Test 3 Flashcards
what is the echogenicity of muscles?
moderate echogenicity with echogenic striations seen in long axis view
what can muscles be mistaken with?
ovaries or masses within pelvis
what is a common muscle to be mistaken for an ovary?
iliopsoas
is the uterus intra or retro?
retro
when does the uterus descend into the true pelvis
between birth and puberty
what is anterior to the uterus
pubic bone and bladder
what is posterior to the uterus?
rectum
what are the 3 major portions that make up the uterus?
- fundus
- body
- cervix
cornua
area of body that tubes enter
what is superior to the cornua?
fundus
what area is between cervix and cornua?
body
what is the cervix?
slight narrowing btw body and proximal cervix
what opens into the upper vagina?
cervix
what is the canal of the cervix made up o internally?
external and internal os
what is located at the distal end of the cervix space between vagina?
- 2 lateral fornix
- anterior fornix
- posterior fornix
vagina
Fibromuscular canal that lies in the midline
where does the vagina run?
cervix to the external genitalia
what does the cervix protrude into?
proximal vagina
what are the 3 layers of the uterus?
- perimetrium
- myometrium
- endometrium
what is the big muscle in the uterus taking up majority of the uterus?
myometrium
what is the myometrium divided into? (inner to outer)
- subendometrial halo (inner layer)
- intermediate
- outer
what layer of the uterus sloughs off each menses?
superficial functional layer
what part of uterus stays attached during menstration?
deep basal layer
what ligaments are paired?
- broad ligament
- cardinal
- uterosacral
- round
what ligaments are single?
- posterior
- anterior
where do the broad ligaments extend?
lateral aspect of uterus to the lateral pelvic walls
what ligament of the uterus is double folds of parietal peritoneum?
broad ligaments
what ligament is the lower extension of broad ligament?
cardinal ligament
what is the coarse of the round ligaments?
Fibromuscular cords extends from upper outer angles of uterus through inguinal canal and attach labia majora
where are the uterosacral ligaments?
Posterior uterus to sacrum, each side of rectum
what does the anterior ligament form?
-anterior cul de sac
OR
-vesicouterine pouch
where does the anterior ligament coarse?
anterior surface of the uterus to posterior surface of bladder
what does the posterior ligament form?
-Pouch of Douglas (PCDS) OR -posterior cul de sac OR -rectouterine recess
what happens to the uterus when fertilization occurs?
implants into the endometrial lining and develops within UT
what uterus layer contracts at labor?
myometrial
what happens to the uterus when fertilization does not occur?
- menstruation occurs
- myometrial contractions aide sloughing off endometrium
where does the blood supply run?
within the broad ligament and within the ovary
blood supply read over
female pelvis slide 24
what part of the female reproductive organs are fixed?
cervix is fixed in midline
what part of the female reproductive system is mobile?
body and fundus
what is uterus flexion?
axis of the uterine body relative to the cervix
what is the uterus version?
axis of the cervix relative to the vagina
can the bladder affect position of uterus?
yes bladder being full or empty changes uterus position
what is the normal position of the uterus?
anteverted (or anteflexed)
what normal variants in position can the uterus be?
- retroverted
- retroflexed
retroverted
Entire uterus is tilted backward (relative to vagina)
retroflexed
Body is tilted posteriorly (relative to cervix)
what is the size and shape of an infantile uterus?
- 2.8 cm in length
- cervix 2/3rds total length
- tubular or inverse pear shape
what is the size and shape of an neonate uterus?
- slightly larger than infantile die to maternal hormone stimulation
- 3.4 cm in length
- inverse pear shape
what is the size and shape of an after age 8 until puberty uterus?
-uterus gradually increases in size
what is the size and shape of an uterus at puberty?
- increase in size, especially the body
- diameter and length of body about double cervical size
- becomes adult size and shape
what is the size and shape of an uterus in an adult?
- 7-8 cm length x 5 cm width x 4 cm AP (max. dimensions before pregnancies)
- pear shaped
what does parity mean?
pregnancy
how much does the uterus grow in a pregnancy?
increases normal size by 1 cm in each dimension
what is the size and shape of a menopausal uterus?
- atrophies 3.5 to 6.5 cm (L) x 1.2 to 1.8 cm (AP)
- pear shaped but small
what is the regular size of an adult uterus on ultrasound?
7-8 cm in length (8 length cm x 5 width cm x 4 AP cm )
what is the shape of an uterus?
pear shaped
what is the contour of the uterus?
smooth
what is the echotexture of the myometrium?
homogenous
what are the 3 layers of the uterus in ultrasound?
- subendometrial halo
- intermediate layer
- outer layer
what is the echogenicity of the subendometrial halo?
hypoechoic
what is the thickest layer of the uterus?
intermediate layer
what is the echogenicity of the intermediate layer?
low to moderate echogenicity
what is the echotexture of the intermediate layer?
homogenous
is the outer layer thin or thick?
thin
what is the echogenicity of the outer layer?
slightly less echogenic than the intermediate layer
what separates the outer layer ad the intermediate layer?
arcuate arteries
is the uterus bigger or smaller in post menopausal stage?
smaller
what can happen in the arcuate arteries in the postmenopausal sonographic uterus?
calcifications
read slide 39
don’t make sense
LMP
last menstrual period
-Day 1 is the first day of menses
how long is the average menstrual cycle?
28 days
what are some reasons we scan the female pelvis?
