1 GYN-Lecture to send.pptx

8/10/2019 1 GYN-Lecture to send.pptx

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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


RIGHT OVARY - LONGITUDINAL IMAGE Long axis image of the right ovary with superior to

inferior and anterior to posterior measurement


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1 GYN-Lecture to send.pptx