Normal Pelvis

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1

What what age do embryos look the same?

up to 8 weeks

2

When is the development of the external genitalia complete?

by 12 weeks

3

what drives structural changes?

hormones

boys get a testosterone bath

4

What is required for a pediatric pelvic exam?

distended bladder

5

What can be done if the child does not have a distended bladder?

catheterisation to fill bladder with sterile water

6

levator ani muscles

card image

pelvic floor muscles

7

What do the sex organs develop from?

two muellerian ducts

paramesonephric

8

What does the paramesonephric duct develop into?

female genitalia

  • vagina
  • uterus
  • fallopian tubes
9

What does the mesonephric duct develop into?

male genitalia

  • testis
  • penis
10

What is the wolfian duct

mesonephric duct

11

What is the mullerian duct

paramesonephric duct

12

Which gender has mullerian and wolfian ducts?

both

13

What is the sonographic appearance of the pediatric uterus?

prominent

bright echogenic endometrial

14

What is the bright echogenic endometrial lining a result of?

hormonal stimulation received in utero

15

What happens when there is an incomplete fusion of mullerian duct?

congenital malformations

16

Congenital abnormalities occur in how many females?

.5%

17

What are the Class 1 anomalies of the uterus?

vaginal atresia

transverse vaginal septum

incomplete hymen

18

What are the Class 2 anomalies of the uterus?

Hydrocolpos

hydrometrocolpos

hermatometrocolpos

19

What does congenital abnormalities of the uterus sometimes involve?

kidneys

20
card image

Where is the fundus?

card image

upper rounded portion

21
card image

Where is the cornua?

card image

the attachment of the fallopian tubes into the fundus

22
card image

Where is the corpus

card image

body

23
card image

Where is the cervix?

card image

extends into the vagina

24
card image

Where is the isthmus?

card image

between corpus and cervix

25

What is a bicornuate uterus?

card image

class 4 anomaly

26

What is the sonographic appearance of a bicornuate uterus?

two unterine horns

thick uterine septum

27

What is didelphys uterus?

card image

Class 3 anomaly

28

What is the sonographic appearance of a didelphys uterus?

complete duplication of the reproduction tract

29

What is unicollis uterus?

card image

Class 2 anomaly

30

What is the sonographic appearance of a unicollis uterus?

long narrow uterus

sometimes laterally tilted right or left

31

What is subseptus uterus?

card image

Class 5 anomaly

32

What is the sonographic appearance of a septated uterus?

one fundus

tissue divides the uterus into two cavities

can extend into the vagina

33

WHat is a arcuate uterus?

class 6 anomaly

T shaped uterus

difficult to diagnose

34

What is the cause of an arcuate uterus?

fetal exposure to DES

35

What region does the pelvis occupy?

  • left iliac
  • hypogastic
  • right iliac
36

How is the pelvis divided?

linea terminalis

  • true pelvis
  • false pelvis
37

Where is the true pelvis?

diaphragm - linea terminalis

posterior/inferior cavity that extends backwards into the skeletal framework

38

Where is the false pelvis?

linea terminalis - iliac crest

39

What is the shape of the true pelvis?

bowl shape

40

What is the area called between the uterus and the bladder?

anterior culdesac

41

What is the area called between the uterus and the rectum?

posterior culdesac

42

Where is the uterus compared to the bladder?

posterior

43

Where is the uterus compared to the sigmoid colon?

anterior

44

the peritoneum lines which walls of the uterus?

anterior and posterior

45

the vagina lies where to the bladder?

posterior

46

the vagina lies where to the rectum?

anterior

47

How do the fallopian tubes lie to the uterus?

lateral

48

Where is the fallopian tubes to the peritoneum?

course with in the folds of the broad ligament

49

In what area are the ovaries located?

in the adnexa

50

Where is the adnexa?

peritoneal cavity space located posterior to the broad ligament

51

Ureters & internal iliac vessels lie ________ to ovaries.

posteriomedial

52

External iliac vessels lie ________ to ovaries.

anteriolateral

53

What is the size of the uterus?

8 cm x 5.5 cm x 3 cm

long x thick x wide

54

What is the length of the cervix?

2-3 cm long

55

How is the uterus in multiparous women compared to nulliparous woman?

Larger

56

What is uterine size in children

2.5 cm x 1 cm x 2 cm

long x thick x wide

57

What is the size of the ovaries during reproductive years?

