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113 Cards in this Set
- Front
- Back
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Name the 4 bones of the pelvis
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1. Sacrum
2. Coccyx 3. 2 innominate bones (ischium, ilium, pubis) |
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Where is the True Pelvis?
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inferior to the sacral prominence
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Where is the False Pelvis?
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From the sacral prominence to the upper margin of the pubic symphysis
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What are the 4 suspensory ligaments of the UTERUS?
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1. Cardinal
2. Broad 3. Sacro-uterine 4. Round |
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Where is the Cardinal ligament?
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Superior and Lateral to the uterus and inferior from the vagina
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Where is the Broad ligament?
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Lateral from the uterus
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Where is the sacro-uterine ligament?
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Posterior to the cervix
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Where is the round ligament?
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Anterior and inferior to the broad ligament
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What are the 3 suspensory ligaments of the OVARY?
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1. Ovarian
2. Mesovarian 3. Infundibulopelvic |
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Where is the Ovarian ligament?
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From the inferior border of the ovary to the uterine cornu
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Where is the Mesovarian ligament?
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From the ovary to the posterior broad ligament
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Where is the infundibulopelvic?
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Superior to the broad ligament
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Where is the Psoas muscle?
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From the lower thoracic spine stretching lateral/anterior and going to the lateral/anterior abdomen and ending at the lesser trochanters
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What muscle merges with the Psoas muscle to form the lateral margin of the pelvis?
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The Iliacus muscles
Inferior to the iliac crest |
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What are the plevic diaphragm muscles and their purpose?
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1. Levator ani
2. Coccygeus they form the perineum and hold the pelvic organs in place with abdominal pressure |
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Where and how would you see the Obturator Internus on ultrasound?
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1. thin/hyperechoic
2. imaged TRVS 3. seen at Post/Lat edge of bladder when angling inferiorly |
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Where is the Dome of the bladder?
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the superior concavity
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Which of the vaginal fornices is the smallest?
Whis is the largest? Why? |
Anterior - smallest
Posterior - largest - frequent site of fluid |
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What are the characteristics of the body of the uterus?
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- contains the uterine cavity
- extends lateral at cornua - widens above tubes (fundus) - isthmus turns to CVX at internal OS - isthmus is the lower uterine segment |
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What are the 3 layers of the uterus?
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- mucosa (endometrium)- varies in thickness from 1mm - 8mm
- muscularis (myometrium) - thick, 3 layered. - perimetrium (serosa) - not usually seen on ultrasound |
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How big is a Pediatric uterus?
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3.3 x .75 cm
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How big is a premenarchal uterus?
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4.3 x 1.3 cm
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How big is a nulliparous uterus?
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8 x 3 cm
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How big is a multiparous uterus?
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9 x 4 cm
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How big is a postmenopausal uterus?
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it varies based on the the # of pregnancies and amount of time since menopause
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What are the follicles found in the outer layer of the overy (cortex) called?
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Primordial follicles
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What is the volume range of a premenopausal ovary?
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5.1 cm3 - 3.2 cm3
volume depends on where in cycle |
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How do you compute volume?
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l x w x h x .523
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What are the 3 regions of the fallopian tubes?
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- intramural (interstitial)
- isthmus - ampullary - LONGEST - extends and terminates at infundibulum - distal part has fimbria |
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What are the 3 pelvic peritoneal recesses?
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- Space of Retzius - between anterior bladder and pubic bone
- Vesicouterine pouch - ANTERIOR CUL-DE-SAC - usually has nothing but possibly loops of bowel - Rectouterine space - POST CUL-DE-SAC - POUCH OF DOUGLAS - common site for free fluid |
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What supplies the ovaries with blood?
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The ovarian arteries
Branches of the aorta |
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What supplies the uterus with blood?
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The uterine arteries
Branches of the Anterior/Internal iliacs |
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What does Low Resistance mean?
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tissue that nees constant blood supply so there is always antegrade flow
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What does High Resistance mean?
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tissue has fewer blood vessels and receives little or no flow in diastole
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What are some Low resistance tissues?
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- Brain
- Kidneys - Malignant tissue - Trophoblastic tissue |
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What are some High resistance tissues?
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- skeletal muscles (at rest)
- Non-dominant ovaries |
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What are the endocrine organs that regulate menses?
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- hypothalamus
- pituitary - ovaries |
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What does the hypothalamus do in the menses cycle?
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Produces gonadotropin (GnRH) that stimulates the pituitary
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What does the pituitary do in the menses cycle?
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Produces follicle stimulating hormone (FSH) and Leutinizing hormone (LH) that stimulates the ovary
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What does the ovary do in the menses cycle?
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the FSH triggers production of estrogen and causes follicles to grow
the LH triggers ovulation in the dominant follicle |
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What does the dominant follicle become after ovulation?
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A corpus luteum
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What does the corpus luteum do in the menses cycle?
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It produces progesterone
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If there is no fertilization, what does the corpus luteum do?
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It stops producing progesterone and signals the hypothalamus to begin again
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How does the ovary appear in the follicular phase of ovulation?
