OB Test #1

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Author:
marie78
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256240
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OB Test #1
Updated:
2014-01-14 19:47:49
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Uterus Pelvis
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Description:
OB Exam #1
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  1. Levator Ani
    • Pelvic Floor
    • Hammock like muscle
    • TRV/INF
    • POST to VF
  2. Iliopsoas
    • Posterior seen in longitudinal adnexa
    • TRV UT/Adnexa
  3. Amenorrhea
    Absence of menses
  4. Dysmenorrhea
    Painful bleeding
  5. Menarche
    Onset of menses; usually between 11 & 14 y/o
  6. Menorrhagia
    Heavy bleeding
  7. Menopause
    Termination (Cessation) of regular menses prior to 40 y/o
  8. Sonohysterography
    • Ideal test for demonstrating polyp size & location
    • Saline Infused Sonogram (SIS) in endom
  9. LMP
    Last Menstrual Period (1st day)
  10. Gravida
    # of pregnancies
  11. Parita
    # of births
  12. Hematometrocolpos
    • Blood in vagina & UT
    • Imperforate Hymen seen in younger pts
    • Cervical Stenosis in older pts
  13. Graafian Follicle
    • Dominant follicle
    • 1.5-3 cm in size
  14. Mullerian/Wolfian ducts
    • Form the male & female genital tracts respectively
    • Wolffian: Mesonephric (Male)
    • Mullerian Paramesonephric (Female)
  15. Synchiae
    • Scarring (adhesions) in endometrium assoc w/ Asherman's Syndrome
    • Can cause infertility
  16. Ovaries
    • Endocrine Gland
    • Secretes Estrogen and Progesterone
    • Has a Cortex (80% Parenchyma) and Medulla
  17. Ovaries normal size measurements
    • Menstruating: 4x2x2 cm
    • PMP: 2x1x1 cm
  18. USA of Ovaries
    • Oval
    • Hypoechoic tissue w/ mult anechoic follicles
    • Located in Waldeyer's Fossa in the adnexa
  19. Parts of Uterus (UT)
    • Fundus
    • Body (Corpus)
    • Isthmus (Imaginary line)
    • Cervix
  20. 3 Layers of UT
    • Perimetrium: Outer/ Serosal
    • Myometrium: Muscular/contracts during labor
    • Endometrium: Inner, Mucous (Zona Functionalis/Zona Basalis layer)
  21. 6 UT Positions
    • Anteverted
    • Anteflexed
    • Retroverted
    • Retroflexed
    • Dextroposed
    • Levoposed
  22. Anteverted
    • FWD placement of UT @ CX
    • Fundus pts ANT
    • Most common position
  23. Anteflexed
    Bending FWD of UT at the body (Isthmus) 90 degrees
  24. Retroverted
    Tilting backward of UT @ CX
  25. Retroflexed
    • Bending backward of UT @ the body
    • Fundus pts POST
  26. Dextroposed
    UT tilts toward the RT side
  27. Levoposed
    UT tilts toward the LT side
  28. Nulliparous measurment
    • w/o children
    • 6-8 cm (SAG)
    • 3-5 cm (A/P)
  29. Parous/Multiparous measurements
    • 8-10 cm (SAG)
    • 4-6 cm (A/P)
    • 4-6 cm (TRV)
  30. PMP
    • Varies
    • Based on parity
    • Up to 5 cm
  31. Fallopian Tubes
    aka: Oviducts; salpinges
  32. 5 Parts of Fallopian Tubes
    • Interstitial/Intramural
    • Isthmus
    • Ampulla
    • Infundibulum
    • Fimbrae
  33. Interstitial/Intramural
  34. Cornu
    • Narrow relatively straight
    • Most dangerous place for ectopic pregnancy
  35. Isthmus
    • Medial portion
    • Closest to UT
  36. Ampulla
    • Longest portion 
    • Common site for ectopic pregnancy and 
    • Fertilization
  37. Infundibulum
    Trumpet-shaped end
  38. Fimbrae
    Finger-like projections
  39. Arterial Path of Blood to UT
    Internal Iliac Art to UT art to UT to Arcuate art to Radial Art to Spiral Art
  40. Arterial path of Blood to OV
    • aka Gonadal Art
    • LAT branches off ABD AO below Renal Art & Join w/ UT art
    • Have dual bl supply (UT/OV art)
  41. Venous Return from OV
    • Rt OV Vn drains to IVC
    • Lt OV Vn drains to Lt Renal Vn to IVC
  42. Transabdominal Scanning
    • Pt is Supine
    • Requires full UB
    • Large cross-section of pelvis (big pix)
    • Resolution not as good
  43. Transvaginal (endovag)
    • Pt in Lithotomy position (supine w/ knees up)
    • Empty UB
    • Limited field of view
    • Better Quality images
  44. Contraindications for EV exam
    • Virgin
    • No consent signed
    • PT refuses
