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SON5022 Gyne > Things i think i should know topic 1 - 3 > Flashcards

Things i think i should know topic 1 - 3 Flashcards

1
Q

List the advantages of TVS

A
  • No need for a full bladder
  • Fewer artifacts as anterior abdomen attenuation is avoided
  • Closer contact with pelvic organs means higher frequency and better resolution
  • Dynamic assessment i.e. push into ovary
  • Examination of patients who are unable to fill their bladder
  • Examination of obese patients
  • Evaluation of a retroverted or retroflexed uterus
  • Better characterization of the internal characteristics of a pelvic mass
  • Better detail of a pelvic lesion
  • Better detail of the endometrium
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2
Q

List the disadvantages of TVS

A
  • There are not many
  • High frequency means limited depth though usually sufficent
  • Due to positioning against the uterus field of view may be limited i.e. cannot push in further
  • Imaging of specific organs rather than a global view of the region (uterus, ovaries, adnexa)
  • Transducer movement can be limited by the confines of the vagina.
  • Urine in the bladder may displace organs or masses outside the field of view.
  • Fundal masses, such as leiomyomata, may be difficult to evaluate or can even be missed transvaginally and may require transabdominal sonography to visualise them or to best evaluate their size.
  • invasive
  • emotionally sensitive
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3
Q

List some causes of Endometrial Thickness in Premenopausal Women

A
  • submucosal fibroid
  • endometrial polyp
  • endometrial hyperplasia
  • trophoblastic disease
  • uterine synechiae or adhesions
  • early intrauterine pregnancy and collections of blood or pus due to either infection, cervical cancer or cervical stenosis.
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4
Q

List some causes of Endometrial Thickness in The Postmenopausal Woman

A
  • Endometrium measuring > 8mm in thickness tho some debate
  • Thickening indicates an abnormal endometrium.
  • most significant reason is endometrial carcinoma.
  • Ultrasonography cannot distinguish benign from malignant endometrial growth.
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5
Q

How does the endometrium appear during menstruation?

A

Early - hypoechoic central line representing blood and tissue surrounded by a hyperechoic endometrial echo.
Late - the hypoechoic echo that represents blood disappears and the endometrium appears as a single line.

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6
Q

How does the endometrium appear during the proliferative phase?

A
  • endometrium appears as a single thin stripe representing the cavity
  • a hypoechoic halo encompassing it
  • creating what is called the triple stripe appearance.
  • The thin surrounding hyperechoic layer represents the basalis.
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7
Q

How does the endometrium appear during the proliferative phase?

A

at its greatest thickness and echogenicity.

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8
Q

What are some indications for sonohysterography?

A
  • not routinely needed
  • done on day 4-10 of cycle
    1. endometrium not adequately evaluated by TVS or TAS
    2. women with abnormal bleeding when a focal lesion is not visualized sonographically
    3. evauation of endometrial or intracavitary abnormalities detected by TVS
    4. infertility
    5. suspected congenital uterine malformations
    6. evaluation of women taking tamoxifen
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9
Q

What are the four functions of the reproductive system?

A
  • to produce eggs and sperm cells
  • to transport and sustain these cells
  • to nurture developing offspring
  • to produce hormones.
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10
Q

What is the normal size of the uterus?

A
  • 8 cm in length, 5 cm in width, and 4 cm in anteroposterior (AP) diameter.
  • extra 1-2cm in each dimension after kids
  • Atrophy after menopause
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11
Q

List the vessels of the uterus from outer to inner

A
  • Arcuate arteries
  • between the outer and intermediate layers of the myometrium
  • branch into the radial arteries
  • These run in the intermediate layer to the level of the inner layer
  • branch into the spiral arteries
  • These enter the endometrium and supply the functional layer
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12
Q

How do you differentiate the hypoechoic glandular area from a hypoechoic mass in the cervix?

A
  • The uniform elongated nature of this finding should help distinguish it from a true mass.
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13
Q

Why might a Nabothian cyst have internal echoes?

A

Proteinaceous material or haemorrhage

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14
Q

What is the name for cervical folds?

A

Plicae palmatae

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15
Q

What are possible normal sources of fluid in the POD?

A
  • blood or fluid caused by follicular rupture
  • blood from retrograde menstruation
  • increased capillary permeability of the ovarian surface caused by the influence of estrogen.
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16
Q

What are some pathological sources of fluid in the POD?

A
  • generalized ascites
  • blood resulting from a ruptured ectopic pregnancy or hemorrhagic cyst
  • pus from infection.
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17
Q

How can sonography aid in identifying type of fluid in the POD?

A
  • blood, pus, mucin, and malignant exudates usually contain echoes within the fluid
  • serous fluid (either physiologic or pathologic) is usually anechoic.
  • Clotted blood may be very echogenic, mimicking a solid mass.
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18
Q

If the uterus is lying to one side where might you find the ipsilateral ovary?