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- has a dominant follicle around day 8 (10 mm)
- follicle grows 1-3mm/day - may have decreased reflectivity 24 hrs from ovulation - may see cumulus oophorus |
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How does the ovary appear at ovulation?
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- the dominant follicle decreases
- free fluid may be seen in the PCDSq |
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How does the ovary appear during the luteal phase of ovulation?
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- the corpus luteum will have a varied appearance
- doppler flow will by hypervascular around corpus luteum |
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How does the endometrium appear during the Proliferative Phase?
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hypoechoic around a midline echo. Becomes isoechoic at end of proliferative phase
- measures 6-8 mm |
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How does the endometrium appear during the Secretory Phase?
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more vascular and echogenic
- midline echo not seen - possible posterior enhancement - measures up to 18mm |
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Define Hypomenorrhea
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small amount of bleeding
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Define Hypermenorrhea (Menorrhagia)
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large amount of bleeding
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Define polymenorrhea
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frequent bleeding
(sooner than every 21 days) |
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Define oligomenorrhea
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infrequent bleeding
(over 35 days apart) |
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Define menometrorrhagia
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irregular frequency AND volume
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Define dysmenorrhea
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painful menses
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Define amenorrhea
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absence of menses
- primary - never had one - secondary - stopped having them |
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Describe a normal postmenopausal uterus
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- uterus and cvx proportional
- endometrium thin <8mm - may have small amt of fluid in endo - the lower the estrogen, the smaller the stripe - if on hormones, will resemble premenopausal endometrium (up to 8mm) |
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What 2 things does Hormone Replacement Therapy do?
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- can alleviate symptoms of menopause
- can prevent severe osteoporosis and improve cardio risk |
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What are the risks of Hormone Replacement Therapy?
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- increases chance of hyperplasia
- increases chance of endometrial carcinoma |
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What are the sizes of the endometrium if:
1. unopposed estrogen 2. estrogen phase of HRT 3. progesterone phase of HRT 4. continuous combos |
1. up to 8mm
2. 10-12mm 3. below 10-12mm 4. less than 8mm |
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What is Tamoxifin?
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A nonsteroid anti-estrogen used in patients with cetain types of breast cancer
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What can Tamoxifen make the endometrium look like?
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- may have subendometrial cysts
- may cause endometrial hyperplasia - may cause endometrial carcinoma |
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What are the 5 causes of POSTmenopausal bleeding?
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- endometrial apathy (MOST COMMON)
- HRT (estrogen causes) - endometrial carcinoma - cervical carcinoma - estrogen-producing tumor of the ovary |
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What is the appearance of the uterus and ovaries in a NEONATE
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cvx - 2 x length of body
endometrium - bright/echogenic ut lenght - 3 x .5-1 cm ov location - anywhere between the kidneys and the true pelvis |
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What is te appearance of the uterus and ovaries in a PREPUBERTAL patient?
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cvx - equal to body length
ut lenth - 2.5 - 3 cm endometrium - not well seen ovaries - small cysts may be seen (9-17mm) |
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What are the 6 reasons for scanning a pediatric pelvis?
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- r/o ovarian cyst
- assess ovaries if PCOD suspected - r/o ovarian neoplasm - r/o congenital ut abnormalities - determine presence/absence of ut and vag in newborn with ambiguous genitalia - eval ut and ovs in precocious puberty (eary menses) |
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Define Hydrocolpos
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fluid in vagina or uterine cavity
- Common reason- imperforate hymen |
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Define hematrometra
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blood in uterus
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Define Hydrometrocolpos
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fluid in uterus AND vagina
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Define Pyometrocolpos
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Pus in the uterus and vagina
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What might you see in a hydrocolpos peds patient?
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- hypoechoic distention of endeometrium or vagina
- posterior enhancement - internal echos may be see (clot) - hydronephrosis may be present (severe cases) |
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What are 6 uses or ultrasound in reproduction?
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- establishes normal anatomy
- monitors follicular growth -confirms ovarian response to drugs -identifies hyperstimulated ovaries -Guides oocyte removal -guides cath placement in IVF, ZIFT, GIFT or intrauterine insemination |
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What is Ovarian hyperstimulation syndrome?
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a condition from excessive stimulation of ovaries
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When does Ovarian hyperstimulation syndrome happen?
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MOST COMMON - women on infertility drugs
- women with PCOD - young/lean women - more severe in pts that conceive |
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What does Ovarian hyperstimulation syndrome look like?
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- bilateral large simple cysts
- diameter over 5 cm - resembles theca lutein cysts |
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Why would you scan IUD patients?
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- to confirm IUD position
- to document myometrial penetration |
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What might you see in patients on OCPs? (Oral Contraception)
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- ovaries may not have dominant follicle
- endometrial growth may be small - endometrial thickness can help determine if OCP amount is correct (if for bleeding) |
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What are the four categories of anomalous internal genitalia?
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- Failure of formation
- Failure of fusion - Failure of dissolution (if septem doesn't dissolute - septate uterus - Failure of structures to disappear (MOST COMMON OUTCOME - Gartner's Duct Cyst |
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What other anatomy should you check if you see anomalous internal genitalia?
