Ch. 5 normal anatomy of the female pelvis

What are the four most common uterine positions?

1. Anteflexed 2. Anteverted 3. Retroflexed 4. Retroverted

The pelvic diaphragm consists of what muscles?

1. Coccygeus muscle 2. Levator Ani group

What are the 5 pelvic organs?

1. External genitalia 2. Unitary bladder and urethra 3. Uterus, Fallopian tubes, and vagina 4. The ovaries 5. The colon and rectum

What does the cortex of the ovaries consist of

1. Follicles in various stages of development 2. Tunica albuginea

What are the four segments of the uterus?

1. Fundus 2. Body or corpus 3. Isthmus 4. Cervix

What are the three key descriptions of pelvic muscle appearance on US

1. Hypoechoic compared to fat or smooth muscle 2. Linear internal echos that show the muscle fiber bundles 3. Echogenic fascia and retroperitoneal fat outline the boarders

What are the four portions of the Fallopian tubes?

1. Interstitial/intramural 2. Isthmus 3. Ampulla 4. Infundibulum

What 3 things make ultrasound one of the most popular imaging modalities?

1. Non ionizing radiation 2. There are two approaches 3. High resolution images

What are the three layers of the bladder, and which layer is not visible on sonography?

1. Outer layer: serosa layer. NOT VISIBLE ON SONOGRAPHY due to thinness and intimate contact with adjacent layers of fascia and fatty tissue 2. Middle layer: muscularis or detrusor muscle. Thick layer with smooth muscle fibers 3. Inner layer: mucosa. VERY echogenic

What 3 tissue layers make up the uterus?

1. Perimetrium 2. Myometrium 3. Endometrium

What are the 3 principle functions of the female pelvis?

1. Provides weight bearing bridge between the spine and the lower limbs 2. Directs the pathway of the fetal head during childbirth 3. Protects reproductive and other pelvic organs

Postmenopausal normal mean ovarian volume

5.8cm^3

Premenopausal Volume of an Ovary

6-9cm^3

Describe the vaginal canal?

7-10 cm or smooth muscle

Average length of the Fallopian tubes

7-14 cm (don't usually see on a US)

Hypoechoic

Appears darker on US

adnexa

Area around an organ

orthogonal

At right angles (perpendicular)

Anteflexion

Bending of the fundus toward the abdominal wall

retroflexed uterus

Bending of the fundus toward the rectum

What is the frequency range for endovagional transducers?

Between 5 and 9 MHz

Where is the urinary bladder located?

Between the symphysis pubis and the vagina

B

Bladder

What is the only ligament seen with ultrasound? And under what conditions can it be seen in?

Broad ligament BUT is only seen when ascites is present

What is the normal sonographic appearance of an ovary?

CHOCOLATE CHIP COOKIES Smooth despite follicles Homogenous echotexture May exhibit small more echogenic medulla Small anechoic or cyclic follicles may be seen in the Cortex

Which ligament connects the cervix to the lateral pelvic wall?

Cardinal ligament

What does the central medulla layer of an ovary consist of?

Connective tissue containing blood, nerves, and lymphatic vessels

What are the two layers of the ovary?

Cortex- outer layer Medulla- inner layer

Cervix

Cylindrical projection into the vagina that secretes an alkaline secretion that helps with sperm penetration Acts as a sphincter during pregnancy Usually around 3cm

Describe a newborn uterus

Different ratio than normal adult proportions: 2/3 cervix and 1/3 body and fundus. The cervix is larger than the body and fundus

Fimbriae function

Direct the ovum into the Fallopian tube following ovulation

What is the main function of the broad ligament?

Divides the true pelvis into anterior and posterior compartments

What are the pros for EVS sonography?

EVS (endovaginal) techniques allow higher frequency transducers, thus increasing the detail because of the close proximity to pelvic organs.

ascites

Excessive free fluid

Which "pelvis" supports the intestines?

False pelvis

What provides optimal imaging for the transabdominal exam?

Filled urinary bladder AND Curvilinear broadband transducer in the 3-5 MHz range

infundibulum

Fimbrae at the end that maintain close relationship with the opening of the tube and the ovary

How do you calculate a cervical measurement?

Finding the measurement from the internal Os to the External Os

Follicle

Fluid filled structure of an ovary which an egg develops before ovulation

Ante

Forward

What frequency setting does transvaginal imaging use?

High frequency transducer

Follicle-stimulating hormone (FSH)

Hormone that stimulates growth and maturation of the ovarian Graafian follicle. The anterior pituitary gland secretes the hormone

How will the deeper, permanent basal layer of the endometrium of the uterus appear sonographically?

Hyperechoic and will remain thin

How do skeletal muscles appear on an ultrasound?

Hypoechoic compared to fat or smooth muscle Exhibits linear internal echos outlining the muscle bundles (looks like striations on a muscle)

What pelvic muscles occupy the false pelvis?

Iliacus

What muscles make up the levator ani group?

Iliococcygeus Pubococcygeus Puborectalis

Where is endometriosis usually located?

In the ovaries

hypertrophy

Increase in size

What are the characteristics of a low frequency setting?

Increased depth, decreased resolution

What are the characteristics of a high frequency transducer?

Increased resolution, decreased depth

What part of the uterus marks the transition between the body and the cervix of the uterus?

Isthmus

Describe Fallopian tube width

It widens as it moves away from the uterus

LA

Levator Ani muscles

What is the location of the piriformis muscle?