A

superior to the uterine fundus

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19
Q

Where are the ovaries most commonly found?

A

Waldeyer fossa

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20
Q

What size are the normal ovaries?

A

Up to 22mL in the reproductive female

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21
Q

How does the early corpus luteum appear?

A
  • contains internal low-level echoes consistent with hemorrhage
  • crenulated thick walled cyst
  • peripheral colour doppler signals
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22
Q

How does the late corpus luteum appear?

A

collapsed

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23
Q

How does a post menopausal ovary appear?

A

Small, hypoechoic, lacks follicles
1.2-5.8mL
>8mL abnormal

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24
Q

What sonographic signs indicate ovulation has taken place?

A
  • The disappearance of the dominant follicle with associated free fluid in the pelvis signifies ovulation.
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25
Q

What is a corpus albicans?

A
  • As the corpus luteum ages it collapses and becomes a more solid, fatty structure, a corpus albicans, not well visualised on sonography.
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26
Q

Comment on unilocular post menopausal cysts

A
  • low incidence of malignancy in less than 5 cm in diameter and without septations or solid components
  • ovarian cysts less than 7 cm and greater than 1 cm in diameter be followed by serial yearly sonographic examinations without surgical intervention
  • Unless there is an increase in size or a change in the characteristics of the lesion.
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27
Q

When is surgery recommended in a post menopausal cyst?

A
  • greater than 7 cm and for those containing multiple internal septations or one or more solid nodules.
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28
Q

What is the role of FSH?

A

stimulates the ovarian follicles to develop and produce estrogens.

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29
Q

When does estrogen rise to a peak?

A

just before the luteinizing hormone (LH) surge.

30
Q

When does ovulation usually occur in relation to hormones?

A

24 to 36 hours after the LH surge.

31
Q

What happens to hormones if fertilisation does not occur?

A

blood levels of circulating estrogens and progesterone fall

32
Q

What does the fall of estrogens and progesterone do to the endometirum?

A

causes the endometrium to regress and menstruation to start again

33
Q

What is GnRH?

A

Gonadotropin hormone-releasing hormone (GnRH), A hormone made by a part of the brain called the hypothalamus

34
Q

What does GnRH do?

A

causes the pituitary gland in the brain to make and secrete the hormones luteinizing hormone (LH) and follicle-stimulating hormone (FSH)

35
Q

What regulates GnRH?

A

Steroid feedback regulates GnRH release. For most of the reproductive cycle, estradiol negative feedback suppresses GnRH release

36
Q

What is the effect of estrogen and progesterone during the cycle?

A
  • Produced by the ovarian follicles and corpus luteum

* Produce cyclic changes in the endometrium

37
Q

What are the approximate timing of cycle phases?

A

menstrual 1-5
Proliferative 6 - 15
Luteal/secretory 16 - 28

38
Q

What happens during the menstrual phase?

A
  • functional layer of the uterine wall is sloughed off with the menstrual flow
  • lasts 4 to 5 days
  • After menstruation, the eroded endometrium is thin
39
Q

What happens during the proliferative phase?

A
  • Lasts approximately 9 days
  • coincides with the growth of ovarian follicles
  • controlled by estrogen secreted by the follicles
  • two to three-fold increase in the thickness of the endometrium
40
Q

What happens during the luteal (secretory) phase?

A

secretory phase)
• lasts approximately 13 days
• coincides with the formation, functioning, and growth of the corpus luteum.
• The progesterone produced by the corpus luteum stimulates the glandular epithelium to secrete a glycogen-rich material
• endometrium thickens because of the influence of progesterone and estrogen from the corpus luteum

41
Q

What happens when fertilisation does not occur?

A
  • The corpora lutea degenerate
  • Estrogen and progesterone levels fall and the secretory endometrium enters an ischemic phase
  • Menstruation occurs
42
Q

What happens if fertilisation does occur?

A
  • formation of a blastocyst begins
  • blastocyst begins to implant in the endometrium on approximately the sixth day of the luteal phase
  • Human chorionic gonadotropin, a hormone produced by the syncytiotrophoblast, keeps the corpora lutea secreting estrogens and progesterone
  • The luteal phase continues and menstruation does not occur.
43
Q

Briefly describe endometrial appearance throughout the cycle

A
  • Menstrual phase: a thin, single echogenic line, 0.5-1 mm.
  • Proliferative phase: hypoechoic thickening, 4-8 mm.
  • Secretory phase: hyperechoic thickening 7-14 mm.
44
Q

Briefly describe the post menopausal endometrium

A
  • No HRT: atrophic, single echogenic line, < 5 mm.

* With HRT: single echogenic line, < 8 mm.

