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neonatal and pedatric pelvis Flashcards

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0
Q

how do oogonia multiply?

A

rapidly by mitosis

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1
Q

What do the primary sex cords converge to form?

A

a network of canals called the RETE OVARII

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2
Q

XY chromosome is…

A

male

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3
Q

XX chromosome is…

A

female

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4
Q

fetal gender is determined by?

A

sperm which fertilizes ovum

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5
Q

Which ducts mostly form female reproductive system??

A

Müllerian ducts

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6
Q

what forms the uterus and upper third of the vagina?

A

the Müllerian ducts

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7
Q

what do the fused caudal ends of the Müllerian ducts form?

A

vagina

cervix

uterus

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8
Q

When do the Müllerian ducts elongate?

A

7-12 weeks gestation

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9
Q

how does fusion occurs?

A

caudal to cranium…bottom to top

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10
Q

What is the wall thickness of the bladder?

A

Full: 1.5-3mm

empty or partially filled: <5mm

should be a smooth, thin wall

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11
Q

How do you varify the bladder jets?

A

with color doppler…ureters should not be dilated

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12
Q

Should you see fluid in the neck and urethra of the bladder?

A

no…no fluid should be visualized

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13
Q

Where do the ureters enter the bladder?

A

at the trigone of the bladder…posterior edge small indentation

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14
Q

What are you looking for if you see fluid in the neck or urethera of the bladder?

A

an obstruction

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15
Q

What are the specifics of a newborn uterus?

A

Prominent - maternal hormones

pear shaped

length 3.5cm

fundus/cervix ratio: 1:2

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16
Q

What are the specifics of a 2-3 month old baby’s uterus?

A

teardrop shape - tublular configuration

length 2.5-3cm

fundus/cervix ratio: 1:1

no discernible endometrial stripe

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17
Q

What does the uterus of a child age 7 look like?

A

begins to increase in size and take on the pear shape

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18
Q

what does the pubtery/ post pubery uterus look like?

A

dramatic changes in shape and size

length 5-7 cm

fundus/cervix ratio 3:1

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19
Q

What does the vagina look like in children?

A

difficult to properly evaluate

full bladder need to scan

tubular structure posterior to bladder

continuity with cervix

bright central echo

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20
Q

Where do you find pediatric ovaries and what size are they?

A

use volume measurement

may be difficult to see- anywhere between lower pole kidneys to true pelvis

size stable up to 5 y/o 0.75 - 0.86 cm cubed

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21
Q

Why would a newborn have prominent follicles in the ovary?

A

because of maternal hormones

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22
Q

What causes congenital anomalies of the uterus and ovaries?

A

developmental abnormalities

interference with blood supply or distortion of uterine cavity

may cause infertility or spontaneous abortion

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23
Q

What percentage of females have congenital anomalies of the uterus and ovaries?

