Ovaries and Fallopian tubes

Ovaries are ____ organs that have dual blood supply from both the ____ artery and ovarian branches of the ____ arteries.

Ovaries are intraperitoneal organs that have dual blood supply from both the ovarian artery and ovarian branches of the uterine arteries. Ovaries may be located everywhere throughout the true pelvis, excluding the posterior cul-de-sac

Serous cystadenocarcinomas account for ___-___ % of all malignant ovarian tumors • Normally occur in ____ women

40-50% of malignant ovarian tumors normally occur in post-menopausal women

Mucinous cystadenocarcinomas account for __-__% of all malignant ovarian tumors • Normally occur in females in the ___-___ year age group.

5-10% of all malignant ovarian tumors normally occur in females in the 40-70 year age group

A hemorrhagic ovarian cyst can have various appearances due to ? More often has a ___/___ appearance Can present a "___ of ___"

A hemorrhagic cyst can have various appearances depending on the age of the bleed. Most often appears complex or completely echogenic depending on the hemorrhagic component present and the stage of lysis. Weblike or lacy appearance. ring of fire

Clinical findings of follicular cyst? Sono findings of follicular cyst?

Clinical Findings of Follicular Cyst: - Asymptomatic - Pain associated with hemorrhage and enlargement of cyst Sono Findings of Follicular Cysts: - Simple cyst- smooth, round borders, anechoic, posterior enhancement - Hemorrhagic cyst- variable appearance, including complex components or entirely echogenic, depending on the amount of blood and the stage of lysis.

Clinical findings of Serous Cystadenoma? Sono findings of Serous Cystadenoma?

Clinical: - often asymptomatic, but may present with weight gain or bloating Sono: - large predominantly anechoic mass that contains septations or papillaryprojections

Clinical findings of Mucinous Cystadenoma? Clinical findings of Serous Cystadenoma?

Clinical: - pelvic pressure and swelling since larger Sono: - large predominantly anechoic mass that contains septations and papillary projections. - May sometimes contain echogenic layering debris.

Clinical findings of Cystic teratoma (Dermoid cyst)? usually found in what population?

- Often asymptomatic - If torsion or rupture occurs, the patient may present with acute pelvic pain -Usually found in females of child-bearing age

Sono findings of Cystic Teratoma? (dermoid) Signs?

-Complex, partially cystic mass in the ovary that includes one or more echogenic structures that may shadow - "Tip of the iceburg" sign, only the anterior element of the mass is seen, while the greater part of mass is obscured by shadowing - Dermoid plug- produces posterior shadowing - Dermoid mesh- produced by hair and will appear as numerous linear interfaces within the cystic area of the mass.

Theca Lutein Cyst are not common, but are found in what two types of patients? what level will be elevated ? patients may suffer from ?

• Patients who are pregnant and have gestational trophoblastic disease (aka Molar pregnancy) OR • Patients undergoing fertility treatment Both groups of patients will have extremely elevated levels of hCG (like super elevated!) may suffer from hyperemesis (excessive N&V) and pelvic fullness.

Sono findings of Cystadenoma Carcinoma? Serous? Mucinous?

• Serous cystadenocarcinoma: - similar to benign version, but ascites also present • Mucinous cystadenocarcinoma: - Similar to benign version- Ascites also present- Pseudomyxoma peritonei may also be present (cancerous growth in appendix due to mucin in peritoneal cavity)

Ovaries: Days 1-14 is the ___ phase Days 15-28 is the ___ phase Endometrium (uterus) Days 1-14 is the ___ phase Days 15-28 is the __ phase

1-14: follicular phase (think: prepping follicles) 15-28: luteal (the hormone that causes the G follicle to pop out) 1-14: proliferative phase (think: the uterus is prepping for life) 15-28: secretory phase (think: if there is life, the uterus wants to secrete it)

Endometrioma/Chocolate Cyst is? benign or malignant?

Benign blood-containing tumor that is associated with endometriosis, and forms from the implantation of ectopic endometrial tissue. This tissue is functional, meaning that hormones of menstruation act on this tissue like it would the uterus, causing it to hemorrhage. - More commonly found on the ovary, but can be located anywhere outside endometrial cavity.

Ovarian Hyperstimulation Syndrome (OHSS) is?

Causes the ovary to become enlarged and contains multiple theca lutein cysts

Most common benign ovarian tumor?

