Cervix, Uterus, and Ovaries Flashcards
cervicitis with foamy, greenish discharge and strawberry cervix
caused by trichomoniasis
cervicitis with thin, gray discharge with fish smell
caused by bacterial vaginosis
cervicities with thick, creamy discharge
caused by neisseria gonorrhea
cervicitis with purulent pus like discharge
caused by chlamydia trachomatis
cervicitis with white/curd like discharge
candidiasis
patient presents with post coital bleeding, dysmenorrhea, dyspareunia, lower abdominal pain, back pain, urgency, frequency, dysuria, puriritis, and vulvular pain. Also has leukorrhea. What is in ddx?
cervicitis. ask about discharge if acute condition
problem with cervicitis is it is often asymptomatic. if left untreated, can potentially lead to..
PID, chronic pelvic pain, infertility, and ectopic pregnancy
atypical cells of undetermined significance
ASCUS cells- abnormal, but not enough to call dysplasia
CIN II of cervical dysplasia
abnormal cells in half thickness of cervix lining
CIN III of cervical dysplasia
abnormal cells in entire thickness of cervix lining, but has not spread below to surface layer
in what treatments of cervical dysplasia can depth of tx be controlled/not controlled?
controlled in laser tx, not controlled in cryotherapy
result of cryotherapy tx in cervical dysplasia
damaged cells will shed in heavy watery discharge for 1 month
which tx of cervical dysplasia has lowest recurrence rate?
hysterectomy
tx of cervical dysplasia
cryotherapy, laser, cone biopsy, LEEP, hysterectomy
F/U of cervical dysplasia
CIN I- cytology at 6 months and 12 months OR HPV DNA testing at 12 months. CIN II and III- cytology or colposcopy at 4-6 months x 2 years
cell type affected in cervical cancer
squamous cell- 85%. adenocarcinoma on the rise
how to differentiate cervicitis with cervical cancer via symptoms. both may have post coital bleeding, but
cervicities- pruritic, cervical cancer- non pruritic
dx of cervical cancer
papsmear- vaginal cytology, cervical biopsy or endocervical curettage or conization
prevention of cervical cancer
gardasil quadravalent (6/11/16/18) or cervix bivalent HPV vaccine (16/18)
patient presents with heavy, irregular vaginal bleeding and pelvic pressure and pain. US shows fibroid tumor causing enlarged uterus. What other tests to do you?
suspect leiomyoma- pregnany test, U/A, Hgb levels,
tx for leiomyoma
symptomatic- intermittent ocp or progestrin,, myomectomy, hysterectomy
if preggo with leimyoma, and fibroid tumor greater than 3 cm,
increased risk of preterm labor, placental abruption, pelvin pain, and c-section
when do leiomyoma grow and atrophy?
responsive to hormones- so rapid growth in estrogen phases (enlarges with menstrual cycle) and atrophies during menopause
leiomyoma tumor made of of…
CT and smooth muscle
noncancerous uterine thickening
adenomyoma
heavy bleeding and severe cramping with menstrual periods. dx?
maybe its menorrhagia or leiomyoma. do surgical excision- if endometrial tissue in thick uterine lining, consider adenomyoma
tx for adenomyoma
lupron or synarel, surgery good when confined to isolated area in muscle wall.
dx of adenomyoma
surgical excision- only proven way to truly diagnose
first line imaging test for females with abnormal uterine bleeding
transvaginal US
sx of cervical or uterine polyps
postcoital bleeding, intermenstrual bleeding, heavy periods, metrorrhagia, leukorrhea
how to diagnose cervical/uterine polyps
transvaginal US, microscopic examination, sonohysterography, hysteroscopy
most cervical/uterine polyps originate from
endocervix
tx of cervical/uterine polyps
excise/cut, leave in place and monitor, laser tx
number 1 symptom in endometrial cancer
endometrial cancer
most common diagnosed gynecological malignancy is united states
endometrial cancer
female 60 years old with abnormal bleeding including post menopausal, pelvic pain and discomfort
suspect endometrial cancer. do biopsy
strongest predictor of survival in endometrial cancer
stage 1 depth of myometrial invasion
majority of endometrial cancers are what kind of cancers?
primary- adenocarcinoma
endometrial cancer tx
total hysterectomy and bilateral salpingo-oophorectomy
ovarian cancer- benign or malignant?
