OBstetrical & Gynecological Sonography > Week 1 > Flashcards

Week 1 Flashcards

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1
Q

Bones that make up pelvis

A
  • Ilium
  • Ischium
  • Pubis
    –> Innominate bones
  • Sacrum
  • Coccyx
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2
Q

What 3 principles does the female pelvis serve

A

1 - Provides a weight bearing bridge below the spine and the bones of the lower limbs through the sacrum and innominate bones

2 - Directs a pathway for the fetal head during childbirth

3 - Protects the reproductive organs and other pelvic organs

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3
Q

What separates the True and False pelvis?

A

Linea Terminalis

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4
Q

What organs are located in the true pelvis?

A

Pelvic colon
bladder
rectum
uterus
vagina
fallopian tubes
ovaries
suspensory ligaments

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5
Q

What organs are located in the false pelvis?

A

Ilium
Sigmoid colon

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6
Q

pelvic muscles sonographically properties

A

have linear striations

borders are outline by echogenic fascia and retroperitoneal fat

not as echogenic as fat

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7
Q

What are the muscles in the pelvic diaphragm?

A

1) Levator Ani muscle
- Puborectalis - anterior support
-pubococcygeus - midline anterolateral support
- illiococcygeus - posterolateral support

2) coccyges muscle - sacral support

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8
Q

Pelvic muscles in true/lateral pelvis

Functionally related to what?

A

Functionally related to hip movement

1) Piriformis

2) Obturator Internus

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9
Q

Posterior pelvic muscles

A

1) Illiopsoas
–> “bulls eye”, lateral to bladder

2) Psoas

3) Iliacus

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10
Q

Anterior Pelvic muscle

A

1) Linea Alba
–> fusion of LT and RT Rectus Abdominis

2) Rectus Abdominis

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11
Q

Monthly Chain of Events in the Follicule in a female that does not become Pregnant

A

1) Starts with 1st day of bleeding

2) Ovarian estrogen levels are low which triggers secretion of GNRH in hypothalamus

3) As a result of hypothalamus activity, there is gradual increase of FSH and LH from anterior pituitary (these two hormones stimulate follicle growth and maturation which is accompanied by increased estrogen production.)

4) Sharp estrogen peak before ovulation during last part of follicular phase
–> rising peak stimulates LH production but rising estrogen concentration inhibits FSH secretion
–> estrogen triggers midcycle surge of LH which induces ovulation

5) estrogen secretion decreases slightly after ovulation, progesterone increases rapidly after ovulation

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12
Q

What is the principle function of LH (Lutenizing hormone)

A

Support the growth of the Corpus Luteum

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13
Q

What happens if the ovum is not fertilized

A

The corpus luteum starts to regress

Concurrent drop of progesterone and estrogen levels by day 22-24 of cycle

The withdrawal of hormone support of the endometrium is followed by its reintegration and menstruation

Low concentration of ovarian hormone permits cycle to be reinitiated

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14
Q

What is FSH

A

stimulates the development of the ovarian follicles and the production of estrogen by follicular cells

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15
Q

What is LH

A

Serves as a trigger for ovulation and stimulates the follicular cells and corpus luteum to produce progesterone

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16
Q

Gonadotropin-releasing hormone

A

synthesized by hypothalamus

stimulates the release of FSH and LH (gonadotropins) that are produced by anterior pituitary and act on ovaries

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17
Q

Menarche

A

time of the 1st menstrual period

monthly reproductive cycles are regulated by hypothalamus, ovaries, and pituitary gland

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18
Q

What are the basic functions of the menstrual cycle

A

To reproduce

To provide a new lining for implantation

Nutrients for a new egg

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19
Q

Ovarian cycle

A

–> regulated by FSH and L these are released by pituitary and ovarian sex hormones (estradiol and progesterone)

3 phases:
Follicular (1-13)

Ovulatory (14)

Luteal (15-28)

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20
Q

Antrum

Secondary follicle

A

When the follicular cells divide, a cavity containing follicular fluid is created

When the antrum is formed, the ovarian follicle is called a secondary follicle

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21
Q

Cumulus oophorus

A

Primary oocyte surrounded by follicular cells and projects into the enlarged antrum

The expelled secondary oocyte is surrounded by thezona pellucida,an acellular glycoprotein coat, and one or more layers of follicular cells, which are radially arranged to form the corona radiata and the cumulus oophorus

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22
Q

Stigma

A

Follicles inside the antrum continue to enlarge and soon a bulge on the surface of the ovary, a small, oval, avascular spot appears on this bulge called the stigma.