Cystic Teratoma (Dermoid Cyst)

Early follicular phase (just after period) will present what type of vascularity flow? Late follicular phase? (just prior to ovulation)? Early luteal phase? (just after ovulation) Late Luteal phase ? (prepping to start process over with new follicles)

Early follicular phase- high resistance with absent or low diastolic velocity Late follicular phase- low resistance with increased end diastolic flow Early luteal phase- low resistance with increased end diastolic flow Late luteal phase- high resistance with absent or low end diastolic velocity

Endometriosis is? if that tissue hemorrhages, it will form? Commonly found where?

Endometriosis is the implantation of functional endometrial tissue outside the uterus. • This tissue hemorrhages and forms benign bloody tumors• These tumors are referred to as Endometriomas • Most commonly found adjacent to the ovaries.

If the dominant follicle fails to ovulate, it may continue to enlarge and form a ? Can range in size from __-___ Will follow normal characteristics of?

Follicular Cyst Normally range in size from 3-8 cm.• Follows the normal characteristics of a simple cyst.

Cystadenoma Carcinoma is?

Serous or Mucinous cystadenomas becoming malignant.

Serous cystadenomas are the more common of the two, comprising ___ of all benign ovarian neoplasms. • Mucinous less common, but are normally ____, and account for ___-___% of all benign ovarian tumors.

Serous, 30% Mucinous, larger, 20-25%

Paraovarian cyst is ? normally arise from? cause symptoms?

Small cysts located adjacent to, but not attached to the ovary • Normally arise from the broad ligaments • Normally asymptomatic.

Ovarian Torsion is? almost always caused by? Ovary itself will appear ? measures?

a twisting of the ovary that causes pain and ischemia. (cutting off blood supply) Almost always caused by a cyst or adnexal mass Torsed ovary will always be enlarged, measuring >5 cm.

Fallopian tubes travel within the __ ligament Proximal segment closest to? Distal segment closest to ?

broad uterus ovary

Ovulation normally occurs on day 14 when the dominant follicle ruptures. The dominant follicle converts to the ___ ___, (which if one is pregnant, this will stay throughout pregnancy)

corpus luteum

A follicular cyst that contains blood is referred to as a ?

hemorrhagic cyst

NORMAL sono appearance of ovaries? size depends on?

homogenous with medium to low level echogenicity. • Follicles of various size are seen in the reproductive years. • Size of the ovaries depends on the physiological state and age of the patient.

Landmark for ovary? seen better transvag or transabd?

landmark: Internal iliac artery/vein

ovary consists of outer medulla and inner cortex. Explain the functions

outer medulla: contains vasculature and lymphatics. Inner cortex: involves mass of ovary and is site of oogenesis.

Cystic Teratoma/ Dermoid Cyst results from? (hint: this sh*t is nasty)

retention of an unfertilized ovum that differentiates ovum into three germ cell layers. As a result of the combination of the three germ cells, it may contain a variety of material: • Hair • fat • bone• teeth

Cystadenomas can either be __ or ___ they are ? benign or malignant? Which is more common? Normally found in what age group?

serous or mucinous large benign tumors of the ovaries benign serous cystadenomas are more common 20s-40s

Clinical findings of ovarian torsion?

• Acute unilateral lower abdominal or pelvic pain • N & V • May be leukocytosis present

Sono findings of endometriomas?

• Appear echolucent with transabdominal scanning • Appear filled with low level homogenous echoes with endovaginal imaging, possibly posterior enhancement • Often may be multiple.

Fallopian tubes can be seen when they are become ___. Can be filled with simple serous fluid (____) • Or blood (____) • Or pus (____)

• Can be filled with simple serous fluid (hydrosalpinx) • Or blood (hematosalpinx) • Or pus (pyosalpinx)

Sono appearance of ovarian torsion?

• Enlarged ovary • lack of internal flow compared to other ovary • Free fluid • Presence of a mass separate from the ovary that is the actual culprit • Remember that ovary has a dual blood supply which can "muddy" the diagnosis.

Clinical findings of endometriomas? normally found in what age group?

• Patient may be Asymptomatic (rarely) • Pelvic pain • Infertility • Dysmenorrhea (painful menstruation) • Dyspareunia (painful intercourse) • Normally found in females of child bearing age (20-40)

Clinical Findings of Cystadenoma Carcinoma?

• Weight loss • Pelvic pressure or swelling • Abnormal vaginal bleeding • Elevated CA 125