Reproductive System

The hormone-secreting gland that results from a ruptured ovarian follicle is known as the:

a. paraurethral gland.

b. pituitary gland.

c. hypothalamus.

d. corpus luteum.

corpus luteum

Spermatogenesis occurs in which of the following

structures?

a. seminal vesicles

b. seminiferous tubules

c. epididymis

d. vas deferens

Seminiferous tubules

Which of the following promotes growth of

interstitial cells in the testes and stimulates

secretion of testosterone in men?

a. gonadotropin-releasing hormone

b. progesterone

c. estrogen

d. luteinizing hormone

luteinizing hormone

Ovulation typically occurs during which day of a woman's 28-day cycle?

14

In which structure does fertilization typically take place?

a. vagina

b. ovary

c. fallopian tube

d. uterine body

fallopian tube

Which of the following are contraindications to hysterosalpingography (HSG)?

1. pregnancy

2. active menstrual bleeding

3. intrauterine fibroid

pregnancy

Active menstrual bleeding

HSG typically is performed during which days

following the onset of menstruation?

7 to 10

Which of the following might help reduce cramping

caused by contrast media injection during HSG?

a. prednisone

b. ibuprofen

c. diphenhydramine

d. corticosteroid

Ibuprofen

Which of the following is the most common

abnormality found in subfertile men?

a. varicocele

b. azoospermia

c. vassal obstruction

d. retrograde ejaculation

Variocele

Which of the following maneuvers can help

demonstrate prominent veins during color Doppler

ultrasonography for varicocele evaluation?

a. Heimlich

b. Valsalva

c. Müeller

d. Adson

Valsalva

the __ functions as a reservoir for urine and aided by the urethra expels urine from the body

bladder

When your urine reaches ________, the desire to void arises

250 mL

Involuntary urination is called

incontinence

The female urethra is a narrow canal about 1.5 inches (4 cm) long which extends from the internal urethral orifice to the

External urethral orifice

The urinary bladder for a female lie posterior to, and just superior to the upper margin of the

Pubic symphysis

What are the female reproductive organs?

ovaries, fallopian tubes, vagina

The female uterus, uterine tubes and ovaries pass into the __ cavity

peritoneal

The male reproductive organs are located ________ the peritoneum and are separated completely from organs within the peritoneal cavity

below

radiographic image of the uterus and uterine tubes of female reproductive system

hysterosalpingogram

The female reproductive organs are located within the

true pelvis

What is the central organ of the female pelvis?

uterus

The uterus is subdivided in order (4 sections)

1) fundus 2) corpus (body) 3) isthmus 4) cervix (neck)

What is the rounded superior portion of the uterus

fundus

What is the larger central component of the uterine tissue?

corpus

What is the narrow constricted segment often describes as the lower uterine segment that joins the cervix at the internal os?

isthmus

What is the distal cylindrical portion that protects into the vagina ending as the external os?

cervix

What are the three layers of the uterus?

__ (lined with perimetrium and forms capsule around the uterus), __ (smooth muscle), and __ (lines uterine cavity)

Serosa, myometrium, endometrium

between the body and fundus, and how the uterine fallopian tubes communicate with the uterine cavity

cornu

The uterine tubes divided into four segments:

1) __ segment (proximal portion that communicates with uterine cavity)

2) __ (constricted portion of the tube, where it widened into the central segment, termed the ampulla, which arches over the bilateral ovaries)

3) __ (most distal and contains finger like extensions termed fimbriae, one of which is attached to each ovary)

4) __ __ (where the ovum passes through this ovarian fimbrae into the uterine tube, where if it is fertilized it then passes into the uterus for implantation and development)

interstitial, isthmus, infundibulum, ovarian fimbria

The distal infundibulum portion of the uterine tubes containing the fimbriae opens into the

peritoneal cavity

What is the purpose of an HSG?

-To demonstrate the __ cavity and the __ (degree of __) of the uterine __

- the __ and __ of the uterine cavity are assessed to detect any uterine __ process

- as the contrast agent fills the uterine cavity, the patency of the uterine tubes can be demonstrated as the contrast material flows through the tube and spills into the peritoneal cavity

uterine, patency, openness, tubes, shape, contour, pathological

What are the clinical indications for a hysterosalpingography?