- pelvic pain
- pregnancy
what procedure gives you a global scan of the pelvis?
transabdominal ultrasound
what can be some reasons not to do transabdominal ultrasound?
- patients unable to hold bladder
- obese patients
- retroverted uterus (beyond focal zone of transducer)
how much do patients fill bladder?
24-32 oz
physically how much do patients fill their bladder?
4 glasses finish 1 hour prior to exam
why do we get patients to fill their bladder?
- displaces uterus from pelvis
- displaces gas filled bowel
- acoustic window
what are some technical difficulties for doing an transabdominal ultrasound?
- obese patients
- surgical scars
- barium or gas filled
- abdominal dressings
what is the patient prep for transvaginal?
- discuss what is involved
- verbal consent
- empty bladder
- 5-8 MHz transducer
- cover transducer with probe cover
- follow proper cleaning procedures after exam
what are some advantages of TVU?
- higher frequency so better resolution
- can use on obese patients
- can use on patients that cant fill bladder
- can use on retroverted uterus
- better distinction
- better detail
what can you see better on a TVU?
- difference between adnexal masses and bowel
- characterization of internal pelvic mass
- pelvic lesion
- endometrium
what is a disadvantage to TRU?
smaller field of view
when would we not give a transvaginal exam?
- when we were not given consent
- when the patient is young
- when the patient is old
what runs laterlly from uterus in the upper free margin of broad ligament?
fallopian tubes
how long are the fallopian tubes?
7-12 cm in length
what are the 4 portions the fallopian tubes are divided into?
- intramural
- isthmus
- ampulla
- infundibulum
where is the intramural?
contained within muscular wall uterus (closest to the uterus)
what is the narrowest portion the fallopian tubes?
intramural
where is the isthmus?
medial third of tube
-slightly wider and cordlike
what is the longest part of the fallopian tube?
Ampulla
1/2 the tube (tortuous)
what is the most distal portion of the fallopian tubes?
infundibulum
what is the shape of the infundibulum?
funnel shaped end
-opens into the peritoneal cavity
what is the shape of the ovaries?
oval or elliptical
what are the ovaries covered by?
single layer called germinal epithelium becomes continuous with peritoneum at the hilum of ovary
are the ovaries intra or retro?
intra
what are the layers of the ovary?
- germinal epithelium
- tunica albuginea
- cortex
- medulla
where do the follicles develop and mature?
cortex
is the medulla smaller or bigger in volume compared to the cortex?
smaller
what is the medulla composed of?
fibrous tissue and blood vessels
what does the mesovarian attach?
anterior surface of ovary to posterior surface of broad ligament
what does the ovarian ligament attach?
lower pole of ovary to uterus
what does the suspensory ligament attach/
upper pole to lateral wall of pelvis
what carries the ovarian vessels and nerves?
suspensory ligament
is the suspensory ligament rigid?
no
is the ovary fixed or mobile?
mobile
what is the lateral extension of the broad ligament?
suspensory ligament
where do the ovarian arteries run?
within suspensory ligament
where do the ovarian arteries come from?
aorta just inferior to renal arteries
where does the right ovarian vein drain?
into the IVC
where does the left ovarian vein drain?
left renal vein
when looking at the ovaries what does uterine position influence?
ovarian position
what is the method for finding size of ovaries?
length x width x height (AP) x 0.523
-first 2 years
0 to 5 years ovarian volumes remain ________
stable
5 to menarche ovaries gradually increases in________
size (4cc)
Menstruating adult female variable size of ovaries
- Mean ovarian volume TVP 6.8 cc
- Upper limit 18cc
Post menopause size of ovaries
Mean volume 1.2 to 5.8 cc (atrophy)
over ______ in ovaries is considered abnormal in a post menopausal women
8cc
what is echotexture of ovaries?
homogenous
what is the echogenicity of ovaries?
- more echogenic medulla
- echogenic ovarian foci (commonly seen, non shadowing)
what may be seen in the periphery in the cortex of a ovary?
small, well defined anechoic or cystic follicles
Focal calcification
- Occasionally seen
- Stromal reaction previous hemorrhage or infection
- ***maybe early neoplasm (follow up)
what hormones are stimulated in early proliferative stage?
- FSH (follicle stimulating hormone)
- LH (luteinizing hormone)
in early proliferative stage ? increases in size until day _______
8 or 9
in early proliferative phase one follicle becomes _________
dominant
what develops if fluid in one of the nondominant follicles is not resorbed
follicular cyst
what develops after ovulation?
corpus luteum (empty house)
how is the corpus luteum seen on ultrasound?
Seen as a small, hypoechoic or isoechoic structure in periphery of ovary
corpus luteum involutes before _________
menstration
what is less likely to be seen after a hysterectomy?
corpus luteum
what does postmenopausal ovaries look like on an ultrasound?
lack of follicles or completely absent
what is ADNEXA?
appendages or accessory structures of an organ
adnexa refers to?
adjacent structures
- uterine tubes
- ligaments
- ovaries
what are the days of the early proliferative cycle?
days 5-13
what are the days of the late proliferative (periovulatory) cycle?
days 14-16
what are the days of the secretory stage?
days 16-28
what are the days of the menses cycle?
day 1-5 approx
what is the thickness of the endometrium in the early proliferative cycle?
5-7mm
what is the thickness of the endometrium in the late proliferative stage?
under 11 mm
what is the thickness of the endometrium in the secondary phase?
16mm
