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Senior - OB 3 > 12 - Benign Gyn Disorders > Flashcards

12 - Benign Gyn Disorders Flashcards

1
Q

Describe the normal cycle for breast epithelial cells

A

Proliferate during luteal phase

Breast fullness and tenderness in the week preceding menses

Undergo programmed cell death at the ends of the luteal phase

Estrogen and progesterone levels decline

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2
Q

What happens to breast lobules at menopause?

A

They involute and are replaced with fat

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3
Q

Fibroadenomas are composed of:

A

Glandular and cystic epithelial structures surrounded by a cellular stroma

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4
Q

What is the MC breast mass ID’d in adolescence?

A

Fibroadenomas

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5
Q

When are fibroadenomas most frequently found?

A

Premenopausal women

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6
Q

Galactorrhea

A

Expressible nipple discharge - common, probably not a big deal

Spontaneous nipple discharge (galactorrhea) - must evaluate!

Commonly 2/2 prolactinoma or hypothyroidism (long list slide 15)

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7
Q

MC organism for mastitis?

- what’s a girl to do?

A

Staphylococcus

Keep breastfeeding or pumping

If sxs don’t improve rapidly with ABX, get US to r/o abscess

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8
Q

Nonpuerperal mastitis?

A

Uncommon

Image and bx to r/o inflammatory breast CA

Peripheral abscess? I and D and ABX

Subareolar abscess? Duct excision / removal of sinus tracts

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9
Q

Two main categories for breast pain

A

Cyclic or noncyclic

If it’s noncyclic -> more concerning…frequently a simple cyst, but COULD BE CA

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10
Q

How does vulvar dz most commonly present?

A

Itching

  • but the working diagnosis is CANCER so get a biopsy if you see something
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11
Q

Lichen sclerosis

  • definition
  • presentation/sx
  • dx
  • tx
A

Post-menopausal women

Hormones/genetics/AI/we dont know

INFLAMMATION of the dermis

Pruritus, irritation, vulvar thickening

Burning, dyspareunia

CELLOPHANE paper appearance of gentle stretching of skin

May need to bx if suspicious lesions

Txt - minimize irritation, topical ‘roids - if severe, retinoids or phototherapy

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12
Q

Lichen simplex chronicus

  • cause
  • txt
A

2/2 chronic irritation - intense itch-scratch cycle

Excoriations - skin responds by thickening

Txt - eliminate the trigger, sitz baths, benadryl, wear cotton gloves at night, topical steroids

If no resolution in 3 weeks, bx

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13
Q

Red lesions (dermatoses) include:

A

Atopic dermatitis

Contact dermatitis

Psoriasis

Vestibulitis

Lichen planus

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14
Q

Atopic derm

A

Pt will have hx of allergies, eczema

Chronic relapsing course

Topical steroids, immunomodulators, treat the dry skin

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15
Q

Contact derm

A

Usually 2/2 irritant

20% of the time 2/2 allergy

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16
Q

Common vulvar irritants:

A

Slide 34 (review deck)

She mentioned dyes and laundry detergents

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17
Q

Psoriasis

A

Adherent silver scale

T-cell mediated

Stress or menses can exacerbate

Txt - emollients, steroids

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18
Q

Lichen planus

  • definition
  • presentation
A

Uncommon - affects men and women equally, ages 30-60

Autoimmune T-cell disorder

May be drug-induced

Cutaneous and mucosal surfaces

Pt c/o vaginal discharge, pruritus, burning pain, dyspareunia, postcoital bleeding

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19
Q

3 variants of licen planus

A
  1. Erosive (MC and most difficult to treat)
  2. Papulosquamous
  3. Hypertrophic
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20
Q

The 5 p’s of lichen planus?

A

Purple pruritic polygonal papules and plaques

21
Q

Txt for lichen planus

A

Topical steroids

Vaginal hydrocortisone

22
Q

Sxs of intergtrigo

A

Friction / moisture between skin folds

Burning and itching

Longstanding -> hyperpigmentation and verrucous changes

23
Q

Txt of intertrigo

A

Drying agents

Mild topical steroid if inflamed

If infected, txt

Lose some weight

Wear loose-fitting clothing

24
Q

What is the MCC of vaginal irritation after menopause?

