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
