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Author:
rbeacr
ID:
120658
Filename:
ob
Updated:
2011-12-11 12:42:18
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40 sonographic doppler evaluation female pelvis
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The sonographic and doppler evaluation of the female pelvis
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  1. History questions (pelvic)
    • LMP, gravity/parity
    • pysiologic menstural status
    • horomone regime
    • symptoms
    • history of cancer
    • family history
    • pelvic surgeries
    • lab test/ pap/ biopsy/ findings
  2. premenarche
    prepuberty- before menses
  3. Manarche
    after puberty, menses 21-28 days
  4. pre/peri menopause
    • stage of 2-10 yrs
    • gradual decline in estrogen
    • menses shorter, longer, irregualr
  5. menopausal
    menses completely stopped generally for 1 yr
  6. fill a bladder
    32 oz of water 1 hr before exam
  7. full bladder
    • displaces bowel
    • anatomic landmark
    • acoustic window
    • pushed uterus back
    • better able to visualize fundus
  8. tv probe penetration
    • limited field of view 8-10 cm
    • high frequency
  9. introitus
    vaginal opening
  10. muscles
    • may be mistaken for ovaries/masses
    • symmetric bilateral arrangement indicates they are muscles
  11. obturator internus
    • in lesser/true pelvis
    • seen at posterior lateral corners of bladder at level of vagina and cervix
  12. pelvic floor muscles
    • levator ani at inferior aspect of bladder
    • posterior to obturator internus
  13. illiopsoas muscle
    • in greater pelvis
    • insert into lesser trochanter of femur
  14. S/D ratio
    Pourcelot resistive index (RI)
    Pulsatility index (PI)
    • PS/ED
    • PS-ED/PS
    • PS-ED/mean
  15. souces of blood to vagina
    • 2 sources
    • anterior vagina and cervix=uterine artery
    • posterior vagina= internal illiac, vaginal artery
  16. ovaries blood supply
    • uterine artery
    • ovarian artery

    increased blood flow in late follicular early luteal phase
  17. arcuate vessles
    • separates serosa from myometrium
    • seen in periphery of uterus
    • calcification can be seen in post menop(accelerated in diabetic pts)
  18. radial arteries
    arise from arcuate and travel centrally to myo/endometrium
  19. straight and spiral arteries
    • arise from radial arteries
    • in endometrium
  20. prepubertal uterus/cervix
    • cerix is 2:3 uterine legnth
    • 1-3cm
  21. nulliparous uterus/cervix
    • cervix is 1:3 uterine legnth
    • 6-8cm

    add 2cm for multiparous
  22. postmenopausal uterus/cervix
    • cervix is 2:3 uterine legnth
    • 3-5cm
  23. endometrium layers
    • superficial funcional (sheds)
    • deep basal
  24. endometrium during mensturation
    (days 1-4)
    • hypechoic central line 4-8mm
    • as blood disapears 2-3mm
  25. endometruim early proliferative phase
    (5-9) (10-14)
    • three line sign
    • (5-9) single thin stripe 6mm
    • (10-14) 10mm
  26. endometrium secretory (luteal) phase (15-28)
    • greatest thickness
    • isoechoic functional and basal layer
    • 7-14mm
  27. postmenopausal endometrium
    • should be <5mm
    • HRT 4-10mm
  28. parts/size of fallopian tubes
    • Salping
    • covered by peritoneum except fimb ends
    • interstitial- connects to uterus
    • isthmus- prior to entrance- stiff
    • ampullary- fertilization takes place
    • indundibular- fimbriated ends- distal
    • width1-4mm legnth 8-14cm
  29. ovarian size
    • 3-5 x 2 x 2
    • volume is best method
    • = L x W x a/p x 0.523
    • one ovary 2xs volume of other is abnormal
  30. ovarian vein drainage
    • Rt. ovarian vein into IVC
    • Lt. ovarian vein into lt. renal vein

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