulating Hormone (FSH) (secreted by anterior pituitary gland) Initiates follicle growth

Follicles generate estrogen, this also allows repair of endometrium

Day 10 estrogen reaches high levels and Peak around days 12-13.

Estrogen surge triggers the pituitary gland to release luteinizing hormone (day 13-14)

Within 24-36 hours of surge ovulation occurs (Day 14)

Corpus luteum then produces estrogen and progesterone (day 14-28)

Estrogen and progesterone stimulate endometrium to thicken

No pregnancy, corpus luteum degenerates and mensus occurs

The drop in estrogen and progestrone trigger the hypothalamus to start the process again

If pregnany occurs the hormone human chorionic gonadotropin (hcG) prevents ovulation and keeps the corpus luteum producing progestrone

The progestrone, in turn, keeps the pregnancy developing until the
placenta develops

A

Gonadotropin releasing hormone -> follicular stimulation hormone -> estrogen -> luteinizing hormone -> estrogen and progesterone

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50
Q

what order does ovaries ovulate it?

A

they rotate. left one this month, right one next month etc

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51
Q

corpus luteum vs corpus albicans appearance

A

corpus luteum appears small hypoechoic to
isoechoic structures.
* If the ovum is not fertilized, the degenerating
corpus luteum eventually sinks into the
stroma of the ovary as a white scar or corpus
albicans.

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52
Q

-Produced normally by the fallopian tubes, endometrium and peritoneal lining
-Tumor marker
-Protein released by ovarian tumors
-Levels don’t usually rise until cancer is in advanced stage.
-May miss approximately ½ of early tumors
-Higher level – more likely ovarian cancer

A

CA 125

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53
Q

Dominant follicle Also called a _________ cyst or _________ cyst

A

functional, physiologic

54
Q

4 main category pathology found on ovaries

A

Benign cysts
Benign neoplasms
Malignant neoplasms
Torsion

55
Q

____________ cyst - most common cause for ovarian enlargement in young women.

A

functional

56
Q

Different types of functional cyst?

A

Simple/follicular cysts
Corpus luteum cysts
Hemorrhagic cysts
Theca-lutein cysts

57
Q

benign cyst include ____________ cyst, _________ _________, and __________

A

functional cyst
Polycystic disease
Endometriomas

58
Q

Simple cyst are also known as

A

follicular cyst

59
Q

Most common lesion to occur in the ovary
Most cysts measure less than 5-6 cm and will regress during the subsequent menstrual cycle (>6cm—aspirate, remove, risk of CA?)
Birth control pills may be used to help resolve cysts
May be complicated by hemorrhage
Can reach up to 20cm in size

A

simple (follicular) cyst

60
Q

Which cyst???

-Caused by hemorrhage into a corpus luteum.
-Unilocular cysts that fill with blood and cystic fluid as a part of normal ovulation
-If pregnancy occurs, corpus luteum will be present during the first trimester of pregnancy.
-When pregnancy does not occur it atrophies to become the corpus albicans

A

Corpus Luteum Cyst

61
Q

Sonographic Appearance

Posterior enhancement
Thicker crenulated (scalloped) wall
Commonly complicated by hemorrhage (clot)
Usually unilocular
Peripheral rim of color around the wall

A

corpus luteum cyst

62
Q

Ovarian cysts are commonly complicated by hemorrhage. The ______________ side appears preferred in hemorrhagic degeneration. It is postulated that the rigid rectosigmoid on the ___________ provides cushioning from trauma and twisting. This may reduce torsion and hemorrhagic complications.

A

right ,left

63
Q

Sonographic Appearance of Hemorrhagic Ovarian Cyst over time

Acute hemorrhage

A

Hyperechoic, may mimic a solid mass

64
Q

Sonographic Appearance of Hemorrhagic Ovarian Cyst over time

As clot hemolyzes

A

Internal pattern becomes more complexed, fibrin strands (weak reflectors), lacy appearance.

65
Q

Sonographic Appearance of Hemorrhagic Ovarian Cyst over time

Older hemorrhagic cyst

A

A clot will form and begin to retract,
Clot may have a convex border

66
Q

Largest of the functional cysts

A

Theca-luteal cysts

67
Q

Associated with high levels of human chorionic gonadotropin (hCG).