Located deeply posterior in the true pelvis LESS ROUTINELY IMAGED DUE TO ITS DEEP LOCATION

Interstitial/intramural

Located within the uterine wall or within the Cornu Lumen is approx. 1mm MOST NARROW PORTION OF THE FALLOPIAN TUBE

What frequency setting is used with transabdominal pelvic imaging?

Lower frequency settings

Ampulla

Lumen approx. 6mm, the widest of the Fallopian tube. Curves around the ovary Normal site of Fertilization

Calculation for volume of an ovary

LxWxH/2= volume in cm^3

Isthmus

Medial portion Closest to the uterus

What ligament attaches the ovary to the posterior layer of the broad ligament?

Mesovarian ligament (like a part of the broad ligament)

What pelvic muscles occupy the true pelvis?

Obturator internus Piriformis Coccygeus Levator ani

OI

Obturator internus muscle

Which muscle can be easily mistaken for ovaries on US?

Obturatur internus muscle

Internal Os

Opening from the cervix into the uterus

External Os

Opening from the cervix into the vagina

Which ligament can you use to sometimes help you find the ovaries?

Ovarian ligament aka utero-ovarian ligament

What are the four uterine layers from outer to inner?

Papa Mama Baby Fetus Perimetrium Myometrium Basilis layer of the endometrium and Functionalis layer of the endometrium

What are fornices?

Portion of the vagina around the cervix that creates gutters

What ligament do the ovaries attach to?

Posterior aspect of the broad ligament

What is the most common site for pelvic fluid to collect?

Posterior cul-de-sac

What space lies between the uterus and the rectum?

Posterior curl-de-sac AKA pouch of Douglass

What is an alternate filling method to achieve a full bladder?

Preexisting Foley catheter

What three muscles form the iliopsoas muscle?

Psoas major Psoas minor iliacus

Describe an adult uterus ratio

Ratio: 1/3 cervix and 2/3 body and fundus

R

Rectum

Which muscle forms most of the anterior body wall?

Rectus abdominus

What pelvic muscles occupy the abdomnopelvic region?

Rectus abdominus Psoas major

What is one of the most common complaints of pain during pregnancy?

Round ligament pain

What 4 bones form the osseous pelvis?

Sacrum Coccyx Two large innominate bones (fusion of ilium, is hum, and pubic bones)

What scan plane is best to use to determine muscle?

Sagittal

What space lies between the pubic symphysis and the bladder?

Space of Retzuis AKA retropublic or previssicle space

What is the benefit of TAS sonography?

TAS (transabdominal) scanning uses LOWER frequency settings which results in GREATER depth of an atomic coverage

What is the space that lies between the uterus and the bladder?

The anterior cul-de-sac AKA vesicouterine space

What is the uterine Cornu?

The area where the uterus starts to form into the fallopian tubes

Which layer of the uterus will remain constant though the menstrual cycle and which layer of the uterus will change through the menstrual cycle?

The basal layer of the endometrium will remain constant and the functionalis layer of the endometrium will change as it sheds through the menstrual cycle

Body or corpus of the uterus

The main portion of the uterus

Which fornix is a frequent site of vaginal fluid build up?

The posterior fornix BECAUSE OF GRAVITY. the pt. Lies down, fluid builds in the posterior fornix

Which fornix is bigger, the posterior fornix or the anterior fornix?

The posterior fornix. the anterior fornix is smaller than the posterior fornix. (think: the posterior fornix has to be big enough to catch all that fluid!)

What muscle does the psoas major muscle merge with, and what muscle does this merge create?

The psoas major merges with the iliacus muscle which forms the iliopsoas muscle

Homogenous

The same

What is the con to TAS sonography?

The use of lower frequency results in decrease a atomic resolution

How many fornices are there and what are they called? THINK IN 3D WITH THIS

There are 4 fornices 1. Anterior fornix - surrounds the anterior aspect of the external cervix 2. Posterior fornix- surrounds the posterior aspect of the external fornix 3. Lateral fornix 1- surround the lateral aspect of the external fornix on either side 4. Lateral fornix 2- surround the lateral aspect of the external fornix on either side

anteversion

Tipping of the entire uterus toward the anterior abdominal wall. USUAL POSITION OF THE UTERUS WHEN THE BLADDER IS EMPTY

Retroverted uterus

Tipping of the entire uterus toward the sacrum

What is the purpose of the uterosacral ligament?

To provide posterior support to the uterus. Attaches posterior uterus to anterior sacrum

What is the purpose of the cardinal ligament?

To provide support to the uterus and cervix on either side

Isthmus

Transition from the corpus to the cervix

What is the function of Fallopian tubes?

Transport fertilized ovum to the uterus through peristaltic contractions

What "pelvis" can both the coccygeus and the levator ani muscles be found in?

True pelvis

What tissue covers the cortex of the ovary

Tunica Albuginea- a dense connective tissue

What are the outer arteries of the Uterus?

U Are Really Smart Uterine, Arcuate, Radial, Spiral

fundus of the uterus

Upper expanded portion of the uterus between the Fallopian tubes. Round or domed shaped

U

Uterus

What is considered abnormal volume of an ovary

Volume of more than TWICE that of the OPPOSITE side is considered abnormal regular doses of actual size

When is the bladder considered adequately full for sonography?

When the dome of the bladder extends above the uterine fundus

multiparous

a woman who has given birth two or more times

Retro

backward

nulliparous

female who has borne no offspring

What is the imaginary line that separates the true and false pelvis?

linea terminalis

Contralateral

opposite side

What bones form the posterior wall of the pelvis?

sacrum and coccyx

Ipsilateral

same side