Dunn OB/GYN VIII Flashcards
ASCUS
atypical squamous cells of undetermined significance
ASC-H
atypical sqamous - high grade
AGUS
atypical glandular undetermined significanse
LSIL
low grade squamous intraepithelial
HSIL
high grade squamous intraepithelial lesion
workup for abnormal pap
age
degree of abnormality
risk factors
risk factors for abnormal pap
no recent pap smoking age 1st intercourse number of partners immunocompromised
colposcopy
look at cervix through microscope
gives histology
mild dysplasia
CIN I
moderate dysplasia
CIN II
severe dysplasia, CIS
CIN III
CIN
cervical intraepithelial neoplasia
1-3 and invasive cancer
CIN I
10% progress
CIN II
30-40% progress
CIN III
all need treatment**
also - invasive cancer need treatment
tx - excision
cervical cancer spread
lymph nodes
tx of cervical cancer
follow up pap destroy excision hysterectomy radical hysterectomy (top third vagina and nodes)
indication for conization
CIN II and III
endocervical disease on colposcopy
inadequate colposcopy
who doesn’t get pap smears
get screened - no cervical cancer- can screen for it
low SES minorities foreign born living in US < 10 years no health care
CIN 2 and 3
10-13 years to invasive cancer
cervical cancer incidence and death rates
in US
-has gone down
major factor for cervical cancer
no screening
paps and eduation
more educated - get more paps
cervical cancer screening
should begin at age 21 - if sexually active**
<21yo no screening regardless of sex onset
highest incidence cervical cancer
30-65yo
adolescents
STI screen - urine
no paps
age 21-29
cytology alone every 3 years
HPV - not for screening
HPV test - expensive
pap - cheap
avoid HPV test
age 20-29
age 30-64
recommend cotesting
cytology and HPV testing every 5 years**
bc more CIN III this age grop
high risk HPV
colposcopy
adequate negative screening
3 paps
2 HPV
history of abnormal pap
still need to check after hysterectomy
standards for paps
21-65yo
cotesting >30yo (with HPV test)
biggest gain in reducing cervical cancer
screening women who don’t screen
47yo F G4P3
- continued bleeding
- > 3 days per day
- menses more frequent and longer last year
- severe cramping
- smoker
- fam hx ovarian cancer, asthma
- underweight
- low BP
- looks ill
abnormal uterine bleeding
hCG negative
U/S - 6cm mass in fundus normal ovaries
leiomyoma with myxoid degeneration**
smoking
reduces risk for endometrial cancer
-decreases circulating estrogen
PALM-COEIN
abnormal uterine bleeding
-nonpregnant
polyp
adenomyosis
leiomyoma
malignancy and hyperplasia
coagulopathy ovulatory dysfunction endometrial iatrogenic not yet classified
post menopausal abnormal uterine bleeding
rule out cancer**
acute bleeding in ER
IV estrogen
high dose progesterone
OCPs
endometrial polyp
common cause of perimenopausal and early postmenopausal uterine bleeding
generally benign
hyperplastic growth of glands
growth - stimulated by estrogen or tamoxifen**
uterine leiomyoma
most common benign tumor in females
malignant variant - leiomyosarcoma
subtypes - pedunculated, subserosal, submucosal, intramural
most common benign neoplasia of femal genitals
fibroids
smooth m and CT growth
E/P sensitive**
E/P sensitive
fibroids - uterine leiomyoma
complications of fibroids
torsions/infertility
adenomyosis
noncyclical pain
menorrhagia
enlarged uterus no adnexal tenderness
endometrium grows into myometrium
tx for adenomyosis
NSAIDs OCPs progestins ablation hysterectomy
stimulated by estrogen
fibroid of uterus
-uterine leiomyoma
leading cause of hysterectomy in US
fibroids
risk fx for fibroids
AAs early menarche (10yo) obesity red meat, beer HTN
tx of fibroids
expectant management
control bleeding - OCPs
GnRH agonist
myomectomy, hysterectomy
myxoid degeneration
large leiomyoma that outrgrows blood supply
also have cystic, red carneous, and hyaline degeneration
postmenopausal bleeding
usually painless
pain - stenotic cervix, severe/rapid bleeding, infection, torsion, tumor
atrophic endometrium
thin uterus that tears and bleeds
most common cause of postmenopausal bleeding
atrophic endometrium
hypoestrogen
pale, dry vagina smooth and shiny with loss of most rugation**
endometrial hyperplasia
increased gland:stroma
tends to be estrogen dependent
needs a biopsy
can have endogenous estrogen production - ovarian/adrenal tumor
also with exogenous estrogen
at risk for endometrial cancer
obese - more estrogen
most common genital cancer women over 45yo
adenocarcinoma of endometrium
tx of atrophy
vaginal estrogen therapy
tx of endometrial hyperplasia
cyclic progestin therapy
tx of endometrial hyperplasia with atypia
hysterectomy
