Disorders Of The Uterus

Question 1

RF for fibroids

Answer 1

Obesity, nulliparity, family history, African, long term COCP

Question 2

RF for endometrial cancer

Answer 2

Obesity, nulliparity, diabetes, late menopause > 52, tamoxifen, unopposed estrogen therapy, fam hx of colorectal and endometrial cancer, anovulation, post menopausal

Question 3

Causes of AUB/PALM-COEIN

Answer 3

Polyps, adenomyosis, leiomyoma, malignancy & hyperplasia, coagulopathy, ovarian dysfunction, endometrial, iatrogenic, not otherwise classified

Question 4

Fibroid symptoms

Answer 4

AUB: menorrhagia, dysmenorrhea, IMB/spotting, Anaemia
Pelvic pain: acute (torsion/ischemia), chronic (dyspareunia)
Lower abd pain/mass: abd distention
Infertility
Recurrent miscarriage
Urinary symptoms: frequency, urgency nocthria, UTI

Question 5

Tests for fibroids

Answer 5

Bedside: UPT, first pass urine
FBC 
Pelvic U/S: check endo thickness 
Hysteroscopy: biopsy, polypectomy 
USG KUB: TRO hydronephrosis

Question 6

What do you see on TVS for adenomyosis?

Answer 6

cystic glands in SM

thickening of the junction zone with a ‘venetian blind’ pattern of acoustic shadowing

Question 7

Classic triad of endometriosis

Answer 7

Dysmenorrhea, deep dyspareunia, subfertility

Question 8

Tests for endometrial cancer

Answer 8

Pap smear if <70 
FBC, serum CA-125 
TVS: endometrial thickness should be <4mm 
Endometrial sampling via pipelle 
Hysteroscopy + D&C +/- biopsy 
Staging: MRI uterus, CXR, CT-TAP

Question 9

Management of endometrial CA

Answer 9

FIGO staging
Surgery: TAHBSO +/- pelvic lymphadenectomy
Radiotherapy adjuvant
Chemo adjuvant
Hormonal therapy: high dose oral/intrauterine progestin for fertility preservation, symptom relief or Mets

Question 10

Indications for surgery for fibroids

Answer 10

> 3cm, reduced QOL, refractory to medical treatment, rapid enlargement especially post-menopausal, leiomyosarcoma

Question 11

Main causes of menorrhagia

Answer 11

Dysfunctional uterine bleed, fibroids, endometriosis, adenomyosis, IUD, endometrial/cervical polyps

Question 12

Main causes of PCB

Answer 12

Cervical trauma, cervical polyps, cervical CA, cervicitis/vaginitis, PID

Question 13

Main causes of IMB

Answer 13

• endometrial/cervical polyps
• ectropion
• endometrial CA
• cervicitis/vaginitis
• contraception
• pregnancy
• PID

Question 14

Clinical features of endometrial polyps

Answer 14

IMB, PCB, PMB

Menorrhagia, subfertility

Question 15

Tests for endometrial polyps and management

Answer 15

TVS
Hysteroscopy, saline infusion sonography
Managed by hysteroscopy, D&C, polypectomy and send tissue for HPE

Question 16

Tests for endometriosis

Answer 16

UPT 
MSU 
FBC 
Serum Ca-125 
TVUSS 
MRI 
Direct visualization via laparoscopy + curative resection

Question 17

Managing endometriosis

Answer 17

Medical management like in fibroids 
Surgical:
- fertility preserving: keyhole surgery with burning or excision
- if endometrioma > 3cm, need surgery 
- TAHBSO

Question 18

Other symptoms of endometriosis other than triad

Answer 18

Menorrhagia, IMB, chronic pelvic pain
Urinary: cyclical hematuria/dysuria, obstruction
Rectal: cyclical dyschezia/rectal bleed, obstruction
Lungs: cyclical hemoptysis, hemopneumothorax