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Womens Health > endometrial disorders > Flashcards

endometrial disorders Flashcards

1
Q

endometrial hyperplasia

A

endometrial gland proliferation (precursor to endometrial carcinoma)

*due to unopposed estrogen w/o progesterone

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2
Q

common cuases of endom. hyperplasia

A

chronic anovulation, PCOS, perimenopause, obesity (conversion of androgen to estrogen in adipose tissue)

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3
Q

how soon after does hyperplasia occur with estrogen only treatment?

A

3 yrs

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4
Q

what time of life do most women get hyperplasia?

A

after menopause

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5
Q

s/sx of hyperplasia?

A

bleeding–> menorrhagia, metorrhagia, postmenopausal bleeding

+/- vag d/c

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6
Q

dx of hyperplasia

A

transvaginal US : endometrial stripe > 4mm *screening

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7
Q

what is the definitive dx for hyperplasia?

A

endometrial bx

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8
Q

indications for an endometrial bx?

A

> 35 yrs, ↑endometrial stripe seen on TVUS, patients on unopposed estrogen tx, Tamoxifen, AGS on Pap smear or persistent bleeding w/endometrial stripe >4mm

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9
Q

tx of endometrial hyperplasia w/o atypia

A

Progestin (PO or IUD Mirena) → Stops estrogen from being unopposed, limiting endometrial growth
Repeat endometrial bx in 3-6 mos

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10
Q

tx of endometrial hyperplasia w/ atypia

A

hysterectomy, but can just use progesterone

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11
Q

endometiral cancer

A

mos common gyn malignancy in US

*MC in postmenopausal

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12
Q

RF for endo CA

A

↑Estrogen Exposure, nulliparity, chronic anovulation, PCOS, obesity, estrogen replacement therapy, late menopause, Tamoxifen (estrogen stimulates endometrial growth), HTN, diabetes

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13
Q

OCPs and ovarian /endometrial cancers

A

protective againse

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14
Q

s/sx of endo ca

A

abnormal uterine bleeding, postmenopausal bleed

menorrhagia or metrorrhagia

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15
Q

what is metrorrhagia?

A

bleeding that occurs btw periods

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16
Q

dx of edno CA

A

biopsy

US: endometrial strip > 4mm –> may r/o other causes of bleeding

17
Q

what ist the MC endo CA?

A

adenocarcinoma, then sarcoma

18
Q

how is stage I endo CA tx?

A

hysterectomy, post-op radiation

*one of the most curable of gyn cancers

19
Q

stage 2/3 tx

A

TAH-BSO + lymph node escision

20
Q

Stage IV

A

systmeic chemo

21
Q

endometriosis

A

Presence of endometrial tissue (stroma & gland) outside the endometrial (uterine) cavity
The ectopic endometrial tissue responds to cyclical hormone changes

22
Q

where is the most common site for endometriosis?

A

ovaries! but can alos be seen in the posterior cul de sac, broad anmd uteroal sacral ligments, rectosigmoid colon, bladder

23
Q

RF for endometriosis

A

Nulliparity, family history, early menarche

Onset usually < 35 yrs

24
Q

what is the classic triad of s/sx of endometritis?

A

Cyclic Premenstrual Pelvic Pain + low back pain
Dysmenorrhea → Painful menstruation
Dyspareunia → Painful intercourse

25
Q

what other sx may be seen w/ endometritis

A

dyschezia

+/- post metstrau spotting
asx

26
Q

what can endometritis be a main cause of?

A

infertility

27
Q

dx of endometriosis?

A

Physical exam usually normal + fixed tender adnexal masses

Laparoscopy with Bx → Definitive Dx → Used to visualize structures for presence of tissue

28
Q

what may you see on laparoscopy w/ bx of endometriosis?

A

Raised patches of thickened, discolored, scarred or ‘powder burn’ appearing implants of tissue

29
Q

what is an endometrioma

A

Endometriosis involving the ovaries, large enough to be considered a tumor, usually filled with old blood appearing chocolate-colored (CHOCOLATE CYST)

30
Q

medical managment of endometriosis

A

Ovulation Suppression
Premenstrual Pain → Combined OCPs + NSAIDs
Progesterone → Suppresses GnRH → Causes endometrial tissue atrophy, suppresses ovulation
Leuprolide → GnRH analog causes pituitary FSH/LH suppression
Danazol → Testosterone → Induced pseudomenopause → Suppresses FSH & LH & mid-cycle surge

31
Q

surgical management of endometriosis

A

Conservative Laparoscopy with Ablation → Used if fertility desired → Preserves uterus & ovaries
Total Abdominal Hysterectomy with Salpingo-oophorectomy (TAH-BSO) → If no desire to conceive

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