Frmale Pelvis Part 2

Question 1

Sonographic appearance in reproductive years

Answer 1

Vary depending on stage of menstral cycle

Question 2

For size measurement we take

Answer 2

Take AP measurement at the thickest part

Question 3

LMP is

Answer 3

Day 1 of the first day of mense

Question 4

Average menstrual cycle = ___ days

Answer 4

28 days

Question 5

4 stages of menstral cycle

Answer 5

Early proliferative
Later proliferative
Secretory
Menses

Question 6

Early proliferative

Answer 6

Day 5-13

5-7 mm

Question 7

Late proliferative

Answer 7

Day 14-16

>11mm

Question 8

Secretory phase

Answer 8

Days 16-28

16mm

Question 9

Menses

Answer 9

Day 1 to 5

Question 10

Patient history for female pelvis exam

Answer 10

RLQ, LLQ, chronic, acute, pregnancy

Question 11

Transabdomindal ultra sound

Answer 11

Global view
Limited patients ability to hold and fill bladder, obese patients, retroverted uterus (beyond focal zone of transducer)
Limited resolution depth

Question 12

Reasons for full bladder

Answer 12

Displaces uterus
Displaces gas
Use as an acoustic window

Question 13

Technical difficulties on transabdominal US

Answer 13

Obeses
Surgical scar
Gas
Dressing

Question 14

Advantages of transvag

Answer 14

Better resolution higher frequency transducer
Obese patients
Patients who cannot fill bladder
Retroverted uterus
Better distinction adnexal masses and bowel
Better characterization of internal pelvic mass
better detail of pelvic lesion
better detail of endometrium

Question 15

Disadvantage tot TVP

Answer 15

Small feild of view

Question 16

4 portions of fallopian tubes

Answer 16

Intramural
Isthmus
Ampulla
Infindibulum

Question 17

Length of tubes

Answer 17

7-12 cm

Question 18

Intramural

Answer 18

1 cm long, narrowest portion

Contained within muscular wall uterus

Question 19

Isthmus

Answer 19

Medial third of tube

Slighty wider and cordlike

Question 20

Ampulla

Answer 20

Tortuous, approx half the lenth

Question 21

Infindibulum

Answer 21

Most distal portion
Funnel shaped end
Opens into the peritoneal cavity

Question 22

Overies covered by single layer called

Answer 22

Germinal epitherlium which become continuous with peritoneum at the hilim of ovary

Question 23

Ovary sections

Answer 23

Germinal epithelium -> single layer
Tunica albuginea -> fibrous capsule
Cortex-> where the follicles develop and mature
Medulla-> smaller in volume than cortex , composed of fibrous tissue and blood vessels

Question 24

Mesovarian ligament

Answer 24

Attaches anterior surface of ovary to posterior surface of broad ligament

Question 25

Ovarian ligament

Answer 25

Attaches lower pole of ovary to uterus

Question 26

Suspensory ligament

Answer 26

Attaches upper pole to lateral wall of pelvis lateral extension of broad ligament Carries ovarian vessels and nerves

Question 27

Ovarian arteries

Answer 27

From aorta just inferior to renal arteries Run within suspensory ligament Gives off branches to ovaries Anastomose with branches of uterine artery

Question 28

Ovarian veins

Answer 28

Right ovarian vein drains into IVC | Left ovarian vein drains into left Renal Vein (Remember Lt Gondal vein aka. Lt ovarian in

Question 29

Ovaries sonographic appearance

Answer 29

``` Uterine position influences ovarian position Example: uterus is left sided the ipsilateral ovary can lie superior to fundus of uterus Usually lateral or posterolaterally to anteflexed midline uterus Variable positions (laxity of ligaments) ```

Question 30

Menstrating adult female variable size of ovary

Answer 30

6.8 cc

Question 31

Echotexture of ovary

Answer 31

Homogenous

Question 32

Echogenicity of ovary

Answer 32

``` Echogenicity Central, more echogenic medulla Small, well defined anechoic or cystic follicles may be seen in periphery in the cortex Echogenic ovarian foci Commonly seen Non-shadowing ```

Question 33

Echogenic foci in vary

Answer 33

Usually in periphery but can be diffuse | Specular reflectors of tiny, unresolved cysts

Question 34

Focal calcification in ovary

Answer 34

Occasionally seen

Question 35

Changes in ovary during early proliferative phase

Answer 35

Follicles stimulated by FSH (follicle stimulating hormone) and LH (luteinizing hormone) Increase in size until day 8 or 9 One follicle becomes Dominant Dominant reaches size 2.0 to 2.5 cm at ovulation Follicular cyst develops if fluid in one of the nondominant follicles is not resorbed

Question 36

Corpus luteum

Answer 36

Develops after ovulation “empty house” Seen as a small, hypoechoic or isoechoic structure in periphery of ovary Involutes before menstruation

Question 37

Sonographic appearance of corpus luteum

Answer 37

Small size and lack of follicles | Less likely to be seen after hysterectomy due to loss of normal anatomic landmarks

Question 38

Postmenopausal ovary sonographic appearance

Answer 38

Small Lack of follicles or completely absent Hard to find on US

Question 39

ADNEXA

Answer 39

appendages or accessory structures of an organ Example in the female pelvis the uterus, the adnexa refers to the adjacent structures: the uterine tubes and ligaments and ovaries Take an image of the right and left adnexa, adjacent to uterus