Lecture 3 Fallopian and Ovaries

A saline infusion sonogram, (an SIS) is an ultrasound done

after a saline solution has been infused into the uterus. -used to detect uterine abnormalities such as polyps or cysts..

Identification of an ovary that is clearly separate from an adnexal mass is the single most helpful finding????

an abnormal or dilated fallopian tube versus a complex cystic ovarian lesion.

Ovaries are located anterior and medial to what vessels?

anterior and medial to the internal iliac vessels Also Secretes estrogen and progesterone in varying amounts throughout the menstrual cycle•

Ovarian Size

aries with the age/menstrual status of the patient Measurements for Normal Adult -Reproductive Years :2.5 -5 cm L1.5 -3 cm W.5 -2 cm H ( A.P.)

SALPINGITISIS INFLAMMATION OF THE UTERINE TUBES THAT IS USUALLY CAUSED BY

bacterial infection it can cause adhesions which may partially or completely block the lumen of the uterine tubes. This can potentially result in infertility or an ectopic pregnancy

The fertilized egg may not

be able to pass into the uterus, and can implant in the uterine tube.

Most common cause of salpingitis:

sexually transmitted diseases (gonorrhea or chlamydia) •Clinical symptoms: •Could be asymptomatic •Pelvic fullness or discomfort, pain, and/or a low-grade fever (signs of infection)

The normal fallopian tube appears

solid, separate from the ovary and isoechoic to the uterus

A sonohysterosalpingogram uses??

sterile saline and air, which is passed through the cervix into the uterus and visualized by transvaginal ultrasound.

An ectopic pregnancy is amedical emergency-if not diagnosed early,

the implanted blastocyst can cause rupture and hemorrhage of the affected tube.

layers of fallopian tubes

the mucosa, muscularis, and serosa.

If the lumen is partially occluded, sperm may be able to???

to pass through and fertilize the ovum.

Smooth muscle layer (muscularis) contracts (peristalsis) to assist with

transportation of the ova and sperm. Muscle is sensitive to sex steroids, and peristalsis is greatest when estrogen levels are high.

The cortex of the ovaries is covered by the _________.

tunica albuginea (dense connective tissue) and the Germinal epithelium -(thin layer of epithelial cells that cover the albuginea)

fallopian tubes

where fertilization takes place Paired structures ~10 cm long. (7-12) •Attached to superolateral aspects of uterus. •Usually run through broad ligament but may be found in the cul-de-sac. •Distal end terminates in finger-like fimbria that curve over the ovary.

EVALUATION OF PATENCY -HYSTEROSALPINGOGRAM (HSG)

•A hysterosalpingogram is an X-ray •Determines if fallopian tubes are blocked and where the blockage is located •This is the modality of choice to evaluate the fallopian tubes

SONOGRAPHIC EVALUATION OF THE OVARIES

•Mainly homogeneous with medium to low level echogenicity •Multiple follicles may be visualized in women of reproductive age

ECHOGENIC FOCI

•Occasionally tiny (<3 mm) echogenic foci are seen in the normal ovary •They are non-shadowing insignificant findings and do not need follow up.

estrogen and progesterone are responsible for what?

•Producing and maintaining secondary gender characteristics •Preparing the uterus for implantation of a fertilized ovum •Development of mammary glands

narrow section of the uterine tubes connecting the ampulla to the uterine cavity.

Isthmus

Because variations in ovarian measurements are so great,the sonographer may be required to obtain Ovarian Volume which is

Ovarian Volume Formula L x H x W x 0.523 = Volume per cm3 **Unless you are working on an OLD piece of equipment, most ultrasound machines will calculate the volume for you

•Secretes estrogen and progesterone in varying amounts throughout the menstrual cycle??

Ovaries.

The broad ligament is the major source of structural stability for the uterus and is primarily responsible for holding the uterus in a fixed position.

false

The fallopian tube functions to capture the released ovum from the ruptured ovarian follicle and provides a

hospitable environment for fertilization and subsequent transfer of the fertilized ovum to the uterus as it grows

If the dilated tube folds back on itself on fallopian tubes , the two inner walls will create the

incomplete septation sign

Internally, adjacent to each developing gonad, are two primitive ducts

(Wolffian or Mullerian) that can give rise to either the male or the female reproductive tracts.

if the embryo is XY, the SRY gene

(for sex-determining region of the Y chromosome) will be present.

Which of the following statements correctly describes events occurring around mid-cycle (day 14 of an average menstrual cycle

A.An unfertilized egg survives approximately 24 hours following its release. B. Typically, one dominant follicle releases one ovum, or egg. C. The release of an ovum may be associated with leakage of follicular fluid into the posterior cul-de-sac.

widest and longest, most tortuous section of the uterine tubes. Fertilization usually occurs here and it's the most common place for ectopic pregnancy to occur.

Ampulla

HYDROSALPINX FLUID WITHIN THE TUBE can appear

Appears as an anechoic tubular structure within the adnexa Appears as tubular structure with internal low level echoesand debris •Echogenicity -variable because of hemorrhage

finger-like, ciliated projections which capture the ovum from the surface of the ovary.?

Fimbrae

FALLOPIAN TUBES -THE FALLOPIAN TUBE IS DESCRIBED AS HAVING FOUR PARTS (LATERAL TO MEDIAL); called?

Fimbrae, Infundibulum, ampulla and isthmus

funnel-shaped opening near the ovary to which fimbriae are attached.?

Infundibulum

Corpus Luteum

Internal echoes, enhanced through transmission but no central vascularity Typically the corpus luteum is under 3.0cm If pregnancy does not occur, the corpus luteum gradually atrophies to become the corpus albicans, which is not sonographically identifiable.

What are the primary functions of the fallopian tubes?

Provide a method of transport for the oocyte from the ovary to uterine cavity Provide an area for fertilization to occur

Female development proceeds when there is an absence of what gene?

SRY gene. No testosterone or AMH is made

The ovaries are evaluated and measured in two scan planes:

Sagittal and transverse

Ovarian Artery

The arterial supply to the uterine tubes is via the uterine and ovarian arteries. Venous drainage is via the uterine and ovarian veins

Which of the following statements regarding spaces within the female pelvis is correct?

The posterior cul-de-sac is also known as the pouch of Douglas. The rectouterine pouch is located between the uterus and rectum.

THE CUMULUS OOPHORUS

The preovulatory dominant follicle may have a slightly complex appearance, with the oocyte and its supporting structures appearing as a ring-like structure within the follicle (the cumulus oophorus)

Which of the following statements regarding the vascular supply of the genital tract is correct?

The uterine artery supplies oxygen-rich blood to the uterus and vagina. The right ovarian vein drains directly into the IVC.

NORMAL OVARY

Variable appearance over the course of the menstrual cycle Days 8 to 12 one or more dominant follicles will grow to ~20 to 25mm and then rupture After ovulation, the corpus luteum develops

Medulla of Ovaries is the ?

central connective tissue contains blood, nerves, lymphatic vessels and some smooth muscle tissue at the hilum

The area where the fallopian tubes and uterus join is considered

interstitial

The Wolffian ducts regress, and the Müllerian ducts persist, developing into what structure?

into the fallopian tubes, the uterus and the upper part of the vagina. the cranial aspects become the fallopian tubes with the funnel-shaped end remaining open to the peritoneum.

Cortex is the bulk of the?

ovary that contains follicles in various stages of development

The inner mucosa is lined with ciliated epithelial cells and?

peg cells (secretory cells that provide nutrients for the spermatozoa and oocyte). The ciliawaft the ovum towards the uterus.