Handouts Flashcards
1
Q
What are the 4 regions of the Uterus?
A
Fundus
Corpus
Isthmus
Cervix
2
Q
What is the most common uterine position?
A
Anteverted and Anteflexed
3
Q
What is the 3 tissue layers of the uterus?
A
Perimetrium
Myometrium
Endometrium
4
Q
What are the 4 portions of the fallopian tubes?
A
Interstitial (Intramural)
Isthmic
Ampullary
Infundibulum
5
Q
What is the widest portion of the fallopian tubes?
A
Ampullary
*check with Amy
6
Q
What are the bones of the pelvis?
A
Coccyx, sacrum, 2 innominate bones (ilium, ischium, & pubis)
7
Q
What is the only abdominal organ NOT covered by peritoneum?
A
Ovaries
8
Q
What produces hormones and gametes?
A
Ovaries
9
Q
Where will free fluid collect first in the pelvic cavity?
A
Posterior Cul de sac (pouch of douglas)
10
Q
What phase of the menstrual cycle typically lasts from 1 - 5 days?
A
Menstrual phase
11
Q
What phase of the menstrual cycle typically lasts from 6 - 14 days?
A
Proliferative phase
12
Q
If the endometrium measures 7mm in this phase is it normal?
A
No
*check with Amy
13
Q
What hormone is the most influential in this phase? (proliferative)
A
Estrogen
14
Q
What phase of the menstrual cycle typically lasts from 15-28 days?
A
Secretory Phase
15
Q
What hormone causes ovulation to occur?
A
Luteinizing Hormone (LH)
16
Q
What phase begins at ovulation and is also called the luteal phase?
A
Around the 14th day - Secretory phase
17
Q
What phase is mainly under the influence of estrogen and is regrowth of endometrium?
A
Proliferative phase
18
Q
During what phase does the endometrium degenerate?
A
Menstrual Phase
19
Q
What secretes Gonad Releasing Hormone (GnH)?
A
Hypothalamus
20
Q
The rise in GnH causes what organ to release follicle stimulating hormone (FSH)?`
A
Anterior Pituitary
21
Q
A rise in LH (Lutenizing Hormone) causes what to occur?
A
Ovulatory Phase
22
Q
What is the dominant follicle known as?
A
Graafian Follicle
23
Q
What is polymenorrhea?
A
Frequent regular cycles but less than 21 days
24
Q
What is oligomenorrhea?
A
Irregular cycles greater than 35 days apart
25
What menorrhagia?
(hypermenorrhea) Abnormal, heavy and long menstruation
26
What is dysmenorrhea?
Painful or difficult menstruation
27
What is Amenorrhea?
Absence of menstruation
28
What is Mittelschmerz pain?
Sudden sharp pain on one side of lower abdomen occuring on same side as ovulation. "Mid Cycle Pain"
29
Oral Contraceptives limit the release of what?
FSH and LH
30
Corpus Luteum Cysts produce what?
Progesterone
31
What is the normal measurement of an ovary?
2.5 x 1.5 x 0.6
32
Gravidity refers to what?
The # of times a women has been pregnant
33
Nulligravida refers to what?
Never been pregnant
34
Know sizes of uterus - nulliparous and multiparous uterus
Nulliparous - 8cm L, 5.5 cm W, 3cm in AP
Parity - 7.5 - 9cm L, 4.5 - 6cm W. 2.5 - 4cm AP
35
Which hormone causes ovulation to occur?
Luteinizing Hormone (LH)
36
What are all the ligaments?
Cardinal
Uterosacral
Round
Broad
37
Cardinal ligament
Anchor Uterine Corpus and Cervix to lateral pelvic wall
38
Uterosacral ligament
Anchor uterine cervix to sacrum
39
Round ligament
Anchor uterine fundus anteriorly
40
Broad ligament
Part of peritoneum that divides true pelvis into ANT and POS positions
41
What are the bones of the Pelvis?
Sacrum
Coccyx
2 Innominate ( ilium, ischium, pubic) x2
42
Know size of ovaries
2.5-5cm L, 1.5 - 3cm W, 0.6 - 2.2cm AP
(LxWxH)/2 = vol cm^3
43
Corpus luteum cyst - what is it, what hormone does it produce?
A Corpus luteum cyst is a type of ovarian cyst which may rupture about the time of menstruation
Produces Progesterone
44
What hormones are produced by the hypothalamus?
Gonadotropin-releasing hormone (GnRH)
45
What hormones are released by the Anterior Pituitary gland?
```
FSH
LH
GH
Prolactin
TSH
Adrenocorticotropic hormone
```
46
WHat hormones are released by the Posterior Pituitary gland?
ADH
| Oxytocin
47
DES what is it and what are the effects of it?
Diethylstilbestrol (DES) is a synthetic form of the female hormone estrogen. It was prescribed to pregnant women between 1940 and 1971 to prevent miscarriage, premature labor, and related complications of pregnancy
Responsible for CC vaginal carcinoma, Uterine hypoplasia, and "T" - shaped uterus
48
Hematometra
retention of blood in uterine cavity
49
Hematocolpos
Accumulation of menstrual blood in vagina
50
Hematometrocolpos
Accumulation of blood in uterus and vagina as a result of obstruction or imperforate hymen
51
Adenomyosis
Uterine condition in which endometrial glands and stroma are located in the myometrium proximal to the basalis layer of endometrium
52
Where are leiomyomas located?
