Notes: Chapter 17 The Uterus and the vagina

SONOGRAPHIC FINDINGS OF A NABOTHIAN CYST

1. Anechoic mass within the cervix 2. May be multiple 3. May be complex

SONOGRAPHIC FINDINGS OF A GARTNER DUCT CYST

1. Anechoic mass within the vagina

CLINICAL FINDINGS OF A GARTNER DUCT CYST

1. Asymptomatic

CLINICAL FINDINGS OF A NABOTHIAN CYST

1. Asymptomatic

SONOGRAPHIC FINDINGS OF ADENOMYOSIS

1. Diffusely enlarged uterus 2. Hypoechoic or echogenic areas adjacent to endometrium 3. Heterogeneous myometrium 4. Myometrial cysts 5. Ill-defined interface between myometrium and endometrium 6. Thickening of the posterior myometrium

SONOGRAPHIC FINDINGS OF VAGINAL OBSTRUCTIONS

1. Distension of the uterus, vagina, or both with anechoic or complex fluid

SONOGRAPHIC FINDINGS OF A UTERINE LEIOMYOMA

1. Hypoechoic mass within the uterus 2. Posterior shadowing from the mass 3. Degenerating fibroids may have calcifications or cystic components 4. Multiple fibroids appear as an enlarged, irregularly shaped, diffusely heterogenous uterus

CLINICAL FINDINGS OF VAGINAL OBSTRUCTIONS

1. Pelvic pain (often at the time of menses in adolescent girls) 2. Enlarged uterus 3. Abdominal pain 4. Urinary retention 5. Amenorrhea (adolescent girls)

CLINICAL FINDINGS OF LEIOMYOSARCOMA

1. Pelvic pressure 2. Menorrhagia 3. Palpable abdominal mass 4. Enlarged, bulky uterus 5. Urinary frequency 6. Dysuria 7. Constipation 8. Infertility

CLINICAL FINDINGS OF A UTERINE LEIOMYOMA

1. Pelvic pressure 2. Menorrhagia 3. Palpable pelvic mass 4. Enlarged, bulky uterus (if multiple) 5. Urinary frequency 6. Dysuria 7. Constipation 8. Infertility

SONOGRAPHIC FINDINGS OF LEIOMYOSARCOMA

1. Rapidly growing mass within the uterus 2. Hypoechoic mass within the uterus 3. Posterior shadowing from the mass 4. Degenerating fibroids may have calcifications or cystic components 5. Multiple fibroids appear as an enlarged, irregularly shaped, diffusely heterogenous uterus

CLINICAL FINDINGS OF ADENOMYOSIS

1. Uterine enlargement 2. Dysmenorrhea 3. Menometrorrhagia 4. Pelvic pain 5. Dyspareunia 6. Multiparous

_________ __________ is the most common female malignancy in women younger than age 50

Cervical carcinoma

_________ fibroids and ________ fibroids usually lead to abnormal uterine bleeding because of their location in relationship to the endometrium.

Intracavitary and submucosal

the most common benign gynecologic tumors and the leading cause of hysterectomy and gynecologic surgery

Leiomyomas

These masses are characterized by a rapid increase in growth and are more commonly found in perimenopausal or postmenopausal woman

Leiomyosarcoma

_________ fibroids may torse, thus cutting off the blood supply to the mass. This lack of blood supply results in necrosis and clinically the patient will present with acute, localized pelvic pain

Pedunculated

the component that is shed during menstruation

The functional layer of the endometrium

The endometrium can be further divided into

a deep or basal layer and a superficial or functional layer

Focal adenomyosis in the form of a mass is termed an

adenomyoma.

The normal position of the uterus is considered to be

anteversion or anteflexion

Gartner duct cysts are often

asymptomatic

Adenomyosis is the invasion of endometrial tissue into the myometrium. The basal layer of the endometrium can often extend into the myometrium at depths of

at least 2.5 mm.

the most common structural defect of the uterus is the

bicornuate uterus

The largest part of the uterus is the

corpus, or body.

The clinical presentation of adenomyosis is varied and nonspecific, with most women experiencing

dysmenorrhea, menometrorrhagia, pelvic pain, and dyspareunia.

Between the two layers of the endometrium lies the ______________, which is contiguous with the lumen of the fallopian tubes laterally, and the cervix inferiorly

endometrial (uterine) cavity

Patients with___________ tend to be younger and have fertility troubles, while those with __________ are often older and multiparous.

endometriosis, adenomyosis

The inner mucosal layer of the uterus is referred to as the

endometrium

Fibroid growth has been associated with ________ ________ and consequently their size may increase during pregnancy and reduce after menopause.

estrogen stimulation

________ may prevent cervical dilatation during pregnancy, thus often requiring a cesarean section to be performed at the time of delivery.7

fibroids

The involvement of adenomyosis may be either ____________ or__________ and is typically found more often within the ____________ portion of the uterus

focal or diffuse, posterior

The uterus can be divided into four major divisions:

fundus, corpus, isthmus, and cervix

The diagnosis of precocious puberty typically constitutes an endocrinologic workup to evaluate _____ ________.

gonadotropin levels.

The medical treatment for fibroids is ________ _________, which typically results in a reduction in tumor size. Surgical treatment may either be ___________ or ____________. Another alternative treatment for fibroids involves ________ __________ __________, which is used to inhibit blood supply to the mass.

hormone therapy, hysterectomy or myomectomy. uterine artery embolization

Treatment for adenomyosis is _____________ or ______________, with the latter often producing limited, if any, relief from symptoms.

hysterectomy or hormone therapy

hematometrocolpos, a condition when both the uterine cavity and vagina are filled with blood. This obstruction is frequently associated with the presence of an

imperforate hymen

The vagina is composed of three layers:

inner mucosal layer, middle muscular layer, and an outer layer that may be referred to as the adventitia.

Fibroids may also impact fertility if they are_________ or__________ fibroids, as the location of these fibroids may result in a higher incidence of spontaneous abortion.

intracavitary, submucosal

True precocious puberty is associated with __________ or may simply be_________.

intracranial tumors, idiopathic

The most common location for fibroids is

intramural

The uterus, vagina, and fallopian tubes develop from the paired

müllerian ducts (paramesonephric ducts).

The middle layer is the _________ or_________, which constitutes the bulk of the uterine tissue, providing the area where contractile motion occurs.

myometrium or muscular layer

Those who are at greater risk for the development of fibroids are women who are

obese, black, nonsmokers, and perimenopausal

Pseudoprecocious puberty has been linked with_______,________, and _______ ________. Therefore, patients who present with the indication of precocious puberty should perhaps be sonographically assessed for ovarian and adrenal gland tumors.

ovarian, adrenal and liver tumors.

The outermost layer is referred to as the ____________ or____________, which is continuous with the fascia of the pelvis

serosal layer or perimetrium

The uterine wall consists of three layers

serosal layer or perimetrium, myometrium or muscular layer, endometrium.

Following menopause, the uterus typically becomes much __________ than the premenopausal uterus

smaller