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66 Cards in this Set

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"Exophytic" or "pedicle" and arises from a stalk.
Pedunculated Fibroid.
Fibroid that can mimic an Adnexal mass and have to make sure its not an ovarian mass.
Pedunculated Fibroid
**Look at Adnexal area.
Fibroid that hangs off the edge and will move with the uterus; Must see connection with uterus with blood flow.
Pedunculated Fibroid
A.k.a. "Myometrial" Located in the most common location for a fibroid, the Myometrium.
Intramural Fibroids
Aysmptomatic fibroid and looks like a cluster of grapes
Intramural Fibroid
Fibroid lying directly beneath the endometrium and often projecting into the cavity.
Submucosal Fibroid
Symptoms of fibroid: Menorrhagia, Dysmenorrhea, & PMB.
Submucosal & Intracavitary fibroids
Fibroid that may lead to Anemia and affect fertility
Submucosal Fibroid
True or False: If there are no fibroids in the endometrial cavity they will be Aymptomatic.
True
Fibroid originating from and lying entirely in the endometrium.
Intracavitary Fibroid
Easiest Fibroid to remove by Myomectomy. Can do a DNC and no cutting is involved.
Intracavitary Fibroid
Fibroid that feels like having "labor pains".
Intracavitary Fibroids.
Fibroid that's located close to the outer, peritoneal surface of the Uterus.
Subserosal Fibroid
Fibroid that can cause pain & pressure against adjacent fibroids.
Subserosal Fibroids
Fibroids within the round or broad ligaments
Interligamentous Fibroids.
What are characteristics of a fibroid?
Leiomyolipoma , Calcification (Hyaline degeneration), & degeneration.
What is Leiomyolipoma?
A fatty fibroid.
What is a fibroid that calcifies?
Hyaline degeneration
What happens when a fibroid degenerates?
The mass outgrows its blood supply, necrosis takes place, causes pain, complex/cystic areas develop, may contain calcifications w/in.
What is Leiomyosarcoma?
A malignant degeneration of a fibroid.
Very rare (.2%), very rapid growth in post-men women.,
What are treatments for fibroids?
Myomectomy, Hysterectomy, Angiographic embolization, Observation for growth.
What is Endometrial Hyperplasia
Excessive thickening of the endometrial tissue or proliferation of the Endometrial tissue.
What does proliferation mean?
Cells multiplying and growing
What are causes of Endometrial Hyperplasia?
Unopposed Estrogen & Tamoxifen Therapy
When is unopposed estrogen used?
Women who have had an oophorectomy or are postmenopausal.
What is a common cause for DUB & PMB & Endometrial cancer?
Unopposed Estrogen


When is Tamoxifen Therapy used & what is it?
Used in postmenopausal pts w/breast CA., It's a hormonal drug that stim. the endo- so patients are more prone to endo polyps, fibroids, CA.
What is the diagnosis for Endometrial Hyperplasia?
When endometrial msmt is greater then 14mm in premen & post-menopausal women on HRT, and if >8mm in post-menopausal women not on HRT.
Clincal symptom of Endometrial Hyperplasia?
Irregular bleeding
What is the differential diagnosis for Endometrial Hyperplasia?
Early Intrauterine pregnancy, Secretory Endometrium, Estrogen replacement therapy, Endo- polyps or fibroids, Endo CA.
What are Endometrial Polyps?
A mass attached to the endometrial cavity by a stem or pedicle.
Made up of endometrial tissue covered by epithelium. Peak age 40-49. Hyperechoic area in endo-
What is the ultrasound appearance of Endometrial polyps?
Hyperechoic areas w/in endo-, indistinguishable for endo- hyperplasia, irregular endo- contour seen after menses.
Contain a "feeder vessel" which provides blood supply to this pelvic anomoly?
Endometrial Polyps
Fibroids don't have this characteristic.
What is Sonohysterography?
Used for confirmation of endometrial polyps or fibroids.
Saline is infused into the endometrium using a cathater thats passed thru cervical canal under u/s guidance. 97% effective in diagnosis.
T or F: Polyps have more color going into them then Fibroids?
False. Fibroids are made of muscle so they will have more color on them.
T or F: Fibroids are more hypoechoic then Polyps?
True. Polyps are more Hyperechoic.
A.k.a. "inclusion" or "Retention" cyst
Nabothian Cyst
What are characteristics of a mass documentation?
Landmarks, measurement, characteristics.
Characteristics that should be included in documentation of a mass:
Mass contour and echotexture, sound transmission, solid/liquid, septations within?, Nodularity present? (excrescence), Mobile?,
What are type of probe is used for TAS?
3.5-5.0Mhz Curved Linear Array Transducer
What type of probe is used for TVS?
5.0-13.0MHz endocavitary transducer.
Advantages for using TAS
Panoramic view
Advantages for using TAS
Displacement of bowel
Advantages for using TAS
patients of all ages
Advantages for using TAS
can see mid-abdominal pathology
Advantages for using TAS
better visualization
Advantages for using TAS
Full bladder technique
Advantages for using TAS
Wider field of view
Advantages for using TAS
More accurate measurements
Disadvantages for using TAS
Adnexal structures difficult to visualize
Disadvantages for using TAS
Bowel/colon/recutum can mimic a mass
Disadvantages for using TAS
Fine detail of masses cannot be delineated
Disadvantages for using TAS
uncomfortable prep
Disadvantages for using TAS
large patient size is limiting
Disadvantages for using TAS
Limited visualization of retroverted or retroflexed uterus
What are Indications for doing Transvaginal Sonography (TVS)?
Gynecological survey, 1st trimester pregnancy, Suspected Ectopic, Emergent situation, Intrauterine pathology, Fertility studies, difficulting obtaining TAS images.
What type of procedure do you use gluteraldehyde disinfectant for?
TVS
TVS Advantages
Resolution is greatly improved
TVS Advantages
More specific information
TVS Advantages
No exam prep needed -- bladder does not need to be full.
TVS Disadvantages
Narrow or stenotic cervix
TVS Disadvantages
Obesity, limited probe manipulation
TVS Disadvantages
May be difficult to tolerate due to level of pain
TVS Disadvantages
pelvic masses >10cm may be difficult to visualize
TVS Disadvantages
Limited visualization of retroverted or retroflexed uterus
TVS Disadvantages
May be limiting due to patient age (premenarchal/ postmenopausal)