  45. Normal endom measurement for menstruating female
    • 1-14 mm 
    • 18 mm MAX prior to menses
  46. Normal Endom measurement for PMP
    • < 5 mm
    • 8 mm (if on HRT)
  47. 3 phases of Endom cycle
    • Menses/Proliferation
    • Ovulation
    • Secretory
  48. Menses/Proliferation(Endom cycle) Phase 1
    • Days 1-5 Menses (endom shed)
    • Days 6-14 Proliferation (endom begins to thicken) Hyperechoic line, 2-7 mm in size
  49. Ovulation (Endom cycle) Phase 2
    • Day 14
    • 3-stripes on USA
    • the egg is released fr the dominant follicle
  50. Secretory Phase (Endom cycle) Phase 3
    • Days 15-28
    • Endom cont to thicken up to 14 mm
    • If no fertilization, production of estrogen/progesterone decreases
  51. Spaces for fluid to collect
    • Space of Retzius
    • Anterior Cul-de-Sac
    • Posterior Cul-de-Sac
    • Fornices
    • Morrison's Pouch
  52. Space of Retzius
    • aka: retropubic or prevesical space
    • Located bet the pubic bone & ANT UB wall
  53. Anterior Cul-de-Sac
    • aka: Vesicouterine space (pelvic ascites)
    • ANT to UT, POST to UB
  54. Posterior Cul-de-Sac
    • aka: Rectouterine space or Pouch of Douglas
    • POST to CX, ANT to Rectum
    • Common site for FF in pelvic region
  55. Fornices
    LAT, ANT, POST
  56. Morrison's Pouch
    Between liver & RT Kid 
  57. USA of IUD
    • Hyperechoic w/ acoustic shadow
    • Possible reverberation artifact w/ post shadowing
    • S/B located in fundus or mid-portion of UT body
  58. DES
    • Drug used from late 40's to early 70's for treatment of spontaneous abortions and pre-term labor
    • T-Shaped UT causes poor pregnancy outcome and cervical carcinoma
    • Small w/ bulbous fundus & short cx
  59. Menstrual/Ovarian Cycle
    • Follicular Phase
    • Ovulation
    • Luteal Phase
  60. Follicular Phase
    • Days 1-14
    • Stimulated by FSH
    • Graafian follicle (dominant) may be identified by about day 8 measuring 10 mm max 15-30 mm
  61. Ovulation
    • Day 14
    • Surge in LH=rupture of follicle and egg is released
    • FF in Post Cul-de-sac
  62. Luteal Phase
    • Days 15-28
    • Ruptured dominant follicle= the Corpus Luteum (CL)
  63. A peak in what hormone causes ovulation
    LH (Lutenizing Hormone)
  64. FSH comes from where?
    Ant Pituitary Gland
  65. Function of Corpus Luteum (CL)
    • Makes & secretes progesterone to prep endom for implantation
    • If implant occurs CL cyst of preg secretes estrogen/progesterone through 1st tri of pregnancy until placenta takes over
    • If no implantation occurs, CL regresses and atrophies = Corpus Albicans (scar tissue)
  66. Broad Ligament
    Extend fr LAT aspects of UT & attach to LAT Pelvic wall
  67. Round Ligament
    • ANT/INF to Broad Lig & Fallopian Tubes (FT)
    • Attach to UT cornu to ANT pelvic wall
  68. Nabothian Cyst
    • Small Cyst in Cx
    •  
  69. Gartner's Duct Cysts
    • Anterolateral wall of vagina
    • Remnant of Wolfian Duct
  70. Common cause of PMP vaginal bleeding
    Endometrial Hyperplasia
  71. Endometrial Polyps USA
    • Non-specific
    • Thickened endo
    • Discrete mass (focal, round, echogenic)
    • Possible vascular stalk on doppler
  72. Endometritis USA
    • Inflammation of the Endom
    • Complex
    • Thickened endom
    • Edematous
  73. Fibroid
    • Common tumor in female pelvis
    • Benign
    • aka: Leiomyomas, myomas, fibromyoma
  74. Types of Fibroids
    • Intramural
    • Subserosal
    • Submucosal
    • Intraligamentous
    • Cervical
  75. Intramural Fibroid
    • w/in the myometrium
    • Most common
  76. Subserosal Fibroid
    • Beneath perimetrium
    • Outer surface
  77. Submucosal
    • Beneath endo cavity
    • Produces symptoms
  78. Intraligamentous
    Between layers of the broad ligament
  79. Cervical
    In Cervix
  80. Adenomyosis
    • Deposits of endometrial tissue in myometrium
    • Ectopic
  81. USA of Adenomyosis
    • Enlarged UT (Bulbous fundus)
    • Asymmetric thickening of ANT/POST UT wall
    • Heterogeneous
    • Streaky shadow "venetian blind"
    • Difficulty visualizing endom
    • Small cysts in myometrium
  82. Types of UT
    • Bicornuate UT: most common
    • Didelphys UT: Complete duplication
    • Arcuate UT: Heart shaped

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