OB Test #2

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Author:
marie78
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258486
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OB Test #2
Updated:
2014-01-28 23:27:51
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Ovaries
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Test 2 on Ovaries
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  1. Stage I Cervical Cancer
    • Confined to CX
    • USA: Normal, Hypo echoic
  2. Stage II Cervical Cancer
    Spreads beyond CX but not to pelvic walls
  3. Stage III Cervical Cancer
    Extends to pelvic walls
  4. Stage IV Cervical Cancer
    • Extends beyond pelvis (UB, RECTUM, METS)
    • USA: further enlargement, irreg wall thickening in UB & Rectum
    • "Bulky CX appearance" through EndoVag
  5. Krukenberg Tumor
    METS fr OV tumor in GI tract (Secondary)
  6. Krukenberg Tumor USA
    • May be bilat, solid
    • Hypoechoic or complex (mostly solid)
    • Possible ascites
  7. Endometriosis
    • Ectopic endom/Benign/In the OV
    • Presence of functional endom tissue outside the UT
  8. Clinical Signs/Symptoms of Endometriosis
    • Asymptomatic
    • Severe Pelvic pain
    • Chronic pain
    • Infertility
  9. 4 D's of Endometriosis
    • Dysmenorrhea
    • Dyspareunia
    • Dysuria
    • Dyschezia (painful defacation)
  10. USA Endometriosis
    • "Chocolate Cyst" Endometrioma
    • Well defined borders
    • Diffuse, homogeneous, low-level internal echoes
    • Post enhancement
    • Solid, cystic or complex
    • Possible FF level
    • Thick or slight irreg walls
    • Possible echogenic foci
  11. Uterine Arteriovenous Malformation (UVM)
    • Vessel Cluster
    • Abnormal connection/tumor of Art & Vein
    • Important to find!!! Can cause major bleeding during labor or surgery (i.e. D&C)
  12. USA of AVM
    • Asymptomatic
    • Highly Vascular
  13. Dysgerminoma
    • OV Germ Cell Tumor
    • Female Counterpart of Seminoma
    • Under 30 y/o  primarily
    • Highly Malignant
  14. USA of Dysgerminoma
    Varies
  15. Ovarian Cancer
    • 4th leading cause of cancer death in women
    • "Silent Killer"
  16. Risk Factors of Ovarian Cancer
    • 50-59 y/o
    • Hx of unsuccessful pregnancies or nulliparous
    • Family Hx of breast/or ov cancer
    • Infertility
    • Late menopause
  17. Clinical Signs/Symptoms of OV Cancer
    • Asymptomatic
    • Abd pain/pressure
    • Vaginal bleeding
    • Hormone imbalance (endocrine)
    • Weight change (<,>)
  18. USA of OV Cancer
    • Varies
    • Solid/mural nodule
    • Incr Vascularity
    • Yields LOW resistant waveform (high diastolic vel)
  19. Follicular OV Cyst
    • Benign
    • Overstimulation of a follicle that does not rupture or regress
    • Unilocular, localized pain
    • 3-8 cm
    • Anechoic, thin walled, symmetrical, post enhancement
  20. Theca-Lutein Cyst (OV)
    • Benign
    • Largest of functional cysts
    • Responds to hormones
    • Overstimulation fr high HCG levels (infertility treatment)-causes GTD/Molar pregnancies
  21. Theca-Lutein Cyst (OV) USA
    USA: Bilateral mult. large cysts
  22. Corpus Luteum Cyst
    • Benign (Days 15-28)
    • After ovulation of dominant follicle
  23. USA of Corpus Luteum Cysts
    • <4cm, internal echoes
    • thick, anechoic
    • Incr Vascularity
    • Post enhancement
  24. Corput Luteum Cyst (hemorrhagic)
    (-) pregnant=CL cont. to grow or hemorrhage into lumen
  25. Corpus Luteum Cyst (Pregnancy)
    • (+) pregnant=secrete progesterone & persist thru weeks 14-16 of pregnancy
    • Thick, Hyperechoic, irreg walls
    • Possible solid appearance
  26. Teratoma/Dermoid
    • Benign Cystic
    • Most common Germ Cell
  27. Teratoma/Dermoid (Symptoms)
    • Asymptomatic
    • ABD pain, mass, swelling
    • Abnormal bleeding
  28. Teratoma/Dermoid USA
    • Varies
    • Mostly cystic in adnexa
    • Complex (possible CA++)
    • Echogenic
    • FF level or Fat Fluid level
    • Tip of the Iceberg, Dermoid Plug, Dermoid Mesh
  29. PID (Pelvic Inflammatory Disease)
    Inflammation of pelvic & adnexal structures
  30. PID Causes
    • STI
    • Surgery (D&C)
    • Ruptured appendix
    • Diverticulitis
    • Abortion
    • Post partum infection
  31. Lasting Results of PID
    • Infertility
    • Tubal Scarring
    • Ectopic pregnancy
  32. Stage III PID (USA)
    • (TOA:Tubo-Ovarian Abscess)
    • Complex Adnexal Mass
    • Uni/Bi-lateral
    • Incr Vascularity
    • Indisticnt walls of mass
