Chapter 12 and 39- female pelvis scanning protocol

acoustic window, 3.5, 5

A transabdominal approach requires a full bladder to use as an _______ and typically necessitates the use of a _____ to _____ MHz transducer.

luteal phase

After ovulation, the ovary enters the _______. This phase begins with ovulation and is about 14 days in length

fibria, infundibulum

Although many follicles develop, only one matures completely that will release a mature ovum at ovulation. When the follicle ruptures and the mature ovum is expelled into the peritoneal cavity, the ______ of the uterine tube draw the released egg into the _______.

empty bladder, 7.5, 10

An endovaginal exam is performed with an _______ and allows the of a higher frequency transducer, _____-_____ MHz

abnormal

Any fluid found in the anterior cul de sac, Morison's pouch, or lateral pelvic recesses or a large collection of fluid in the posterior cul de sac is considered ______

no

Are pelvic ligaments routinely identified sonographically?

no

Are ureters usually identified sonographically?

progesterone, human chorionic gonadotropin, 3

As ______ levels decline, menstruation occurs and the cycle begins again. Should conception and implantation occur, _______ produced by a zygote causes the corpus luteum to persist. It will continue to secrete progeterone for ____ months until the placenta takes over

estrogen, graafin follicle, 2 cm

As ovarian follicles grow, they fill with fluid and secrete increasing amounts of ______. Typically 5-8 preantral follicles begin to develop and only one reaches maturity each month. A mature follicle is known as a ________ ; typically ____ in size right before ovulation

false pelvis

As the bladder fills with urine, the dome can extend superiorly into the _____

16, 18, 1

Bladder shape is variable depending on distention; it can hold as much as ___ to ___ oz of urine. The normal distended urinary bladder wall measures __cm or less

radial

Blood is supplied to the endometrium by the _____ arteries that radiate from the arcuate arteries within the myometrium

primary oocyte

By the onset of menses, each ovary contains thousands of undeveloped follicles, each composed of a single ______

14

Day ___ of the menstrual cycle is when ovulation usually occurs.

follicular, proliferative

Days 1-4 of the menstrual cycle correspond to the ______ of the ovaries and menses and the _______ of the uterine endometrium

luteal, secretory

Days 15-28 of the menstrual cycle correspond to the _______ phase of the ovaries and the ______ of the uterine endometrium.

no

Do the ovaries ever move in front of the uterus or broad ligaments?

1, 14, follicle-stimulating hormone, secondary follicle

During the follicular phase ( days ____-____), ________ is released by the pituitary gland to initiate the development of several primary ovarian follicles. As each primary follicle grows, its oocyte reaches a mature size. At this stage of development, the oocyte and surrounding structures are referred to as ______.

corpus luteum, 9, 11, corpus luteum

During the luteal phase, cells in the lining of the ruptured ovarian follicle begin to multiply and create the ______, or yellow body, which immediately begins secreting progesterone. ____-____ days after ovulation, the _____degenerates, causing progesterone levels to decline

ovulation

During the menarchal years, an ovum is released once a month by one of the two ovaries. This process is known as _______.

transverse abdominus, transverse abdominus

Each ______ muscle forms the anterolateral borers of the abdominopelvic cavity. the muscular sheath around each rectus abdominus muscle fuses with the ________ muscles to form the tendinous linea alba at the midline.

broad ligament

Each _______ extends between the uterine cornu and ovary.

anterior

Each ovary is _____ to a ureter and internal iliac artery

iliacus

Each psoas muscle joins an _____ muscle at the level of the iliac crests to form the iliopsoas muscles that travel anteroinferiorly to insert into the lesser trochanter of the femur

broad ligaments

Each uterine tube, round ligament, ovarian ligament, and vascular structures of the uterus and ovaries are positioned between the two layers of the ________. These structures are surrounded by fat and connective tissue, called parametrium.

proliferative, estrogen, endometrium

Following menses, the endometrium goes into the ______ phase that lasts until day 14 of the menstrual cycle. During this phase, ovarian follicles contain cells that begin to release the hormone ______, which initiates the thickening and swelling of the _______ in preparation for implantation by a fertilized ovum.

corpus luteum, corpus luteum, progestrone

Following ovulation, the ruptured follicle fills with blood and is called the ______. This begins the ovarian luteal phase and the endometrial secretory phase of the menstrual cycle. The ______ transforms into an endocrine gland and secretes the hormone _____, which promotes glandular secretions of the uterine endometrium further preparing it for implantation by a fertilized ovum.

