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SON5022 Gyne > Things i think i should know topic 4A - 4B > Flashcards

Things i think i should know topic 4A - 4B Flashcards

1
Q

What is the embryologic origin of the urogenital system?

A

the intermediate mesoderm along the posterior wall of the abdomen and both begin growth around the fourth week.

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2
Q

What do the paramesonephric (Müllerian) ducts become in the female?

A

the fallopian tube, uterus, cervix and upper part of the vagina.

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3
Q

When do male and female morphologic characteristics begin to form?

A

7th week

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4
Q

What do the ovaries develop from?

A

Cortical cords, mesenchyme,

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5
Q

Which ducts play an important part in the development of the male reproductive system?

A

Mesonephric (Wolffian ducts)

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6
Q

Which ducts have a leading role in the development of the female reproductive system?

A

Paramesonephric (Mullerian ducts)

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7
Q

Why do the mesonephric ducts of female embryos regress ?

A

The absence of testosterone

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8
Q

Why do paramesonephric ducts develop?

A

paramesonephric ducts develop because of the absence of MIS • Mullerian inhibiting substance .

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9
Q

What is the appendix vesiculosa

A

• cranial end of the mesonephric duct that may persist

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10
Q

What are Gartner duct cysts ?

A

• Parts of the mesonephric duct, corresponding to the ductus deferens and ejaculatory duct, that may persist

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11
Q

What is the hydatid of morgagni?

A

Part of the cranial end of the paramesonephric duct that does not contribute to the infundibulum of the uterine tube that may persist as a vesicular appendage

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12
Q

What causes mullerian duct abnormalities?

A

Arrested development of the müllerian ducts, failure of fusion of the müllerian ducts, and/or failure of resorption of the median septum

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13
Q

What are The most common types of MDAs to have associated renal anomalies ?

A

uterus didelphys (often with renal agenesis ipsilateral to an obstructed horn) and unicornuate uterus (usually renal agenesis ipsilateral to the side of the absent or rudimentary horn).

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14
Q

What are the most common MDAs?

A
  • septate uterus
  • bicornuate uterus
  • unicornuate uterus
  • uterine didelphys
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15
Q

What is the most common cause of uterine aplasia?

A

Mayer-Rokitansy-Kuster-Hauser syndrome, with most patients having uterine and vaginal agenesis

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16
Q

What causes unicornate uterus?

A

• Arrested development of one Mullerian duct

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17
Q

What causes uterus didelphys?

A

• Complete failure of fusion of the Mullerian ducts

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18
Q

What causes a septate uterus?

A

• Failure of resorption of the median septum

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19
Q

What are the common pathology of the myometrium?

A

Leiomyoma, leiomyosarcoma, adenomyosis, AVM, Lipoleiomyoma

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20
Q

What are fibroids (leiomyoma) made up of?

A

Smooth muscle and connective tissue

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21
Q

What can make a fibroid grow?

A

oestrogen

22
Q

What might the clinical presentation of fibroids be?

A
  • may be free of symptoms
  • may complain of a self-detected mass
  • abnormal uterine bleeding
  • acute or chronic pelvic pain
  • pressure symptoms or secondary symptoms.
23
Q

How can fibroids affect structures around the uterus?

A
  • Urinary frequency or urgency occurs because of diminished bladder capacity.
  • Compression of the ureters may result in hydroureteronephrosis.
  • A mass in the cul-de-sac may produce obstipation, constipation or haemorrhoids because of rectal pressure.
24
Q

What is the sonographic appearance of fibroids?

A
  • Hypoechoic or heterogeneous solid mass
  • Occasionally isoechoic
  • occasionally hyperechoic (consider lipoleimyoma)
  • Round or oval shape
  • Distortion of external uterine contour or endometrium, depending on size and location
  • If large enough will have mass effect on extra uterine structures
  • Attenuation or shadowing
  • Minority are Calcificied
  • Cystic areas from degeneration or necrosis
25
Q

What can suggest a fibroid is malignant?

A

. Evidence of local invasion, distant metastasis or sudden accelerated growth in a previously static tumour and postmenopausal enlargement should suggest the possibility of a superimposed malignant process.

26
Q

What are some typical ultrasound appearances of adenomyosis?

A

o diffuse heterogenous attenuative change to the uterine texture; and/or
o very small myometrial cysts without discrete lesions.
o asymmetric thickening of myometrium
o linear striations
o ill-defined endometrium
o should be associated with uterine tenderness
o Always ask “Does this hurt?” as the transducer palpates the uterus.

27
Q

WHy would you defer assessment to another stage of the cycle when looking at the endometrium?

A

The secretory endometrium can potentially obscure pathology

28
Q

What are the normal values of endometrial thickness?

A 
Premenopausal women:	
•	menstrual phase 1-4
•	proliferative phase 4-8
•	secretory phase 7-14mm
Postmenopausal women:	
•	without HRT 5mm or less
•	with HRT 8 mm or less
29
Q

What are some causes of endometrial thickening?