A

approx 0.5%

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24
If you have a renal abnormality what else do you probably have??
a congenital uterine or ovarian abnormality
25
If you find a Müllerian anomaly what should you ALWAYS check??
the kidneys
26
How are mullerian anomalies classified?
into six groups based on prognosis for future fertility and surgical correction
27
What is class 1 mullerian anomalies?
incomplete vaginal canalization
28
what is class 2 mullerian anomalies?
unicornuate uterus
29
what is a class 3 mullerian anomaly?
uterus didelphys
30
what is class 4 Müllerian anomaly?
bicornuate uterus
31
What are the details of a class 1 mullerian abnormality?
segmental mullerian agenesis (incomplete vaginal canalization) vaginal atresia
32
What is a hydrocolpus?
fluid filled vagina
33
what is a hydrometrocolpos?
fluid filled vagina and uterus
34
what is a hematometrocolpos?
blood filled vagina and uterus
35
what are the signs of vaginal atresia?
hydrocolpus hydrometrocolpos hematometrocolpos cervix may be absent large cystic pelvic mass in neonatal period or dx at puberty imperforate hymen
36
What are the details of a class II Müllerian anamoly?
unicornuate uterus complete unilateral arrest of Müllerian ducts may have small rudimentary horn if partial arrest long, slender uterus (cigar shaped) deviated to one side frequently renal agenesis on contralateral side small laterally positioned uterus infertility and pregnancy loss
37
What are the details of a class III Müllerian ducts anamoly?
uterus didelphys complete nonfusion of the Müllerian ducts complete duplication of uterus cervix and vagina not usually associated with infertility problems - no treatment The fundus of each is completely separate 2 endometrial echo complexes
38
What is a class IV Müllerian duct anaomly?
bicornuate uterus partial non-fusion of the Müllerian ducts duplication of the uterus - common cervix wide spaced cavities low incident of fertility complications (not usually treatment) rudimentary cavity = 12-16 weeks gestation, uterine cavity rupture 2 endometrial cavities visualized
39
What is a class V mullerian anamoly?
Septate uterus HIGHEST INCIDENCE of infertility problems MOST COMMON UTERINE ANOMALY
40
What is a class VI Müllerian duct anamoly?
exposure to diethylstilbestrol (DES) in utero-synthetic drug used in the 1970's during pregnancy to treat threatened and habitual abortion (miscarriage) drug causes vaginal malignancies in their daughters uterus: normal shape and size uterine cavity: "t" shaped, irregular contour
41
What is ambiguous genitalia?
two types: hermaphroditism female pseudohermaphroties
42
What is true hermaphroditism?
both ovarian and testicular tissue internal and external genitalia variable 46 XX daryotype or mosaics (46XX/46XY)
43
What is female pseudohermaphroties?
46, XX karyotype no duplication of internal structures just external structures increase production of androgens or androgen therapy for mother masculinization of external genitalia (enlarged clitoris, abnormalities of urogenital sinus and partial fusion of the labia majora) ultrasound used to determine presence or absence of uterus, vagina and ovaries
44
Why is ultrasound used for ambiguous genitalia?
to determine presence or absence of uterus, vagina, and ovaries
45
What are the two types of precocious puberty?
True precocious puberty precocious pseudopuberty
46
What is True precocious puberty?
ALWAYS isosexual (same sex...girl with girl parts, boy with boy stuff) development of secondary sexual characteristics and increasing size and activity of reproductive organs prior to normal puberty age usually < 10y/o uterus enlarged, postpubertal configuration 2:1 and 3:1 fundus/cervix ratio ovarian volume enlarged > 1 cubic cm functional cysts present
47
What is precocious pseudopuberty?
Maturation of secondary sexual characteristics but not reproductive organs (boys can develop breasts, girls facial hair) no activation of hypothalamic -pituiitary-gonadal axis usually associated with increase steroidal release from adrenal glands = tumors should always scan the liver and adrenal glands to rule out lesions
48
Why do we ultrasound precocious puberty?
to scan the liver and adrenal glands to rule out lesions or tumors that will create increase in steroid release
49
What is a pediatric ovarian cyst?
ovarian cyst...may form in utero but spontaneously resolve 3-7mm cysts normal higher incident in neonates fo mothers with toxemia, diabetes, RH isoimmunization - greater than normal release of placental chorionic gonadotropin
50
What is the criteria to call something a cyst?
round or oval well circumscribed smooth thin walls posterior enhancement anechoic
51
What is a torsion?
when there is sudden onset of severe pain and no blood flow is reaching the testicle or ovary...no blood flow, color or power doppler registers
52
What is ovarian torsion
may occur at any age sudden onset of severe pain more common associated with ovarian cyst/mass arterial AND venous blood flow must be seen venous flow will be compromised first enlarged and edematous ovary
53
What does color flow show?
ONLY direction of flow not if it artery or venous so either could be blue or red
54
Do ovaries with torsion have color blood flow in them?
no...might have color around it, but not IN it
55
What are ovarian teratomas?
uncommon in adolescent and neonate 60% germ cell benign or malignant most common in pediatrics is benign mature teratoma or dermoid cyst....finish
56
What are secondary sex cords or cortical cords made from?
surface epithelium
57
What is a primordial follicle?
when cortical cords break up into isolated cell clusters at 16 weeks gestation
58
At 16 weeks gestation what do the primordial follicles contain?
an oogonium
59
before birth what to all oogonia enlarge to form?
oocytes which remain in an arrested state until puberty
60
What do male/female reproductive organs develop from?
same source - gonadal ridges grow to form primary sex cords
61
What is fully formed by the 12th week of gestation?
external genitalia
62
What forms most of the male reproductive system?
wolffian ducts
63
What do the unfused cranial ends of the Müllerian ducts form?
Fallopian tubes
64
When can fusion anomalies of the Müllerian ducts occur?
throughout the process of the ducts transforming into the reproductive system
65
How do you image an infant/toddler pediatric pelvis?
# fill the bladder have parent keep child well hydrated
66
How do you image a pediatric pelvis of a potty train child?
drink 2 glasses of fluids 1 hour prior to exam hold bladder
67
how do you image a young teen pelvis?
3-4 glasses of fluid 1 hour prior to exam
68
Do we perform endovaginal exams on children/minors?
No, unless there are extenuating circumstances
69
What will help you determine if you have found a cyst or if its just the bladder?
post void bladder scan will reveal if it's a cyst or the bladder
70
What is the appearance of a neonatal ovary?
heterogeneous secondary to tiny cysts
71
what is the appearance of pediatric ovaries as they increase in age from neonatal?
homogeneous possible small cysts
72
What is an a Müllerian abnormality?
improper fusion incomplete development on one side incomplete vaginal canalization
73
what is a class 5 mullerian anomaly?
Septate uterus
74
What is a class 6 Müllerian anomaly?
diethylstibestrol (DES) exposure "T" shaped uterus
75
What are the symptoms of vaginal atresia?
symptoms: abdominal pain and distention lack of menses in pubescent child
76
when do you suspect class 1 Müllerian anomaly?
suspected when a girl reaches puberty without menstruaton possible transverse vaginal septum or vaginal atresia (not fully formed)
77
What is a septate uterus?
2 uterine cavities - closely spaced 1 fundus possibly 2 cervical canals or vaginal septum
78
How does pediatric ovarian cyst look on US?
anechoic structure adjacent to or within ovary may have debris if hemorrhage - little or no color flow to ovary if torsion
79
What are the most common complications of a pediatric ovarian cyst?
hemmorrhage, torsion may rupture
80
What are the malignant ovarian teratomas?
dysgerminoma embryonal carcinoma endodermal sinus tumor immature teratoma chorocarcinoma mixed tumor
81
how do benign teratoma or dermoid cysts present in peds?
usually asymptomatic until it gets very large most frequent complication is torsion 16-40%
82
What is the sonographic appearance of a dermoid/ teratoma?
varied -complex, heterogeneous mass frequently echogenic foci with acoustic shadowing- less shadowing in neonates "tip of the iceberg" on US means DERMOID (usually much larger than what you can see)

OB/Gyn (14 decks)

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