3 cm x 5 cm x 2 cm

long x thick x wide

2.5-5 cm x .6-2.2 cm x 1.5-3 cm

58

What is the ovarian volume?

6 - 13 cc

59

What is the ovarian volume formula?

.523 x L x W x T (cm)

60

What is the size of the ovaries post menopausal?

2 x 1 x 2 cm

61

what muscle starts at the arcuate line and makes up the anterior lateral walls of the pelvis?

card image

obturator internus

62

What muscle starts posterior and works anterior through the sciatic notch, makes up posterior wall lateral wall of the pelvis?

card image

piriformis

63

What muscle produces a hammock which supports the muscles in the true pelvis?

card image

levator ani

64

What are the two muscles that make up the levator ani in the female pelvis?

pubococcygeus

iliococcygeus

65

Which muscle makes up the medial and anterior floor of the female pelvis?

card image

pubococcygeus

66

Which muscle makes up the lateral floor of the female pelvis?

card image

iliococcygeus

67

Which muscle makes up the posterior floor of the female pelvis?

card image

coccygeus

68

What is found within the folds of the broad ligament?

card image

fallopian tubes

round ligament

ovarian ligament

blood vessels

69

What is the broad ligament?

peritoneal folds

70

Explain how the broad ligament extends around the uterus.

extends from the uterine cornea to the lateral walls of the uterus.

71

What is the area posterior to the broad ligament called?

adnexa

72

Which ligament gives the uterus its characteristic forward bend?

card image

round

73

Which ligament extends from the upper cervix to lateral walls of the pelvis?

card image

cardinal ligament

74

Which ligament extends from the posterior cervix to the sacrum?

card image

uterosacral

75

What is the space called between the symphysis and bladder?

card image

space of Retzius

76

What is in the space of Retzius?

adipose

77

Where is the vessicouterine pouch?

card image

posterior to the bladder

78

What is another name for the vessicouterine pouch?

card image

anterior cul de sac

79

Where is the trigone region of the bladder?

posterior inferior

80

What is the muscle of the bladder?

detrussor

81

Where is the pouch of douglas in the female pelvis?

card image

between the rectum and the uterus

82

What is another name for the pouch of douglas?

posterior cul de sac

83

Which pouch is the most dependent?

pouch of douglas

84

What extends from the uterus to the external genitalia?

vagina

85

How long is the vagina?

9 cm

86

What forms the fornices?

the cervix extending into the vagina

87

Name the fornices

anterior

posterior

left

right

88

What are the layers of the vaginal walls?

mucosa

muscularis

adventia

89

Explain the vaginal walls

usually collapsed with walls forming rugae

90

What is the shape of the uterus?

pear

91

What is the endometrium?

mucus producing inside layer

divided into 2 layers

zona functionalis

zona basal layer

92

What is the zona functionalis?

the most interior portion of the endometrium this layer is shed every month

93

What is the zona basal?

the second layer of the endometrium, this layer produces the zona functionalis

94

What is the myometrium?

middle muscle layer of the uterus

95

What type of muscle makes up the myometrium?

longitudinal and circular smooth muscle

96

What is parturition?

the action or process of giving birth to offspring

97

Which layer of the uterus causes contractions during parturition?

myometrium

98

What is the uterine serosa?

AKA perimetrium

thin connective tissue layer on the outside

99

What is anteversion?

card image

normal position

100

What is anteflexion?

card image

bent forward

101

What is retroversion?

card image
102

What is retroflexion?

card image

bent back wards

103

Where does fertilization usually occur?

ampulla of the fallopian tubes

104

name the parts of the fallopian tubes

fimbriae

infundibulum

ampulla

isthmus

interstitial

105

What is fimbriae?

card image

finger like structures at the end of the fallopian tubes that surround the ovary

106

Where is the infundibulum of the fallopian tubes?

card image
107

Where is the ampulla of the fallopian tubes?

card image
108

Where is the isthmus of the fallopian tubes?

card image
109

Where is the interstitial of the fallopian tubes?

card image
110

How long are the fallopian tubes?

10 cm

111

Explain how the ovum is moved through the fallopian tubes.

gentle pulsated motion

ciliated

mucus

peristalsing muscle layers

112

What is the shape of the ovaries?

almond

113

Are the ovaries covered by peritoneum?

NO

how would fertilization occur?

