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Term 1 > Normal Anatomy (Female Pelvis) > Flashcards

Normal Anatomy (Female Pelvis) Flashcards

(107 cards)

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1
Q

Echogenicity of Muscle

A
  • moderate echogenicity

- echogenic striations within

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2
Q

How many planes do we image muscles in?

A

2

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3
Q

What can muscles be mistaken for?

A
  • ovaries or masses in pelvis

- ex. iliopsoas can look like a bullseye in TRV

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4
Q

Is the uterus retroperitoneal or intraperitoneal?

A

-retroperitoneal

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5
Q

What happens to the uterus between birth and puberty?

A

-descends from lower abd into true pelvis

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6
Q

3 Major Portions of Uterus

A
  • fundus
  • body
  • cervix
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7
Q

Cornua

A

-area of body where tubes enter

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8
Q

Body of Uterus

A

-area between cervix and cornua

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9
Q

Fundus of Uterus

A

-at/superior to cornua

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10
Q

What does the cervix open into?

A

-upper vagina

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11
Q

What is the cervix made of internally?

A

-canal made up of internal and external os

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12
Q

What is at the distal end of the cervix?

A
  • 2 lateral fornix
  • anterior fornix
  • posterior fornix
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13
Q

Where is the fibromuscular canal, and where does it run from?

A
  • midline of vagina

- runs from cervix to eternal genitalia

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14
Q

Uterus

A

-hollow, thick walled organ

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15
Q

3 Layers of Uterus

A
  • perimetrium
  • myometrium
  • endometrium
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16
Q

Myometrium

A
  • big muscle
  • majority of uterus
  • 3 layers: inner (subendometrial halo), intermediate, outer
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17
Q

Superficial Functional Layer of the Endometrium

A

-parts that sloughs off each menses

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18
Q

Deep Basal Layer of Endometrium

A

-stays attached to uterus

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19
Q

Uterine Ligaments

A
  • broad (paired)
  • cardinal (paired)
  • uterosacral (paired)
  • posterior (single)
  • anterior (single)
  • round (paired)
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20
Q

Broad Ligaments

A
  • double folds of peritoneum
  • uterus in suspended between these folds
  • extend from the lateral aspects of uterus to the lateral pelvic walls
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21
Q

Cardinal Ligaments

A

-lower extensions of broad

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22
Q

Round Ligaments

A

-fibromuscular cord extends from upper outer angles of uterus through the inguinal canal and connect to labia majora

