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Flashcards in neonatal and pedatric pelvis Deck (83):
0

What do the primary sex cords converge to form?

a network of canals called the RETE OVARII

1

how do oogonia multiply?

rapidly by mitosis

2

XY chromosome is...

male

3

XX chromosome is...

female

4

fetal gender is determined by?

sperm which fertilizes ovum

5

Which ducts mostly form female reproductive system??

Müllerian ducts

6

what forms the uterus and upper third of the vagina?

the Müllerian ducts

7

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

vagina

cervix

uterus

8

When do the Müllerian ducts elongate?

7-12 weeks gestation

9

how does fusion occurs?

caudal to cranium...bottom to top

10

What is the wall thickness of the bladder?

Full: 1.5-3mm

empty or partially filled: <5mm

should be a smooth, thin wall

11

How do you varify the bladder jets?

with color doppler...ureters should not be dilated

12

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

no...no fluid should be visualized

13

Where do the ureters enter the bladder?

at the trigone of the bladder...posterior edge small indentation

14

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

an obstruction

15

What are the specifics of a newborn uterus?

Prominent - maternal hormones

pear shaped

length 3.5cm

fundus/cervix ratio: 1:2

16

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

teardrop shape - tublular configuration

length 2.5-3cm

fundus/cervix ratio: 1:1

no discernible endometrial stripe

17

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

begins to increase in size and take on the pear shape

18

what does the pubtery/ post pubery uterus look like?

dramatic changes in shape and size

length 5-7 cm

fundus/cervix ratio 3:1

19

What does the vagina look like in children?

difficult to properly evaluate

full bladder need to scan

tubular structure posterior to bladder

continuity with cervix

bright central echo

20

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

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


21

Why would a newborn have prominent follicles in the ovary?

because of maternal hormones

22

What causes congenital anomalies of the uterus and ovaries?

developmental abnormalities

interference with blood supply or distortion of uterine cavity

may cause infertility or spontaneous abortion

23

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

approx 0.5%

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)