Test 3 Flashcards
1
Q
what is the echogenicity of muscles?
A
moderate echogenicity with echogenic striations seen in long axis view
2
Q
what can muscles be mistaken with?
A
ovaries or masses within pelvis
3
Q
what is a common muscle to be mistaken for an ovary?
A
iliopsoas
4
Q
is the uterus intra or retro?
A
retro
5
Q
when does the uterus descend into the true pelvis
A
between birth and puberty
6
Q
what is anterior to the uterus
A
pubic bone and bladder
7
Q
what is posterior to the uterus?
A
rectum
8
Q
what are the 3 major portions that make up the uterus?
A
- fundus
- body
- cervix
9
Q
cornua
A
area of body that tubes enter
10
Q
what is superior to the cornua?
A
fundus
11
Q
what area is between cervix and cornua?
A
body
12
Q
what is the cervix?
A
slight narrowing btw body and proximal cervix
13
Q
what opens into the upper vagina?
A
cervix
14
Q
what is the canal of the cervix made up o internally?
A
external and internal os
15
Q
what is located at the distal end of the cervix space between vagina?
A
- 2 lateral fornix
- anterior fornix
- posterior fornix
16
Q
vagina
A
Fibromuscular canal that lies in the midline
17
Q
where does the vagina run?
A
cervix to the external genitalia
18
Q
what does the cervix protrude into?
A
proximal vagina
19
Q
what are the 3 layers of the uterus?
A
- perimetrium
- myometrium
- endometrium
20
Q
what is the big muscle in the uterus taking up majority of the uterus?
A
myometrium
21
Q
what is the myometrium divided into? (inner to outer)
A
- subendometrial halo (inner layer)
- intermediate
- outer
22
Q
what layer of the uterus sloughs off each menses?
A
superficial functional layer
23
Q
what part of uterus stays attached during menstration?
A
deep basal layer
24
Q
what ligaments are paired?
A
- broad ligament
- cardinal
- uterosacral
- round
25
what ligaments are single?
- posterior
| - anterior
26
where do the broad ligaments extend?
lateral aspect of uterus to the lateral pelvic walls
27
what ligament of the uterus is double folds of parietal peritoneum?
broad ligaments
28
what ligament is the lower extension of broad ligament?
cardinal ligament
29
what is the coarse of the round ligaments?
Fibromuscular cords extends from upper outer angles of uterus through inguinal canal and attach labia majora
30
where are the uterosacral ligaments?
Posterior uterus to sacrum, each side of rectum
31
what does the anterior ligament form?
-anterior cul de sac
OR
-vesicouterine pouch
32
where does the anterior ligament coarse?
anterior surface of the uterus to posterior surface of bladder
33
what does the posterior ligament form?
```
-Pouch of Douglas (PCDS)
OR
-posterior cul de sac
OR
-rectouterine recess
```
34
what happens to the uterus when fertilization occurs?
implants into the endometrial lining and develops within UT
35
what uterus layer contracts at labor?
myometrial
36
what happens to the uterus when fertilization does not occur?
- menstruation occurs
| - myometrial contractions aide sloughing off endometrium
37
where does the blood supply run?
within the broad ligament and within the ovary
38
blood supply read over
female pelvis slide 24
39
what part of the female reproductive organs are fixed?
cervix is fixed in midline
40
what part of the female reproductive system is mobile?
body and fundus
41
what is uterus flexion?
axis of the uterine body relative to the cervix
42
what is the uterus version?
axis of the cervix relative to the vagina
43
can the bladder affect position of uterus?
yes bladder being full or empty changes uterus position
44
what is the normal position of the uterus?
anteverted (or anteflexed)
45
what normal variants in position can the uterus be?
- retroverted
| - retroflexed
46
retroverted
Entire uterus is tilted backward (relative to vagina)
47
retroflexed
Body is tilted posteriorly (relative to cervix)
48
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
49
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
50
what is the size and shape of an after age 8 until puberty uterus?
-uterus gradually increases in size
51
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
52
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
53
what does parity mean?
pregnancy
54
how much does the uterus grow in a pregnancy?
increases normal size by 1 cm in each dimension
55
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
56
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 )
57
what is the shape of an uterus?
pear shaped
58
what is the contour of the uterus?
smooth
59
what is the echotexture of the myometrium?
homogenous
60
what are the 3 layers of the uterus in ultrasound?
- subendometrial halo
- intermediate layer
- outer layer
61
what is the echogenicity of the subendometrial halo?
hypoechoic
62
what is the thickest layer of the uterus?
intermediate layer
63
what is the echogenicity of the intermediate layer?
low to moderate echogenicity
64
what is the echotexture of the intermediate layer?
homogenous
65
is the outer layer thin or thick?
thin
66
what is the echogenicity of the outer layer?
slightly less echogenic than the intermediate layer
67
what separates the outer layer ad the intermediate layer?
arcuate arteries
68
is the uterus bigger or smaller in post menopausal stage?
smaller
69
what can happen in the arcuate arteries in the postmenopausal sonographic uterus?
calcifications
70
read slide 39
don't make sense
71
LMP
last menstrual period
| -Day 1 is the first day of menses
72
how long is the average menstrual cycle?
28 days
73
what are some reasons we scan the female pelvis?
