Uterus

Adenomyosis is ? normally occurs where? ____ ___ may be present

- The invasion and presence of endometrial tissue into the myometrium - Normally occurs in fundus and posterior uterus (may either be focal or diffuse) -Small myometrial cysts may be present (this will cause wall to look heterogenous)

Fibroid (leiomyoma) treatment? 3 options

-Hormonal therapy may be successful in reducing fibroid size -Surgical:- Hysterectomy (complete removal of uterus) or Myomectomy: removal of the fibroid itself. Conserves the uterus (considered for people who want children) -Uterine Artery Embolization: Uterine artery is embolized (usually "coiled") can result in a reduction of fibroid size and eliminate the clinical symptoms.

Broad ligament attaches what?

-double-layer fold of the peritoneum that attaches the lateral portions of the uterus, covers fallopian tubes and ovaries, and attaches to the lateral pelvic sidewalls. -extensive mesentery that encloses the ovaries, uterine tubes, and uterus.

Menstruation: Endometrium is shed. This is days ___-___ and endo will measure:

1-7 (depending on when period ends) endo measures 1-4mm

Uterine wall layers?

1. perimetrium (serosal) 2. myometrium (the bulk of the uterine tissue, providing the area where contractile motion occurs) 3. endometrium (can be further divided into the deep basil layer and the superficial functional (decidual) layer.)

Early proliferative phase (just after period), endo will measure __-__ mm

4-8mm

a newborn baby girl may have a thickened ____ due to ?

A newborn baby girl may have thickened endo due to stimulation of babies endo by maternal hormones.

Anteverted uterus is? Anteflexed uterus is?

Anteverted: body tilts forward or anteriorly, formed a 90-degree angle with the vag Anteflexed: uterine body folds forward, possibly coming in contact with the uterus.

What is the internal and external os of the cervix? The vaginal ____ envelop the inferior aspect of cervix

Cervix has an internal os (which is in contact with the isthmus, or inner portion) and an external os (in close contact with superior vag). The vaginal fornices (or fornix) envelop the inferior aspect of the cervix

Leiomyosarcoma is characterized by? Sono appearance?

Characterized by a rapid increase in growth over a short period of time. Sonographic appearance very similar to fibroids also, but this mass is rapidly growing - Hypoechoic shadowing from the mass - Posterior shadowing - Degenerating fibroids may have calcifications or cystic components. Multiple fibroids appear as enlarged, irregularly shaped, diffusely heterogenous uterus.

Didelphys uterus is?

Complete duplication of the uterus, cervix, and vagina

What is a Nabothian cyst? benign or malignant? symptomatic or asymptomatic?

Essentially a cyst located in the cervix. • Always benign. • Always asymptomatic.

In the pre-pubertal population, the cervix is ___ than the uterus, measuring ?

In the pre-pubertal population, the cervix is much larger than the uterus. prepubertal: 2cm

Most common location for uterine fibroid (leiomyoma)?

Intramural (within the myometrium)

Most common benign uterine tumor? Leading cause to hysterectomy in US?

Leiomyoma (fibroid) uterine fibroid

Uterine Leiomyomas (Fibroids) are?

Leiomyomas are benign tumors of the smooth muscle within the uterus

Uterine anomalies are caused by fusion anomalies of the ____ ___ .Since the uterus and kidneys develop at the same time, a patient with a uterine anomaly may also have renal anomalies

Mullerine ducts

Retroverted uterus is? Retroflexed uterus is?

Retroverted: uterine body tilts backward or posteriorly without a bend where the cervix and body meet. Retroflexed: uterus tilts posteriorly and actually comes in contact with the cervix.

sonohysterography is? hysterosalpingogram is used to examine what?

Saline is infused into the uterine cavity to better evaluate the endometrium. An excellent way to differentiate a thickened endometrium vs. a polyp or fibroid within the endometrium. an X-Ray procedure using contrast to examine if the Fallopian tube are patent.

Starting with puberty, the uterus ___ and is ___ than the cervix.

