Things i think i should know topic 4A - 4B Flashcards
What is the embryologic origin of the urogenital system?
the intermediate mesoderm along the posterior wall of the abdomen and both begin growth around the fourth week.
What do the paramesonephric (Müllerian) ducts become in the female?
the fallopian tube, uterus, cervix and upper part of the vagina.
When do male and female morphologic characteristics begin to form?
7th week
What do the ovaries develop from?
Cortical cords, mesenchyme,
Which ducts play an important part in the development of the male reproductive system?
Mesonephric (Wolffian ducts)
Which ducts have a leading role in the development of the female reproductive system?
Paramesonephric (Mullerian ducts)
Why do the mesonephric ducts of female embryos regress ?
The absence of testosterone
Why do paramesonephric ducts develop?
paramesonephric ducts develop because of the absence of MIS • Mullerian inhibiting substance .
What is the appendix vesiculosa
• cranial end of the mesonephric duct that may persist
What are Gartner duct cysts ?
• Parts of the mesonephric duct, corresponding to the ductus deferens and ejaculatory duct, that may persist
What is the hydatid of morgagni?
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
What causes mullerian duct abnormalities?
Arrested development of the müllerian ducts, failure of fusion of the müllerian ducts, and/or failure of resorption of the median septum
What are The most common types of MDAs to have associated renal anomalies ?
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).
What are the most common MDAs?
- septate uterus
- bicornuate uterus
- unicornuate uterus
- uterine didelphys
What is the most common cause of uterine aplasia?
Mayer-Rokitansy-Kuster-Hauser syndrome, with most patients having uterine and vaginal agenesis
What causes unicornate uterus?
• Arrested development of one Mullerian duct
What causes uterus didelphys?
• Complete failure of fusion of the Mullerian ducts
What causes a septate uterus?
• Failure of resorption of the median septum
What are the common pathology of the myometrium?
Leiomyoma, leiomyosarcoma, adenomyosis, AVM, Lipoleiomyoma
What are fibroids (leiomyoma) made up of?
Smooth muscle and connective tissue
What can make a fibroid grow?
oestrogen
What might the clinical presentation of fibroids be?
- 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.
How can fibroids affect structures around the uterus?
- 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.
What is the sonographic appearance of fibroids?
- 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
What can suggest a fibroid is malignant?
. 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.
What are some typical ultrasound appearances of adenomyosis?
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.
WHy would you defer assessment to another stage of the cycle when looking at the endometrium?
The secretory endometrium can potentially obscure pathology
What are the normal values of endometrial thickness?
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
What are some causes of endometrial thickening?
- Pregnancy
- Retained products of conception
- Fibroids (submucosal or intracavitary)
- Endometritis
- Adhesions
- Hyperplasia
- Polyps
- Cancer
What Pathology of the endometrium most often presents as excessive or ill-timed bleeding?
- Atrophy
- Hyperplasia
- Polyp
- Carcinoma
- Endometritis
- malposition of an intrauterine contraceptive device (IUD)
What pathology of the endometrium can present as amenorrhoea or hypomenorrhoea?
- endometrial synechiae
* hematometrocolpos
What pathology of the endometrium can present as infertility?
- polyp
* endometrial synechiae
What pathology of the endometrium can present as pain?
- malposition of an IUD
- polyp, especially those with a long stalk that protrude into the cervix
- endometritis
- hematometrocolpos
What causes a large amount of PMB?
• endometrial atrophy accounts for a large proportion of cases of postmenopausal bleeding
What is hydrometrocolpos and hematometrocolpos?
- 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
What are some causes of endometrial hyperplasia?
• 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.
Why is endometrial hyperplasia a difficult to diagnose finding?
• hyperplasia has a nonspecific sonographic appearance, biopsy is necessary for diagnosis.
What age group are endometrial polyps most commonly found in?
• frequently seen in perimenopausal and postmenopausal women
What is the sonographic appearance of a polyp?
• 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)
What is the hyperechoic line sign?
The appearance of one or two well-defined short echogenic linear echoes at the polyp borders
In what age group does endometrial carcinoma most commonly occur?
• Most (75%-80%) occur in postmenopausal women
How does endometrial carcinoma commonly present?
Bleeding
What are some risk factors for endometrial carcinoma?
o estrogen replacement therapy in postmenopausal women
o anovulatory cycles in premenopausal women
o obesity
o diabetes
o hypertension
o low parity
How can endometrial carcinoma cause hematometra?
• Endometrial carcinoma may also obstruct the endometrial canal, resulting in hematometra.
HOw can endometrial carcinoma look on sonography?
• thickened endometrium
• poor definition of the endometrial/myometrial interface
• an indistinct endometrium in an enlarged uterus.
- cystic hyperplasia
What are the different stages of endometrial carcinoma?
- 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
What are endometrial adhesions?
- (synechiae) are posttraumatic, postinfection, or postsurgical in nature
- may be a cause of infertility or recurrent pregnancy loss.
What is asherman syndrome?
• Asherman syndrome is the combination of synechiae that lead to menstrual dysfunction or infertility.
Describe the appearance of RPOC?
- 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.
What is pstt?
• 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)