Test 1 Flashcards
(169 cards)
1
Q
what are the portions of the fallopian tube from medial to lateral?
A
- cornual (interstitial)
- isthmus
- ampulla
- infindibulum
2
Q
what is another name for rectouterine pouch?
A
posterior cul-de-sac
puch of douglas
3
Q
what is the location of the rectouterine pouch?
A
- anterior to the rectum
- posterior to the uterus
4
Q
what is the most inferior part of the pelvic cavity?
A
rectouterine pouch
5
Q
what is the significance of the rectouterine pouch?
A
most common site for fluid to collect
6
Q
what is another name for the space of retzius?
A
- retropubic space
- prevesical space
7
Q
what is the location of the space of retzius?
A
- anterior to urinary bladder
- posterior to symohysis pubis
8
Q
what is another name for the vesicouterine pouch?
A
anterior cul-de-sac
9
Q
what is the location of the vesicouterine pouch?
A
- anterior to uterus
- posterior to urinary bladder
10
Q
what does the uterosacral ligament support?
A
cervix
11
Q
how is the length of the uterus measured?
A
from fundus to the external cervical os
12
Q
how is the height (thickness) of the uterus measured?
A
perpindicular to the length of the widest portion of the uterine body
13
Q
how is the width of the uterus measured?
A
widest portion of the uterine body in short axis
14
Q
what is the size of the uterus for a premenarche?
A
2-4cm length
0.5-1 cm height
1-2 cm width
(cervix as long as uterus)
15
Q
what is the size of a menarche uterus?
A
- nulliparous-6-8.5cm x 3-5cm x 3-5cm
- parous-8-10.5cm x 3-5cm x 5-6cm
16
Q
what is the size of a postmenopausal uterus?
A
3.5-7.5cm x 2-3cm x 4-6cm
17
Q
what is the hypoechoic area around the endometrium?
A
outer basal layer
18
Q
what should the endometrium not exceed?
A
14mm
19
Q
what are the ovaries composed of?
A
almond-shaped intraperitoneal endocrine organs that are composed of cortical and medullary tissue covered by epithelium
20
Q
what is the site of follicular development?
A
ovarian cortex
21
Q
where is the vascular core of the ovary?
A
medulla
22
Q
what are the 2 blood sources that supply the ovary?
A
- ovarian artery arising from the aorta
- ovarain branch of the uterine artery
23
Q
what is the function of the ovary?
A
produce ova
24
Q
what are the hormones of the ovary?
A
- estrogen = secreted by follicle
- progesterone = secreted by corpus luteum
25
what are the measurments if the menarche ovary?
- 2.5-5cm length
- 1.5-3cm wide
- 0.6-2.2 cm height
26
what does ovarian volume vary with?
- age
- menstraul status
- body habitus
- pregnancy status
- phase of menstrual cycle
27
what is the volume of a menarche ovary?
9.8 cm3
28
what is the volume of a postmenopausal ovary?
5.8 cm3
29
what is the primary hormone that reflects the activity of the ovaries?
estradiol
30
what does estrodiol do during pregnancy?
levels will steadily rise
31
where are small amounts of estradiol located?
adrenal cortex and arterial walls
32
what are the normal estrogen levels?
5-100 ug/24 hours
33
what is the primary female sex hormone?
estrogen
34
what is estrogen primarily produced by?
developing follicles and the placenta
35
what stimulates the production of estrogen in the ovaries?
- FSH
| - LH
36
what organs produce a small amount of estrogen?
- breasts
- liver
- adrenal glands
37
what are the functions of estrogen?
- it promotes formation of female secondary sex characteristics
- accelerates growth in height and metabolism
- reduces muscle mass
- stimulates endometrial growth and proliferation
- increases uterine growth
38
what is the function of FSH (follicle stimulating hormone)?
initiates follicular growth and stimulates the maturation of the Graafian follicles
39
where is FSH secreted?
anterior pituary gland
40
what are the levels of FSH in the ages of life?
normally low in childhood and slightly higher after menopause
41
what are the levels of FSH in the cycle?
levels decline in the late follicular phase and demonstrate slight increase at the end of the luteal phase
42
what hormone is essential in both males and females for reproduction?