Starting with puberty, the uterus enlarges and is much larger than the cervix. adolescent: 4-5cm Nulliparous: 6cm

Subserosal fibroid (leiomyoma) distorts the uterine ___. may have a stalk and described as ____ These are more prone for?

Subserosal: grows outward and distorts the uterine contour. Some subserosal fibroids have a stalk and are described as pedunculated. These are prone to torsion, thus cutting off blood supply to the mass. Can result in necrosis and patient will present with acute localized pelvic pain

What is leiomyosarcoma? Most common found in what population? Clinical symptoms of this?

The malignant counterpart of a fibroid (leiomyosarcoma) Most commonly found in perimenopausal or post menopausal females. Clinical symptoms are the same as a fibroid

Do the ovaries have a dual blood supply? Explain

The ovaries have dual blood supply. Each ovary is supplied from an ovarian artery and a branch of the uterine artery. Ovarian artery will anastomose with uterine artery near lateral portion of uterus.

The post-menopausal uterus is ___ and ___

The post-menopausal uterus is very small and atrophic Menopausal nulliparous: 4-5cm Menopausal multiparous: 6cm

Uterus, vag, and fallopian tubes develop from the paired ____. Incomplete fusion, or agenesis of ____ will result in?

Uterus, vag, and fallopian tubes develop from the paired Mullerian ducts. Incomplete fusion, or agenesis of Mullerian ducts will result in an anatomic variant of the uterus, cervix, and/or vag. These Mullerian anomalies are known as congenital malformations.

vaginal atresia is? vaginal septum is? Imperforate hymen is? • These can present as an obstruction to the vagina, and affect the appearance of the vagina, cervix and endometrium of the uterus.

Vaginal Atresia is a birth defect in which the vagina is closed or absent. Typically this condition does not occur alone, but is one of several developmental problems in a female baby Vaginal Septum is when your vagina is split into two parts by a band of tissue. It happens during fetal development (can either be trans or sag) Imperforate Hymen a membrane extends all the way across the area of the hymen, blocking the vaginal opening (there is only a but hole)

Venous drainage mimics arterial supply EXCEPT for?

Venous vasculature mimics arterial supply. EXCEPT, the left ovarian vein drains into the left renal vein. The right ovarian vein drains into the aorta

Gartner duct Cyst is ? cause symptoms?

When a cyst is seen in the Vagina Typically small • Almost always asymptomatic. always visualized transabdominally for obvious reasons

Arcuate uterus is?

a minor irregularity in the shape of your uterus. Unlike a typical pear-shaped uterus, an arcuate uterus has a small dent at the top of the uterus.

Submucosal fibroids are adjacent to and can distort shape of? may be ____ These are usually the cause of abnormal ___

adjacent to the endometrium and can distort the shape of the endometrium. Submucosal fibroids may also be intracavitary as they are entirely within the endometrial canal. Submucosal and intracavitary fibroids usually lead to abnormal uterine bleeding due to their impingment on the endometrium.

Normal two positions of the uterus

anteverted or anteflexed

Branches of the uterine artery?

arcuate artery -> radial arteries-> spiral arteries

Arcuate artery supplies? radial artery supplies? spiral artery supplies?

arcuate- lateral aspect of myometrium radial- supply blood to deeper layers of myometrium spiral- supply blood to functional (decidual) layer or endo

Colpos = ? Metra = ? Hydro = ? Hemato =?

colpos = vagina metra = uterus hydro= water hemato = blood

Ovarian ligament connects ?

connects ovary to the lateral side of the uterus, do not contain any blood vessels.

Round ligament connects?

connects the uterus to the labia majora. It originates at the junction of the uterus and uterine tube. It passes through the inguinal canal to insert at the labium majora

Myometrial cysts are typically due to ?

due to adenomyosis When this tissue is entrapped within the uterine muscle wall, they can be seen as small cysts in the wall. Micro hemorrhage can occur within these entrapped areas of endometrium. When these cysts are microscopic, the wall simply looks "heterogeneous". The uterine muscle cells react to this invasion of the endometrial tissue by enlargement and thickening. As a result, the uterus is often enlarged, with one wall thicker than the other.