estrogen, progesterone, follicular

In the absence of fertilization, _____ and ____ levels diminish and a new menstrual cycle starts on day 1 with menses of the endometrium and the beginning of the ovarian ______ phase.

yes

Is it normal to observe a small accumulation of free fluid throughout the menstrual cycle in the posterior cul de sac?

yes

Is it normal to see a small amount of fluid in the posterior cul de sac?

transabdominal, endovaginal

It is generally recommended that a complete pelvic exam consist of a ______ scan followed by an _______

1, 5

Menses generally occurs during days ___-_____ of the menstrual cycle. The thickened, superficial layer of the endometrium is shed when fertilization of an ovum does not occur.

14

Menstruation almost always occurs ___ days after ovulation

10, 12, 1.4

Normally, each kidney has one ureter that travels inferiorly through the retroperitoneum for ____ to ____ in from the renal hilum to the posterior portion of the bladder. The ureters are less than ____ in wide and decrease in diameter as they course toward the bladder

space of retzius

Retropubic space, also called ________ is located between the anterior bladder wall and the pubic symphysis

follicle stimulating hormone

Secretion of _______ by the anterior pituitary gland causes ovarian follicles to develop during the first half of the menstrual cycle

anterior pituitary gland

Secretion of follicle stimulating hormone by the _______ causes ovarian follicles to develop during the first half of the menstrual cycle

uterine, ovarian

The _____ artery and ______ artery are routinely evaluated with Doppler

uterine

The _____ artery gives off many branches that perforate the serosa and carry blood to the myometrium

sigmoid colon

The _____ is continuous with the descending colon in the lower left quadrant of the pelvis and is loosely secured to the posterior pelvic wall.

pelvis

The _____ is that part of the peritoneal cavity extending from the iliac crests superiorly to the pelvic diaphragm inferiorly

isthmus

The _____ is the transition point between the body of the uterus and the cervix. It is the point where the uterus bends anteriorly or posteriorly with an empty bladder.

fundus

The _____ is the widest and most superior portion of the uterus

piriformis

The _____ muscles are situated in the posterior region of the true pelvis behind the uterus

follicular phase

The _____ of the ovulatory cycle begins with the first day of menstrual bleeding and continues until ovulation on day 14

body

The _____ of the uterus lies between the fundus and the cervix and is the largest portion of the uterus

corpus, body

The _____ or _______ is the largest part of the uterus that is continuous with the uterine cervix

vesicouterine space

The _____ or anterior cul de sac is anterior to the fundus of the uterus between the urinary bladder and uterus

pituitary gland, ovaries

The ______ and _____ secrete hormones that control changes in the ovary and the uterine endometrium throughout the menstrual cycle. The changes in the ovary correlate to the changes in the endometrium.

ureters

The ______ are small muscular tubes that are part of the urinary system that conveys urine from the kidneys to the urinary bladder

pelvic diaphragm

The ______ is a group of muscles lining the floor of the true pelvis to support the pelvic organs.

uterus

The ______ is a muscular, hollow organ where the fertilized ovum embeds and the developing embryo and fetus are nourished.

vagina

The ______ is a reproductive organ that is part of the genital tract.

true pelvis

The ______ is the region deep to the linea terminalis

isthmus

The ______ is the slightly constricted portion of the uterus where the uterine body meets the uterine cervix

fundus

The ______ is the widest and most superior segment of the uterus that is continuous with the uterine corpus

space of retzius

The ______ or prevesical or retropubic space isa fascial space between the anterior bladder wall and pubic symphysis

fallopian tubes, uterine tubes

The ______, ______, or oviducts are coiled muscular tubes that open into the peritoneal cavity at their lateral end.

broad ligaments

The _______ are the only pelvic ligaments routinely identified monographically.

urinary bladder

The _______ is a symmetrical, hollow, muscular organ. It is part of the urinary system and serves as a reservoir for the urine that is formed in the kidneys

vesicouterine recess

The _______ is also known as the anterior cul de sac; it is found anterior to the fundus of the uterus between the urinary bladder and the uterus.

