Week 2 Normal Anatomy And Appearance Femal Pelvis

Question 1

List 4 major functions of the reproductive system

Answer 1

1. Produce egg and sperm cells
2. Transport and sustain egg and spermcells
3. Nurture developing offspring
4. Produce hormones

These 4 functions are divided between primary and secondary reproductive hormones

Question 2

Describe anatomy of the ovaries

Answer 2

Primary organise
Pared
Lie in shallow depression on either side of the uterus
Endocrine cells in ovary surround developing egg and are called follicle cells

Question 3

Describe the female uterus

Answer 3

Hollow, thick walled organ that recieved fertilised oocyte. It is the environment for development of the fetus. It is in the pelvic cavity, between the rectum and urinary bladder

Question 4

List the external genitalia organs

Answer 4

Collectively called the vulva and is made up on:
Mon pubis
Labia majora
Minora
Clitoris
Bulb of the vestibule
Vestibule of vagina opens into:
1. Orifices
2. Urethra
3. Ducts or paraurethral and vestibular glands

Question 5

Breifly describe the 3 layers that make up the uterus wall

Answer 5

1. Endometrium: inner mucous layer that is adhered to myometrium
2. Myometrium: middlelayer of smooth muscle and hormones stimulate Child birth to dilate cervix OS. Myometrial contractions on menses - cramps
3. Perimetrium: is the serosa or outer peritoneum and is thin connective tissue

Question 6

List and breifly define the 5 types of prolapse

Answer 6

1. Urethrocele: prolapse of anterior vaginal wall, includes urethra
2. Cystocele: prolapse of anterior vaginal wall, includes bladder
3. Uterovaginal: prolapse of the uterus/cervix or upper vagina
4. Rectocele: prolapse of posterior vaginal wall, includes rectum
5. Enterocele: prolapse of upper posterior vaginal wall, include rectovaginal pouch

Question 7

Describe the appearances of the endometrium through he menstural stages

Answer 7

1. Menstural phase: endo is a thin echogenic line
2. Proliferative: endo thickness increases to 4-8mm, the functional hypoechoic later is hypoechoic to the echogenic line
3. Late proliferative / pre ovulatory: the hypoechoic area increases due to oedema and becomes more defined
   4 ovulation: the functional layer is hypoechoic and turns hyperechoic
4. Secretory: the functional layer is hyperechoic due to increases mucous / glycogen, thickness is between 7-14mm, there are increases interfaces for reflection

Question 8

List 7 symptoms of fibroids (leiomyoma)

Answer 8

Heavy or prolonged menstrual bleeding
Pelvic pain or pressure
Frequent urination
Difficulty emptying the bladder
Constipation
Back or leg pain
Enlarged abdomen

Question 9

What are the thre main categories of fibroids (leiomyoma)

Answer 9

1. Intramural: confined to the myometrium, the most common
2. Submucosal: project into the uterine cavity and displace or distort the endo, less common, symptoms can include infertility
3. Subserosal: project from peritoneal surface of uterus +/- pedunculated, presents as a mass

Question 10

Discuss fibroids (leiomyoma)

Answer 10

Composed of smooth muscle cells and connective fibrous tissue
Most common neoplasm of the uterus
Occur in 20-30% women, increased incidence in women of colour
Normally multiple and common cause for enlarged uterus
Frequently as to patio
Estrogen dependant, increase in size due to anovulatory cycle and pregnancy
Fibroids in the first trimester carry an increased risk of miscarriage, this is increased if there is multiple
Fibroids dont interfere when located in lower segment of uterus
They rarely develop post-menopausal, they normally stabilise or decrease in menopause
Rapid increase is suspicious

Question 11

What is the Sonographic appearance of fibroids

Answer 11

Hypoechoic
Heterogenous
Distort uterus control (Submucosal)
Difficult to differentiate Submucosal and intramural
Enhancement/shadowing
Calcification seen in older women

Question 12

Discuss adenomyomosis

Answer 12

Presence of endometrial glands and stroma within myometrium
Smooth muscle hyperplasia
More often seen in posterior wall
Diffuse (widely spread echogenic foci) or nodular varieties (circumscribed nodules - adenoyomas)
Clinical presentation is non specific, uterine enlargement, pain, dysmenorrhea, menorrhagia, multiparous
Ultrasound will show enlarged uterus that is heterogenous myometrium without a discrete mass, possible asymmetrically thickened, endo-myo border is poorly define
Can be difficult to differentiate from a leiomyoma

Question 13

Discuss the post menopausal endometrium

Answer 13

Thine echogenic endo reliable to exclude endometrial cancer
PM bleeding often due to atrophic endo
Study found in 114 pt with endo cancer all had thickness >5mm
Menopausal pt often using HRT to relieve symptoms and the estrogen replacement decreases risk of osteoporosis

However, unopposed oestrogen increase risk of carcinoma and hyperplastia so it is often given with progesterone

Question 14

Discuss endometrial hyperplasia

Answer 14

Proliferation of glands of irregular size and shape with increase in gland:stroma ratio
It is a diffuse process
Histologically: 1) hyperplasia w/o cellular atypica (2% progress to Ca) or 2) hyperplasia w cellular atypica (25% progress to Ca)
Both with and without varieties can be further divided in A) complex (adenomatas) or B) simple (cystic)
Endo hyperplasia is a common cause for irregular bleeding
Can be caused by unopposed estrogen therefore more common in menopausal women
Also seen in PCOS, anovulatory, obese (endogenous hormones)

Question 15

Describe the sonographic appearances of endo hyperplasia

Answer 15

Diffusely thick and echogenic with defined margins
Focal / asymmetrical variations are possible
Small cysts - cystic changes can be seen in polyps)

Question 16

Describe endo atrophy

Answer 16

Most present menopausal with PV bleeding
Thin endo <5mm
Histologically: glands dilated but calls flat and stroma fibrotic

Question 17

What is Hydrometrocolpos and Hematometrocolpos

Answer 17

Hydrometrocolpos - before mensturation, accumulation of secretions in vagina and uterus

Hematometrocolpos - after mensturation, retained blood, marked distension

Question 18

Discuss endometrial polyps

Answer 18

Common Benign lesions peri & post menopause
Most are asymptomatic but most common symptom is bleeding
In mensturating women, polyps associated with inter menstural bleeding, menometrorrhagia and infertility

Histologically: localised overgrowths of endometrial tissue covered by epithelium, can be pedunculated of broad based

20% of polyps are multiple
Malignant regeneration is rare

Ultrasound - echogenic endo thickening that can be diffuse or focal, a focal round echogenic mas, fluid / cystic

Question 19

Discuss endometrial carcinoma

Answer 19

Highly curable as 75% of the time is is contained within the uterus
Most (70-80%) occur in post menopausal women
Clinically presents as bleeding
Strong association with estrogen, obesity and hypertension
Atypical endo hyperplasia 25% progress to carcinoma
Ultrasound: thickened endo that is well defined, uniformly echogenic, indistinguishable hyperplasia and Polyps, endo can be heterogenous
There is an increased risk of endometrial cancer is using tamoxifen (breast cancer)