A patient should not be evaluated for abnormal vaginal bleeding when?

during late secretory phase because period is just about to start

Endometrial polyp (uterine polyp) is? occurs when? Benign or malignant? May cause ___ ___ if polyps are present.

form as a result of cells in the lining of the uterus (endometrium) overgrowing. Benign, (but can turn malignant if high risk) may cause irregular bleeding

Thickness of basil layer stays pretty consistent, but the ___ layer is reactive towards the hormones and menstrual cycle

functional or decidual layer is reactive

The uterus can be divided into these 4 divisions:

fundus, body, isthmus (lower uterine segment), cervix

Since reproductive organs develop around the same time as renal development, what is a good assumption?

if there are congenital anomalies of the uterus, there might be coexisting anomalies of the kidneys.

Secretory phase is what days? endo measures ?

just after ovulation, days 14-28 endo measures 7-14 mm depending on the day

Ovarian artery originates from? supplies what?

lateral aspect of abdominal aorta supplies the ovary

Internal iliac arteries branch into?

left and right uterine arteries

Late proliferative phase (right before ovulation, prior to day ___), endo will measure ? what sign may be present here?

prior to day 14, 6-10 mm the 3 line sign may be present

most common mullerine duct anomaly?

septate uterus

Uterine arteries supply?

supply blood to the uterus, fallopian tubes, and ovaries (course along lateral aspect of uterus within folds of broad ligament)

Bicornate uterus is?

two endometrial cavities (two endometriums) with one cervix

Unicornuate uterus is?

uterus has only one horn

Septate uterus is?

uterus has two separate endometrial cavities separated by an AP septum. Septate uterus can often cause spontaneous abortions. (most common Mullerian duct anomaly.

Hydrocolpos is ? normally occurs when? if fluid also accumulates in the uterus, it is then termed:

vagina is distended with simple anechoic fluid. Normally only occurs in the neonatal period (first four weeks of life). hydrometrocolpous.

Sono appearance of adenomyosis? size? wall appearance? myometrium appears? cysts? thickening of?

· Diffusely enlarged uterus · Can have asymmetrical wall thickening · Hypoechoic or echogenic areas adjacent to endometrium · Heterogenous myometrium · Myometrial cysts · Ill-defined interface between endometrium and myometrium · Thickening of fundal or posterior myometrium

Clinical findings of adenomyosis? what population does this normally affect?

· Uterine enlargement · Boggy, tender uterus · Pelvic pain · Dyspareunia (pain during intercourse) · Normally affects an older and multiparous patient population.

Clinical findings of vag obstruction in adolescent population?

• Cyclic pelvic pain • Enlarged uterus • Abdominal pain • Amenorrhea (absence of menstruation)

Hematometra is? Hematocolpos is? Hematometrocolpos is?

• Hematometra: Patients that have retained menstrual blood in the uterus • Hematocolpos: retained blood in the vagina only •Hematometrocolpos: Retained blood in both uterus and vagina.

Sono appearance of fibroid (leiomyoma)? echogenicity? multiple fibroids will cause uterus to look? Fibroids are affected by estrogen so may enlarge with ____ and shrink after ___

• Hypoechoic mass • Possibly some posterior shadowing • Degenerating fibroids may have calcifications or cystic components • Multiple fibroids may appear as a diffusely enlarged uterus with a heterogenous texture • Note: Fibroids are affected by estrogen so may enlarge during pregnancy and shrink after menopause.

Clinical findings of Uterine fibroids (leiomyoma)? What two fibroid location is most likely to cause infertility?

• Pelvic pressure • Menorrhagia -abnormal heavy or prolonged bleeding • Palpable pelvic mass • Enlarged, bulky uterus (if multiple) • Infertility (if they are submucosal or intracavitary)