LH
43
where is LH secreted from?
anterior pituituary gland
44
what stimulates LH production?
increasing estrogen levels
45
what triggers ovulation?
a surge in LH levels and initiates the conversion of the residual follicle into a corpus luteum
46
what does the corpus luteum do?
produces progesterone to prepare the endometrium for possible implantation
47
how long does the LH surge typically last?
48 hours
48
when does FSH releasing facotor become active?
before puberty
49
where is FSH produced?
by the hypothalmus
50
what is the path of FSH?
FSH is released into the bloodstream, reaching the anterior pituitary gland
51
what stimulates FSH production?
low levels of estrogen
52
what is LH produced by?
hypothamus
53
what ages is progesterone low?
childhood and postmenopause
54
where is progesterone produced?
adrenal glands
corpus luteum
brain
placenta
55
when is progesterone produced to increased amounts?
during pregnancy
56
what are the functions of progesterone?
preparing the endometrium for possible implantation or starting the next menstrual cycle
57
descrive menstrual phase
- days=1-5
- functional layer necroses
- decreased estrogen and progesterone
58
describe early proliferation
- days 6-9
- thin echogenic endometrium
- increasing estrogen
- coincides with follicular phase of the ovary
59
describe late proliferation
- days 10-14
- preovulatory
- triple line appearance
60
describe secretory phase
- days 15-28
- post ovulatory or premenstrual phase
- functional layer thickens
- progesterone increases
61
how is ovulation regulated?
by the hypothalmus within the brain
62
when does LH usually reach its peak?
10-12 hours before ovulation
63
what triggers ovulation?
a surge in LH accompained by a smaller FSH surge
64
describe early follicular phase
- days 1-5
| - 5-11 small follicles
65
descrive late folliciaular phase
- days 6-13
- before ovulation
- graafian follicle: 2-2.4 cm
- estrogen levels increase
66
describe ovulatory phase
- day 14
- rupture of graafian follicle
- pelivc pain-mittelschmerz
67
what happens in the ovarian phases?
graafian follicle
| -some vascularity at periphery
68
describe early luteal phase
- days 15-18
- post ovulation
- corpus luteum secretes estrogen and progesterone
- free fluid in cul-de-sac
69
when does the corpus luteal cyst regress if fertlization does not occur?
late luteal
70
when is menopaue defined?
cessation of menstration for 12 months
71
Approximately________ of cases will demonstrate a simple ovarian cyst with post menopause
15%
72
Simple ovarian cysts less than ____ in diameter are most likely benign
5 cm
73
what does hormone replacement therapy include?
both estrogen and progesterone
74
what should the endometrium measire in post menopause?
under 8mm
75
what should endometrium thickness not exceed in post menopausal women?
should not excees 8mm in asymptomatic patients or 5mm in patients with vaginal bleeding
76
what can decrease in estrogen in post menopausal women do to pelvic organs?
shorten the vagina and decrease cervical mucous
77
what are oral contraceptives?
inhibit ovulation, endometrium has a thin echogenic line
78
what is depot-medroxprogesterone?
inhibits ovulation, endometrium has a thin echogenic line
79
what is levonorgestrel implant?
thin capsule is placed under the skin for 5 years, endometrium is thin
80
what do intrauterine devices do?
ovulation and corpus luteum continue
81
what are types of intrauterine devices?
paraguard (copper T)
| mirena (hormone releasing)
82
what is the 3rd most common gynecological malignancy?
cervical carcinoma
83
cervical carcinoma is an __________ neoplasm
epithelial
84
what occurs with a cervical carcinoma?
- intermenstrual or postcoital bleeding
- hypoechoic or heterogenous retrovesical mass
- endometrial fluid collection
85
what are nabothian cysts?
obstructed inclusion cysts in cervix
86
what may cause nabothian cysts?
chronic cervicitis
87
are nabothian symptomatic or asymptomatic?
asymtomatic
88
what do nabothian cysts look like?
- multiple or solitary anechoic structures <2cm
| - may contain internal echoes
89
what is another name for leiomyomas?
myoma
| fibroid
90
what is the most common pelvic tumor?
leiomyoma (fibroid)
91
what is the leading cause of hysterectomy?
leiomyoma
92
what are the most common leiomyoma?
myometrial
93
when may leiomyomas be painful?
when they degenerate
94
what are the fibroid locations?
