1 gyn-lecture to send.pptx
TRANSCRIPT
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TOPICS TO BE COVERED
FEMALE REPRODUCTIVE SYSTEM ANATOMY
Uterus
Vagina
Ovaries
Fallopian Tubes Location
Physiology
Sonographic appearance
Normal variants
Patient preparation
Patient positioning
Transducer choice
Breathing technique
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LOCATION
The urinary bladder is posterior to the symphysis
pubis
The uterus, cervix, and vagina are posterior to the
distended bladder and anterior to the rectum
The fundus of the uterus usually lies just to the rightor left of midline
The cervix and vagina usually lie in the midline of he
pelvic cavity.
The ovaries are lateral to the uterus an lie against thepelvic side walls
The ureter and internal iliac vessels are posterior to
the ovary
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ANATOMY
The female pelvic cavity consists of the female reproductive
organs, a portion of the ureters, the urinary bladder,
musculature, and intestinal tract
The female reproductive system consists of the vagina, uterus,
two fallopian tubes, and two ovaries
The adnexa consists of the ovaries, fallopian tubes, pelvicligaments, and pelvic side walls
The vagina is a muscular, tubular structure that extends from
the cervix of the uterus to the vulva
The uterus is a muscular, hollow organ. The size of the uterus is
variable depending on patient parity and age
Postpubertal size is usually 7 to 8 cm long, 3 to 5 cm wide, and
3 to 5 cm thick
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The uterus consists of three muscle layers
Endometrium: the inner mucous layer.
Myometrium: the middle, smooth muscle, thickest layer.
Serous: the outer peritoneal layer.
The uterus is pear-shaped; its rounded superior portion is thefundus and inferior tapering portion is the cervix or neck.
The middle portion of the uterus is referred to as its body.
The uterus has a centrally located endometrial cavity. Thecervical portion of the cavity where it meets the vagina isreferred to as the external os and where it meets the uterinebody is referred to as the internal os.
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The uterine cavity is continuous with the centrally located vaginal
canal.
The fallopian tubes arise from the uterus and course within thebroad ligament for about 10 cm (4in) toward the ovaries.
The ovaries are oval-shaped organs that lie within the ovarian
fossa against the pelvic sidewalls. The size of the ovaries is
variable and depends on age.
Postpubertal size is approximately 2 cm long, 2 cm wide, and 3
cm to 4 cm thick.
The two ureters are long, narrow tubular structures that extend
from the hilum of each kidney to the urinary bladder. The ureters
are less than 1.4 in wide and 10 to 12 in long. The uretersdecrease in diameter as they course to the bladder.
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The urinary bladder is a symmetrical, hollow, muscular
organ. Bladder shape is variable depending on distention.
The bladder can hold as much as 16 to ounces of urine.
The normal distended urinary bladder wall measures 1 cm
or less.
Pelvic side wall musculature includes:
Obturator internus muscle.
Iliopsoas muscle.
Piriformis muscle.
Pubococcygeal sling muscle.
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Muscle Location
Rectus abdominis Anterior wall
Psoas Major Posterior
Illiacus Iliac fossa
Obtrator Internrus Lateral wall
Priformis Posterior wall
Coccygeus Posterior floor
Levator Ani Middle and anterior floor
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PHYSIOLOGY
The function of the uterus, vagina, and ovaries is
reproduction.
The function of the ureters is to carry urine from the
hilum of each kidney to the urinary bladder. The function of the urinary bladder is to store urine
until the urge to void is felt.
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SONOGRAPHIC APPEARANCE
The uterine myometrium is midgray or medium-level echoes with
even texture. The contour of the normal myometrium should appear
smooth. Occasionally round, anechoic venous structures may be
seen along the uterine periphery.
The endometrial cavity is a thin echogenic line that varies in
intensity and thickness depending on the menstrual phase andpatient age.
The vaginal walls are midgray or medium-level echoes with even
texture that is equal to the normal uterus. The vaginal canal is
echogenic.
The ovaries are midgray or medium-level echoes with even texture
that is equal to or more echogenic than the normal uterus. Uterine
follicles are seen as round or oval anechoic structures along the
ovarian periphery.
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The pelvic side wall musculature is midgray ormedium-level echoes with even texture that is lessechogenic than the normal uterus and ovaries.