A
  • Pregnancy
  • Retained products of conception
  • Fibroids (submucosal or intracavitary)
  • Endometritis
  • Adhesions
  • Hyperplasia
  • Polyps
  • Cancer
30
Q

What Pathology of the endometrium most often presents as excessive or ill-timed bleeding?

A
  • Atrophy
  • Hyperplasia
  • Polyp
  • Carcinoma
  • Endometritis
  • malposition of an intrauterine contraceptive device (IUD)
31
Q

What pathology of the endometrium can present as amenorrhoea or hypomenorrhoea?

A
  • endometrial synechiae

* hematometrocolpos

32
Q

What pathology of the endometrium can present as infertility?

A
  • polyp

* endometrial synechiae

33
Q

What pathology of the endometrium can present as pain?

A
  • malposition of an IUD
  • polyp, especially those with a long stalk that protrude into the cervix
  • endometritis
  • hematometrocolpos
34
Q

What causes a large amount of PMB?

A

• endometrial atrophy accounts for a large proportion of cases of postmenopausal bleeding

35
Q

What is hydrometrocolpos and hematometrocolpos?

A
  • Before puberty, the accumulation of secretions in the vagina and uterus is referred to as hydrometrocolpos.
  • After menstruation, hematometrocolpos results from the presence of retained menstrual blood
36
Q

What are some causes of endometrial hyperplasia?

A

• unopposed estrogen stimulation which could be due to
o use of unopposed estrogen HRT
o persistent anovulatory cycles (such as with polycystic ovarian syndrome)
o obese women with increased production of endogenous estrogens
o estrogen-producing tumors, such as ovarian granulosa cell tumors and thecomas.

37
Q

Why is endometrial hyperplasia a difficult to diagnose finding?

A

• hyperplasia has a nonspecific sonographic appearance, biopsy is necessary for diagnosis.

38
Q

What age group are endometrial polyps most commonly found in?

A

• frequently seen in perimenopausal and postmenopausal women

39
Q

What is the sonographic appearance of a polyp?

A

• may appear as nonspecific echogenic endometrial thickening
• may be diffuse or focal
• may also appear as a focal, round, echogenic mass within the endometrial cavity
• At times cystic appearance and distend the endometrial cavity
- may be a feeding artery present on colour (pedicle artery sign)

40
Q

What is the hyperechoic line sign?

A

The appearance of one or two well-defined short echogenic linear echoes at the polyp borders

41
Q

In what age group does endometrial carcinoma most commonly occur?

A

• Most (75%-80%) occur in postmenopausal women

42
Q

How does endometrial carcinoma commonly present?

A

Bleeding

43
Q

What are some risk factors for endometrial carcinoma?

A

o estrogen replacement therapy in postmenopausal women
o anovulatory cycles in premenopausal women
o obesity
o diabetes
o hypertension
o low parity

44
Q

How can endometrial carcinoma cause hematometra?

A

• Endometrial carcinoma may also obstruct the endometrial canal, resulting in hematometra.

45
Q

HOw can endometrial carcinoma look on sonography?

A

• thickened endometrium
• poor definition of the endometrial/myometrial interface
• an indistinct endometrium in an enlarged uterus.
- cystic hyperplasia

46
Q

What are the different stages of endometrial carcinoma?

A
  • Stage IA, cancer is in the endometrium only or less than halfway through the myometrium
  • In stage IB, the tumor is still localized to the uterus but has spread halfway or more into the myometrium
  • In stage II, cancer has spread into connective tissue of the cervix, but has not spread outside the uterus
  • In stage III, the cancer has spread outside of the uterus or into nearby tissues in the pelvic area
  • In stage IV, the cancer has spread to the inner surface of the urinary bladder or the rectum (lower part of the large intestine), to lymph nodes in the groin, and/or to distant organs, such as the bones, omentum, or lungs
47
Q

What are endometrial adhesions?

A
  • (synechiae) are posttraumatic, postinfection, or postsurgical in nature
  • may be a cause of infertility or recurrent pregnancy loss.
48
Q

What is asherman syndrome?

A

• Asherman syndrome is the combination of synechiae that lead to menstrual dysfunction or infertility.

49
Q

Describe the appearance of RPOC?

A
  • vascularized tissue in the endometrial cavity is usually indicative of RPOC
  • tissue that is not vascularized could be due to either blood clot or devascularized RPOC.
  • size of the suspected RPOC is important because that may guide therapy.
  • If RPOC are seen and they extend beyond the endometrial cavity into myometrium, this is indicative of an invasive placental condition such as placenta accreta.
50
Q

What is pstt?

A

• uncommon cause of postpartum bleeding
• Should be considered when there are persistently low serum levels of human chorionic gonadotropin (hCG) and/or elevated levels of human placental lactogen
Placental site trophoblastic tumor (PSTT)

SON5022 Gyne (8 decks)

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