Pelvic Powerpoints (PID, Infertility, Abnormal Uterine Bleeding, and Ovarian Masses)

Question 1

What is endometriosis and what is it caused by?

Answer 1

endometrial tissue that is infiltrating outside of the uterus

caused by hormones.

Question 2

What is the most common location of endometriosis?

Answer 2

The ovaries

Question 3

What are the symptoms of endometriosis?

Answer 3

pain, abnormal uterine bleeding and dysmenorrhea.

Question 4

What is an endometrioma and what is it caused by?

Answer 4

mass or lesion caused by accumulation of endometrial tissue

Question 5

What is the nickname for an endometrioma?

Answer 5

chocolate cyst

Question 6

Can we always diagnose an endometrioma or endometriosis?

Answer 6

not always.

Question 7

What will an endometrioma look like on ultrasound?

Answer 7

well-define thin walls, anechoic, enhancement, avascular.

Question 8

What are some differentials for an endometrioma?

Answer 8

hemorrhagic cysts, simple cyst, dermoid, or a fibroid.

Question 9

Is polycystic ovarian disease an endocrine or exocrine disease process and how is it diagnosed?

Answer 9

endocrine

diagnosed from lab values

Question 10

What disease causes anovulation?

Answer 10

polycystic ovarian disease

Question 11

30% of polycystic ovarian disease are obese.

T/F

Answer 11

TRUE

Question 12

What will the ovaries look like with a patient with polycystic ovarian disease?

Answer 12

bilateral ovaries w/ multiple follicles measuring 2-10 mm without a dominant follicle

Question 13

What ovarian disorder will have the sign “string of pearls?”

Answer 13

polycystic ovarian disease

Question 14

Bicornuate uterus’ will have _ vaginas, _ - _ cervixes, and __ uterus’.

( how many )

Answer 14

1 vagina, 1-2 cervix, and 2 uterus’

Question 15

A didelphys uterus will have _ uterus, _ cervix and _ vaginas

Answer 15

COMPLETE separation (think di is 2 so two separate uterus’)

2 uterus, 2 cervix, 2 vaginas

Question 16

With a septate uterus, there is a septum dividing the endo and a patient can get pregnant in one endo and not the other

t/f

Answer 16

TRUE

Question 17

What is ovarian hyperstimulation caused by an what will it look like on ultrasound?

Answer 17

caused by infertility treatments and will have multiple large ovarian cysts.

Question 18

What is PID (the dirty girl disease)

Answer 18

its a type of a sexually transmitted disease and can also be associate with abortions or childbirth

Question 19

What are the syptoms of PID?

Answer 19

pain, fever/chills/ increased WBC, N/V, vaginal discharge and bleeding.

Question 20

How is PID typically diagnosed and what labs will be elevated?

Answer 20

usually diagnosed though lab tests urine and vaginal secretions, and will have increased WBC

Question 21

What are a few complications of PID?

Answer 21

chronic PID, infertility, ectopic pregnancy, chronic pain, and peritonitis

Question 22

What will you see on Ultrasound with PID?

Answer 22

Salpingitis, pyosalpinx, hydrosalpinx, TOA, and endometritis

Question 23

What is salpingitis?

Answer 23

infection of the tubes

Question 24

Salpingitis includes thickened walls measuring greater than ___ mm. increased blood flow, and fluid in culdesac

Answer 24

5 mm

Question 25

What is pyosalpinx and what can we do to distinguish between bowel and pyosalpinx?`

Answer 25

pyosalpinx is echogenic debri within tubes. The walls will be thickened We can distinguish from bowel by watching for peristalsis

Question 26

What is a tuboovarian complex?

Answer 26

bacteria from infection that reaches the ovaries.

Question 27

What is a tuboovarian abscess

Answer 27

an abscess containg air or gas that is accompanied by pain, fever, discharge an bleeding. MUST BE DRAINED

Question 28

What's the difference between a Tuboovarian abscess and a tubo ovarian complex?

Answer 28

a tuboovarian abscess makes the ovaries and tubes unrecognizable whereas the tuboovarian complex, you can still distinguish both the ovary and tubea

Question 29

What is a peritoneal inclusion cyst and what is it caused by?

Answer 29

normal fluid released by ovary trapped in peritoneum. Appears as irregular or loculated fluid around ovary. Caused by trauma, surgery or TOA

Question 30

What is the clinical indications for an ovarian mass?

Answer 30

pelvic pain or fullness, palpable mass, history of ovarian or breast cancer.

Question 31

What are a few sex cell ovarian tumors?

Answer 31

fibromas, thecomas, ganulosa cell tumors, and sertoli-leydig cell tumors

Question 32

What is a fibroma?

Answer 32

a sex cell tumor that does not produce hormones and will be asymptomatic

Question 33

What is a thecoma tumor and what does it cause?

Answer 33

a sex cell tumor that produces estrogen and causes Meig's with pleural effusion and ascites.