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The urinary tract
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What are the 3 other names for Fibroids?
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- Leiomyomas
- Fibromyomas - Myomas |
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Where are these fibroids:
1. intramural 2. submucosal 3. subserosal 4. exophytic 5. pedunculated 6. interligamentous 7. cervical |
1. myometrium
2. against endometrium 3. along outer uterine wall 4. growing out of the uterus 5. attached by a stalk 6. in the broad ligament 7. cervix |
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What are symptoms of leiomyomas?
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- heavy menses (menometrorrhagia)
- enlarged uterus - alteration of menses flow - pelvic pain |
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What is the appearance of a pelvis with a myoma?
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- well seen hypoechoic mass
- increased attenuation - calcifications - distortion of uterine contour - compression on post bladder wall |
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What is Adenomyosis?
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A benign diffuse infiltrate of the myometrium by endometrial glands
- often posterior - appears as focal areas of decreased echogenicity with possible cysts - uterus usually enlarged |
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What is the MOST COMMON GYN malignancy?
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Endometrial carcinoma
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What are the risk factors for endometrial carcinoma?
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- Obesity
- Premenopausal - anovulatory - Postmenopausl - if on HRT - hx of atypical hyperplasia - hx of tamoxifen use - strong fam hx of ut cancer |
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What are the signs of endometrial carcinoma?
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premenopause - hypermenorrhea or intermentsrual flow and pain
postmenopause - vaginal bleeding |
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What will you see with endometrial carcinoma?
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- alteration of the size/shape of the uterus (usually increased)
- thickenings and irregular endometrial tissue - fluid in the endometrial cavity |
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What is endometrial hyperplasia?
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proliferation of endometrial glandular tissue
- similar appearance to carcinoma |
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How would you determine with ultrasound if hyperplasia is present?
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- scan immediately after menses
Should have: - smooth endometerial borders - homogeneous texture - thickness (pre) >14mm - thickness (post) >5mm (on estrogen) - thickness (post on both) >8mm - estrogen phase <8mm - progesterone phase |
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What symptoms might a patient have if they have endometrial polyps?
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- usually asymptomatic
might have: - infertility - abnormal uterine bleeding - postmenopausal bleeding |
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What might you see if a patient has endometrial polyps?
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- thickened enometrial stripe
- a discrete mass in the endometrium - a vascular stalk - it may not be seen different from hyperplasia |
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What is the best evaluation for endometrial polyps?
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Sono HSG
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What are functional cysts?
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hormaonally active cysts from normal stimulation
- nml size - .5-3cm |
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What are the 4 categories of functional cysts?
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- follicular
- corpus luteum - corpus luteum of pregnancy - theca lutein |
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What is a follicular cyst?
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A dominant follicle that doesn't release the ovum or regress in ovulation
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What is a corpus luteum cyst?
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The follicle that remains after the ovum is released and may grow or break
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What is a corpus luteum cyst in pregnancy?
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The remaining follicle that persists and produces progesterone
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What is a theca lutein cyst?
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The cyst that results from overstimulation by high levels of HcG
- associated with trophoblastic disease |
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What are the features of a simple cyst?
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- anechoic
- well defined borders - posterior enhancement |
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What are the features of an Acute Hemorrhagic cyst?
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- hyperechoic
- well defined walls - mimics solid mass - posterior enhancement |
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What are the features of a Subacute Hemorrhagic cyst?
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- complex echogenicity
- internal echos - possible fluid levels |
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Who are the risks for ovarian torsion?
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- pre-existing mass or cyst
- children - young women with mobile anexa - pregnant women |
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What is the most common symptom of ovarian torsion?
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Acute adnexal pain
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What might you see with ovarian torsion?
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- large ovaries with multiple follicles
- no color doppler or spectral doppler - may be adnexal mass - arterial flow, but no venous flow |
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What is another name for Polycystic Ovarian Syndrome?
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Stein-Levanthal Syndrome
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What is Polycystic Ovarian Sydrome associated with?
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Chronic Anovulation
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What might you see with Polycystic ovarian Syndrome?
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- bilateral multiple cysts of various sizes
- normal size but many tiny cysts - multiple cysts from 2-10mm around border on EV - ALWAYS BILATERAL |
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What is the MOST COMMON ovarian Neoplasm?
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Surface Epithelial-Stromal Tumors
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How common are surface epithelial-stromal tumors?
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65-75% of ovarian neoplasms
and 89-90% of ALL ovarian malignancies |
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What are the 5 categories for Epithelial-Stromal Tumors?
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- Serous
- Mucinous - Endometrioid - Clear Cell - Transitional Cell (Brenners) |
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What might benign serous tumors of the ovary look like?
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- sharp margins
- anechoic - large but unilocular with thin lined septations |
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What might malignant serous tumors of the ovary look like?
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- multilocular
- multiple papillary projections - multiple septations - multiple echogenic foci - may have echogneic material - usually associated with ascites |
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What is Pseudomyxoma peritonei?
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gelatinous material sprad into the peritoneal cavity by mucin-secreting cells from a benign or malignant mucinous epithelial tumor
- may look like ascites with septations |