The cul-de-sac or pouch of Douglas is a recessedportion of the peritoneum posterior to the uterusthat is seen when it contains fluid or blood. It isnormal to see a small amount of anechoic free fluidbetween the echogenic walls of the cul-de-sac andthe myometrium of the uterus.
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SONOGRAPHIC APPEARANCE
The fallopian tubes are not normally seen.
The ureters are not normally seen.
The urinary bladder cavity is not seen if it iscollapsed; otherwise it appears anechoic.
The bladder wall appears as a smooth, thin
echogenic line. Distended bladder shape isvariable but transversely it may appear somewhatsquared.
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Anteverted Uterus
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The menses phase
The menses phasethis phase, which
typically lasts from day 1 to day 5, is the time
when the lining of the uterus is actually shed
out through the vagina if pregnancy has not
occurred. Most women bleed for 3 to 5 days,
but a period lasting only 2 days to as many as
7 days is still considered normal.
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The follicular phase
This phase typically takes place from days 6 to 14.During this time, the level of the hormoneestrogen rises, which causes the lining of the
uterus (called the endometrium) to grow andthicken. In addition, another hormonefollicle-stimulating hormonecauses follicles in theovaries to grow. During days 10 to 14, only one of
the developing follicles will form a fully matureegg (ovum).
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Ovulation
Ovulationthis phase occurs roughly at
about day 14 in a 28-day menstrual cycle. A
sudden increase in another hormone
luteinizing hormone
causes the ovary to
release its egg. This event is called ovulation.
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The luteal phase
This phase lasts from about day 15 to day 28.After the egg is released from the ovary it beginsto travel through the fallopian tubes to theuterus. The level of the hormone progesterone
rises to help prepare the uterine lining forpregnancy. If the egg becomes fertilized by asperm and attaches itself to the uterine wall, thewoman becomes pregnant. If pregnancy does not
occur, estrogen and progesterone levels drop andthe thickened lining of the uterus is shed duringthe menstrual period.
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NORMAL VARIANTS
Retroverted uterus:
The entire uterus is tilted posteriorly
Sonographic appearance is the same as that of
the normal uterus Retroflexed uterus:
Only the uterine fundus and body are tilted
posteriorly. Sonographic appearance is the same as that of
the normal uterus
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Retroverted Uterus
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NORMAL VARIANTS
Didelphia uterus:
Developmental variant causing two uterine bodies, twocervices, and two vaginas.
Sonographic appearance is the same as that of the
normal uterus, cervix, and vagina.
Bicornuate uterus:
Developmental variant causing two uterine bodies(divided) or two uterine horns (septated) with onevagina and one or two cervices.
Sonographic appearance is the same as that of thenormal uterus, cervix, and vagina.
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Didelphia uterus
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Bicornuate uterus
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PATIENT PREP
Full urinary bladder.
32 to 40 ounces of clear fluid should be ingested one
hour before the exam and finished within a 15 to 20
minute time period. if for any reason the patient cannot have fluids,
sterile water can be used to fill the bladder through
a Foley catheter.
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PATIENT POSITION
Supine.
TRANSDUCER
3.0 MHz or 3.5 MHz.
5.0 MHz for thin patients.
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TRANSABDOMINAL FEMALE PEVLIS SCANNING
PROTOCOL
LONGITUDIANL IMAGES
Longitudinal image of the midline images of the pelvic cavity just
superior to the symphysis pubis
Longitudinal image of the right adnexa that may include part of
the uterus depending on its lie
Longitudinal image of the left adnexa that may include part of theuterus depending on its lie
Longitudinal image of the right lateral wall of the bladder and
pelvic side wall
Longitudinal image to include left lateral wall of the bladder andpelvic side wall
Long axis image of the uterus to include as much endometrial
cavity as possible with superior to inferior and anterior to posterior
measurement
Same image as above without calipers
S O S
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TRANSABDOMINAL FEMALE PEVLIS
SCANNING PROTOCOL
TRANSVERSE IMAGES
Transverse image of the vagina
Transverse image of the cervix
Transverse image of the uterus body
Transverse image of the uterus fundus with right to
left measurement
Same image as above without calipers
RIGHT OVARY - LONGITUDINAL IMAGE Long axis image of the right ovary with superior to
inferior and anterior to posterior measurement
Same image as above without calipers