Benign Conditions of Cervix, Uterus, Endometrium Flashcards

1
Q

What are the three components of the cervix

A

Ectocervix
External os
Endocervical canal

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2
Q

What is the ectocervix?

A

Vaginal part of the cervix

Lined in thick non-keratinised stratified squamous epithelium

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3
Q

Where is the external os visible?

A

At the centre of the ectocervix as a dark circular area

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4
Q

What is the endocervical canal lined in?

A

Simple columnar epithelium

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5
Q

What is a cervical ectropion?

A

A visible columnar epithelium on the endocervix
Appears as a round, red area
Physiologycal

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6
Q

What are triggers for a cervical ectropion?

A

3Ps
Pill
Puberty
Pregnancy

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7
Q

What are symptoms of a cervical ectropion?

A

Intermentstrual, poistoctal bleeding

Mucous (excessive, clear, odourless)

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8
Q

How do you (ix+) manage a cervical ectropion?

A

CONSIDER SMEAR / BIOSPY FOR CERVICAL CANCER
Cervical and lower genital tract swabs to exclude STI

Change from oestrogen based hormonal contraceptive
Cervical ablation

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9
Q

What should you double check when investigating cervical ectropion?

A

Cervical, lower genital tract swab - STI

Smear - cervical malignancy

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10
Q

What is a nabothian follicle?

A

When columnar glands in transformation zone seal over, forming small cysts on ectocervix

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11
Q

How do you treat nabothian follicles?

A

NO treatment required

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12
Q

What are cervical polyps?

A

Benign tumours from endocervical epithelium

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13
Q

What do cervical polyps look like?

A

Smooth reddish protrusions

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14
Q

How are cervical polyps removed?

A

By avulsion, with polyp forceps

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15
Q

What is cervical stenosis?

A

Pathological narrowing of endocervical canal

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16
Q

What causes cervical stenosis?

A

Iatrogenic

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17
Q

What does cervical stenosis cause?

A

Entrapment of blood within uterus (haematometra) causing cyclical dysmenorrhoea with no menstrual bleeding

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18
Q

How do you treat cerbical stenosis?

A

Surgical dilatation of cervix

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19
Q

What are endometrial polyps?

A

Focal endometrial outgrowths

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20
Q

What are RF for endometrial polyps?

A

Obesity
Late menopause
Tamoxifen, HRT

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21
Q

How do polyps respond to hormonal changes?

A

They DONT

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22
Q

How do you investigate polyps’

A

TVUSS

Hysteroscopy

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23
Q

How do you manage endometrial polyps?

A

Polypectomy (surgical) - through hysteroscopy (day case)

Small one resolve alone

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24
Q

What is Asherman Syndrome?

A

Fibrosis and adhesion formation within the endometrial cavity following irreversible damage of the single layer of thick basal epithelium (which Does not regenerate)

25
Q

What is a complication of Asherman syndrome?

A

Subfertility

26
Q

What are causes of Asherman Syndrome?

A

Surgery
Overzealous curettage in TOP
Pregnancy w uterine infection (endometritis)

27
Q

How do you manage Asherman syndrome?

A

Adhesiolysis (surgical breakdown of intrauterine adhesions)

28
Q

What are fibroids?

A

Leiomyoma

Benign tumour of uterine smooth muscle

29
Q

What are RF for fibroids?

A

Nulliparous
Obese
Afro carribean ethnicity

30
Q

What are the four locations of fibroids

A

SICS

Subserosal
Cervical
Intramural
Submucosal

31
Q

What are symptoms of fibroids?

A
HMB, IMB
Subfertility, recurrent pregnancy loss, 
Pressure and pain 
Bladder and bowel dysfunction 
Abdominal distension
32
Q

How do fibroids reacts to oestrogen=?

A

They are OESTROGEN DEPENDENT

  • enlarge during pregnancy
  • shrink after menopause
33
Q

How do fibroids cause sub fertility?

A

mechanical distortion of endometrial tissue, preventing implantation / occlusion of FT

34
Q

What are investigations for fibroids?

A

FBC (anaemia)
USS (TVUSS, TAUSS)
Saline infusion sonography

RMI
Hysteroscopy

35
Q

What is the medical mx of fibroids?

A

For HMB:

  • LNG-IUS
  • Tranexamic acids
  • COCP
  • Injection f GnRH agonist (induces temporary menopause)
  • Ulipristal acetate
36
Q

What is Ulipristal Acetate

A

Selective Progesterone Receptor Modulator

37
Q

What is surgical mx for fibroids?

A

Myomectomy (surgical resection of fibroids, preserves fertility)
Transcervical fibroid resection
Hysterectomy
Uterine artery embolisation

38
Q

What must you give prior to myomectomy / hysterectomy?

A

GnRH agonist pre-treatment for 3 months

This reduces bulk and vascularity of fibroids

39
Q

What is radiological tx for fibroids=

A

Uterine artery embolisation

40
Q

What is adenomyosis?

A

Endometrial glands and storm are found deep within the myometrium

41
Q

How does adenomyoisis present?

A

Secondary dysmenorrhoea
Uterine enlargement
HMB

42
Q

What is the gold standard investigation for adenomyosis?

A

MRI

43
Q

How do you manage adenomyosis?

A

Progesterone containing LARC

Hysterectomy - permanent tx

44
Q

Are fibroids associated to leiomyosarcoma?

A

very few women with fibroids then develop leiomyosarcoma
Likely to be only because they are similar (confusing for dx) or coincidental as fibroids are very common

Little evidence for causation

45
Q

What is the main RF for fibroids?

A

OESTROGEN

46
Q

What are possible triggers for fibroid growth?

A

PREGNANCY

also high BMI

47
Q

Why is high BMI a trigger for fibroid growth?

A

Adipose tissue converts testosterone to oestrogen

48
Q

What are the four types of fibroid you can get?

A

Submucosal
Cervical
intramural
Subseerosal

49
Q

Where do submucosal fibroids sit?

A

Below the mucosa

They bulge out into the endometrial cavity

50
Q

Where do cervical fibroids sit?

A

At the cervix

51
Q

Where do intramural fibroids sit?

A

Within the myometral wall

52
Q

Where do subsrosal fibroids sit?

A

Just below serous layer, on outer edge of uterus

53
Q

What is another term for dysmenorrhoea?

A

UTERINE ANGINA

Essentially because contractions during periods cause reduced blood supply, leading to pain

54
Q

WHAT DO symptoms for fibroids depend on?

A

ON the LOCATION of the fibroid

55
Q

What are common symptoms with fibroids and why do they occur?

A
  • HMB (increased surface area means increased bleeding)
  • Dysmenorrhoea (increased uterine angina)
  • Anaemia (from excess bleeding)
  • Subfertility (if submucosal, makes it hard for implantation)
  • Pain and pressure sx (if very large(
56
Q

How do fibroids affect pregnancy?

A

Early miscarriage
Late miscarriage
Premature birth

Because fibroids stretch the myometrium, triggering early labour

57
Q

What is red degeneration of fibroids?

A

Fibroid grows excessively during pregnancy
It outgrows the blood supply
DIes

58
Q

What factors should you consider when managing fibroids?

A

Effect on quality of life
Fertility
Cultural wishes