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Flashcards in Lecture 10 Deck (16):

What is the mode of scanning of the female pelvis?

1. Transabdominal - bladder needs to be full.
2. Transvaginal - probe is size of tampon. Needs to be culturally and appropriate for the women to do a TV scan.


Describe a transabdominal scan?

The bladder pushes the uterus back. The patient empties their bladder and you can hardly see a thing. Every time a woman fills her bladder her uterus tends to go back, and overtime it empties it goes forward.


What is a retroverted uterus?

This is where the cervix is still int he normal position, but the whole uterus is tilted back towards the sacrum. 10% of women have it, clinically you can’t feel the uterus and if you are going to insert IUCD, there is a chance of perforation - worthwhile to know. When people start scanning, because they can’t see well they make the patient to keep filling their bladder.


Describe endometrial changes?

The endometrium thickens and thins, you start out with a thin line to getting very fat and at day 12 (ovulation) there is a change in the endometrium. The glycogen changes, and you get a halo and then the women menstruates. When the woman has just ovulated you will see a little bit of fluid (Pouch of Douglas - potential space behind the uterus - when the woman ovulates, because the follicle bursts and releases fluid, the fluid drains into the pouch).


What other conditions can cause fluid to appear in the Pouch of Douglas?

Ectopic pregnancy - implants in the fallopian tubes.


What do normal ovaries look like on ultrasound?

They look like almonds - they are about the size of an almond. There are little follicles that you can see as little black bubbles (3-5mm). When one follicle ripens (once a month) it can reach up to 25mm, then it will burst. When the follicle bursts it can cause pain - middle of the cycle - and the fluid drains to the Pouch of Douglas.


What occurs in polycystic ovaries?

They become round and stop being almond shaped. Because of the hormonal loop, there needs to be the release of the follicle to ripen, if they don’t get the signal they sit there and don’t release the egg. There are lots of 5mm cysts that don’t release the eggs - infertility. In a CT scan, the follicles sit under the surface of the ovary but they look like pearls.


Where is the ovary tucked in?

Underneath the broad ligament.


How can you see if the fallopian tube is open or blocked?

Insert dye into the uterus (via transvaginal). Normally spillage will indicate that the tube is open. No spillage will indicate that the tube is blocked (thus the egg cannot come down to be fertilised).


What is pelvic floor?

This typically occurs to women who after giving birth to babies, they have a weak pelvic floor. Everything is prolapsing, socially embarrassed to go out because she leaks. She can’t empty her bladder very well, the tilt means she can’t empty very properly. The test in the past is hard to prove it, but MRI is excellent.


Describe imaging of the male pelvis?

It is a little more limited than for the female. The big area of imaging is the prostate and scrotum (also urinary bladder). Almost all ultrasound and MR. We are trying to limit radiation for the gonads. Really stress that you need to know the clinical question, was there trauma? Need to engage with he patient, if the patient does not feel comfortable with you they will never tell you what goes down on there. Limited usefulness of plain films (need ultrasound and MR).


Describe scrotum ultrasound?

Every man who is getting a scan is very grateful that they can know what is going on. The biggest barrier is before the ultrasound (the doctor). Always say you will be covered the whole time, nothing will be on show, scanning under a sheet. Most of the cancer occurs in the testis, and most of the infection occurs in the epididymis. Look for blood flow (testicular torsion).


Describe testicular torsion?

In a child with an acute scrotum, testicular torsion is not the most common condition. In 750 children with an acute scrotum:
-32% epididymitis.
-29% appendix torsion.
-19% testicular torsion.
Our main goal is to detect or exclude a testicular torsion.


Describe epididymitis?

Inflammatory process involving the scrotum in adults typically caused by urinary tract infection or sexually transmitted organisms (chlamydia or gonorrhoea). In children the infection is usually caused by streptococcus or E.Coli. Very swollen epididymis.


Describe testicular tumour?

Tumour will present as lumps, men will not talk about having a testicular lump. Much more curable, and long term survival than breast cancer. Where in a young guy will you get pulmonary metastases, you will find them in the testis. The anxiety that men will have is quite high.


Describe prostate imaging?

1. Trans-abdominal.
2. Trans-rectal.
3. MRI (multi parametric) - pick up much more precisely with the ability of certain techniques of where the cancer is sitting.
4. Diagnosis and treatment of prostate cancer is a controversial topic.
We do the full bladder view and then we get them to empty, with a big prostate gland they generally can’t.