- intramural (myometrial)
- subserosal
- pedunculated
- submucosal
95
what fibroid distorts the uterine contour?
subserosal
96
what fibroids cause abnormal uterine bleedng?
submucosal and intramural
97
what is adenomyosis?
glands and stroma from the basal layer of endometrium penetrate into the myometrium
98
adenomyosis is found in _______ of hysterectomy specimens
70%
99
what does adenomyosis cause?
dysmenorrhea and AUB
100
what is the sonographic appearance of adenomyosis?
- myometrial alterations
- trans vag may demonstrate poor defintion of the endometrial and junctional zone caused by endometrial tissue extending from the basal layer
101
what is endometrial hyperplasia?
an abnormal proliferation (growth) of the endometrium in responce to excess or unopposed estrogen
102
what does endometrial hyperplasia look like sonograhically?
endometrium is diffusely thickened although asymmetric or focal thickening may be present
103
what is the most common gynecologic cancer, affecting 1 in every 50 women?
endometrial adenocarcinoma
104
when are most cases of endometrial adenocarcinoma diagnosed?
post menopausal women
105
what is the most common clinical presentation for endometrial adenocarcinoma?
postmenopausal bleeding
106
what are the risk factors for endometrial adenocarcinoma?
- unopposed estrogen stimulation
- obesity, nulliparity, diabetis, hypertension
- tamoxifen therapy for breast cancer
- chronic anovulation
- presence of atypical endometrial hyperplasia
107
what does endometrial carcinoma look like sonographically?
- thickened endometrium >4mm in postmenopausal women
| - heterogenous echotexturem hematometra, enlarged uterus
108
what is needed to differentiate between hyperplasia and a carcinoma?
biopsy
109
what are endometrial polyps?
bengin focal overgrowths of endometrial glands and stroma
110
where can polyps extend?
into the cervix or vagina
111
who is endometrial polyps more prevalent in?
perimenopausal and postmenopausal women
112
what can polyps cause?
- coital spotting
- intermenstrual bleeding
- menorrhagia
- menometrorrhagia
113
what is the sonographic appearance of a polyp?
- typically isoechoic to the surrounding endometrium causing the appearance of wither focal or global endometrial thickening
- cystic spaces within the polyp
- evidence of a vascular feeding vessel on color doppler
- well define by saline
114
why is tamoxifen given to cancer patients?
block estrogenic effects on breast tissue
115
what endometrial abnormalities can occur with tamoxifen?
- carcinoma
- hyperplasia
- polyps
116
what is ashermans syndrome?
adhesions from a previous deep curretage or endometrial infection
117
what are the clinical symptoms of ashermans syndrome?
- asymptomatic
- amenorrhea
- dysmenorrhea
- hypomenorrhea
- infertility
118
what is retained products of conception?
some of the gestational contents may remain within the uterine cavity and cause bleeding or infection
119
what do retained products of conception uaully consist of?
placetal tissue which can persist for months and result on AUB
120
what is the sonographic appearance post pardum?
uterus immediately is enlarged and typically returns to normal size and shape within 6-8 weeks after delivery
121
what are some immediate post pardum finsings with RPOC?
residual fluid and echogenic material=hemorrhage within the endometrial cavity
122
how do you rule out RPOC?
evaluate the endometrial cavity for a focal echogenic mass and assess endometrial thickness
123
what measurement shows RPOC is unlikely?
endometrial thickness is less than 10mm
124
when is RPOC likely?
an echogenic mass with vascularity is present
125
what may an echogenic mass without vascularity represent?
either RPOC or blood clots
126
what is a hematometra?
blood trapped in the endometrial cavity
127
what are the symptoms of hematometra?
pelvic pain
amenorrhea
hypomenorrhea
pelvic mass
128
what is hematometra caused by?
imperforated hymen
cervical stenosis
vaginal neoplasm
129
what is a gartner duct cyst?
small cysts within the vagina
130
what is hematocolpos?
blood accumulation in the vagina
131
what is hematometrocolpos?
blood accumulation in the uterus and vagina
132
what is a hydrosalpinx?
distally blocked fallopian tube filled with serous or clear fluid
133
is hydrosalpinx usually bilateral or unilateral?
bilateral
134
what may hydrosalpunx be caused by?