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23
Q

Uterosacral Ligaments

A

-fold like extensions of peritoneum

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24
Q

Anterior Ligament

A
  • fold in peritoneum
  • from anterior surface of uterus to posterior surface of bladder
  • forms anterior cul de sac (vesicouterine pouch)
  • fluid collects in this area
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25
Posterior Ligament
- extends from posterior side of uterus to rectum - forms deep pouch (aka pouch of douglas, posterior cul de sac or rectouterine recess) - fluid collects in this area
26
Where does fertilization implant?
-endometrial lining
27
Where does fertilization develop?
-uterus
28
What contracts during labour?
-myometrium
29
What happens if fertilization doesn't occur?
- menstruation | - myometrial contractions aid sloughing off endometrium
30
Blood Supply
- uterine arteries arise from internal iliac arteries - travel within broad ligament, at cornua anastomose with ovarian artery - enters myometrium - uterine plexus of veins runs along with arteries
31
Which parts of the uterus are mobile?
- body and fundus | - cervix is fixed midline
32
Flexion
-axis of uterine body relative to the cervix
33
Version
-axis of the cervix relative to the vagina
34
What can affect/change the position of the uterus?
- distension of bladder | - rectal fullness
35
Which way does the uterus normally lie?
-anteverted and anteflexed
36
Retroverted Uterus
-entire uterus is tilted backward
37
Retroflexed
-body is tilted posteriorly
38
Uterus Size and Shape
-vary throughout life (age, hormonal status, etc.)
39
Infantile Uterus
2. 8cm long - cervix is 2/3 total length - pear shaped
40
Neonate Uterus
- slightly larger than infantile due to maternal hormone stimulation - 3.4cm long - pear shaped
41
Uterus (age 8-puberty)
-gradually increases in size
42
Uterus at Puberty
- increase in size (especially body) - diameter and length of body are double cervical size - becomes adult size and shape
43
Adult Size Uterus
- 8 cm long - 5 cm wide - 4 cm AP - pear shaped
44
Parity
-pregnancy
45
What does pregnancy do to the size of the uterus?
-increased normal size by 1cm in each dimension
46
Menopausal Uterus
- atrophies 3.5 to 6.5 cm (L) by 1.2 to 1.8 cm (AP) - pear shaped - small
47
What is the echotexture of the myometrium in an adult uterus?
-homogenous
48
What is the contour of the adult uterus?
-smooth
49
What is the echogenicity of the inner layer of the myometrium (subendometrial halo)?
-hypoechoic
50
Sonographic Appearance of the Intermediate Layer of the Myometrium
- thickest - homogenous - low to moderate echogenicity
51
Sonographic Appearance of the Outer Layer of the Myometrium
- thin | - slightly less echogenic than intermediate layer
52
What separates the intermediate and outer layers of the myometrium?
-arcuate arteries
53
Sonographic Appearance of Postmenopausal Uterus
-small -can half calcification in arcuate arteries (linear calcific foci) -small echogenic foci within inner myometrium (single or multiple, non shadowing)
54
Endometrium Sonographic Appearance in Reproductive Years
- varies depends on stage of cycle | - size varies
55
Where is the Ap measurement of the endometrium done?
-thickest part
56
LMP
-day 1 of the first day of menses
57
How long is the average menstrual cycle?
28 days
58
4 Phases of Menstrual Cycle
1) early proliferate 2) late proliferate 3) secretory 4) menses
59
Early Proliferate
- 1st stage of menstrual cycle - days 5 to 13 - 5mm
60
Late Proliferate
- 2nd phase of menstrual cycle - days 14 to 16 - 11mm
61
Secretory
- 3rd phase of menstrual cycle - days 16 to 28 - 16mm
62
Menses
- 4th stage of menstrual cycle | - day 1 to 5
63
What are some clinical indications for scanning the female pelvis?
- pregnancy (dating) | - pelvic pain (RLQ, LLQ, generalized, chronic, acute, etc.)
64
Transabdominal US of Pelvis
- global view - limited to patients ability to fill and hold bladder - difficult on obese patients - retroverted uterus is beyond the focal zone of transducer
65
Patient Prep. for Pelvic Exam
- fills bladder (24 to 32 oz) | - approx. 4 glasses of water (finish 1 hour before exam)
66
Why do we get patients to fill their bladder?
- displaces uterus from pelvis - displaces gas filled bowel - use as an acoustic window
67
Technical Difficulties with Transabdominal US
- obese patients - surgical scars (artifacts) - barium or gas filled bowel - abdominal dressings
