Sonographic Scanning Protocol Female Pelvis Protocol

Female Pelvis Protocol Terms and practice Questions The True pelvis is _______ to the linea terminalis and the False pelvis is _______to the linea terminalis. True - Deep False - Superior Which pelvis houses the reproductive organs, bladder and ureters? True Pelvis What are the other 2 names for the true pelvis? Lesser pelvis Pelvis minor List the 3 pelvis regions: 1. RT iliac 2. Hypogastric 3. LT iliac Which organs are in the RT iliac region of the pelvis? (list 4) Cecum of colon Appendix Distal end of RT ureter RT ovary Which organs are in the LT iliac region of the pelvis? (list 3) Sigmoid colon Distal end of the LT ureter LT ovary Which organs or located in the hypogastric region of the pelvis? Distal end of the ileum Urinary bladder Uterus Uterus is located between the ______ and _______ Urinary Bladder (ant) Rectum (post) Is the uterus retro or intraperitoneal? Retroperitoneal List the 3 layers of the uterus (superficial to deep) 1. Serosa 2. Myometrium 3. Endometrium What are the 2 layers of the endometrium? Superficial Deep Which layer of the endometrium is the functional layer in which is the basal later? Superficial layer is functional Deep later is basal Which layer of the endometrium increases in size during menstrual cycle and sloughs off during menses? Superficial (functional) layer What is the deep layer of the endometrium composed of? Dense stroma and mucosa glands Which layer of the endometrium is the largest? Myometrium The outer peritoneal, thin layer the completely covers the myometrium is the ______. Serosa List the 4 parts of the uterus: 1. fundus 2. Corpus/Body 3. Isthmus 4. Cervix Corpus and fundus are bent POSTERIORLY until fundus is adjacent to cervix pointing inferiorly. Cervix and vagina linearly oriented Retroflexed Developmental variant causing 2 uterus, 2 cervices and 2 vaginas Didelphia Developmental variant causes 2 uterine bodies (divided) or 2 uterine horns (septated) with 1 vagina Bicornuate uterus How does the fallopian tubes direct the mature ovum to the uterus? Gentle peristalsis of the smooth muscle wall Normal length of fallopian tubes? 7-12cm List the 4 parts of the fallopian tubes: 1. Interstitial or Intramural 2. Isthmus 3. Ampulla 4. Infundibulum What is the narrowest segment of the fallopian tube? Interstitial or Intramural segment What is the most dangerous location for an ectopic pregnancy to occur? Interstitial segment because of its close proximity to the uterus. If it ruptures, risking the fallopian tube and uterus to both be ruptured causing more bleeding and risk of losing both. What is the longest segment of the fallopian tube? Ampulla What is the most common location for an ectopic pregnancy to occur? Ampulla` The _________ segment of the fallopian tube is the widest segment with a funnel-shaped end containing fingerlike extensions called _________. Infundibulum; Fimbria What is a good landmark to look for while scanning the ovaries? Internal iliac arteries are often posterior to the ovaries Ovaries are in the _________, the peritoneal spaces located posterior to _______ within the _________ pelvis. Ovaries located within adnexa Adnexas are the peritoneal spaces located posterior to the broad ligaments within the true pelvis. Why do you need a full bladder during a pelvic US? A fully distended bladder displaces bowel to view the pelvis organs and acts as an acoustic window. Transducer used for pelvis exam. 3.0-3.5MHz; 5 MHz for thin patients What patient hx should be obtained? LMP GPA hx of pelvic surgeries Pelvic exam results What is the widest. most superior portion of the uterus? Fundus Largest part of the uterus and is continuous with the cervix: Corpus/Body The LUS (lower uterine segment) where the uterus usually bends, also where the body meets the cervix is called the ________. Isthmus The lower cylindrical part that projects into the vagina: Cervix Which part of the cervix is at the same level of the isthmus? (internal or external os) Internal os Opening of cx, approx. 2-4cm The external os is closest to the ____________. Vagina The size of the uterus depends on the ______ and ________ of the patient. Parity and age Size of prepubertal UT? 2.5cm long x 3cm wide x 1cm AP A prepubertal UT, the ______ is the longest part and the ______ is the shortest part. Cervix - longest Body - Shortest Size of postpubertal, nilluparious UT 7-8cm long x 3-5cm wide x 3-5 cm AP (larger than prepubertal) Average size of multiparous uterus 8.5cm long x 5cm wide (larger than postpubertal) A post-menopausal uterus size significantly ___________ and usually reverts to __________ where cervix is greater portion of uterus. Decreases in size Prepubertal shape What is the normal/ most common position of the uterus called? Anteverted When and why can the uterus be mobile? Because of the ligaments and peritoneal connections, can be mobile with displacement when bladder or rectum is full or with pregnancy. With regards to uterine positions, define ante vs retro; flexed vs verted Ante = anterior Retro = posterior Flexed = fundus position Verted = cervix position The position where the cervix and vagina form a 90 degrees angle and corpus and fundus are tilted anteriorly. Anteverted (most common uterine position 98%) Cervix and vagina form a 90-degree angle, corpus and fundus are bent anteriorly, fundus points inferiorly and rests of the cervix Anteflexed Corpus and fundus are tilted posteriorly, cervix and vagina linearly oriented Retroverted Days 1-14 corresponds with the _______ of the ovaries and the ______phase of the endometrium Follicular - ovaries Proliferative - endometrium During the follicular phase, ________ is released by the ________. FSH; Pituitary gland Menses usually occurs days ____-____ then the endometrium goes into the _______________ phase. 1-5; Proliferative What is occurring during the proliferative phase? Which hormone is involved? Follicles are releasing estrogen that initiates the thickening and swelling of the endometrium that is preparing for implantation of a fertilized ovum. Ovulation occurs on day ____. 14 Days 15-28 in the ovaries are called______ and in the endometrium is called______. Ovaries - Luteal Endometrium - Secretory Following ovulation, the ruptured follicle fills with blood and is called ___________. This occurs during the _____________ phase in the ovaries. Corpus luteum; Luteal phase Absence of _________, __________ and ___________ diminish the corpus luteum. It then regresses into ___________. Fertilization Estrogen Progesterone Corpus albicans What hormones promote continuing thickening of endometrium during the secretory phase? Estrogen and progesterone Sonographic appearance of menstrual phase (days 1-4): Endometrium is thin and bright Sonographic appearance of early proliferative phase (days 5-9): Thin bright line measures 4-8mm Sonographic appearance of late proliferative phase (days 10-14): Multilayered; Bright stripe is surrounded by thick functional zone that appears hypoechoic relative to the basal layer that is surrounded by the hypoechoic inner layer if the myometrium. Normally measures 610mm Sonographic appearance of secretory phase (days 15-28): Functional zone even thicker and brighter, becomes isoechoic to basal layer and canal. Measures 714mm Sonographic appearance of fallopian tubes: Normal fallopian tubes not usually seen or visualized unless abnormal or fluid filled Sonographic appearance of the uterus: Mid-grey, medium echoes with even texture Smooth contour Round anechoic venous structures may be seen in periphery Sonographic appearance of ovaries: Mid-grey, medium echoes with even texture Iso or more hyperechoic than normal uterus Anechoic follicles seen round or oval around periphery. Patient prep for pelvic exam? Full bladder 32-40oz of clear fluid 1hr prior to exam within 15-20-minute time period