rectouterine pouch

The _______ is located posterior to the uterus between the uterus and rectum; it is often referred to as the Pouch of Douglas and is normally the most posterior and inferior region of the peritoneal cavity

false pelvis

The _______ is the area superior to the linea terminalis and inferior to the iliac crests

endometrium

The _______ is the glandular portion of the uterine body

cervix

The _______ is the lower cylindrical portion of the uterus that projects into the vagina.

retropubic space

The _______ is the space between the anterior bladder wall and the pubic symphysis. It is also known as the Space of Retzius

obturator internus

The _______ muscles line the lateral walls of the true pelvis

posterior cul de sac

The _______ or rectouterine pouch, or pouch of Douglas is the most posterior and dependent portion of the peritoneal sac. It is located between the rectum and uterus

anterior cul de sac

The _______ or vesicouterine pouch, is a shallow peritoneal space located between the anterior wall of the uterus and urinary bladder. This space all but disappears as the urinary bladder fills with urine

endovaginal examination

The _______ usually offers a more detailed study but is limited in its field of view of penetration

common iliac

The ________ arteries course anterior and medial to the psoas muscles, providing blood to the pelvic cavity and lower extremities

linea terminalis

The ________ is an imaginary line drawn from the symphysis pubis around to the sacral promontory.

rectouterine space

The ________ is ofter referred to as the pouch of douglas and is normally the most inferior and posterior region of the pelvic cavity

transabdominal

The ________ offers a wider field of view for a general screening of the pelvic anatomy.

shadow, ovary, peristalsis

The appearance of the rectosigmoid colon varies according to content, but typically the sigmoid colon and the rectum contain gas and fecal matter that cast a posterior acoustic ________. Collapsed bowel can mimic an _______, however observation of _______ allows differentiation.

posterior, superior, anterior

The body of the uterus is _______ to the vesicouterine pouch and _____ to the surface of the bladder, ______ to the rectouterine pouch, ileum, and colon

retroverted

The broad ligaments may be identified if the uterus is _______.

uterine tube

The central cavity of the uterus opens into a _______ on either side and into the vaginal canal below

2, 4

The cervical portion of the endometrial canal extends from ____ to ____ cm from its internal os at approximately the same level as the isthmus, where it joins the joins the endometrial canal to its external os, which projects into the vaginal canal

internal, external

The common iliac arteries normally bifurcate into the _____ and _____ iliac arteries

luteinizing hormone, luteinizing hormone, corpus albicans

The corpus luteum depends on _______ to continue to produce progesterone, but ironically, progesterone levels inhibit ______ production. Consequently, the corpus luteum regresses and only a fibrous tissue mass called a ________ remains in the ovary.

true pelvis, false pelvis

The descriptive compartments of the pelvic are the _____ and _____

internal os, external os

The endocervix communicates by the ______ with the uterine canal and with the vagina by the ________

secretory, 15, 28, luteal, endometrium, estrogen, progesterone

The endometrial phase after ovulation is referred to as the ______ phase. It occurs from days ___ to _____, and corresponds with the _____ phase of the ovarian cycle. During this phase, the ruptured follicle becomes the corpus luteum which secretes progesterone, leading to the thickening of the _______. If there is no pregnancy, ____ and ____ decrease

functional layer, basal layer

The endometrium consists of 2 layers: 1. _______- superficial layer of glands and stroma (supporting tissue) that shed with menses) 2. _______- thin layer of the blind ends of endometrial glands that regenerate new endometrium after menses

functional layer, basal layer

The endometrium is composed of two layers: 1. ________- increases in size during the menstrual cycle and partially sloughs off during menses 2. _______- composed of dense stroma and mucosal glands; not significantly influenced by the menstrual cycle

10, 12, 1, 4

The fallopian tubes are approximately ___ to ____ cm in length and ____ to ___ mm in diameter

infundibulum, ampulla, isthmus, interstitial

The fallopian tubes are divided into 4 anatomic portions:

fundus, body, isthmus, cervix

The four parts of the uterus are:

rectus abdominus

The large pair of ______ muscles extend from the sixth ribs and xiphoid process of the sternum down to the pubic symphysis

7, 12, 3mm

The length of the uterine tubes varies from ___ to ___ cm. Their widest diameter is approximately ____

vagina, uterus

The lining of the _____ and _____ enclose a continuous cavity or channel through which the fetus passes at birth

hypothalamus, estrogen, progesterone

The menstrual cycle is regulated by the ______ and is depended on the cyclic release of _____ and _____ from the ovaries

