Benign Gyn Flashcards
Uterine bleeding that occurs outside of normal menstruation
Abnormal Uterine Bleeding (AUB)
Characteristics of NORMAL Menstruation
Every ~30 days
4-6 in duration
~30 mL
Differential for Abnormal Uterine Bleeding
PALM-COEIN
Polyp Adenomyosis Leiomyoma Malignancy Coagulopathy Ovulatory Dysfunction Endometrial Iatrogenic Not-Yet Classified
Cause of Abnormal Uterine Bleeding; sessile or pedunculated hyperplastic growth of endometrial glands; risk factors are obesity, hormone therapy and Tamoxifen
Endometrial Polyps
Cause of Abnormal Uterine Bleeding; MOST common BENIGN tumor of genital tract; well circumscribed, non encapsulated smooth muscle tumor; Estrogen and Progesterone important for growth; also known as “fibroids
Leiomyomas
Leiomyomas, or “fibroids”, are more common in what race
African-American
What are the various types of Leiomyomas (“fibroids”)
Pedunculated Non-Pedunculated Submucosal Intramural Subserosal
Signs/Symptoms of Leiomyomas (“fibroids”)
Heavy bleeding Painful menses Pelvic pressure Urinary frequency Infertility/ pregnancy loss
Examples of Coagulopathies responsible for Abnormal Uterine Bleeding
Von Willebrand’s Disease
Factor Deficiencies
Platelet Abnormalities
Abnormal Uterine Bleeding caused by coagulopathies usually presents in (childhood/adulthood)
Childhood
Causes of Ovulatory Dysfunction (and thus, Abnormal Uterine Bleeding)
PCOS Hyperprolactinemia Hypothyroidism Obesity Stress Extreme exercise
Examples of Iatrogenic causes of Abnormal Uterine Bleeding
IUDs
Hormonal Contraceptives
Hormone Therapy
Commonly diagnosed BENIGN gynecologic condition; ectopic endometrial glands and stroma into Ovaries, Peritoneum, Bowel, Bladder, etc.; thought to be due to retrograde menstruation; implants usually appear as “powder burns”, but can also look like “red flame areas” or adhesions; histology shows endometrial epithelium, stroma and hemosiderin-laden macrophages
Endometriosis
Most common appearance of Endometriosis implants
“Powder burns”
Common ectopic sites of Endometriosis
Ovaries
Peritoneal cavity
Bowel
Bladder
Histologic findings for Endometriosis
Endometrial Epithelium and Stroma
Hemosiderin-laden macrophages
Pathogenesis of Endometriosis
Retrograde flow: reverse menses through fallopian tubes w/ implantation of viable endometrial cells
Why is Endometriosis almost exclusively in menstruating age group
Because it is thought to be due to retrograde menstrual flow
Signs/Symptoms of Endometriosis
Asymptomatic Painful periods (Dysmenorhea) Painful sex (Dyspareunia) Chronic Pelvic Pain Infertility
Cause of Abnormal Uterine Bleeding; endometrial gland and stroma WITHIN the Uterine MUSCLE; diffusely enlarged, tender, BOGGY uterus; the ectopic tissue causes hypertrophy of surrounding muscle, causing diffuse enlargement of Uterus; thought to be due to endomyometrial invagination
Adenomyosis
Pathogenesis of Adenomyosis (ectopic endometrium in uterine muscle)
Invagination of Endomyometrium
General treatment options for Benign Gynecologic Diseases
Oral Contraceptives*
Progestins*
GnRH agonists (downregulate receptors)
Surgery
*symptoms worse with menstruation, so suppressing flow improves symptoms
How do GnRH agonists help with the treatment of Benign Gynecologic Diseases, like fibroids and endometriosis
Is a CONTINUOUS administration of GnRH, unlike the pulsatile fashion our body does; this continuous GnRH stimulation eventually causes downregulation on the Anterior Pituitary, lowering LH and FSH, and thus estrogen and progesterone
Pathology when a follicle fails to rupture and continues to grow; 10% lifetime chance of needing surgery for Adnexal mass due to chance of MALIGNANCY; can be asymptomatic or pelvic pain and pressure
Ovarian Cysts
Most common type of BENIGN ovarian neoplasm; EPITHELIAL derived; can be either serous (more common) or mucinous
Cystadenoma
Benign neoplasm of the ovaries; GERM CELL derived; composed of all three germ layers (teeth, hair, sebum, etc.)
Cystic Teratoma (“Dermoid”)
RARE benign neoplasm of the ovaries; derived from gonadal stroma surrounding the oocytes, granulosa and theca cells
Sex-Cord Neoplasm
Ovarian cyst due to a remnant of the Mullerian duct; “Hydatid cyst of Morgagni”
Paraovarian Cyst
Complete or Partial rotation of the ovary around it ligament; can result in ischemia, infarction and necrosis; SURGICAL EMERGENCY
Ovarian Torsion