most benign, but when malignant, leading cause of death for reproductive tract
abdominal pain and bloating, pelvin pain/pressure. no abnormal bleeding. what cancer would you suspect?
ovarian cancer
markers in ovarian cancer
CA-125 helps distinguish between benign and malignant, hCG, lactate dehydrogenase, alpha fetoprotein
ovarian cancer diagnosis
pelvic US and exam, markers, transvaginal US in high risk females
you diagnose malignant ovarian cancer. what are tx options
total hysterectomy and bilateral salphingo-oopherectomy and lymphadenopathy plus post op chemo
benign ovarian cancer tx
remove tumor, unilateral oopherectomy may be done
patient presents with dyspepsia, bloating, bowel/bladder pressure, dyspareunia, severe acne, deep voice, hirsutism. how to diagnose?
suspect benign ovarian neoplasm- do a pelvic exam. transvaginal US to determine architecture of mass. CBC for WBC to r/o PID. beta-hCG check. UA, serum estrogens and androgens if PCOS workup, CA-125 if post menopausal to differentiate benign vs. malignant pelvic pass, alpha fetoprotein
patient presents with painful, tender mass on bimanual exam. Pelvic US shows smooth, thin walled, unilocular cyst less than 10 cm. OCP’s will help prevent these from reoccuring. suspect..
follicular cyst
US shows complex, grossly yellow, rough edged cyst in ovary
corpus luteum cysst
which cyst can present like appendicitis
corpus luteum cyst
labs in theca lutein cyst
chorionic gonadotropin elevated, US or PE reveal bilateral, clear straw colored fluid
ectocervix vs. endocervix covered by …
ecto-stratified squamous epithelium. endo - columnar epithelium (mucous secreting)
is endo or ectocervix hormone sensitive?
ectocervix
ectocervix extends from…
squamocolumnar junction to vaginal fornices
classifications of leiomyoma
intramural, intraligamentous, cervical, parasitic, submucous, subserous
first line imaging study of choice for evaluation of women with abnormal uterine bleeding
transvaginal ultrasound
soft red pedunculated protrusion from the cervical canal at external os, intermenstrual or postcoital bleeding, post douching, post menopause bleeding. . In age 25, nulliparous. previously on tamoxifen.
endometrial polyps (cervical or uterine polyp)
how to diagnose endometrial polyp
transvaginal ultrasound, sonohysterography, hysterectomy
most common diagnosed gynecologic malignancy in U.S.
endometrial cancer
to confirm diagnosis of endometrial cancer-
endometrial tissue biopsy
distinguish between type I and II endometrial cancer
I- estrogen dependent. Most of the cases. favorable prognosis. low grade nuclear atypia. II- estrogen INdependent- spontaneous, less well differentiated, worse prognosis than Type I
most common type of endometrial carcinoma
adenocarcinoma
approx 10% of endometrial cancers=
serous carcinomas
endometrial cancer tx
TAH-bso, radiation for metastatic disease
strongest predictor of survival in endometrial cancer
stage I depth of myometrial invasion
leading cause of death for reproductive tract cancer
ovarian malignant tumors
BRCA1 gene mutation. chance of ovarian cancer?
39% lifetime risk
malignant ovarian tumor in premenopausal vs. postmenopausal-
25% postmenopause, 10% premenopause
abnormal bleeding in ovarian cancer?
NO. vague GI symptoms, pelvic pressure and pain
Is CA-125 used for screening in ovarian cancer?
No
CA-125 sensitivity and specificity
distinguishes between benign and malignatn pelvic masses. is sensitive, but not very specific (also may be elevated in endometriosis)
imaging in ovarian cancer
transvaginal ultrasound for high risk women
benign ovarian neoplasm tx
tumor removal/unilateral oophorectomy
malignant ovarian cancer tx
complete surgical staging plus abdominal hysterecomy and BSO with omenetomy and selective lymphadenectomy
2 types of funcitonal ovarian cysts
follicular and corpus luteum
most common functional cyst
follicular cyst
what medication increases risk of ovarian cyst formation?
tamoxifen
cystectomy/wedge resection for cyst indicated when:
premenopausal cysts more than 5 cm that persist more than 12 weeks, when mass is solid, mass is greater than 10 cm, postemenopausal cyst
