4 - Fallopian tubes and uterus Flashcards
What rare disorder usually occurs as a result of an ovarian cyst or neoplasm?
Adnexal torsion
What IS an adnexa, exactly?
uterine appendages….aka fallopian tubes, ovaries, and surrounding connective tissue
Your patient presents with sudden onset LLQ pain, n/v, fever, tachycardia, and tachypnea. Her LLQ pain is exacerbated by direct palpation. You note rebound tenderness, and +psoas. You think you might feel an adnexal mass but you can’t be sure because there is voluntary guarding. What is your complete DDx?
1) adnexal torsion
2) appendicitis
3) ectopic pregnancy
4) ruptured ovarian cyst
5) tubal ovarian abscess 2nd to PID
6) neoplasm with rapid growth
How will you narrow down your DDx? Meaning, what tests will you order?
(1) adnexal torsion
2) appendicitis
3) ectopic pregnancy
4) ruptured ovarian cyst
5) tubal ovarian abscess 2nd to PID
6) neoplasm with rapid growth)
1) HCG to r/o ectopic
2) US will also r/o ectopic and check for mass
3) CBC to check for bleed or infection
4) CT to r/o appendix and/or mass
5) PCR (polymerase chain rxn) screens for GC/CT to r/o PID
If you discover your patient does indeed have an adnexal torsion, what do you do now?
Arrange surgical release of torsion. (EMERGENCY)
Either by bx or direct visualization, you determine that your patient has some endometrial tissue that is outside of the uterus. What is your diagnosis?
Endometriosis
What are the 3 theories as to how endometrial tissue can end up in places where it doesn’t belong?
1) Tubal regurgitation. (Menstrual tissue regurgitates back up into the fallopian tubes)
2) Metaplasia of mesothelium. (The peritoneum is pluripotent, and if it is agitated, the cells can begin to differentiate into endometrial tissue rather than peritoneal tissue)
3) Hematogenous dissemination. (Endometrial tissue gets into blood stream)**Not as common
What is the “classic tetrad” of endometriosis?
Expect on exam
1) dysmenorrhea
2) dyspareunia
3) chronic pelvic pain
4) infertility
What are the unusual manifestations of endometriosis?
Bleeding (rectal, nasal, hemoptysis) often a/w menses….
or abnormal tissue in laparotomy scars
What are the most cost effective ways to manage endometriosis in a patient who does not wish to become pregnant?
Oral contraceptives or Depo-provera
What type of treatment essentially induces an artificial menopause?
GnRH agonist (expensive, menopause side effects)
If medication management of endometriosis does not provide relief, what is another option?
Sx (laparoscopy or laparotomy)
What are the 3 major types of female GU cancers?
cervical, ovarian, endometrial
What is the MOST COMMON histology of endometrial cancer?
Expect on exam
Adenocarcinoma
What are the risk factors for endometrial cancer?
1) 50+ yoa
2) early menarche
3) late menopause
4) FHx
5) obesity (HTN/DM)
6) No pregnancies
7) Unopposed estrogen stimulation (HRT)
* *More exposure to estrogen increases risk, whereas progesterone has an endometrial protective effect.
