Ultrasound Registry Review Anatomy GYN
Body of UT
(Corpus) mid section of the UT that has great flexibility to expand with pregnancy
Non-dominate follicles do not exceed
11 mm (1.1 cm)
Ovulation occurs on day
14 of the menstrual cycle
The secretory phase occurs during days ___ of the menstural cycle
15-28 During the secretory phase of the uterus (luteal phase of ovaries), the hormone progesterone is produced by the ovaries. Progesterone (as well as estrogen) is secreted by the corpus luteum, (which means yellow body), which develops from the Graafian follicle (dominate follicle)
A dominate follicle reaches a max diameter of ___ just prior to ovulation
2.5 cm
Average size of the ovary
3 x 2 x 1 cm and has a volume of 6-13 cc
Nulliparous UT measures
7 x 4 x 2 Average is 8 x 5 x 3
Endo in a asymptomatic 68 year old should not exceed
< 8mm post meno, no bleeding <8mm endo thickness post meno, bleeding <5mm endo thickness
If fertilzation does not occur after ovulation, the corpus luteam becomes
A corpus albicans (Latin for "white body") is an ovarian scar composed of connective tissue that forms after the corpus luteum degenerates, a process called luteolysis. The corpus albicans is primarily made of collagen and persists on the ovary for a few months.
Grand multiparity
A women who has already delivered 5 or more infants who have achieved a gestational age of 24 weeks or more
Hypogastric artery
Also known as the internal iliac artery is the smaller terminal branch of the common iliac artery. It supplies the pelvic walls, pelvic viscera, external genitalia, perineum, buttock and medial part of the thigh
Most common place for egg fertilization to occur in what part of the FT
Ampulla - most widest and longest portion. for the same reason as the most common fertilization place, it is also common for ectopic pregnancies
A uterine body/fundus that is tilted anteriorly with a sharp angle to the CX
Antefelxed
What vessel carries blood to the uterine arteries?
Anterior branch of the internal iliac arteries common illiac branches into external and internal. EIA supplies legs with blood IIA supplies the pelvic organs
What is not located in the true pelvis
Bowel - it is mainly located in the false pelvis
Dextroflexion
CX is midline while the UT body is flexed to the right
Surge of LH
Causes ovulation, from the pituitary gland. after ovulation, the LH casues the follicle to develop into a corpus luteum cyst
A dominate follicle is not seen in what type of patients
Depo provera is a type of birth control that would prevent the formation of dominate follicle and ovulation
Graffian follicile is another term for
Dominant follicle
Fibroid growth is stimulated by
Estrogen. increased levels can cause fibroids to grow in size. also those who are pregnant or taking HRT will see increase in size also
Oral contraceptives suppress the production of ___ to prevent follicle maturation
Follicle stimulating hormone to prevent follicle maturation and ovulation. endometrial proliferation will also be suppressed and the layer will not go through cyclical changes (remains thin)
The ovary is normally found in what area (pouch)
Fossa of Waldeyer
Doppler waveform of a nulliparous uterus
High resistance, high velocity non-pregnant UT does not require much flow to function, this produces high res , high vel waveform
How would you describe the PW doppler obtained from the tissues surrounding the dominate follicle ?
High velocity, low resistant
Gonadotropin releasing hormone is produced by
Hypothalamus as GRH increases, the pitutiary gland senses and releases FSH into the blood stream, rising FSH levels casues the ovaries to increase estrogen production and causes follicle growth
What produces hormones to influence the ovaries in the menstrual cycle?
Hypothalamus and pituitary gland
What structure is located laterally to the ovaries?