```
Intramural - in myometrium
Submucosal - below endometrium
Sub- Serosal/ Serosal - at serosal surface of uterus
Pedunculated - extras uterine
Intracavity - Prolapsing from a cavity
```
53
Sonohysterogram - What is this procedure, what does it help to identify?
Injecting 25 - 30 mL of saline into the endometrial cavity to highlight polyps and other problems. It is also used to check for obstruction of the fallopian tubes
54
What are all the cysts?
Theca lutein
Graafian
Corpus luteum
Paraovarian
55
Theca lutein cysts
Largest functional cyst 3 - 20cm. Results from exaggerated corpus luteum response in patients with high levels of hCG. Associated with gestational trophoblastic disease such as hydatidiform mole, chorioadenoma, and choriocarcinoma. Multilocular and bilateral
56
Graafian cysts
Follicular Cysts - Result from either non- rupture of dominant follicle or failure of immature follicle to undergo atresia. 3 - 10cm. Usually resolves in 6 - 8 weeks can cause pelvic pain, hemorrhage to torsion or rupture
57
Corpus Luteum cysts
Failure of the follicular cyst. Corpora Lutea must be greater than 3 cm to be considered luteal cyst. Usually uniocular and unilateral. regresses usually after 3 menses cycles
58
Paraovarian cysts
Developed from vestigial wolffian duct structures or tubal epithelium uniocular, do not change w/ ovarian cycle.
59
What are the differential diagnosis of cervical carcinoma?
Leiomyoma involving cervix
Endometrial carcinoma involving cervix
Endometrial polyps prolapsed into vagina
60
What are Signs and symptoms of Uterus Leiomyomas?
```
Pelvic pain
Menorrhagia
Asymptomatic
Bladder and rectum pressure
Infertility
Spontaneous Abortion
```
61
What are US appearance of uterus leiomyomas?
Wide variety of US appearance: whorled appearance, lobulated uterus, hypo - anechoic
62
What is Krukenberg tumor?
Malignant ovarian tumor that has most likely metastasized from G.I. or breast, signet - ring cells are key histologic sign.
US appearance: Moth eaten pattern
63
Meigs Syndrome
Presentation of Ascites, Pleural effusion and ovarian tumor (most commonly, fibroma)
Symptoms subside after removal of tumor
64
What is Ovarian Torsion?
Complete or incomplete rotation of ovary on its vascular pedicle
65
Ultrasound Appearance of Ovarian Torsion
On ultrasound, may appear as a large ovary with hypoechoic and hyperechoic areas
66
Ovarian Torsion occurs most commonly in what age group?
Most common in childhood or women < 30 years of age
67
Signs and symptoms of Ovarian Torsion?
- Acute onset of pelvic pain
- Nausea
- Vomiting
68
Stein Leventhal Syndrome is also known as?
Polycystic Ovaries
69
In Polycystic Ovaries, endocrine disorders result in?
High free serum testosterone
| High LH or FSH
70
Ultrasound Appearance of Polycystic Ovaries
- Normal ovaries
| - Bilaterally enlarged ovaries with multiple small follicles around periphery
71
What are the categories of benign Ovarian Neoplasms?
Epithelial tumors
Germ cell tumors
Stromal tumors
72
What is another name for Dermoid Tumor?
Dermoid Cyst or Benign Cystic Teratoma
73
Benign Cystic Teratoma
AKA: dermoid cyst, teratoma
- Common germ cell tumors
- Most common in premenopausal women
- Most common ovarian tumor for women less than 20 years of age
- Have little malignant potential
74
What are Functional Cysts?
```
OVARIAN FOLLICLES
FOLLICULAR CYSTS
CORPUS LUTEUM CYSTS
THECA LUTEIN CYSTS
PARAOVARIAN CYSTS
```
75
Ovarian Follicles
- LOCATED ON BOTH OVARIES
- SMALL ANECHOIC STRUCTURES
- USUALLY MULTIPLE
- DOMINANT FOLLICLE REACHES 2.0-2.5 CM BEFORE OVULATION OCCURS
76
Follicular Cysts
```
OVER DISTENSION OF A GRAAFIAN FOLLICLE THAT DID NOT RUPTURE
FOLLICLE THAT DID NOT RESOLVE
USUALLY UNILATERAL
1.0 - 10.0 CM IN SIZE
FOLLOW UP MAY BE ORDERED
MOST RESOLVE OR CHANGE IN SIZE
```
77
Corpus Luteum Cysts Menstruation
- Corpora lutea forms after dominant follicle ruptures.. REACHES 3 CM IN SIZE
- Usually unilateral and simple.. CORPUS LUTEUM CYST MAY MEASURE 5-8 CM
- Hemorrhage and rupture may cause pain
- Usually resolves within 14 days
78
Corpus Luteum Cysts Pregnancy
- Remains if fertilization occurs
- Holds the pregnancy
- Produces progesterone
- Resolves between 10 and 16 weeks from LMP
- Rupture may cause pain
79
Theca Lutein Cysts
- Caused by high levels of human chorionic gonadotropin
- 50% Associated with gestational trophoblastic disease (MOLAR PREGNANCY).