Question 34

What will both a fibroma and thecoma look like on US?

Answer 34

hypoechoic solid masses.

Question 35

What is the age range for a granulosa cell tumor and what is it caused by? What's it look like on US?

Answer 35

mostly postmenopausal and caused from estrogen. thickened enometrium and variable ovary appearance.

Question 36

Can sertoli-leydig cell tumors be malignant?

Answer 36

yes..up to 20% are.

Question 37

What is an endometroid tumor?

Answer 37

an epithelial originated, possibly malignant cystic mass with solid components It is often bilateral and is associated with endometrial cancer.

Question 38

When is mucinous cystadenocarcinoma typically diagnosed? (age range)

Answer 38

older populations.

Question 39

What will mucinous cystadenocarcinoma look like on US?

Answer 39

thicker septations, solid areas, and vascularity

Question 40

When is mucinous cystadenoma typically found and what will it look like on US?

Answer 40

younger populations, most are benign sonographically it is multiloculated, internal echoes, thick septations, and papillary projections. VERY LARGE.

Question 41

What age range is a serous cystadenoma (benign)found and will it need surgery to be removed?

Answer 41

40-50 years of age. yes surgery is needed.

Question 42

When age range is serous cystadenocarinoma (malignant) found and what lab value will be increased.

Answer 42

peri-post menopausal. | elevated CA125

Question 43

What is a dermoid? besides the nastiest thing ever?

Answer 43

it is a germ cell composed of teeth, bones, nails, fat and hair.

Question 44

What are the clinical symptoms of a dermoid?

Answer 44

asymptomatic usually, possibly pelvic pain, can be large and painful.

Question 45

On ultrasound, what will a dermoid look like?

Answer 45

nasty. vascularity around periphery, fat/fluid levels, echogenic material within, posterior portional will be shadowed making measurements difficult

Question 46

A dermoid is associated with what sonographic sign?

Answer 46

tip of iceberg sign from echogenic material within.

Question 47

What are the clinical symptoms of ovarian torsion?

Answer 47

severe pain, N/V, possible palpable mass

Question 48

What are the sonographic finings of ovarian torsion?

Answer 48

large ovary with normal vascularity (venous flow is the first to go), cyst on ovary, and twisting of vessels outside ovary.

Question 49

where does the paraovarian cysts originate from

Answer 49

broad ligament adjacent to ovary.

Question 50

What is the normal follicle size?

Answer 50

3 cm

Question 51

If someone has the BRCA1 or BRCA 2 gene, what are they more at risk for?

Answer 51

ovarian masses

Question 52

What are some risk factors for endomentrial adenocarcinoma and what are the clinical symptoms?

Answer 52

hormone therapy, obesity, hypertension, diabetes, tamoxifen and nulliparity clinical symptoms include abnormal uterine bleeding and post menopausual bleeding

Question 53

What will endometrial carcinoma look like on US?

Answer 53

thickened irregular or illdefine endometrium, enlarged uterus, invasion of myometrium and increase blood flow

Question 54

What does tamoxifen (used for breast cancer) do to the uterus?

Answer 54

it makes the endometrium heterogenous and thickened with cystic areas

Question 55

What is a polyp of the endometrium and where are they typically found?

Answer 55

overgrowths of enometrial glands and stroma it is attached blood floby a stalk with blood flow uterus or cervix

Question 56

What is hyperplasia of the endometrium and what causes it?

Answer 56

overgrowth of endometrial tissue estrogen causing endometrium to constantly reproduce

Question 57

What is adenomyosis and what is it cause by?

Answer 57

cells rom basal layer of endometrium migrating into myometrium unknown cause

Question 58

What are the symptoms of adenomyosis?

Answer 58

painful periods and abnormal uterine bleeding

Question 59

What is the sonographic findings of adenomyosis?

Answer 59

heterogenous, hypoechoic striations and cyst like areas, increased vascularity, and thickened posterior wall.

Question 60

Name the three locations of fibroids and their names.

Answer 60

Intramural-in myometrium Submucosal- in endometrium Subserosal-exophytic

Question 61

Which of the locations of fibroids causes abnormal uterine bleeding?

Answer 61

submucosal --in endo.

Question 62

What ethnicity is more at risk for fibroids?

Answer 62

african americans

Question 63

These fibroids are fed by estrogen. T/F

Answer 63

true

Question 64

What are the symptoms of a fibroid?

Answer 64

calcify, pain, irregular bleeding, an feeling fullness.

Question 65

What are the types of abnormal uterine bleeding?

Answer 65

menorrhagia (long and heavy, menometorrhagia (irregular and heavy), after intercourse, infrequent.

Question 66

What are some causes of abnormal uterine bleeding?

Answer 66

Uterine-fibroids and adenomyosis Endo- carcinoma, hyperplasia, and polyps Reproductive tract- PID Endocrine-hormone imbalance, PCOS, low weight, and thyroid condition, perimenopasual.