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23
Q

how long after a surge of LH production does ovulation follow

A

24 hours

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24
Q

corpus luteum

A
  • ovarian follicle collapses shortly after ovulation
  • under influence of LH walls of follicle develop into corpus luteum
  • glandular structure
  • secretes primarily progesterone (and some estrogen)
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25
what happens if oocyte is fertilized? not fertilized?
if fertilized: - corpus lute enlarges to form "corpus lute of pregnancy" - increases its hormone production - degeneration of corpus lutes is prevented by hCG if not fertilized: - corpus lute degenerates 10 to 12 days after ovulation - called "corpus lute of menstruation" - degenerated corpus lute is transformed into white scar tissue in ovary forming corpus albicans
26
corpus albicans
white scar tissue degenerated corpus luteum
27
phases of menstrual cycle
Menstrual phase: - functional layer of endometrium is shedded (4-5 days) - endometrium is thin Proliferative phase: - endometrium gradually thickens due to cellular growth - lasts approximately 9 days Secretory / Luteal phase: - lasts approx 13 days - coincides with formation, function, growth of corpus luteum - endometrium thickens due to influence of progesterone and estrogen from corpus luteum - if menstruation does not occur: corpus luteum degenerates - estrogen and progesterone levels drop, endometrium enters an ischemic phase - menstruation occurs
28
vagina
- thin walled muscular tube - extends from cervix to vestibule of external genitalia - lies between urinary bladder and rectum - A+P walls are in contact except at upper end where cervix enters on anterior wall - posterior wall is longer than anterior wall - upper end of vagina surrounds cervix extending higher posteriorly and forming 4 recesses around cervix ("fornices") - ring shape of vagina divides anterior, lateral, and posterior fornices
29
what are the two sources of blood supply for vagina
1) Branch off the uterine artery: Anterior surface 2) Branch off vaginal arteries: Posterior surface --> both are branches of the internal iliac artery
30
uterus
- thick walled hollow muscular organ - located beneath 2 layers of broad ligament laterally --> bladder anteriorly, recto sigmoid colon posteriorly - supported by pelvic diaphragm - covered by fold of peritoneum
31
what are 4 segments of uterus
1) Fundus 2) Corpus (body) 3) Isthmus 4) Cervix
32
Fundus
- most cephalad - above entrance of fallopian tubes - rounded/dome-shaped area above uterine cavity - narrow at outer and lateral margins to form cornu (where interstitial portion of the fallopian tubes enter)
33
Corpus
- largest portion of uterus - uterine cavity (endometrial cavity) - body
34
Isthmus
- marks the transition from the corpus to the cervix or neck - most flexible portion
35
Cervix
- neck of the uterus which projects into the vagina
36
Uterine cavity
- has an inverted triangle shape - cavity is widest at the fundus and narrowest at the isthmus
37
Walls of uterus are composed of what
1) Serosa/Perimetrium: outer layer - thin, not visible sonographically - continuous with pelvic fascia 2) Myometrium: middle layer - thick - composed of smooth muscle cells and connective tissue fibres 3) Endometrium (type of mucosa): lining - inner surface - forms the walls of the uterine cavity
38
Myometrium
Muscular middle layer of the uterus Subdivided into 3 layers: 1) Longitudinal muscle fibers: outer layer - less echogenic then the intermediate layer - separated from intermediate layer by arcuate vessels 2) Rich vascularized thick middle: intermediate layer - homogenous texture of low to moderate echogenecity 3) Dense spiral muscles: inner layer - arranged both longitudinally and obliquely - hyper echoic and surrounds echogenic endometrium (subendometrial halo)
39
Endometrium
- specialized mucosa that varies in echogencity, thickness, and composition brought menstrual cycle - composed of superficial layer (Zona functionalis) which is shedded each month - deep basal layer
40
how does menstrual phase appear on ultrasound?
endometrium is thin and hyper echoic
41
how does proliferative phase appear on ultrasound?
endometrium thickens (due to estrogen) - echogenecity of basal layer increases - echogenecity of functional layer decreases - triple line appearance
42