- Associated with drug therapy for infertility (ovarian hyperstimulation syndrome)
- Are bilateral, multilocular, and large (3-20 cm)
- May persist 2-4 months after evacuation of molar pregnancy
80
Paraovarian Cysts
- Found in broad ligament
- Difficult to determine if ovarian or paraovarian
- Can be small up to 15 cm
- Do not regress or change with time
- Can be complicated by hemorrhage, torsion, rupture or infection
81
Differential Diagnoses for Paraovarian Cysts
DIFFERENTIAL DIAGNOSES:
Serous cystadenoma
Endometrioma
82
What are the malignant Tumors of the Ovaries
```
Ovarian Carcinoma
Epithelial Types:
Epithelial Neoplasms
Sex Cord Neoplasms
Germ Cell Neoplasms
Metastases to the the Ovary
```
83
What are the most common of the Sex Cord Neoplasms?
- GRANULOSA-THECA CELL TUMOR
| - ANDROBLASTOMA (SERTOLI-LEYDIG CELL TUMOR)
84
Sex Cord Neoplasms: GRANULOSA-THECA CELL TUMOR
- 1-2% of all tumors
- Most common in postmenopausal patients
- Abnormal uterine bleeding (estrogen)
- Associated with endometrial hyperplasia or carcinoma
- Unilateral
- Solid and homogeneous
85
Sex Cord Neoplasms: SERTOLI-LEYDIG CELL TUMOR
AKA: androblastoma
- Rare (less than .5% of ovarian tumors)
- Most common in adolescence
- Present with virulization
- Almost always unilateral
- Usually solid
86
Sex Cord Neoplasms: SERTOLI-LEYDIG CELL TUMOR
AKA: androblastoma
- Rare (less than .5% of ovarian tumors)
- Most common in adolescence
- Present with virtualization
- Almost always unilateral
- Usually solid
87
Germ Cell Neoplasms:
| 3 Types
- Choriocarcinoma
- Teratocarcinoma
- Endodermal Sinus Tumor
88
Germ Cell Neoplasms: Choriocarcinoma
- Very rare as ovarian neoplasm
- Most common in infants and young children
- May cause precocious puberty
- Elevated serum hCG levels
- Usually unilateral
- Solid hemorrhagic tumor
- Aggressive
89
Germ Cell Neoplasms: Teratocarcinoma
- AKA: immature teratoma
- Occurs in children and young adults
- Composed of immature neuroepithelium
- Usually unilateral
- Variable US appearance, possible with cystic and highly echogenic components
90
Germ Cell Neoplasms: Endodermal Sinus Tumor
- AKA: yolk sac tumor
- 2nd most common malignant ovarian germ cell tumor
- Common in childhood, adolescence and young adults
- Elevated levels of AFP
- Usually unilateral
- Can be solid, or cystic and solid
91
Metastases to the Ovary
KRUKENBERG TUMOR
- Metastases to ovary from primary elsewhere
- Most common site of primary is GI tract, but can be breast, lung, pancreas, or lymphoma
- Usually bilateral
- May be cystic, mixed, or solid on ultrasound
- May demonstrate the “moth-eaten” sign
92
What is Pseudomyxoma Peritonei?
Mucinous Cystadenoma with a rupture
93
What are risk factors for development of Endometrial Carcinoma?
- OBESITY
- DIABETES
- HIGH BLOOD PRESSURE
- SHORT IN HEIGHT
- JEWISH
- AGE (postmenopausal)
- ESTROGEN USE AFTER MENOPAUSE
94
Signs and symptoms of Endometrial Carcinoma?
- BLEEDING OR DISCHARGE AFTER MENOPAUSE
| - Pain
95
Endometrial Carcinoma: Where does it begin and where does it grow to?
- BEGINS IN THE ENDOMETRIUM
| - GROWS TOWARD THE MYOMETRIUM
96
Endometrial Carcinoma: STAGING is based on?
Degree of tumor spread
97
Endometrial Carcinoma: GRADING is based on?
Degree of tumor differentiation
98
Dysfunctional Uterine Bleeding (DUB)
Vaginal Bleeding not related to menstrual cycle
99
HYPERmenorrhea
excessive volume during cyclic menstrual bleeding
100
HYPOmenorrhea
abnormally small amount of menstural bleeding
101
Polymenorrhea
Frequent menstrual bleeding less than 21 days apart
102
Oligomenorrhea
menstrual bleeding greater than 35 days apart
103
Menorrhagia
excessive bleeding in time and/or volume
104
Dysmenorrhea
painful uterine bleeding
105
Amenorrhea
absence of menstrual flow
106
Vaginal Agenesis
Absent vagina
107
Vaginal Atresia
Lack of vaginal development
