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Clin Med III > benign uterine and ovarian diseases > Flashcards

benign uterine and ovarian diseases Flashcards

1
Q

leiomyomas

A
  • aka fibroids
  • most common pelvic tumor in women
  • benign
  • come from SMC of myometrium
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2
Q

locations of leiomyomas

A
  • intramural myoma- most common
  • subserosal
  • submucosal
  • cervical
  • if stemmed= pedunculated
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3
Q

si/sx of leiomyomas

A
  • most are small and asymptomatic
  • heavy or prolonged menstrual bleeding
  • pelvic pain/pressure
  • urinary frequency, difficulty emptying bladder
  • LBP
  • dyspareunia
  • reproductive dysfunction
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4
Q

PE findings and diagnosis for leiomyomas

A
  • enlarged and irregular uterus
  • +/- tenderness
  • dx with transvaginal US
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5
Q

treatment for leiomyomas

A
  • based on type of fibroid and severity of sx
  • menopause causes fibroids to shrink
  • watchful waiting
  • medical mgmt
  • surgery* mainstay of tx
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6
Q

medical management for leiomyoma

A
  • NSAIDs- only for dysmenorrhea
  • OCPs or IUDs
  • GnRH- leuprolide (leupron) to induce menopause state
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7
Q

surgical options for leiomyoma

A
  • hysterectomy
  • myomectomy- cut out fibroid layer, must be submucosal fibroid
  • endometrial ablation- burn tissue to stop BF
  • uterine artery embolization
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8
Q

indications for leiomyoma surgery

A
  • abnormal uterine bleeding
  • bulk related sx
  • infertility
  • recurrent miscarriages
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9
Q

adenomyosis

A
  • ectopic endometrial tissue within myometrium
  • causes hypertrophy and hyperplasia
  • boggy uterus
  • not well differentiated from surrounding tissue, difficult to excise
  • more common in parous females
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10
Q

adenomyoma

A
  • adenomyosis confined to one area

- resembles fibrouds

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11
Q

si/sx of adenomyosis

A
  • heavy menstrual bleeding*
  • dysmenorrhea*
  • chronic pelvic pain
  • diffusely enlarged uterus- globular
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12
Q

dx of adenomyosis

A
  • pathology after hysterectomy

- transvag US or MRI may be helpful in assessment

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13
Q

key words on imaging for adenomyosis

A
  • asymmetric thickening of myometrium
  • linear striations
  • loss of clear endomyometrial border
  • increased myometrial heterogeneity
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14
Q

treatment for adenomyosis

A
  • hysterectomy*
  • +/- uterine artery embolization
  • OCPs and IUDs may decrease bleeding and pain
  • GnRH analogs and aromatase inhibitors
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15
Q

endometriosis

A
  • abnormal endometrial mucosa implanted in locations other than uterine cavity
  • estrogen dependent
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16
Q

risk factors for endometriosis

A
  • family hx
  • nulliparity
  • early age menarche
  • short menstrual cycles
  • long duration of menstrual flow
  • heavy menstrual bleeding
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17
Q

common sites of endometriosis

A
  • ovaries- most common
  • uterus
  • posterior cul-de-sac
  • broad ligament/ uterosacral ligament
  • rectosigmoid colon
  • bladder
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18
Q

si/sx of endometriosis

A
  • severity of sx doesnt always correlate to extent of disease
  • asymptomatic
  • dysmenorrhea
  • heavy or irregular bleeding
  • pelvic pain*
  • lower abd pain/ LBP
  • dyspareunia
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19
Q

PE findings for endometriosis

A
  • lateral displacement of cervix
  • localized tenderness in posterior cul-de-sac
  • palpable tender nodule in posterior cul-de-sac
  • pain with mvmt of uterus
  • severe abd pain- ruptured endometrioma
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20
Q

complications of endometriosis

A
  • endometrioma “chocolate cysts”
  • adhesion formation
  • pain
  • anatomic distortion
  • infertility
  • implantation onto nearby structures
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21
Q

diagnosis of endometriosis

A
  • laparoscopy with biopsy*
  • blue black or powder burned appearance
  • transvag US to r/o other pathology
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22
Q

medical management of endometriosis

A
  • 95% responsive to medical mgmt but half have sx relapse in 5 yrs
  • combined OCPs
  • GnHR analogs
  • danazol- androgenic steroid
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23
Q

surgical mangament of endometriosis

A
  • hysterectomy +/- oophorectomy= definitive
  • laparoscopic uterine nerve ablation
  • drainage and laparoscopic cystectomy
  • laparoscopy and surgical endometrial implant ablation- high rate reoperation
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24
Q

ovarian cysts

A
  • occurs in all ages including neonatal/ infancy

- usu found on routine pelvic exam or US incidentally

25
Q

functional ovarian cyst

A
  • most common cystic ovarian lesion
  • usu in reproductive age
  • follicular cyst
  • corpus luteal cyst
  • theca lutein cyst
  • endometrioma
26
Q

simple cyst

A
  • fluid filled

- thin walled

27
Q

complex cyst

A
  • debris, blood
  • varied wall thickness
  • septations
  • hemorrhagic
28
Q

follicular cyst

A
  • rupture of mature follicle doesnt occur
  • unilateral
  • most resolve on their own in 2-3 mo
  • usu present as simple cyst on us
29
Q

corpus luteal cyst

A
  • occur after ovulation
  • thicker walls
  • can be vascular- more likely to be hemorrhagic
  • ring of fire on US
30
Q

theca lutein cyst

A
  • due to ovarian hyperstimulation
  • rare
  • hormonal overstim of bHCG
  • usu bilateral
31
Q