Typically occurs in patients who have gestational trophoblastic disease (molar pregnancy) or muliple gestation pregnancy (not as common)

Can be seen with ovarian hyperstimulation syndrome (Pergonal)

A

Theca-luteal cysts

they are very large

68
Q

What is Stein-Leventhal Syndrome

A

another name for polycystic ovaries

69
Q

-Usually asymptomatic
-Leading cause of infertility and higher than normal rate of early pregnancy loss.
-Anovulatory condition
-These patients have an increased risk of endometrial and breast cancer due to the constant high levels of estrogen.

A

polycystic ovaries

70
Q

Endometrioma is known as the

A

chocolate cyst

71
Q

What type of cyst

Results from endometriosis
Localized form of endometriosis
Usually asymptomatic
Ovary involved in 80% of endometriosis cases

A

ENDOMETRIOMA “Chocolate cyst”

72
Q

-Presence of a mural nodule (associated with teratomas), septations, or irregular wall thickening is strong evidence that mass is a neoplasm (possibly benign)
-Solid mass, thick septa (> 3mm) that demonstrate blood flow, irregular solid areas, poorly defined margins, papillary projections (> 3mm), or ascites may indicate malignancy
-If malignancy suspected, should Doppler mass - usually highly vascular

A
73
Q

Surface epithelial-stromal tumors

highest incidence

A

Serous cystadenoma (carcinoma)
Mucinous cystadenoma (carcinoma)
Endometrioid carcinoma
Clear cell carcinoma
Transitional cell tumor

74
Q

Germ Cell Tumors

A

Teratoma-Dermoid, Immature
Dysgerminoma
Yolk sac tumor

75
Q

Sex cord-stromal tumors

A

Fibroma
Thecoma
Granulosa cell tumor
Sertoli-Leydig cell tumor
Arrhenoblastoma

76
Q

Metastatic tumors

A

Genital primary: uterus
Extragenital primary: stomach, colon, breast
Lymphoma

77
Q

Which type of tumor

-Arise from suface epithelium that covers the ovary
-Serous tumors are the most common
-Mucinous tumors are the second most common.

A

Surface Epithelial-Stromal Tumors

78
Q

Sonographic Appearance

Large, smaller than mucinous tumors
thin-walled, unilocular cystic mass with septations
papillary projections occasionally seen

A

Serous Cystadenoma

79
Q

Sonographic Appearance

huge cystic mass, measuring 15-30 cm
may fill the entire pelvis or abdomen
multiple, thin septations
low level echoes due to mucous material within
papillary projections less frequent than serous

A

Mucinous cystadenoma

80
Q

which type of tumors

Derived from the primitive germ cells of the embryonic gonad.
Most tumors are cystic teratomas

A

Germ Cell Tumors

81
Q

cystic teratomas aka ……………..

A

dermoid cyst

82
Q

what type of tumor/cyst

Highly characteristic appearance:
-Unilocular, anechoic or hyoechoic cyst with a thin, some-what thickened wall
-Hypoechoic or anechoic with a “dermoid plug” (hair, teeth, fat, bone or glandular tissue)
-Septations- due to hair fibers, this is a specific sign call “dermoid mesh.”
-Most commonly - diffuse or focal areas of greatly increased echogenicity often with shadowing because they contain fat, teeth and hair.

A

Cystic Teratoma (Dermoid Cyst)

83
Q

what type of tumor

Arise from the sex cords of the embryonic gonadal or ovarian stroma.
Sonographically appear as solid adnexal masses

A

Stromal Cell Tumors

84
Q

______________ refers to the triad of ovarian fibroma, ascites, and pleural effusion (the effusion is usually unilateral and right-sided)

A

Meigs syndrome

85
Q

What type of tumor?

-Adenoma that is more than 50% fibrous
-Unilateral 90% of time
-Usually encapsulated
-The tumors can grow to a large size and demonstrate cystic degeneration and dystrophic calcification
-Meigs syndrome refers to the triad of ovarian fibroma, ascites, and pleural effusion (the effusion is usually unilateral and right-sided)
-Sonographic appearance typically shows a solid, uniformly hypoechoic mass, with marked sound attenuation

A

Fibroma

86
Q

What type of tumor

Benign
Unilateral
Pathologically similar to fibroma.
Tumors have an abundance of thecal cells instead of fibrous tissue like the fibroma

A

Thecoma

87
Q

Since the symptoms are primarily ____________________ and not pelvic, the early warning signs are often missed by women and their doctors. Only 24% of ovarian cancer is caught early.