28

The menstrual cycle usually follows a _____ day course, during which a single ovum reaches maturity and is released into the genital tract.

hypoechoic

The muscles of the pelvis appear ______ relative to pelvic organs and exhibit the same low-gray sonographic muscular pattern seen from other muscles throughout the body.

medulla

The ovarian _____ is composed of connective tissue and contains nerves, blood, lymph vessels, and smooth muscle at the hilus region

cortex, tunica albuginea

The ovarian ______ consists of follicles and is covered with the _________

adnexa

The ovaries are located in the ______ (the peritoneal cavity spaces located posterior to the broad ligaments) within the true pelvis

ovum, estrogen, progesterone

The ovaries produce the reproductive cell, the _____, and two known hormones: ____ and _____

cortex, medulla

The ovary is composed of an outer _____ and a central _______

psoas major

The paired _____ muscles extend from the lateral aspects of the lower thoracic vertebrae anterolaterally across the posterior wall of the abdominopelvic cavity to the iliac crests.

two

The peritoneal cavity contains ____ potential spaces formed by the caudal portion of the parietal peritoneum. These potential spaces are significant in that fluid may accumulate or pathology may be present in these locations.

proliferative, estrogen

The phase of endometrial regeneration is called the ______ phase, and it lasts until the luteinization of the Graafin follicle occurs around ovulation. Days 5-14, increasing _____ levels leads to the regeneration of the functional layer; This coincides with the follicular phase of the ovary

lateral

The position of the ovaries is variable, but they typically lie ______ to the uterus, against the pelvic sidewalls.

ovarian, abdominal aorta

The primary blood supply to the ovaries is from the ______ arteries which arise from the lateral aspect of the _______ below the renal arteries

hypothalamus

The process of ovulation is regulated by the _______ within the brain

posterior cul de sac

The rupture of the Graafin follicle is associated with a small amount of fluid in the _________ midcycle

3, 2.5, 5, 1.5, 3, .6, 2.2, 9.8, 5.8

The size of the ovaries varies depending on patient age, phase of menstrual cycle, and menstrual status: 1. prepubertal: the ovaries are relatively large at birth with little change until age 5 or 6, when are related grown associated with cystic function are seen. Approximate ovarian volume= ______ mL 2. postpubertal- approximately ____-____ cm long, ____-_____cm wide, and _____ -_____ cm thick, with a mean ovarian volume of _____ mL 3. postmenopausal- mean ovarian volume of ____mL

2.5 cm, 2 cm, 1 cm, cervix, 7, 8, 3, 5, 3, 5, 8.5, 5, cervix

The size of the uterus is variable depending on patient parity and age: 1. prepubertal- size is approximately _____ long, _____ wide, and _____ thick. The ______ comprises a significantly greater proportion of the organ 2. postpubertal, nulliparous- size is usually ____ to ____ cm long, ___ to ____ cm wide, and ___ to ____ cm thick 3. multiparous- uterine mean dimensions are usually ______ cm long and ____ cm wide 4. postmenopausal- size significantly decreases and the uterus assumes prepubertal shape where the _____ comprises the greater portion of the uterus

linea terminalis

The true and false pelves are based on an oblique plane in the pelvis defined by the ________

germinal epithelium

The tunica albuginea of the ovary is surrounded by a thin layer of ________

anechoic

The urinary bladder cavity is not seen if it is collapsed; distended with urine, it appears ______ with bright, reflective walls.

posterior, anterior

The urinary bladder is fixed inferiorly at its base in the true pelvis, directly _____ to the symphysis pubis and _____ to the uterus and vagina

coronal, sagittal

The uterine cavity is funnel shaped in a ______ plane, and slit-like in a _____ plane

true

The uterus is located in the mid-region of the _____ pelvis between the urinary bladder (anteriorly) and rectum (posteriorly)

four

The uterus is pear shaped and descriptively divided into ____ parts

levator ani, cardinal, uterosacral

The uterus is supported by _____ muscles, _____ ligaments, and _____ ligaments

anteflexed, anteverted

The uterus is usually _____ or _____

forward

The uterus normally tilts _____, resting on the dome of the bladder.

cervix

The vagina extends from the external genitalia to the ____ of the uterus

mucosal, smooth muscle, adventitia

The vagina is a muscular, tubular organ with walls composed of 3 layers: 1. inner _______ lining of epithelial cels 2. middle thin, _______ wall 3. outer _______

true

The vagina is located in the mid-region of the ______ pelvis between the urinary bladder (anteriorly) and the rectum (posteriorly).