PCOS

A
  • aka stien leventhal syndrome
  • 10 or more peripheral simple cysts
  • chara string of pearls appearance
32
Q

mature cystic teratoma

A
  • aka dermoid cyst
  • benign germ cell tumor
  • has calcifications, fat, sebaceous tissue, hair and/ or teeth
  • dont spont resolve
  • assoc with ovarian torsion if > 5 cm
  • can become malignant
33
Q

cystadenoma

A
  • serous- thinner fluid, usu bilat

- mucinous- very large, material inside is thicker, bilat

34
Q

cystadenofibroma

A
  • rare, benign
  • resembles malignant tumor
  • complex cystic to solid appearance
  • surface epithelial tumor
  • tx- oophorectomy
35
Q

si/sx of cysts and benign tumors

A
  • asymptomatic*
  • abd pain
  • fullness, heaviness, pressure, bloating
  • irreg/ abnormal bleeding
  • if sudden onset sharp pain think ruptured cyst
36
Q

complications of cysts and benign tumors

A
  • ovarian torsion*, esp if > 5 cm
  • hemorrhagic cyst -> rupture and internal bleeding
  • persistent pain and pressure
37
Q

dx of cysts and benign tumors

A
  • US first line
  • CT pelvis for malignancy
  • MRI if complex mass
  • hCG
  • CA125- tumor marker for ovarian cancer
  • diagnostic laparoscopy
38
Q

US monitoring for simple cysts

A
  • < 5 cm- observe
  • 5-7 cm- f/u annually
  • > 7 cm either MRI or surgery, high risk of torsion
39
Q

US monitoring for post menopausal cysts

A
  • annually

- +/- CA125

40
Q

US monitoring for dermoid cysts

A
  • US q6-12 mo

- cystectomy

41
Q

US monitoring for endometrioma

A
  • initial f/u q 6-12 weeks
  • US annually
  • cystectomy of sx
42
Q

treatment for cysts

A
  • analgesia
  • contraceptives if recurrent functional cysts
  • ovarian cystectomy or oophorectomy
  • surgery not indicated for follicular or corpus luteal cysts unless lg/ hemorrhagic
43
Q

what makes up the pelvic floor

A
  • levator ani
44
Q

pelvic organ prolapse

A
  • herniation of pelvic organs to or beyond vaginal walls
45
Q

anterior compartment prolapse

A
  • aka cystocele

- hernia or anterior vaginal wall with descent of bladder

46
Q

posterior compartment prolapse

A
  • aka rectocele

- hernia of posterior vaginal segment with descent of rectum

47
Q

enterocele

A
  • hernia of intestines to or through vaginal wall
48
Q

apical compartment prolapse

A
  • aka uterine prolapse

- descent of apex of vagina into lower vagina

49
Q

uterine procidentia

A
  • hernia of all three compartments through vaginal introitus
50
Q

risk factors for pelvic organ prolapse

A
  • parity- vaginal delivery
  • advanced age
  • obesity > 25
  • hysterectomy
  • chronic constipation
  • heavy lifting
  • CT disorders
51
Q

si/sx of pelvic organ prolapse

A
  • constipation*
  • fecal urgency or incontinence
  • incomplete fecal or bladder emptying
  • slow urine stream
  • OAB
  • often have sexual avoidance, +/- dyspareunia
52
Q

pelvic organ prolapse stage 0

A
  • no prolapse
53
Q

pelvic organ prolapse stage 1

A
  • 1 cm above hymen
54
Q

pelvic organ prolapse stage 2

A
  • descends into introitus
55
Q

pelvic organ prolapse stage 3

A
  • 1 cm past hymen but does not cause complete vaginal vault eversion or uterine procidenta
56
Q

pelvic organ prolapse stage 4

A
  • complete vaginal vault eversion or complete uterine procidenta
57
Q

conservative therapy options for pelvic organ prolapse

A
  • pessary- silicone device that pt puts in and removes themself
  • pelvic floor muscle exs
58
Q

surgical repair optios for pelvic organ prolapse

A
  • anterior colporrhaphy
  • posterior colporrhaphy
  • sacral colopexy
  • hysterectomy with uterosacral or sacrospinous ligament suspension

Clin Med III (26 decks)

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