Ilioposas muscle
The left ovarian vein empties into
Left renal vein Right ovarian vein empties directly into the IVC
Flat muscle extending laterally on both sides of the vaginal cuff
Levator ani muscles are flat muscles that extend laterally on both sides
If the CX is midline and the UT body is flexed to the left this is called
Levoflexion
Levator ani
Located laterally to the actabulum , triangular sheet cover anterior and lateral walls
Isthmus of UT
Lower portion of the corpus connected to the CX
Non gravid RI in uterine artery
Moderate velocity and high resistance , resistance increases with age until diastolic flow is absent (RI of 1.0)
Great grand multiparity
More than 10 infants
Fundus of UT
Most superior portion, where the cornua extends into the FT
What term refers to a patient that is pregnant with her 3rd child?
Multigravid gravid - number of pregnancies parity - number of births (alive or dead)
Which pelvic muscles form the lateral walls
Obturator internus
What is the USA of a late proliferative endo?
Outer layer is hyperechoic , middle layer is hypoechoic, inner layer will appear as an echogenic line
What is NOT true about androgen levels
Ovaries, adrenal glands and pituitary glands produce testosterone what is true - woman have a small amount of testosterone - ovaries and adrenal glands produce testosterone - overproduction of testosterone results in virillation
What uterine wall layer is composed of fibrous connective tissue
Perimetrium, also called the uterine serosa layer
The most common space for fluid collection
Posterior cul-de-sac (pouch of dogulas)
What patient has a uterine body half the size of the cervix?
Pre pubertal
What type of patient has a uterus described as a CX and corpus(body) of equal length ?
Premenopasual nulliparous ratio of 1:1 (average is 3 x 7 cm)
In what case is the cervix longer than the body(corpus)
Prepubertal
Decrease levels of ___ causes the onset of menses
Progesterone
Decreasing levels of ___ cause the onset of menstruation
Progesterone
What stimulates the endometrial proliferation in the secretory phase?
Progesterone. after ovulation occurs
Which arteries course through the myometrium
Radial arteries branch into spiral and straight arteries, straight arteries supply the basal layer and spiral arteries supply the functional layer and are stimulated by the menstrual cycle
What muscles are located in the greater pelvis?
Rectus abdominis - forms anterior wall of the abdominopelvic cavity transverse abdominis - forms the anterioateral borders of the abdominopelvic cavity psoas major - 2 muscles (left and right) originate in lumbar veretbral region and extend to the illiac crest iliposoas - psoas muscle connects with illacus muscle to form iliposas muscles
Mittleschmertz
Refers to pain with ovulation
A uterine body/fundus that is tilted posteriorly with a sharp angle to the CX
Retroflexed
Lower uterine segment (lus)
Short segment between the body and the CX in the PREGNANT patient
What artery supplies the functionalis layer of the endo?
Spiral arteries and the straight arteries supply the basalis layer
What causes ovulation?
Surge of LH , hormone produced by gonadotropic cells in the anterior pituitary gland. In females, an acute rise of LH triggers ovulation and development of the corpus luteum.
What ligaments are composed of peritoneum ?
Suspensory and broad ligaments
Broad ligament
The broad ligament is a double-layered sheet of mesothelial cells. It extends from the sides of the uterus medially to the pelvic sidewalls laterally and the pelvic floor inferiorly.
The isthmus of the UT refers to
The lower portion of the uterine body that connects to the cervix
What arteries course through the myometrium?
The radial arteries, penetrate serosa too these then branch into spiral and straight straight >> supply basal layer of endo spiral >> supply the functional layer of endo
The uterus is anterior to
The rectum
What is the sonographic appearance of the endo in the secretory phase?
Thick and hyperechoic early prolif = endo is at its thinnest late prolif = thicker hyperechoic
Endo in day 20 of the menstural cycle will appear
Thick and hyperechoic , secretory phase
What is the sonographic appearance of someone in day 12 of their menstrual cycle?