  33. Clinical Symptoms of PID
    • Incr WBC's
    • Fever
    • Lower ABD pain
    • Purulent Vaginal discharge
    • Pelvic tenderness
    • Constant dull pain (Dyspurenia)
  34. Arrhenoblastoma
    • aka: Androblastoma or Setoli-Leydig Tumor
    • Rare
    • Incr. Testosterone (Androgen producing)
    • <30 y/o
  35. Arrhenoblastoma Clinical
    • Hirsutism
    • Masculinizing features in women
  36. USA of Arrhenoblastoma
    • Solid
    • Echogenic
    • Hard to differentiate fr Granulosa Cell Tumor
  37. Granulosa Cell Tumor (OV)
    • Most often PMP (50-55 y/o) Malignant
    • Estrogen producing
    • Juvenile tumors result in precocious puberty
  38. USA of Granulosa Tumor
    • Small: solid
    • Large: Cystic, multiloculated (septations)
    • Possible thickened endom
  39. Endometrial Carcinoma (UT)
    • Most common Malignancy in PMP
    • Tumor starts in UT cavity to myometrium to CX & adnexa
    • Potential METS to Pelvic lymph system
  40. Clinical Symptoms of Endometrial Carcinoma
    • PMP vaginal bleeding
    • Hypermenorrhea
    • Metrorrhagia in PMP
    • Pain due to distension
  41. USA of Endometrial Carcinoma
    • Heterogeneous texture and thickened endo
    • Fluid in endo
    • >5mm
  42. Leiomysarcoma (UT)
    • Malignant Fibroid & RARE
    • Grows rapidly in PMP UT
  43. USA of Leiomyosarcoma
    Indistinguishable from a benign Fibroid
  44. Another name for Endometrioma
    Chocolate Cyst (Endometriosis-Localized form)
  45. Infertility
    Inability to conceive after @ least 1-year w/o any type of birth control
  46. What areas of the pelvic anatomy do we eval w/ US?
    • UT: Normal UT anatomy
    • Endo: Thickness and texture of endo
    • OV: Hyperstimulation of OV & follicles
    • CX and FT
  47. IVF (In-Vitro Fertilization)
    • In a lab/dish
    • Egg is fertilized outside the body
  48. GIFT (Gamete Intrafallopian Tube Transfer)
    • Sperm and Ova are placed into the FT
    • Fertilization occurs in the body
  49. ZIFT (Zygote Intrafallopian Tube Transfer)
    Zygote is placed into the FT (fertlized egg)
  50. Optimal size for a dominant follicle
    • 18-24 mm or
    • 1.8-2.4 cm
  51. Basal Body Temperature
    • Body temp in the am (b4 rising, moving or eating anything)
    • Usually 98.6 degrees
    • Rises 12-24 hrs after ovulation occurs
  52. How do we test for FT patency?
    • SIS: Saline Infused Sonohysterography
    • Salpingogram:X-ray on FT
  53. Thecoma
    Benign OV tumor that shows signs of Estrogen production
  54. "String of Pearls" and what pathology is it associated with?
    • Mult cysts of varying size outside the OV
    • Bilat enlarged OV
    • Assoc w/ Polycystic Ovarian Syndrome (PCOS)
  55. What is Tip of the Iceberg? What Pathology is it associated with?
    • Echogenic mass w/ Post Shadow
    • Assoc w/ Dermoid Cyst (Benign Cystic Teratoma)
  56. Masculinizing OV tumor
    Sertoli-Leydig Tumor aka Androblastoma/Arrhenoblastoma
  57. Hirsutism
    • Masculinizing features in women
    • Hair growth like men
  58. Granulosa Cell Tumor
    Feminizing Ovarian tumor
  59. 4 characteristics of a Simple cyst
    • Anechoic
    • Well defined borders
    • Symmetrical in shape
    • Post enhancement
  60. Stages of PID
    • I: Thickened, irreg endo
    • II: Pyosalpinx, dilated, enlarged tubes w/ possible hydro
    • III: Severe PID =TOA (Tubo-Ovarian Abscess)
    • Chronic: May cause adhesions
  61. Common Infertility treatments
    • Drugs: Clomid, Perganol, Metformin
    • Ovulation monitoring
    • IVF U/S Protocol
    • IVF, ZIFT, GIFT, IUI
    • Basal Body Temp
  62. USA of Mucinous Cystademona
    • Benign
    • Multiloculated
    • Thicker & more numerous septations
    •  Gravity dependent internal echoes
    • HUGE: 50 cm
  63. USA of Mucinous Cystadenocarcinoma
    • Malignant
    • 15-30 cm
    • Echogenic Internal echoes
    • Papillary (solid nodules) projections
  64. Fibroma
    OV Benign, solid Tumor
  65. Meig's Syndrome
    • Associated with:
    • OV Fibroma
    • Ascites
    • Pleural Effusion-Fl around lungs above diaph
  66. OV Cancer Lab Value
    CA 125 (Cancer Antigen)
  67. Normal Waveform for the OV
    High Resistance (Low Diastolic Flow)
  68. OV Hyperstimulation
    • Excessive Stimulation of OV
    • Mult. Large Follicles
    • High Mortality rate
  69. Cumulus OOphorus
    A mural (solid) nodule w/in the dominant follicle suggest ovulation w/in 36 hours

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