114

What are the ovaries consist of?

cortex

medulla

hillium

115

Where are the ovaries to the broad ligament?

posterior

116

What is the ovarian cortex responsible for?

production of ova

117

Where are the ovarian follicles located?

in the cortex

118

epithelial - germinal layer

...

119

What are the ovaries held in place by?

ovarian ligament

infundibulopelvic ligaments

120

What does the medulla of the ovaries consist of?

arteries, veins, nerves, lymphatics

121

What part of the pelvic colon is in the true pelvis?

sigmoid

rectum

122

is the rectum peritoneal?

no

123

Where does the rectum lie compared to the vagina?

posterior

124

explain the vasculature of the pelvis

card image

descending aorta

common iliac

internal iliac

uterine

arcuate

radial

straight spiral

125

what does the uterine artery branch into?

vaginal

uterine

126

What surrounds the uterine arteries?

folds of the broad ligament

127

What do the straight arteries feed?

surface of the uteries

128

Once the uterine arteries enter the uterus what are the branches?

arcuate

radial

129

Where do the ovarian arteries arise?

aorta

130

What does the ovarian arteries join?

the ovarian branch of the uterine artery

131

within the female pelvis veins match arteries

...

132

What is ambiguous genitalia?

pseudo hermaphrodite

true hermaphrodite

mosaic hermaphrodite

133

What is pseudo hermaphrodite?

female babies that appear as boys

androgens cause the labia to enlarge which looks like a boy in utero

134

What happens to pseudo hermaphrodites after birth?

genitalia goes back to normal

135

What is a true hermaphrodite?

baby with ovaries and testicles

sometimes and inguinal canal.

136

What is a mosaic hermaphrodite?

n individual in whom some cells have the male chromosomal complement (XY) and some cells have the female chromosomal complement (XX).

137

What is precocious puberty?

enlargement of uterus prior to 8 years old

138

How is sonography used to diagnose precocious puberty?

initially evaluate size of uterus & ovaries

then to follow the response to treatment

139

What are other procedures for precocious puberty?

CAT scan of pituitary

140

What is the percentage of precocious puberty where there is nothing wrong?

90%

141

What are Neonatal ovarian cysts?

cysts occurring in utero due baby's exposure to placential & materanl hormones

142

What is Neonatal ovarian cysts a result of?

premature follicugenesis in the fetal ovary

143

What are the size of normal follicular cysts?

3 - 7 mm

144

What is toxemia?

pregnancy induced hypertension

145

What is preclampsia?

AKA toxemia

pregnancy induced hypertension

146

What is Pregnancy induced diabetes?

glucose greater than 100

proteins dumped in urine

147

What is Rh isoimmunization?

Dad Rh+

Mom Rh-

baby Rh+

148

What is torsion of the ovaries?

Twisting

Normal adnexa in young girls may be very mobile

149

What can cause torsion in young girls?

Normal adnexa in young girls may be very mobile

changes in size

changes in pressure

150

What can increase the occurrence of ovarian torsion?

presence of mass on an ovary

151

At what age does ovarian torsion occur?

any age

152

When is ovarian torsion most likely to occur?

young girls primarily

most occur before the age of 20

153

What is the presentation of ovarian torsion?

severe onset of abdominal pain

154

What is the major problem in infants with ovarian torsion?

infants can not tell you they are in pain

may be unrecognized leading to necrosis of the avary

155

What is the sonographic appearance of ovarian torsion?

enlargement of infected ovary

fluid in the cul de sac

cyst or tumor on ovary

low flow

* amount of flow present is determined by the amount of torsion

156

What is an ovarian teratoma?

Ovarian tumors not common in neonate or adolescents

157

Germ cell tumors make up ____% of ovarian neoplasms in patients under ____ years old

Germ cell tumors make up 60% of ovarian neoplasms in patients under 20 years old

158

What is the most common pediatric Ovarian germ cell tumor?

dermoid

Benign cystic teratoma

159

What is a Ovarian dermoid?

Benign cystic teratoma

160

Ovarian teratomas tend to be ______ in the young and _____ in older people.

Ovarian teratomas tend to be benign in the young and malignant in older people.

161

What is the sonographic appearance of an ovarian dermoid?

complex mass

hyperechoic

wicked shadow

heterogeneous

echogenic foci

162

What is the most frequent complication of a ovarian teratoma?

torsion