27- Diseases Of The Uterus And Adnexa Flashcards
What is uterine leiomyoma?
Localized proliferation of smooth muscle cells surrounded by a pseudocapsule
High prevalence
Peaks in the 5th decade
Classified by their anatomic locations
Estrogen sensitive
Fibroids grow in pregnancy and shrink in menopause
What is the symptoms of fibroids?
Most of time asymptomatic and found incidentally
Bleeding
Pressure
Pain
What are the characteristics of vaginal bleeding from fibroids?
Most often from submucosal fibroids
Progressively increase amount of blood loss
Alteration of the contractile function of endometrium
Pressure necrosis exposes vascular beds
What is the correlation between bleeding and fibroids?
Abnormal bleeding is not always caused by fibroids even if present
Increasing amount of bleeding in a regular pattern suggests fibroid
Irregular pattern suggest hormonal problem
How does fibroids causes pelvic pressure ?
Enlargement of fibroids causes a sensation of pressure or fullness in the lower abdomen or pelvis without any abnormal bleeding
Other symptoms are frequency, GI symptoms, hydronephrosis
Do fibroids cause pain?
Pain is not a common presentation of fibroids
How to treat fibroids?
No treatment if asymptomatic
Myomectomy if pregnancy is desired
If pregnancy is not desired- progesterone supplementation, GnRH agonist, hysterectomy
What are the etiologies of endometriosis ?
Polymicrobial
Group B strep
Gram negative (e colo, proteus, klebsiella)
How to treat endometriosis ?
First line- ampicillin, clindamycin and gentamycin
If no C section can omit clindamycin
piperacillin, ampicillin/sublactam
Cefotetan, cefoxitin, cefotaxime
What is endometritis?
Rarely seen outside of pregnacy but does occur
Seen with PID
Rare cause of infertility
Caused by chlamydia gonorrhea and mycoplasma
How to treat endometritis?
Polyp removal by D&C
Hysteroscopy
What is adenomyosis?
Presence of endometrial tissue in the myometrium
Common cause of secondary dysmenorrhea
Can cause menorrhagia
How to treat adenomyosis?
Oral contraceptives pills
Levonorgesterol intrauterine system
Hysterectomy
What are the classification of endometrial hyperplasia?
Simple- excessive proliferation of endometrial glands
Complex- abnormal proliferation of glands, not stromal elements
What is the most common gynecologic cancer?
Endometrial cancer
90% of cases are estrogen dependent
What are the risk factors for endometrial cancer?
Obesity Diabetes Hypertension Unopposed estrogen use Early menarche Late menopause Low parity Diabetes
How to treat endometrial cancer?
Surgery- total hysterectomy with bilateral salpingo-oophorectomy
Radiation for patients that cannot undergo surgery
What are the characteristics of follicular cysts?
Most frequently occurring cysts
From failure of a dominant follicle or immature follicle failing to undergo atresia
Treatment with repeat US 6-8 weeks,OCPs
What are the characteristics of corpus luteum cysts?
Post ovulation may cause progesterone to be produced beyond normal leading to amenorrhea
Can be hemorrhagic
Most common is sexually active women 21-25
Sudden onset lower abdominal pain after sex
What is endometrioma?
Ovarian involvement of endometriosis
Less common
Surgery done for chronic pelvic pain
What are the characteristics of torsion?
Most often seen in patients with benign ovarian lesions which twist and occlude vascular supply
Acute lower abdominal pain often with change of position, nausea and vomiting
What are the characteristics of benign cystic teratoma (dermoid cyst)?
Named byVirchow
Derivatives of all 3 layers
Can contain hair, teeth and cartilage components
Rupture is devastating- significant chemical peritonitis
What is ovarian fibroma?
Most common solid benign tumor of ovary
Associated with Meigs syndrome ( hydrothorax, ascites, ovarian fibroma)
Treated by excision
What are the types of epithelial cell neoplasm?
Mucinous cystadenoma- 2 nd most common, less malignant than serous
Serous cystadenoma- most common , range from benign to malignant
