Benign Uterine and Ovarian Disease Flashcards
Most common pelvic tumor in women
fibriods
Where do fibriods arise from
smooth muscle cells of the myometrium
Locations of fibriods
- intramural
- subserosal
- submucisal
- cervical
- pedunculated submucosal or subserosal
Most common location of fibriod
intramural
Signs and symptoms of fibriods
typically asymptomatic
- heavy or prolonged menstrual bleeding
- pelvic pressure/pain
- urinary frequency
- anemia
- reproductive dysfunction
What would an exam show for fibriods
-enlarged uterus
-irregular uterus
+/- tenderness
Diagnostics for fibriods
- transvaginal US
- sonohysterography
- hysteroscopy
- MRI
- hysterosalpingography (HSG)
Treatment of fibriods
treat symptomatically
- NSAIDs (dysmenorrhea)
- OCPS/IUD
- surgery
GnRH analogue (leupron) Danazol (severe cases)
When do you do surgery for fibriods
- bulk related sx’s
- infertility
- miscarriages
Surgical options for fibriods
- hysterectomy
- myomectomy
- endometrial ablation
- uterine artery embolization
What is adenomyosis
ectopic endometrial tissue within the myometrium
“Boggy Uterus”=
adenomyosis
Signs and symptoms of adenomyosis
- heavy menstrual bleeding
- dysmenorrhea
- chronic pelvic pain
- diffusely enlarged uterus
When does adenomyosis present
40-50 years old
Definitive diagnosis of adenomyosis
histology s/p hysterectomy
Ways to give a probable diagnosis of adenomyosis
- transvaginal US
- MRI
“asymmetric thickening or the myometrium”
“linear striations”
“loss of clear endomyometrial border”
“increased myometrial heterogeneity”
Treatment of adenomyosis
hysterectomy is only definitive tx
Alternative tx for adenomyosis
- OCP/IUD
- lupron
- aromatase inh (anastrozole, letrozole)
What is endometriosis
presence of normal endometrial mucosa abnormally implanted in locations other than the uterine cavity
What happens to the ectopic tissue in endometriosis
respond to hormonal fluctuations–> prostaglandins–> inflammatory process and scarring of tissue
Common sites of endometriosis
- ovaries (most common)
- perimetrium
- posterior cul de sac
- broad ligamnet
- rectosigmoid colon
- bladder
Symptoms of endometriosis
- can be aymptomatic
- dysmenorrhea
- heavy or irregular bleeding
- pelvic pain
- lower abd pain/back pain
- dyspareunia
Physical exam findings for endometriosis
- lateral displacement of the cervix
- localized tenderness in pouch of douglas/ nodule
- pain wiht movement of the uterus
Complication of endometriosis
- endometrioma
- adhesion formation
- pain
- anatomic distortion
- infertility
- implantation on nearby structures
Diagnosis of endometriosis
laparoscopy w/ biopsy
classic blue black powder burned appearance
Options for tx of endometriosis (medical)
- hormonal contraceptions
- GnRH hormone analogues (lupron)
- danazol
Surgical management for endometriosis
- hysterectomy +/- oophorectomy
- laparoscopic uterine nerve ablation
- drainage and laparoscopic cystectomy
- laparoscopy and surgical endometrial implant ablation
What is the most common cystic ovarion lesion
functional ovarian cyst
Types of functional ovarian cysts
- follicular
- corpus luteal
- theca lutein
- endometrioma
What are the two types of cysts
- simple cysts
- complex cysts (debris,blood, varied wall thickness)
How do follicular cysts appear on US
simple unilocular, anechoic cyst with a thing smooth wall
When does a follicular cyst occur
when the rupture of a mature follicle doesnt occur
When do corpus luteal cyst occur
after ovulation
“ring of fire” on doppler=
corpus luteal cyst
What causes a theca lutein cyst
overstimulation by hCG
Which cysts are unilateral? Bilater?
unilateral: corpus luteal, follicular
bilateral: theca lutein
Mature cystic teratoma
benign germ cell tumor
How does a MCT appear
cystic–> calcifications, fat, sebaceous tissue, hair, teeth
MCT’s are associated with ___ when ___
ovarian torsion if >5cm
Two types of cystadenomas. Which one is more common?
serous
mucinous (filled with mucinous material)
Serous is more common
What is a cystadenofibroma
surface epithelial tumor
What does a cystadenofibroma resemble
malignant tumor
Treatment of cystadenofibroma
oophroectomy
What could a sudden onset of sharp pain indicate?
ruptured cyst
Complications of cysts
- ovarian torsion (large cysts)
- hemorrhagic cyst
- persistent pain or pressure
Diagnostics for benign cysts
- US (first line)
- CT pelvis (malignancy)
- MRI (if doing surg)
- hCG
- CA125 (post menopause w/ cyst >5cm)
- diagnostic lap
Ovarian cancer marker
CA125
Treatment of ovarian cyst
- analgesia
- OCP (recurrent functional cyst)
- ovarian cystectomy or oophorectomy
When is surgery considered for cysts
- symptomatic
- persistent 5 to 10 cm cyst
- ovarian torsion
- suspected malignancy
When is surgery done with follicular or corpus luteal cysts
if very large or hemorrhagic with rupture
Anterior compartment prolapse
aka. cystocele
hernia of the nateria vaginal wall with descent of bladder
Posterior compartment prolapse
aka. rectocele
hernia of posterial vaginal segment with descent of the rectum
Enterocele
hernia of the intestines to or through the vaginal wall
Uterine prolapse
descent of apex of vagina into lower vagina to or beyond the vaginal introitus
Uterine procidentia
hernia of all three compartment through to vaginal introitus
When do you treat pelvic organ prolapse
only if symptomatic
What are the treatments for pelvic organ prolapse?
- pessary
- pelvic floor muscle exercise
- surgery (anterior cloporrhaphy, posterior cloporrhaphy, sacral colpopexy, hysterectomy)
