endometrial disorders

Question 1

endometrial hyperplasia

Answer 1

endometrial gland proliferation (precursor to endometrial carcinoma)

*due to unopposed estrogen w/o progesterone

Question 2

common cuases of endom. hyperplasia

Answer 2

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

Question 3

how soon after does hyperplasia occur with estrogen only treatment?

Answer 3

3 yrs

Question 4

what time of life do most women get hyperplasia?

Answer 4

after menopause

Question 5

s/sx of hyperplasia?

Answer 5

bleeding–> menorrhagia, metorrhagia, postmenopausal bleeding

+/- vag d/c

Question 6

dx of hyperplasia

Answer 6

transvaginal US : endometrial stripe > 4mm *screening

Question 7

what is the definitive dx for hyperplasia?

Answer 7

endometrial bx

Question 8

indications for an endometrial bx?

Answer 8

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

Question 9

tx of endometrial hyperplasia w/o atypia

Answer 9

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

Question 10

tx of endometrial hyperplasia w/ atypia

Answer 10

hysterectomy, but can just use progesterone

Question 11

endometiral cancer

Answer 11

mos common gyn malignancy in US

*MC in postmenopausal

Question 12

RF for endo CA

Answer 12

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

Question 13

OCPs and ovarian /endometrial cancers

Answer 13

protective againse

Question 14

s/sx of endo ca

Answer 14

abnormal uterine bleeding, postmenopausal bleed

menorrhagia or metrorrhagia

Question 15

what is metrorrhagia?

Answer 15

bleeding that occurs btw periods

Question 16

dx of edno CA

Answer 16

biopsy

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

Question 17

what ist the MC endo CA?

Answer 17

adenocarcinoma, then sarcoma

Question 18

how is stage I endo CA tx?

Answer 18

hysterectomy, post-op radiation

*one of the most curable of gyn cancers

Question 19

stage 2/3 tx

Answer 19

TAH-BSO + lymph node escision

Question 20

Stage IV

Answer 20

systmeic chemo

Question 21

endometriosis

Answer 21

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

Question 22

where is the most common site for endometriosis?

Answer 22

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

Question 23

RF for endometriosis

Answer 23

Nulliparity, family history, early menarche

Onset usually < 35 yrs

Question 24

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

Answer 24

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

Question 25

what other sx may be seen w/ endometritis

Answer 25

dyschezia +/- post metstrau spotting asx

Question 26

what can endometritis be a main cause of?

Answer 26

infertility

Question 27

dx of endometriosis?

Answer 27

Physical exam usually normal + fixed tender adnexal masses | Laparoscopy with Bx → Definitive Dx → Used to visualize structures for presence of tissue

Question 28

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

Answer 28

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

Question 29

what is an endometrioma

Answer 29

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

Question 30

medical managment of endometriosis

Answer 30

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

Question 31

surgical management of endometriosis

Answer 31

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