A

gastrointestinal

88
Q

Most common malignant tumors

Serous cystadenocarcinoma: 40-50%
Mucinous cystadenocarcinoma: 5-10%
Clear Cell: 5-10%
Dysgerminoma: 3-5%
Metastasis: 5-10%

A
89
Q

Malignant Neoplasms

Staged according to spread: 1-4

A

I – limited to ovary
II) limited to pelvis
III) limited to abdomen
IV) spreads beyond abdomen

90
Q

Sonographic findings suggestive of malignancy would include:

-complex architecture with solid and cystic areas,
-thick (>3mm) septations,
-irregular surface or nodules in the walls of cystic areas,
-large size or significant growth,
-the presence of ascites
-low resistance blood flow as seen with Doppler ultrasound.

A
91
Q

A ________________ tumor classically refers to a secondary ovarian malignancy whose primary site arose in the gastrointestinal tract.

A

Krukenberg

92
Q

Is Krukenberg tumors found in one or both ovaries

A

Krukenberg tumors are often found in both ovaries.

93
Q

Partial or complete rotation of the ovarian pedicle on its axis
Results in compromise of lymphatic and venous drainage of the ovary causing edema, loss of arterial flow and possibly infarction.
More common on right than left
Commonly associated with a mass
Large hemorrhagic cyst, CA, dermoid
Palpable mass in 50% patients
May have free-fluid in the cul-de-sac
Complex appearance to ovary

A

ovarian torsion

we already know most of this

94
Q

Common in childhood and reproductive years
MUST DOPPLER!! But is doesn’t make the definitive diagnosis.
Characterized by decreased or absent blood flow .
Ovary may be receiving arterial flow but unable to drain via the veins—ovary will enlarge and display a change in echotexture. May still have internal flow visible!

A

more on ovarian torsion

95
Q

Always remember to use ______________ Doppler as regular ____________ Doppler will often not be sensitive enough to pick up minute blood flow that is still existent in a torsion.

A

Power, Color

96
Q

Ovarian Torsion - diagnosis rests on ovarian ________________ since some cases of torsion demonstrate small amounts of flow still within the ovary. Flow can still be seen in cases where there is only a partial twisting, torsion-detorsion, and in cases where the ovarian artery is not the only feeder for the ovary.

A

enlargement

97
Q

Sonographic Findings
1. Ovarian Torsion is Unilateral
PID and PCOD are bilateral
2. Mal-Positioned ovary
An ovary that has torsion will sometimes be positioned midline and anterior to the bladder.
3. Ovarian Mass Present
4. Ovarian Volumes must be documented.
Measure the volume of the entire ovary including the mass. Then measure the volume of the mass itself. The mass volume is then subtracted from the total volume to obtain the actual volume of the ovary.
If the remaining ovarian volume is >20cc then there is ovarian torsion.

VOLUME = (length X Width X Height) X .523
A

keypoints to rememeber

98
Q

The normal ovarian volume in a premenstrual female is ____________-

A

<6cc.

99
Q

There ovary can have torsion and still have ___________

A

blood flow.

100
Q

Ascending infection of the uterus (endometritis), fallopian tubes (salpingitis) and ovaries (oophoritis)
Often caused by sexually transmitted disease (STD) such as Chlamydia or Gonorrhea

A

pelvic inflammatory disease

101
Q

The CDC revised the diagnostic criteria for PID in 2001 to include minimum findings of

cervical motion tenderness
and uterine and adnexal tenderness,
along with WBCs seen on vaginal wet mount (vaginal smear)

A
102
Q

SONOGRAPHIC APPEARANCE:

Prominent or irregular endometrium
Endometrial fluid or debris
Possibly gas/air within uterus
Fluid in posterior cul-de-sac
Possible pyo or hydrosalpinx

A

PID

103
Q

acutely ill patient with marked tenderness, conglomerate of tissues in which separate tube and ovary can not be distinguished

A

tubo- ovarian abcess

104
Q

thick wall tubular structure with fluid/debris level =

A

pyosalpinx

105
Q

_________________ cysts are complex cystic adnexal masses consisting of a normal ovary entrapped in multiple fluid-filled adhesions. The cysts usually develop in women of reproductive age who have a history of previous pelvic surgery or pelvic infection.