- old infection
- STD
- previous surgery
- adhesions
- endometriosis
135
what is a IUCD?
a flexible contraceptive device inserted through the vaginal canal into the endometrium
136
what is IUCD made of?
T-shaped made of plastic, wrapped in copper, and may or may not contain hormones
137
where shoudl all tyoes of IUD be located?
in the midline portion of the endometrial cavity
138
what does the ParaGuard IUD look like?
2 parallel hyperechoic linear echoes with intense posterior acoustic shadowing
139
what does the Mirena IUD look like?
a hypoechoic or mildly echogenic stem with thin echogenic "T-arms"
140
what does a lippes loop look like?
multple echogenic dots within the endometrial canal
141
what are abnormal or ectopic locations of IUD's?
- migration from the superior fundal to the inferior portion of the endometrium or vaginal canal
- myometrial penetration
- perfration into the peritoneal cavity
142
what are some additional complications of an IUD?
- PID
- ectopic pregnancy
- a coexisting IUP
143
when does ecplusion of the IUD generally occur?
within the first year most commonly during the first few months after insertion
144
when is expulsion more likely to occur?
when inserted soon after childbirth or in women with a history of previous expulsion, nulliparity, or severe menorrhagia
145
what do women present with clinically with expulsion of IUD?
- aymptomatic
- complian of cramping
- vaginal discharge
- intermenstrual or postcoital bleeding
- spotting
- dyspareunia
146
what are the sonographic findings of expulsion of IUD?
absence of the IUD within endometrial cavity
147
what must be done when IUD is not visualzed in the pelvis?
film radiograph of the abdomen and pelvis should be ruled out perforation into the peritoneal cavity
148
when is an IUD abnormally located?
if it sits inferiorly within the endometrial cavity or if any part extends past the confines of the cavity into the uterus or cervix
149
what may be a result when an IUD is in an inferior location?
may result of migration or improper insertion of the device, and patients may experience pain or be asymtomatic
150
what does an inferior located IUD decrease?
the contraceptive effectiveness and is at risk for being expelled
151
what is required if the IUD is embedded in the myometrium?
operative hysteroscopy
152
what does myometrial penetration mean?
extension or penetration of the IUD through the basal layer of the endometrium into the uterine myometrium
153
what is the usual myometrial penetration location of the IUD?
generally the T portion of the IUD extends partially or completelly through the lateral and fundal portions of the endometrial layers embedding into the myometrium of the uterus
154
what are the symptoms of myometrial penetration?
women may be asymptomatic or experience pelvic pain or irregular bleeding
155
when does perforation occur?
almost always occurs during inserton and is associated with an inexperienced clinician, retroverted uterus, and congenital uterine anomalies
156
what is the principal clinical finding for perforation?
pelvic pain
157
what are complications with perforation?
damage and scarring of the surrounding organs and pelvic infection
158
when may infection occur with IUD?
bacteria may enter the endometrial cavity as the IUD is inserted through thee vaginal canal
159
what is a womens risk of infection strongly related to?
previous history of a sexullay transmitted disease and insertion technique
160
how can pelvic infection develop into a serious condition?
affect the:
- uterus
- fallopian tubes
- adnexa
- peritoneum
161
what may pelvic infection result in?
- endomyometritis
- pyosalpinx
- tubovaran abscess
162
what does in situ mean?
right place
163
what does the endometrium look lke with endomyometritis?
- the endometrium may appear thick and irregular, and the uterus may appear enlarged and inhomogenous
- hypervascular endometrium and myometrium may be evident with color doppler
164
when is the risk of pregnancy with an IUD in place the highest?
in the first year after IUD insertion
165
what are the complications with pregnancy in the presence of an IUD?
- most noted complication is ectopic pregnancy
| - spontaneous abortion with an IUD that remains in situ is 40-50%
166
what are other rare complications with pregnancy and IUD?
- chorioamniotiis
- premature rupture of membranes
- preterm labour
- septic abortion
- maternal death
167
true or false? Using an IUD increases a womens risk for ectopic pregnancy
false
| Using an IUD does not increase a woman's risk for ectopic pregnancy
168
where are most ecoptic pregancies located?
in the ampulla segment of the fallopian tube
169
what is the treatment of an ectopic pregnancy?
medical therapy (methotrexate) or surgical intervention
