benign gyn d/o Flashcards
3 common presentations of benign pelvic d/o
AUB
pelvic pain
infertility
uterine diseases
fibroids (“leiomyoma”)
polyps
hyperplasia
ovarian d/o
cysts
tubo-ovarian abscess (TOA)
benign neoplasma
OB d/o
pregnancy
ectopic
molar pregnancy (gestational trophoblastic neoplasia)
what influences leiomyomas? how?
estrogen
its larger with increased estrogen
3 types of leiomyoma
intramural
submucosal
subserosal
intramural leiomyoma location
myometrium
submucosal leiomyoma location
right below endometrium
3 signs of leiomyomas
irregularly enlarged uterus
asymmetric uterus
firm uterus
which disorder can have stress urinary incontinence as a symptom?
leiomyoma (usually asymptomatic tho)
treatment for leiomyoma
hysterectomy
myomectomy
OCP
GnRH analogs
embolization
what is a polyp
any mass of tissue projecting outward from surrounding tissue
where do most polyps arise?
fundus
between fibroids and polyps, which can become malignant
polyps (infrequent tho)
which uterine dz has tamoxifen, obesity, lynch or coden syn and postmenopause HRT as RF?
polyps
sx of polyps
recurring menorrhagia
post-menopausal bleeding
signs of polyps on exam
normal uterus with protruding polyp
tx of polpys
surgical resection if having sx OR >1.5cm, multiple, fertility concerns, cervical protrusion
tissue origin of fibroids vs polyps
fibroids– smooth muscle
polyps— epithelium
which is typically bigger- polyp or fibroids
fibroids are bigger
when do you tx fibroids?
only if symptomatic
which is more influenced by estrogen– fibroids or polyps?
polyps
what is hyperplasia
proliferation of endometrial glands when theres more glans-stroma ratio than normal
what causes hyperplastia
chronic unopposed estrogen stimulation
simple vs complex hyperplasia
simple— glands are dilated w/ occasional outpouch
complex– back to back w/ luminal outpouching and minimal intervening stroma
what does “with nuclear atypia” mean?
progression to endometrial cancer is 10x higher
sx of hyperplasia
heavy bleeding or intramenstrual bleeding
post menopausal bleeding
signs of hyperplasia on exam
anemia
how is hyperplasia diagnosed
endometrial biopsy
US of endometrial stripe
the only time megace is not used to tx hyperplasia
if it is premenopause without atypia
how do you treat hyperplasia with atypia?
premenopause– hysteroscopy w/ D&C–> hysterectomy or megace
postmenopause– hysterectomy, megace
how do you tx hyperplasia w/o atypia?
premenopause— medroxyprogesterone or IUD
postmenopause— treat unopposed estrogen, megace
when do ovarian cysts typically develop?
during menstrual years
what is a functional-follicle cyst?
happens bc fluid doesn’t get reabsorbed in not fully developed follicle
sx of functional-follicle ovarian cyst
typically asymptomatic
can alter cycle, cause pelvic pressure and pain
what does functional-follicle ovarian cyst look like on US?
smooth, thin walled unilocular mass
disappears spontaneously but OCP can reduce it
what are the two types of functional lutein ovarian cysts?
corpus luteum cysts
theca lutein cysts
difference between corpus luteum and theca lutein cysts
corpus may cause torsion, may cause internal bleeding if it ruptures
theca is usually bilateral and has straw colored fluid
3 types of fallopian tube diseases
congenital
infectious
functional
what is congenital fallopian tube dz
absence of tubes
what is infectious fallopian tube dz
any STD that can cause adhesions
what is functional fallopian tube dz
scarring from gyn procedure
ectopic or normal pregancny
sx of fallopian tube d/o
infertility
there are no signs seen in PE
how is fallopian tube d/o treated?
depends on cause– could reanastomose tube w/ surgery
where does gestational trophoblastic neoplasia arise?
fetal tissue
3 types of gestational trophoblastic neoplasia
hydatidiform mole
invasive mole
choriocarcinoma
what is the most common type of gestational trophoblastic neoplasia
hyatidiform mole
what does hyatidiform mole look like?
grape like vesicles filling uterus
which type of gestational trophoblastic neoplasia may cause distant metastases
invasive mole
which type of gestational trophoblastic neoplasia follows term pregnancy or abortion?
choriocarcinoma
sx of gestational trophoblastic neoplasia?
1st trim bleeding
dramatic N/V
what are signs of gestational trophoblastic neoplasia?
vaginal bleeding
preeclampsia or eclampsia
no fetal heart tones
larger uterus than expected
how is gestational trophoplastic neoplasia diagnosed?
US– multiple echoes
quantitative beta-HCG serum >100k (molar?)
thyroid studies
