Uterine Assesment

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Author:
Anonymous
ID:
269501
Filename:
Uterine Assesment
Updated:
2014-04-06 20:09:12
Tags:
uterus gyn sonography ultrasound
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Description:
Med Sono 2 Exam 1
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  1. 3 Processes for malformation
    • 1) Arrested development
    • ex. unicornuate uterus

    • 2) Failure of fusion of mullerian ducts
    • ex.failure of re-absorption of mullerian ducts

    • 3) Failure of re-absorption of mullerian ducts
    • ex. septate & subseptate
  2. Most common uterine anomoly
    Septate Uterus: complete failure (thin or thick membrane) running from fundus to cervix
  3. Uterine didelphis
    • 2 uterus
    • 2 cervix
    • 2 vaginas
  4. Bicornuate uterus bicollis
    • 2 uterus
    • 2 cervix
    • 1 vagina
  5. Bicornuate uterus unicollis
    • 2 uterus
    • 1 cervix
    • 1 vagina
  6. Arcuate uterus
    partial indentation of the fundus of the uterus
  7. Premenopausal pattern:
    i. Menstrual: thin, broken echogenic line

    • ii. Proliferative: Hypoechoic thickening "triple layer sign"
    • * 4-8mm periovulatory

    • iii. Secretory: Hyperechoic thickening
    • * 4-14mm after ovulation
  8. Postmenopausal pattern:
    • i. Pattern without HRT:
    • * ≤ 4mm ▫ If ≤ 4mm with bleeding >> most likely atrophy 
    • * If 5-8mm with bleeding >> biopsy
    • * If >8mm >> sequential hormones & rescan after cycle

    ii. Pattern with HRT: > 4mm
  9. Differential of endometrial thickening
    • ▫ Endometritis (PID)
    • ▫ Adhesions (synechiae)
    • ▫ Hyperplasia
    • ▫ Polyps
    • ▫ CA
    • ▫ Submucosal fibroid
  10. Describe the classification system of uterine fibroids.
    • a. Submucosal: least common
    • ▫ Most common to produce bleeding
    • ▫ Located adjacent to EC
    • *CAN DISPLACE EC*
    • b. Intramural: w/in the myometrium
    • ▫ Most common
    • ▫ Expands laterally & does not displace EC
    • c. Subserosal: adjacent to parametrium
    • ▫ Contour abnormality
    • ▫ Palpable with pelvic exam
    • ▫ Can become pedunculated (exophytic mass)
  11. Describe the clinical symptoms and sonographic patterns associated with uterine fibroids. Describe the sonographic patterns associated with leiomyosarcoma
    • ▫ 35yo +, African Americans, bleeding x 50%
    • ▫ Impairs fertility, urinary urgency/ constipation
    • ▫ Most common tumor of the female pelvis
    • a. Symptoms:
    • ▫ Impairs fertility, urinary urgency/ constipation
    • ▫ @ menopause >> stabilization or atrophy ▫ w/pregnancy >> monitor due to increased hormone levels
    • b. Pattern:
    • ▫ Enlarged uterus w/focal mass
    • ▫ Small fibroids are typically hypoechoic
    • ▫ Hyperechoic = fatty degeneration, calcification
    • ▫ Accompanied with shadowing
    • ▫ Focal hyperechoic/anechoic = necrosis or hemorrhage (painful)
    • ▫ Doppler- low restive flow >> normal spoke and wheel pattern
    • *predominantly solid mass >> uterine in origin*
    • *predominantly cystic mass >> ovarian in origin*
  12. Describe the clinical symptoms and sonographic patterns associated with endometrial polyps.
    • a. Symptoms:
    • ▫ Generally asymptomatic
    • ▫ Slight risk of malignancy post menopausal
    • b. Pattern:
    • ▫ Best visualized in periovulatory
    • ▫ Worst in secretory… sonohysterography or 3d ultrasound may help
  13. Describe the clinical symptoms and sonographic patterns associated with endometrial hyperplasia.
    • ○ Due to excessive hormonal stimulation, most common in 30-40yo age group
    • a. Symptoms:
    • ▫ most frequent cause of uterine bleeding
    • b. Pattern:
    • ▫ Diffuse homogeneous/ sometimes inhomogeneous
  14. Describe the clinical symptoms and sonographic patterns associated with endometrial carcinoma.
    • ○ 90% of uterine malignancies are endometrial
    • ○ Increased incidence after age 50
    • a. Symptoms:
    • * Most frequent- post menopausal bleeding*
    • Abnormal CA-125
    • b. Pattern:
    • ▫ Early- focal irregularity and myometrial distortion
    • ▫ abnormal EC/ myometrial junction >> halo sign
    • ▫ Late- may obstruct EC
    • ▫ Cervical invasion >> stage II
  15. Describe the clinical symptoms and sonographic patterns associated with Gartner duct cysts.
    • * Congenital condition- remnant of the Wolffian duct *
    • Series of tiny vestigial and epithelial cysts extending from broad ligament to vagina
    • i. Symptoms: ?
    • ii. Pattern:
    • ▫ Sizeable, located in anterior lateral vaginal wall
    • ▫ May become infected
    • ▫ If large enough, can obstruct vagina
  16. Describe the clinical symptoms and sonographic patterns associated with Nabothian cysts.
    • Result of cervicitis, retention cysts
    • i. Symptoms:
    • ▫ Asymptomatic and generally insignificant
    • ii. Pattern:
    • ▫ ≤ 3cm cyst
  17. 8. Describe the clinical symptoms and sonographic patterns associated with cervical carcinoma.
    • * 2nd to endometrial CA in incidence
    • * ~45-55 yo
    • i. Symptoms:
    • ▫ Pelvic exam- lesions seen
    • ▫ Possible positive vaginal cytology
    • ▫ Late sign- bladder/ rectal dysfunction
    • ii. Pattern:
    • ▫ Solid retro vesicular mass similar to cervical fibroids
  18. Describe the clinical symptoms and sonographic patterns associated with cervical fibroids.
    • i. Symptoms:
    • ▫ Myoma-previa >> obstruction of birth canal
    • ii. Pattern:
    • ▫ Focal hyperechoic mass with discrete boarders

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