A

Peritoneal inclusion

106
Q

Female egg; secondary oocyte released from the ovary at ovulation

A

ovum

107
Q

posterior portion of the broad ligament that is drawn out to enclose and hold the ovary in place

A

mesoovarium

108
Q

Paired ligaments that extend from the infundibulum of the fallopian tube and the lateral aspect of the ovary to the lateral pelvic wal.

A

suspensory ligament

109
Q

Upper portion of the broad ligament that encloses the fallopian tubes.

A

mesosalpinx

110
Q

Steroidal hormone produced by thh corpus luteum that helps prepare and maintain the endometrium for arrival and implantation of an embryo.

A

progesterone

111
Q

Paired ligament that extends from the inferior and/or medial pole of the ovary to the uterine cornua.

A

Ovarian ligament

112
Q

Anatomic structure on the surface of the ovary, consisting of a spheroid of yellowish tissue that grows within the rutured ovarian follicle after ovulation; acts as a short-lived endocrine organ that secretes progesterone to maintain the decidual layer of the endometrium should conception occur.

A

Corpus luteum

113
Q

Steroidal hormone secreted by the theca interna and granulosa cells of the ovarian follicle that stimulates the development of female reproductive structures and secondary sexual characteristics; promotes the growth of endometrial tissue during the proliferateive phase of the menstrual cycle.

A

estrogen

114
Q

Hormone secreted by the hypothalamus that stimulates the release of follicle-stimulating hormone and luteinizing hormone by the anterior pituitary gland.

A

gonadotropin-releasing hormone

115
Q

Hormone secreted by the anterior pituitary gland that stimulates the growth and maturation of graafian follicles in the ovary.

A

follicle-stimulating hormone

116
Q

Hormonal substance that stimulates the function of the testes and the ovaries

A

gonadotropin

117
Q

Hormone secreted by the anterior pituitary gland that stimulates ovulation and then induces luteinization of the ruptured follicle to form the corpus luteum.

A

luteinizing hormone

118
Q

Benign tumor composed of hair, muscle, teeth, and fat

A

Dermoid tumor

119
Q

Partial or complete rotation of the ovarian pedicle on its axis

A

ovarian torsion

120
Q

Multilocular cysts that occur in patients with hyperstimulation due to a molar pregnancy

A

theca-lutein cysts

121
Q

smooth, thin-walled, well-defined cystic structure that is filled completely with fluid.

A

Simple ovarian cyst

122
Q

Endocrine disorder associated with chronic anovulation

A

polycystic ovarian syndrome

123
Q

Benign tumor of the ovary that is associated with ascites and pleural effusion

A

Meigs’ syndrome

124
Q

Cystic structure that lies adjacent to the ovary

A

paraovarian cyst

125
Q

Small endocrine structure that develops within a ruptured ovarian follicle and secretes progesterone and estrogen

A

Corpus luteum cyst

126
Q

Fluid within the fallopian tube

A

hydrosalpinx

127
Q

Localized tumor of endometriosis most frequently found in the ovary, cul-de-sac, rectovaginal septum, and peritoneal surface of the posterior wall of the uterus.

A

Endometrioma

128
Q

All-inclusive term that refers to all pelvic infections

A

Pelvic inflammatory disease (PID)

129
Q

Infection within the fallopian tubes

A

salpingitis

130
Q

Infection within the ovary

A

oophoritis

131
Q

Retained pus within the inflamed fallopian tube

A

pyosalpinx

132
Q

___________________________– are complex cystic adnexal masses consisting of a normal ovary entrapped in multiple fluid-filled adhesions. The cysts usually develop in women of reproductive age who have a history of previous pelvic surgery or pelvic infection.

A

Peritoneal inclusion cysts

DMS 117 (2 decks)

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