how does secretory phase appear on ultrasound
- endometrium appears homogenous + hyperechoic - functional layer becomes thickened + edematous - spinal arteries become tortuous
43
endometrium measurement
- longitudinal axis (sagittal) of uterus and include endometrial layers - do NOT include outermost hypo echoic layer bc its the myometrial in origin - 1mm after menstruation to 14mm prior to
44
thickness of endometrium after ovulation
7-14mm becomes echogenic blurring "three line" appearance postmenopausal patients NOT on HRT = <5mm postmenopausal pts on HRT or tamoxifen my be up to 8-10mm
45
uterine shape, size, position: infantile or prepubertal
2-3.3cm in length (cervix 2/3 total length) uterus cylindrical along same axis as vagina remains cylindrical but becomes more globular as matures puberty- uterus has inverted pear shape
46
uterine shape, size, position: pregnancy
with each pregnancy corpus + fundus grow thicker increasing globularity of multiparous uterus around 8(L) x 5(W) x 4(AP)
47
uterine shape, size, position: menopause
corpus and fundus shrink and regress to prepubertal state (65+ yrs) around 3.5 to 6.5 cm L 1.2cm to 1.8cm AP
48
Uterus measurement
long axis of uterus: from fundus to tip of cervix largest anteroposterior: long axis rotate transducer 90º for transverse, sweep through uterus and measure widest part of body
49
uterine position
- In true pelvis beneath urinary bladder anteriorly and rectosigmoid colon posteriorly - is variable and changes with varying degree of bladder and rectal distention - cervix is fixed midline but uterine body quite mobile
50
terms: flexion, version, retroflexed, retroverted
flexion (anteflexed): axis of uterus body related to cervix version (anteverted): refers to axis of cervix related to vagina retroflexed: uterus body is tilted posteriorly (relative to cervix) retroverted: entire uterus is tilted backwards (relative to vagina)
51
Cardinal ligament
--> Transverse cervical ligaments --> together cardinal and uterosacral ligaments anchor cervix - lateral region of cervix along lateral margin of uterine corpus - insert into lateral pelvic wall and extend posteriorly to margins of sacrum - posterior edge of ligament is denser than other regions - uterosacral ligaments extend from posterior lateral margin of cervix to sacrum
52
Round ligament
- originate from uterine cornea and extend across pelvic space from posterior to anterior - cross over pelvic brim, pass through inguinal ring and anchor into labia major - tether uterine fundus and tilt it forward in pelvis
53
broad ligament
double fold of peritoneum attaches lateral portions of uterus to lateral pelvic sidewalls suspends the uterus divides the true pelvis into anterior and posterior pelvic compartments ovaries attach to posterior surface of broad ligament
54
structures contained in broad ligament
- fallopian tubes - ovaries - ovarian arteries - uterine arteries - round ligaments - suspensory ligaments - ovarian ligaments
55
blood vessels contained in broad ligaments
ovaries fallopian tubes uterus
56
spaces adjacent to uterus
peritoneum folds back from anterior wall of pelvic cavity to cover dome of bladder then folds more sharply to cover anterior surface of uterus forming: ANTERIOR CUL DE SAC (vesicouterine pouch) --> lies beneath anterior wall of uterus and urinary bladder POSTERIOR CUL DE SAC --> peritoneal reflection from posterior wall of pelvis which covers rectum to posterior wall of uterus - most posterior and dependant portion of peritoneal sac lining peritoneal cavity - fluid originating anywhere in peritoneal sac tens to accumulate into posterior cup de sac
57
Fallopian tubes - oviducts/salpinges
paired musculomembranous tubes that extend from fundus of uterus to ovary - lies along free edge of broad ligement walls consist of 3 layers: 1) outer serosal coat 2) middle muscular layer 3) inner mucosa
58
ALARA
patient safety, AS LOW AS REASONABLY ACHIEVABLE - achieved through 1) decrease in exam time 2) using lowest power level 3) appropriate transducer selection
59
Uterus ligaments
1) cardinal 2) transverse 3) round 4) broad ligament
60
Ovarian ligament
1) ovarian ligament 2) mesovarium ligament 3) suspenders ligament
61
Why is mesovarium ligament special?
It attaches to the broad ligament and posteriorly, attaches vessels to ovaries
OBstetrical & Gynecological Sonography
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