Benign Disorders of the Upper Genital Tract Flashcards
Lower one third of the vagina derives from what embryonic structure?
Urogenital diaphragm
Ovaries derive from what embryonic structure?
Genital ridge
Upper vagina, cervix, uterus, and fallopian tubes derive from what embryonic structure?
Fusion of the paremesonephric (Mullerian) ducts.
Most common anatomic anomaly of the uterus?
Septate uterus - from malfusion of the paremesonephric (Mullerian) ducts.
Cause for increase in mullerian anomalies in the female population? Classic presentation of this anomaly?
DES exposure in utero. T-shaped uterus.
Most common complication of having a uterine septum?
First trimester pregnancy loss (25%) - Decreased ability to perfuse the placenta.
Common complications of having a uni/bicornuate uterus (3)?
Second trimester pregnancy loss, malpresentation, and preterm labor and delivery - Decreased size of the uterine horn
What tests can distinguish between unicornuate and bicornuate uteri?
MRI or laparoscopy.
What is the most common indication for surgery for women in the US? Symptoms?
Uterine leiomyomas (fibroids). Can cause pelvic pain, urinary frequency, constipation, abnormal uterine bleeding, and secondary dysmenorrhea.
Are fibroids polyclonal or monoclonal?
Monoclonal - from from propagation of a single muscle cell.
What increases the growth rate of fibroids? What decreases the growth rate of fibroids?
ESTROGEN and progesterone (endogenous and exogenous). Menopause - decreased estrogen.
Three classes of uterine fibroids?
Most common type?
Type that causes the heaviest bleeding?
Type that causes the most pain?
Submucosal, intramural, and suberosal.
Intramural.
Submucosal.
Pedunculated subserosal.
How to distinguish between fibroids and adenomyosis? Most helpful test?
Fibroids are encapsulated in pseudocapsule.
MRI.
Which race of women are more likely to develop fibroids (as well as at a younger age with more severe fibroids, bleeding, and anemia)
Black women! 50% will get them by 40, only 30% of the general population will get them by 40.
Most common symptom of fibroid? Second most common symptom?
Asymptomatic.
Abnormal uterine bleeding - Menorrhagia, metorrhagia, postcoital spotting, and menometorrhagia.
Most common means of diagnosing fibroids?
Best diagnostic test for submucosal fibroid?
Pelvic ultrasound.
Sonohysterography.
How frequently should a woman with actively growing fibroids be assessed?
Every 6 months.
Role of GNRH agonists (Lupron) in treatment of fibroids?
Decrease size, stops bleeding, and increases hermatocrit.
What is the definitive treatment for uterine fibroids?
Issue with myomectomy?
Hysterectomy.
50% recurrence.
Indications for surgery for fibroids (7)?
Bleeding causing anemia. Pelvic pain. Urinary symptoms. Growth after menopause. Recurrent miscarriage/infertility. Rapid increase in size. Large uterine size (>12 weeks)
Cause of endometrial polyps?
Which age groups are most effected?
Most common symptoms?
Best diagnostic tests?
Overgrowths of endometrial glands and stroma.
40-50 year old women (especially on tamoxifen).
Metrorrhagia, menorrhagia, and menometrorrhagia.
Ultrasound and sonohysteogram.
Why is it important to remove symptomatic endometrial polyps?
They mask bleeding from another source (endometrial hyperplasia or cancer).
DDX of Abnormal bleeding (7)?
Adenomyosis, endometrial polyps, endometrial hyperplasia, endometrial cancer, dysfunctional uterine bleeding, ectopic pregnancy, and Uterine Fibroids.
What causes endometrial hyperplasia?
Unopposed estrogen!
Exogenous - Hormone replacement therapy
Endogenous - Conversion of androgens to estrogens by aromatase in adipocyte cells.
