Disorders of the female genital tract 2 - Uterus and ovaries Flashcards
What is endometriosis?
Endometrial tissue that somewhere other than the endometrium
What are the 4 theories of why endometriosis occurs?
regurgitation theory
metaplasia theory
stem cell theroy
metastasis theory
What is the regurgitation theory?
menstrual tissue goes backwards into the fallopian tube then into the pelvic cavity
implants itself there and grows
What is the metaplasia theory?
endometrium is derived from the same cell as your endothelium
therefore metaplasia may have occured
What 2 things happens after ectopic endometrium is formed?
bleeding into tissues
fibrosis
What are the symptoms of endometriosis?
25% asymptomatic dysmenorrhoea dyspareunia - difficult or painful sexual intercourse pelvic pain subfertility pain on passing stools dysuria
What are the complications of endometriosis?
ectopic pregnancy
ovarian cacer
inflammatory bowel disease
What is endometritis?
inflammation of the endometrium
What are the acute causes of endometritis?
retained products of conception - lacental and/or fetal tissue that remains in the uterus after a spontaneous pregnancy loss (miscarriage), planned pregnancy termination, or preterm/term delivery.
prolonged rupture of membranes
complicated labour
What are the chronic causes of endometritis?
pelvic inflammatory disease
retained gestational tissue
endometrial TB
interuterine contraceptive device infection
What are the symptoms of endometritis?
abdominal/pelvic pain pyrexia discharge dysuria abnormal vaginal bleeding
What are endometrial polyps?
oestrogen dependent outgrowths
What are the symptoms of endometrial outgrowths?
Often asymptomatic intermenstrual bleeding post menopausal bleeding menorrhagia - heavy bleeding dysmenorrhoea - no bleeding
What is leiomyomata (uterine fibroids)?
benign myometrial tumours with oestrogen and progesterone dependent growth
What are the risk factors for leiomyomata (uterine fibroids)?
genetics never given birth before obesity Polycystic ovary syndrome hormone replacement therapy
What are the symptoms of leiomyomata (uterine fibroids)?
Often asymptomatic
menometrorrhagia (Fe def anaemia - tiredness, SOB, chest pains)
subfertility/pregnancy problems
pressure symptoms - constipation, dysuria
What is endometrial hyperplasia?
Excessive endometrial proliferation
What are the risk factors for endometrial hyperplasia?
obesity exogenous oestrogen Polycystic overy syndrome oestrogen-producing tumours tamoxifen HNPCC - PTEN mutations
What are the two types of endometrial hyperplasia?
non-atypical hyperplasia
atypical hyperplasia - over half are carcinomas
What are the 2 types of endometrial carcinomas and when does it occur and how?
Type 1 (endometroid) - progresses from hyperplasia. pre/perimenopausal. Mutation in PTEN/Kras, responsive to oestrogen Type 2 (serous) - endometrial atrophy. Postmenopausal. Mutation is p53. Unresponsive in oestrogen. Abnormal glandular structure
What are the symptoms of polycystic ovary syndrome?
Rotterdam criteria 2/3 of polycystic ovaries hyperandrogenism (hirsuitism/ biochemical) irregular periods (>35 days)
What are the signs and symptoms of endometrial carcinomas?
low FSH, high LH/testosterine/DHEAS (steroid hormone which its function predominantly as a metabolic intermediate in the biosynthesis of the androgen and oestrogen)
abnormal bleeding
pain if late
What staging is used for endometrial carcinomas and ovarian cancer?
FIGO
What are the 2 types of gonadal failure?
Hypergonadotrophic hypogonadism - primary failure of the gonads
Hypogonadotrophic hypogonadism - hypothalmic/pituitary failure
What are the 3 origins of ovarian neoplasms?
surface epithelial stromal tumours
sex cord stromal tumours
germ cell tumours
What are the 3 main histological types of epithelial tumours?
serous
mucinous
endometroid
How are benign epithelial tumours classified?
based on componant of the tumour
cystic, fibrous, cystic and fibrous
What are malignant epithelial tumours classified called?
cystadenocarcinomas
What are the two categories of germ cell tumours?
germinomatous - differentiation towards oogonia
Non-germinomatous
What are the 3 types of non-germinomatous germ cell tumours?
teratoma - differentiation towards multiple cell layers
yolk sac tumours
choriocarcinomas - differentiation towards placenta
What are the symptoms of ovarian cancer?
non-specific symptoms: pain bloating weight loss/anorexia Pregnancy vaginal bleeding urinary frequency
