Module 2 : Sonography Of The Female Pelvis Flashcards Preview

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Flashcards in Module 2 : Sonography Of The Female Pelvis Deck (24)
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1

Reasons for pelvic ultrasound

Pelvic pain
Dysfunctional bleeding
IUCD placement
Mass felt on bimanual pelvic exam
? Pregnancy

2

Exam prep

1 liter of water one hour before exam starts

3

Reasons for full bladder

Pushes uterus from anteflexed position to a more horizontal plane for better visualization

Displaced intestine

Great window for pelvic anatomy

Landmark

Indicates mobility of female pelvic pathology

Comparison for cystic legions

4

Questions to ask for exam

Age
Gravidity - have you been pregnant
Parity - how many children
LMP (Normal?)
Symptoms (cyclical?)
Results of clinical pelvic exM
Previous pelvic surgery
Results of a pregnancy test

5

Gravity (G)

Number of times a women has been pregnant

Including if currently pregnant

6

Parity

Number of term pregnancies or live births

7

Abortion (A)

SA - spontaneous
TA - therapeutic

8

Nulliparous

Never been pregnant

9

Parous

Currently pregnant

10

Prima gravida

First time pregnant

11

Scanning basic protocol

1. Explain what going to do
2. Use protective drapes as per protocol
3. Apply warm gel just above the symphysis pubis
* SWITCH TO HRES
4. Start in sagittal ALWAYS
- assess if bladder is full enough
- scan it to side wall of pelvis in all direction
- SWEEPING = to the vessels
5. Turn transverse and look from inferior to superior aspect of pelvis ( ALL THE WAY TO UMBILICUS)
6. Take required images

12

Bladder filling

Just full enough to cover fundus but not too much that it will squish it!

13

Scanning ovaries

Best view to use is contralateral

USE BLADDER AS WINDOW

14

Obese patients

Move them to trendelenberg
Ask for assistance
Use EV

Ask patient to lift panniculus

15

Endovaginal advantages

Higher frequencies
Better resolution
Empty bladder
Larger image

16

Endovaginal limitations

Pathology may be outside field of view
- fibroid or ovary

If patient can’t fully empty bladder

17

Endovaginal basics

Always cover probe with condom or non latex transducer cover

Explaining
- “ an internal camera to get better images”
- “ similar to inserting a tampon”

18

Endovaginal orientation

Right on top of the organ

Sagittal exam
- cervix is on the right hand side
- fundus on left hand side
- bladder in left hand corner

19

EV vs TRANS ABD or VESICLE

EV
- ectopic pregnancies
- early pregnancies
- ovarian detail
- better endometrium
TRANS
- mandatory for assessing free fluid with ectopic pregnancies, ovaries high in the pelvis, large masses, relational anatomy

* complimentary

20

Contraindications to EV

Effaced or dilated cervix

Young girl (virgin)

Infection (herpes) painful

Atrophic Anatomy (elderly )

21

Measuring the uterus

AP measurement done in long axis

Length includes cervix

Along endometrial canal

22

Measuring endometrium

Outerwall to outer wall

* do not include hypoechoic halo

23

female pelvis detailed routine

1. Sag Ute Cvx Vag (length and AP)
2. Sag endometrial canal (AP)
3. Trans Vag
4. Trans Cvx
5. Trans Ute(width)

* document abnormal

6. Sag right ovary (length and AP)
7. Trans right ovary (width)
8. Sag left ovary (length and AP)
9. Trans left ovary (width)

* also document and measure abnormalities

24

Kidney portion

1. Sag right kid (measured)
2. Trans right kid (measure at mid)
3. Sag left kid (measured)
4. Trans left kid (measured at mid)