Benign Gynecology Flashcards
- Sx: Abdominal discomfort, cramping, spotting
- signs: soft, slightly tender mid-pelvic mass
- Confirmed by ultrasound
- treatment: dilation and drainage ‘
- hallmark of complete of complete obsruction is hematometra (retention of blood in the uterus) or pyometra (infection in the uterus
cervical stenosis
Types of cervial cysts?
Nabothian cysts
mesonephric cysts
endometriosis can produces small reddish or purple structures on the cervical os
epidemiology: most originate from endocervix
* Sx: asymptomatic, intermenstrual or post-coital bleeding
* signs: sepcula exam finds a smooth or red or purple, finger-like projection from endocervix which is 1-2cm in- so soft cannot be palpated on bimanual exam
* treatment: most can be removed (curative)- must be sent for eval.
* complications/prognosis: infection
cervical polyps
- epi: rare, cause unknown; solitary projection from ectocervix near the tranformation zone
- sx: none, usually discovered on exm
- tx: simple excision: MUST be submitted for eval
- complication: HPV infection lesion need long-term follow up care; benign do not need follow up
Papillomas
- epi: uncommon, usually solitary and large
- sx: usually silent unless large where they apply pressure on bladder, rectum or other tissue
- sign: large soft mass seen with specula, felt on bimanual exam
- imaging: plain film (calcification), MRI is diagnosit
treatment: wait/watch—> surgery
leiomyoma
- Epi: common, smooth muscle tumors of the uterus (in 1/2 of women >40); influence by estrogen (large with increased estrogen
- Risk factors: race, parity, age of menarche, OCPs, DES exposure, diet genetics
- Sx: typically asymptomatic; but may include heavy menstrual flow, intermenstrual bleeding, back or pelvic pain, infertility, stress incontinence
- Signs: uterus enlarged, assymetrical or firm
Leiomyoma (fibroids, myoma, fibromyoma)
- Eti: more common in women 29-59, greatest incidence after 50; size ranges from small to filling uterine cavity; most arise from fundus, appears smooth, red or brown, ovid body with velvety appearance
- Risk: tamoxifen, obesity, lynch or cowden syndrome, post-menopause HRT
- sx: recurring menorrhagia, post-menopausal bleeding w/or w/out menstrual cramping
- signs: normal uterus protruding poly
uterine polyps
What are the treatment option of uterine polyps
symptoms: surgical resection
asymptomatic: surgical resection if >1.5cm
* multiple polyps present
* fertility concerns
* cervical protrusion
Polyp vs. fibroid
Fibroid
* smooth muscle; large; enlarged uterine; almost never malignant; no tx if asymptomatic; low estrogen influence; degenerate
polyp
* epithelim, small size; no effect on uterus size; infrequent malignancy; requires evaluation for tx; high estrogen influence; regressive
- greater glans to stroma ratio; results from chronic unopposed estrogen
- has simple vs complex classification
- sx: heavy menstral bleeding or intramenstrual bleeding/spotting, post-menopausal bleeding
- signs: anemia
- look at endometrial stripe
endometrial hyperplasia
treatment for endometrial hyperplasia?
premenopause
* without atypia: medroxyprogestone daily for 12-14 days and monthly for 3-6 months
* with atypia: hysteroscopy with D&C–> hysterectomy or megace
postmenopause
* without atypia: treat unopposed estrogen conditions; megace
* with atypia: hysterectomy; megace
- develop almost exclusively during menstruating years; occur because fluid fails to reabsorb in a incompletely developed follice
- dx: ultrasound find smooth thin walled, uniocular mass-disspear spontaneously
- sx: asymptomatic typically but may cause altered menstrual cycle, pelvic pressure, pain
- ocps may help reduce size, presence and recurrence
physiologic cysts or functional cysts
Types
* congenital- absence of tubes
* infectious-any STD which cause adhesion
* functional- cysts, tumors,scarring from gyn procedue, ectopic or norma
sx: infertility
signs: absent
treatment: depends on cause–> surgery may be option to open reanastomose tube
fallopian tube benign conditions