68
Transvaginal Prep.
- discuss what is involved - verbal consent - empty bladder - 5 to 8MHz transducer - cover transducer with probe cover - follow proper cleaning procedures after exam
69
Advantages of TVP
- better resolution (higher frequency transducer) - obese patients - patients who cannot fill bladder - retroverted uterus - better distinction between masses and bowel - better detail of pelvic lesion - better detail of endometrium
70
Disadvantage of Transvaginal US
- smaller FOV | - cannot do on elderly or young patients or people with complicated pregnancies
71
Where are the fallopian tubes?
-run lateral from uterus in the upper free margin of broad ligament
72
How long are the fallopian tubes?
-7 to 12 cm long
73
4 Portions of Fallopian Tubes
- intramural - isthmus - ampulla - infundibulum
74
Intramural Portion of Fallopian Tubes
- 1cm long - narrowest portion - in muscular wall of uterus
75
Isthmus Portion of Fallopian Tubes
- medial third of tube | - wider and cordlike
76
Ampulla Portion of Fallopian Tubes
- tortuous | - approx. 1/2 of tube
77
Infundibulum Portion of Fallopian Tube
- most distal portion - funnel shaped end - opens into the peritoneal cavity
78
Shape of Ovaries
-elliptical shaped
79
What is the surface of the ovaries covered with?
- single layer called germinal epithelium | - continuous with peritoneum at hilum of ovary
80
Are the ovaries intraperitoneal or retroperitoneal?
-intraperitoneal
81
Ovary Parts
Germinal Epithelium -single layer Tunica Albuginea -fibrous capsule Cortex -where follicles develop and mature Medulla - smaller in volume than cortex - composed of fibrous tissue and blood vessels
82
Ovarian Ligaments
- mesovarian - ovarian - suspensory
83
Mesovarian Ligament
-attaches anterior surface of ovary to posterior surface of broad ligament
84
Ovarian Ligament
-attaches lower pole of ovary to uterus
85
Suspensory Ligament
- attaches upper pole to lateral wall of pelvis - lateral extension of broad ligament - ovarian vessels and nerves run within - not rigid
86
Can ovaries be mobile?
Yes.
87
Ovarian Arteries
- from AO, just inferior to renal arteries - run within suspensory ligament - gives off branches to ovaries - anastomose with branches of uterine artery
88
Ovarian Veins
- Rt ovarian vein drains into IVC | - Lt ovarian vein drains into Lt renal vein
89
Normal Sonographic Appearance of Ovaries
- uterine position affects ovarian position - usually lateral or posterolateral to anteflexed midline uterus - variable positions (laxity of ligaments)
90
Can ovaries be seen transvaginally?
-may be out of FOV
91
Size of Ovaries
- volume is best method | - L x W x AP x 0.523
92
Volume in 1st Year of Ovary
1cc
93
Volume in 2nd Year of Ovary
0.7cc
94
What is the volume of ovaries from 0-5 years?
-stable
95
What is the volume of ovaries from 5 years to menarche?
- gradually increase | - 4cc
96
What is the volume of ovaries in a menstruating adult?
- 6.8cc | - upper limit is 18cc
97
What is the postmenopausal volume of ovaries?
- 1.2 to 5.8cc | - over 8cc is abnormal
98
Echotexture of Ovaries
-homogenous
99
Echogenicity of Ovaries
- central, echogenic medulla - small, well defined, anechoic/cystic follicles may be seen in periphery of cortex - echogenic ovarian foci is commonly seen (non shadowing)
100
Echogenic Foci
- usually in periphery (can diffuse) | - specular reflectors of tint, unresolved cysts
101
Focal Calcification
- occasionally seen | - stromal reaction, previous hemorage or infection
102
Normal Changes in the Early Proliferate Phase
- follicles stimulated by FSH and LH - increase in size until day 8 or 9 - one follicle becomes dominant - dominant reaches size 2 to 2.5 cm at ovulation - follicle cyst develops if fluid in one of the non dominant follicles is not resorbed
103
Corpus Luteum
- develops after ovulation (empty house) - small, hypoechoic/isoechoic structure in periphery of ovary - involutes before menstruation
104
Sonographic Appearance of Ovaries
- small - lack follicles - less likely seen after hysterectomy due to loss of normal anatomic landmarks
105
Postmenopausal Ovary Sonographic Appearance
- small - lack of follicles or completely absent - hard to find on US
106
Adnexa
-appendages or accessory structures of an organ
107
What are the adnexa of the uterus?
- uterine tubes - uterine ligaments - ovaries -we image the Lt and Rt adnexa adjacent to uterus

Term 1 (17 decks)

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