45
Q

List the effects of hormones on the post menopausal endometrium

A

unopposed oestrogen - thick heterogeneous
daily estrogen/progesterone - thin atrophic
sequential estrogen/progesterone - thickness varies with phase of cycle
tamoxifen - thick cystic space

46
Q

List the sonographic appearance of the pre menopausal ovary

A
  • Follicular phase: many follicles (5-11) increase in size until day 8-9, then one follicle becomes dominant; all others become atretic.
  • Pre-ovulatory: follicle measuring 20-25 mm.
  • Luteal phase: corpus luteum, a 20 mm irregular hypoechoic or isoechoic cyst often containing low level echoes. There can be a typical ‘ring’ colour flow.
47
Q

Post menopausal ovary appearance

A
  • No HRT: atrophy, no follicles, decrease in size.

* With HRT: atrophy, no follicles, decrease in size.

48
Q

What is PMB?

A

Post menstrual bleeding

49
Q

What is IMB/metrorrhagia?

A

intermenstrual bleeding

50
Q

What is Menometrorrhagia?

A

prolonged menstrual flow and intermenstrual bleeding.

51
Q

What is VE?

A

Vaginal examination

52
Q

What is dysmennorhia?

A

painful periods

53
Q

What is primary amenorrhea?

A

refers to females who fail to undergo menarche

54
Q

What is secondary amenhorrea?

A

: the absence of menstrual periods for six months, or a length of time equivalent to three normal menstrual cycles, in a female who has been menstruating previously

55
Q

What is oligomennorhea?

A

the occasional occurrence of menses.

56
Q

What is polymennorhea?

A

refers to menses at intervals of less than 21 days.

57
Q

What is Hypermenorrhoea or menorrhagia?

A

prolonged and increased uterine bleeding at regular intervals.

58
Q

What is Dyspareunia?

A

Pain during sex

59
Q

What is PCB?

A

Post coital bleeding

60
Q

What is Mittelschmerz?

A

intermenstrual pain linked with the phenomenon of ovulation, sometimes associated with a small amount of brown discharge.

61
Q

Can you explain why exogenous administration of oestrogen and progestogen inhibits ovulation?

A
  • Both oestrogen and progestogen have an inhibitory effect on the hypothalamus and pituitary resulting in an inhibition of gonadotropin production.
  • Low FSH results in depressed follicular development
  • the dominant action for contraception is LH inhibition. - If there is no mid-cycle LH peak, ovulation will be inhibited even if follicular development occurs.
62
Q

What does oestrogen do in the OCP?

A
  • Prevents ovulation by LH inhibition

* Depressed FSH also depresses follicular development

63
Q

What does progesterone do in the OCP?

A
  • creates an endometrial lining that resists implantation
  • thickens cervical mucus, retarding sperm entry into the upper female reproductive tract
  • supplement the antiovulatory effects of estrogen
  • make pregnancy unlikely should ovulation occur.
64
Q

How does the ovary appear on OCP?

A
  • homogeneous structure
  • without a dominant follicle (sometimes will be present as patient will ovulate)
  • even the small anechoic nonovulatory immature follicles may not be present
65
Q

How will the endometrium appear on OCP?

A

Thin echogenic line

66
Q

What clinical problems does OCP suppress?

A

• Conditions associated with ovulation (ectopic pregnancy and ovarian cysts)
• pelvic inflammatory disease (PID)
• Iron deficiency anaemia is less likely since menstrual bleeding is decreased
• decreased menstrual symptoms
• improvement in acne.
- reduces the risk of developing uterine myomata
- both ovarian and endometrial cancers are about half as common

67
Q

Briefly describe the hormonal changes of menopause

A
  • permanent cessation of menstruation occurs following the loss of ovarian activity
  • gonadotropins, FSH and LH, will rise in an attempt to stimulate more follicles
  • Despite this increase in FSH and LH, oestrogen production by the ovaries does not continue beyond the menopause.
68
Q

What are the benefits of HRT?

A
  • give oestrogen in order to reduce all the effects of oestrogen deprivation
  • especially osteoporosis and cardiovascular disease
  • Oestrogen replacement alone dramatically increases the risk of endometrial cancer
  • risk can be eliminated by the addition of progestogen
  • HRT therefore mostly refers to a combination of oestrogen and progestogen.
69
Q

What is tamoxifen citrate?

A
  • orally administered
  • non-steroidal
  • anti-oestrogen agent
  • used for the treatment of oestrogen receptor positive breast cancer
  • been found to prevent breast cancer in some high-risk populations
  • weak oestrogen agonist in postmenopausal endometrial tissue
70
Q

How does an endometrium on tamoxifen appear?

A
  • nonspecific
  • similar to those described in hyperplasia, polyps, and carcinoma.
  • Cystic changes within the thickened endometrium are frequently seen
  • Polyps are frequently present and can be quite large
  • cystic changes are subendometrial in location and represent reactivation of adenomyosis in the inner layer of myometrium

SON5022 Gyne (8 decks)

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