9

The vaginal canal is approximately ____ cm long

estrogen, progesterone

The varying levels of _____ and _____ throughout the course of the menstrual cycle induce characteristic changes in the endometrium.

luteinizing hormone, endometrium, glycogen

Throughout the menstrual cycle, _____ has been released by the pituitary gland to stimulate the ovaries to secrete estrogen and progesterone. The concentration of estrogen and progesterone promote continued thickening of the ________. In addition, exocrine glands of the endometrial lining produce a _______-rich mucus to help prepare a suitable environment for implantation.

1, 5, progesterone

Typical endometrial cycle can be described in 3 phases, beginning with the menstrual phase: Lasts approximately ___ to ___ days, and begins with declining ____ levels. This causes decreased blood flow to the endometrium resulting in the shedding of some of the zona functionalis

pathology

Ureters are clinically significant in the female pelvis because pelvic _____ can cause obstruction of the ureters and ultimately affect the kidneys

interstitial, isthmus, ampulla, infundibulum

Uterine tubes are descriptively divided into 4 segments: 1. _______- the narrowest segment, which is enclosed by the uterus 2. ________- adjacent to the uterine wall, connected to the interstitial segment. This segment is a short, straight, narrow portion of the tube that widens laterally, to form the ampullary and infundiblular segments 3. ______- the coiled and longest segment where fertilization usually occurs 4. ______- the widest and funnel-shaped end of the tube that opens into the peritoneal cavity adjacent to the ovary. Fringe-like extensions of the infundibulum called fimbria, overlie the ovary and direct the released ovum into the tube

intraperitoneal

Uterine tubes are not routinely identified sonographically unless they become outlined by free _________ fluid.

endometrium, myometrium, serosa

Uterine walls are composed of 3 layers: 1. _____- inner mucosal layer that encloses the uterine cavity, that is continuous with vaginal epithelium inferiorly. 2. ______, middle, smooth muscle layer that forms the bulk of the uterus 3. _______- outer peritoneal layer is a thin membrane that completely covers the myometrium

iliacus

What muscle forms the pelvic side wall?

psoas major

What muscle stretches from the lumbar spine to the anterior side wall?

piriformis

What muscle stretches from the sacrum to the posterior pelvis?

obturator internus, coccygeus

What muscles forms the pelvic floor?

round ligaments

______ hold the uterus i anteverted position

ovulation

______- explosive release of ovum from ruptured graafin follicle

ovaries

_______ are paired, bilateral, almond shaped female reproductive organs in which ova are formed

bicornate uterus

a normal developmental variant causing two uterine bodies (divided) or two uterine horns (septated) with one vagina and one or two cervices

didelphia uterus

a normal developmental variant causing two uterine bodies, two cervices, and two vaginas

menorrhagia

abnormally heavy or long periods

oligomennorrhea

abnormally short or light periods

amenorrhea

absence of menstruation

progesterone

hormone that helps to prepare and maintain the endometrium

luteinizing hormone

hormone that stimulates ovulation

follicle stimulating hormone

hormone that stimulates the growth and maturation of the graafian follicles

polymenorrhea

menstrual cycle occurs at intervals of less than 21 days

mittelschmerz

midcycle dull ache on either side of the lower abdomen

dysmenorrhea

painful menstrual cycle

cumulus oophorus

protrusion within the graafian follicle containing the oocyte

menopause

refers to the cessation of menses

anteflexed

the bladder is empty, the cervix and vagina form a 90 degree angle and the corpus and fundus are bend anteriorly until the fundus points inferiorly and rests near the cervix

anteverted

the bladder is empty, the cervix and vagina form a 90 degree angle and the corpus and fundus are tilted anteriorly

retroflexed

the bladder is empty, the corpus and fundus are bent posteriorly until the fundus is adjacent to the cervix and pointing inferiorly. The cervix and vagina are linearly oriented

retroverted

the bladder is empty, the corpus and fundus are tilted posteriorly until the cervix and vagina are linearly oriented

premenarche

the physiologic status of prepuberty, the time before the onset of menses

menarches

the state after reaching puberty in which menses occurs every 28 days

oligomenorrhea

time between monthly menstrual cycles exceeds 35 days