- assessment of female infertility

- Diagnose any functional or structural defects

- A blockage of one or both uterine tubes may inhibit fertilization

- in some cases HSG can be used as a therapeutic tool

- Evaluation of the uterine tube after tubal ligation or reconstructive surgery

- pelvic pain

- thickened or irregular endometrium

What would be the modality of choice for demonstration of intrauterine pathology?

Ultrasound

Some symptoms of intrauterine pathology

- Abnormal uterine bleeding

- Pelvic pain

- Pelvic fullness

Contraindications for a hysterosalpingography

-pregnancy

-acute pelvic inflammatory disease

-active uterine bleeding

-outside of 7-11 day window

- pelvic infection

- active vaginal bleeding

- previous moderate/severe iodinated contrast reaction

Patient prep for hysterosalpingography

- follow department protocol

- preparation may include a mild laxative, suppositories, or a cleansing, enema, or some combination of these before the procedure

-in addition, patient may be asked to take a mild pain reliever before the examination to alleviate some of the discomfort associated with cramping

-empty bladder to prevent displacement of the uterus and uterine tubes

-Procedure and possible complications should be explained to the patient

- informed consent

- In some instances, physician may perform a manual pelvic examination before radiograph procedure has begun

What imaging equipment is used in a hysterosalpingography?

-Conventional or digital fluoroscopy

-Ideally, the table should have capability to tilt the patient to a -Trendelenburg position if needed

- Gynecologic stirrup should be attached to the table to assist the patient in the lithotomy position

Accessory and optional equipment for HSG

Sterile disposable HSG tray

Tenecalum (instrument with a hooked clamp for gathering and holding tissues and structures in place)

Injection process of HSG:

Pt __ in __ position, pt draped with sterile towels, vaginal speculum is inserted into the vagina, gaging walls and cervix cleaned with antiseptic solution, a __ catheter is inserted into the __ canal, remove speculum, place pt in __, syringe filled with contrast connected to balloon catheter, if uterine tubes are patent (open) the CM flows from the __ ends of the tubes into the __ cavity

supine, lithotomy, balloon, cervical, trendelenburg, distal, peritoneal

A series of collimated images may be obtained while the uterine __ and uterine __ are __

cavity, tubes, filling

What is the CR for a HSG?

2 inches superior to pubic symphysis

Evaluation criteria for HSG

- The pelvic ring as seen on an AP projection should be centered within collimated field

- the cannula or balloon catheter should be seen within the cervix

- an opacified uterine cavity and uterine tubes seen centered on the IR

- contrast medium is seen within peritoneum if one or both uterine tubes are patent

- optimal image receptor exposure and contrast to demonstrate anatomy and contrast medium

- R or L marker should be visualized without superimposition of anatomy

Considerations fro an HSG

- current cervical os stenosis tx

- pretreatment for pelvic infection

- previous allergic-like reaction

What contrast media is used for an HSG?

water-based or water-soluble contrast, 10-30 mL

non-ionic, low osmolar

oil-based, 2-14 mL

HSG set up

- fluoro room

- HSG tray

- contrast media (water-based)

- absorbent pad

- lithotomy stirrups

- warm blanket(s)

- pillow

HSG procedure

patient prep (laxatives, cleansing enema, hold meal, NSAIDS (ibuprofen), pregnancy test)

change into gown

history - reason, LMP

Forms - procedural pause, informed consent, pregnancy Explain procedure

Patient supine on the table

HSG procedure protocol

- pt in lithotomy position, angled sponge under pelvis

- speculum insertion

- lidocaine gel, injection

- catheter introduced, balloon inflated

- remove speculum, move patient

- slow contrast injection

- AP, PA obliques - fluoroscopic

"last hold image" - ALARA

- Deflate balloon and remove catheter

Post removal images

HSG Post instructions/ follow-up care

- provide menstrual pad

- anticipate

cramping

light vaginal bleeding

1-2 days

- contact physician if:

fever

persistent pain

unusual vaginal bleeding

Pregnancy