Thick and hypoechoic they are in late proflierative (day 10-14)
What is the normal apperance of a 3 week post partum endo of a patient who delivered vaginally
Thin echogenic line
Levoposition
UT and CX are displaced to the left
Dextroposition
UT and CX are displaced to the right
coccygenous
adjacent to piriformis, orginates from the coccyx
cardial ligament
aka transverse cervical ligament of mackenrodt, band of fibrous tissue and ligament that extend from upper lateral cervix to the lateral pelvic walls and contains the uterine and vaginal vessels does NOT provide support to the ovary
Early proliferative phase
endo can appear as having 3 layers the outer layer will be hyperechoic, the middle later will be hypoechoic and the inner layer will appear as a thin echogenic line *will be at its thinnest*
What propels the contraction of the egg to uterine cavity
estrogen
What hormone causes the endo to thicken in the proliferative phase?
estrogen stimulates the endo to thicken before ovulation. progesterone stimulates endo thickneing in the secretory phase if fertilization does not occur, progesterone decreases and menses occur
interstitial
extends from the uterine cavity through the uterine muscle
mesosalpinx
fibromusclar bands extending from uterus to labia majora and helps maintain normal uterine position
obturator internus
forms anteior wall of abdominopelvic cavity, extends from xiphoid to symphysis
round ligaments
free margin of the broad ligament where the fallopian tube travels
The ovarian cortex
functional tissue composed of 1000s oocytes embedded in connective tissue varies in thickness according to the age of the individual
this type of waveform is seen in a nullgravida uterus
high resistance, high velocity.
this type of waveform is seen in a nulligravida uterus
high resistance, high velocity. does not require much flow to "function" pregnant uterus is "functioning" and cause flow to change bc of increased arterial flow needs. resistance will decrease causing a monophasic waveform with forward flow in diastole In arteries in the ovary without the dominant follicle, there is a pattern of relatively high resistance, whereas in the active ovary, both during ovulation and during the formation of the corpus luteum, there is a pattern of low resistance with a continuous antegrade arterial flow throughout diastole
What portion of the FT is describe as trumpet shaped because it widens before it opens up into the pelvic peritoneal cavity?
infundibulum - contains the fimbraie , trumpet shaped ends and opens into pelvic peritoneal cavity
Normal ovarian PW doppler waveform
low resistance, low velocity
Rectus abdominis
most inferior structure, forms the floor of the pelvis, has 3 openings for urethra, vagina and rectum
Internal iliac artery
normally courses lateral to the internal iliac vein it courses posterior to the ovary also called the hypogastic artery does *not* supply all the arterial blood to the uterus and ovaries
Unicollis
one cervix
External os
opening from CX to VAG
Internal os
opening from UT to CX
external os of cervix
opening from cervix to vagina
Psoas muscles
originates in lumbar vetebral region, connects with iliacus muscle to form illiposas muscle
What ligament is often mistaken for the ovaries?
piriformis (sometimes iliopsoas)
Broad ligaments
portion of the peritoneum connecting the ovary to posterior broad ligament
What type of patient has a uterus described as the body/fundus being 2x longer?
premenopausal multiparous
What is anterior to the ovary?
rectus abdomins, located in the greater pelvis the urter and iliac artery are posterior iliposas is posterior to the UT and ovaries
What pelvic space is located anterior to the bladder and called the retropubic space?
space of retzius
Piriformis
superior and lateral to levator ani muscles, originates from sacrum
Internal OS of cervix
the opening from the cervix to the uterus
Mesovarium ligament
the portion of the broad ligament of the uterus that suspends the ovaries. The ovary is not covered by the mesovarium; rather, it is covered by germinal epithelium.
Late proliferative endo appears
think and more hypoechoic centrally
anteflexed
uterine body folds to form a sharp angle interorly with the cervix
Retroflexed
uterine body folds to form a sharp angle posteriorly with the cervix
anteverted
uterine body folds to form a slight angle posterior with the cervix
Retroverted
uterine body forms a slight angle posteriorly with the cervix
mesoovarium
wing like folds of the peritoneum extending to lateral pelvic walls, separates pelvic cavity into anterior and posterior portion