  • sxs?
  • txt?
A

Atrophic vaginitis

Sxs - vulvar irritation, clear/yellow or blood-tinged discharge, urinary sxs, dyspareunia

Friable vaginal epithelium, loss of rugae, pale mucosa

Txt - topical estrogen (be careful with unopposed estrogen if uterus still present - if patient has a uterus, CANNOT have unopposed estrogen)

25
Bartholin’s Cyst - overview - txt - risk
Reproductive-age women Painless No txt necessary if asxs, but women don’t like it, so - I and D plus packing, or Word cath placement, or marsupialization (taking out the whole cyst wall - done only if failed Word catheter) If over 40yrs, concern for CA (get bx)
26
Bartholin’s abscess - cause - sxs - txt
Usually a sequelae of the cyst Polymicrobial - screen for STD’s Sxs - severe pain, difficulty walking, sitting, or having sex Txt - if fluctuant, I and D (immediate relief) and Word cath (if packing unavailable) ABX if: recurrent OR high risk (i.e. preggo, cellulitis, systemic infx, immunosuppressed)
27
Cervical stenosis - definition - sxs - cause - tx
Scar tissue contraction or adhesions block the os Sxs - dysmenorrhea, amenorrhea, infertility Caused by certain procedures (i.e. LEEP), congenital, or spontaneously Txt - cervical dilators - vaginal estrogen If severe - increased risk for infection, uterine distention, dystocia - 2/2 impeded menstrual flow
28
What cervical diameter is needed to be considered “sufficient” in the setting of cervical stenosis?
5mm is sufficient for flow Less than 2mm associated with retrograde flow
29
Nabothian cysts - definition - sxs - txt
Trapped columnar cells that secrete mucus resulting in discrete cyst on cervix Usually asxs, no txt necessary If you have to txt, refer for electrocautery or excision
30
Cervical polyp - what is it - txt - dont forget?
One of the most common benign cervical neoplasms Less than 3cm Txt - if small - grasp with forceps and twist off. If sessile, remove with biopsy forceps, cauterize the base. Send ALL to pathology
31
What is the MC pelvic tumor in women? - describe it - sxs - dx - txt
Leiomyomas “fibroids” Slow-growing, estrogen-dependent benign tumor Common indication for hysterectomy Round, rubbery Sxs - most are asxs - bleeding, sensation of pressure, urinary frequency, pelvic pain, infertility possible Dx - bimanual exam, US, path Txt - observe, COCPs, mirena, surg, hysterectomy
32
Adenomyosis - what is it - who gets it - dx - txt
Nests of endometrial glands and stroma embedded within the muscular uterine wall Uterus often globally enlarged Age 40-50 heavy abnormal uterine bleeding 1/3 are asxs Dx - MRI best, then TVUS, then bx Txt - hysterectomy
33
Endometrial polyps - what - who - sxs - dx - txt
Overgrowth of endometrium on a stalk All ages, peaks in 50’s MC sxs - metrorrhagia (intermenstrual bleeding) Dx - TVUS Txt - removal if large or symptomatic
34
Functional cyst syndrome - size - sxs - dx
> 3cm Pelvic pain, dull sensation, heaviness, hemorrhage Dx - bimanual exam, US
35
MC benign ovarian neoplasm type?
Epithelial
36
Benign cystic teratoma
Dermoid cyst Single most common ovarian neoplasm Risk of torsion
37
Txt for premenopausal ovarian cysts 5-7cm (simple, benign qualities)
TVS repeated in 6-12 weeks If over 7cm, MRI or surgical evaluation
38
Txt for postmenopausal ovarian cysts 1-5cm (simple, benign qualities)
CA125 level - if normal, TVS in 6-12 weeks If over 7cm, MRI or surgical eval
39
25% of ovarian torsion cases occur during: 50-80% of cases have?
Pregnancy Ovarian mass
40
Risk factor for ovarian torsion:
Large (>6cm) ovaries - rise up out of the confines of the pelvic bones where they’re more likely to twist
41
Presentation of ovarian torsion
Sudden onset progressive sharp lower abdominal pain Low-grade fever suggests necrosis N/V Can mimic ectopic
42
Txt for ovarian torsion
Salvage if possible Resect tumor or cyst Possible oophoropexy If necrosis or rupture with hemorrhage - remove adnexal structures
43
Fibrocystic changes
Palpably nodular breast tissue or to the histologic pattern of dilated ducts and acini invested with dense collagenous stroma Not a breast CA risk by itself Benign, characterized by hyperplasia Pain and tenderness, usually premenstrual Txt with less caffeine, chocolate, supportive bra
44
Slide 14
Lots of causes galactorrhea
45
Slide 77-78
Ovarian cyst txt guidelines - chart
46
Indications for surgical interventions in leiomyomas?
Rapid enlargement Severe pelvic pain or secondary dysmenorrhea Abnormal uterine bleeding with anemia Urinary tract symptoms Inability to evaluate the adnexa (usually corresponds with fibroid >12 week gestational size uterus) Growth of fibroid after menopause Infertility
47
Benign uterine d/o types?
Estrogen dependent - Leiomyomata - “fibroids” - Adenomyosis - Endometrial hyperplasia Non estrogen dependent - polyp
48
Public cervix announcement
Get your pap today

Senior - OB 3 (6 decks)

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