- pelvic pain
| - pregnancy
74
what procedure gives you a global scan of the pelvis?
transabdominal ultrasound
75
what can be some reasons not to do transabdominal ultrasound?
- patients unable to hold bladder
- obese patients
- retroverted uterus (beyond focal zone of transducer)
76
how much do patients fill bladder?
24-32 oz
77
physically how much do patients fill their bladder?
4 glasses finish 1 hour prior to exam
78
why do we get patients to fill their bladder?
- displaces uterus from pelvis
- displaces gas filled bowel
- acoustic window
79
what are some technical difficulties for doing an transabdominal ultrasound?
- obese patients
- surgical scars
- barium or gas filled
- abdominal dressings
80
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
81
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
82
what can you see better on a TVU?
- difference between adnexal masses and bowel
- characterization of internal pelvic mass
- pelvic lesion
- endometrium
83
what is a disadvantage to TRU?
smaller field of view
84
when would we not give a transvaginal exam?
- when we were not given consent
- when the patient is young
- when the patient is old
85
what runs laterlly from uterus in the upper free margin of broad ligament?
fallopian tubes
86
how long are the fallopian tubes?
7-12 cm in length
87
what are the 4 portions the fallopian tubes are divided into?
- intramural
- isthmus
- ampulla
- infundibulum
88
where is the intramural?
contained within muscular wall uterus (closest to the uterus)
89
what is the narrowest portion the fallopian tubes?
intramural
90
where is the isthmus?
medial third of tube
| -slightly wider and cordlike
91
what is the longest part of the fallopian tube?
Ampulla
| 1/2 the tube (tortuous)
92
what is the most distal portion of the fallopian tubes?
infundibulum
93
what is the shape of the infundibulum?
funnel shaped end
| -opens into the peritoneal cavity
94
what is the shape of the ovaries?
oval or elliptical
95
what are the ovaries covered by?
single layer called germinal epithelium becomes continuous with peritoneum at the hilum of ovary
96
are the ovaries intra or retro?
intra
97
what are the layers of the ovary?
- germinal epithelium
- tunica albuginea
- cortex
- medulla
98
where do the follicles develop and mature?
cortex
99
is the medulla smaller or bigger in volume compared to the cortex?
smaller
100
what is the medulla composed of?
fibrous tissue and blood vessels
101
what does the mesovarian attach?
anterior surface of ovary to posterior surface of broad ligament
102
what does the ovarian ligament attach?
lower pole of ovary to uterus
103
what does the suspensory ligament attach/
upper pole to lateral wall of pelvis
104
what carries the ovarian vessels and nerves?
suspensory ligament
105
is the suspensory ligament rigid?
no
106
is the ovary fixed or mobile?
mobile
107
what is the lateral extension of the broad ligament?
suspensory ligament
108
where do the ovarian arteries run?
within suspensory ligament
109
where do the ovarian arteries come from?
aorta just inferior to renal arteries
110
where does the right ovarian vein drain?
into the IVC
111
where does the left ovarian vein drain?
left renal vein
112
when looking at the ovaries what does uterine position influence?
ovarian position
113
what is the method for finding size of ovaries?
length x width x height (AP) x 0.523
| -first 2 years
114
0 to 5 years ovarian volumes remain ________
stable
115
5 to menarche ovaries gradually increases in________
size (4cc)
116
Menstruating adult female variable size of ovaries
- Mean ovarian volume TVP 6.8 cc
| - Upper limit 18cc
117
Post menopause size of ovaries
Mean volume 1.2 to 5.8 cc (atrophy)
118
over ______ in ovaries is considered abnormal in a post menopausal women
8cc
119
what is echotexture of ovaries?
homogenous
120
what is the echogenicity of ovaries?
- more echogenic medulla
| - echogenic ovarian foci (commonly seen, non shadowing)
121
what may be seen in the periphery in the cortex of a ovary?
small, well defined anechoic or cystic follicles
122
Focal calcification
- Occasionally seen
- Stromal reaction previous hemorrhage or infection
- ***maybe early neoplasm (follow up)
123
what hormones are stimulated in early proliferative stage?
- FSH (follicle stimulating hormone)
| - LH (luteinizing hormone)
124
in early proliferative stage ? increases in size until day _______
8 or 9
125
in early proliferative phase one follicle becomes _________
dominant
126
what develops if fluid in one of the nondominant follicles is not resorbed
follicular cyst
127
what develops after ovulation?
corpus luteum (empty house)
128
how is the corpus luteum seen on ultrasound?
Seen as a small, hypoechoic or isoechoic structure in periphery of ovary
129
corpus luteum involutes before _________
menstration
130
what is less likely to be seen after a hysterectomy?
corpus luteum
131
what does postmenopausal ovaries look like on an ultrasound?
lack of follicles or completely absent
132
what is ADNEXA?
appendages or accessory structures of an organ
133
adnexa refers to?
adjacent structures
- uterine tubes
- ligaments
- ovaries
134
what are the days of the early proliferative cycle?
days 5-13
135
what are the days of the late proliferative (periovulatory) cycle?
days 14-16
136
what are the days of the secretory stage?
days 16-28
137
what are the days of the menses cycle?
day 1-5 approx
138
what is the thickness of the endometrium in the early proliferative cycle?
5-7mm
139
what is the thickness of the endometrium in the late proliferative stage?
under 11 mm
140
what is the thickness of the endometrium in the secondary phase?
16mm
