Fibroids Flashcards

1
Q

Medical term for fibroids

A

Leiomyoma - benign tumour of the smooth muscle of the uterus

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2
Q

Epidemiology of fibroids

A

1/5th of white and 1/2 of Afro-carribean women esp in later reproductive years

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3
Q

Symptoms of fibroids

A

Can be ASYMPTOMATIC

Or:
Heavy menstrual bleeding + IDA symptoms
Abdo bloating + crampy pain during menstruation
Increased urinary frequency if pressing on bladder
Bowel problems e.g. painful defecation, constipation
SUBFERTILITY
Obstetric complications - miscarriages, premature labour, obstructive delivery

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4
Q

TWO main complications of fibroids

A

Anaemia
Subfertility

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5
Q

Diagnosis

A

TVUSS

(also MRI)

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6
Q

Management options for MENORRHAGIA

A

Menorrhagia Mx

IUS - Levonorgestrel intrauterine system COIL
Tranexamic acid / Mefenamic acid
COCP or Oral/injectable progestogen

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7
Q

Management options to shrink or remove the fibroids + which of these is ok for preserving fertility

A

Medical

GnRH agonists (short term) - Goserelin

Surgical
- myomectomy (esp if they want to get pregnant later)
- endometrial ablation (not good if they want to get pregnant)
- hysterectomy
- uterine artery embolisation (to remove blood supply to the fibroid)

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8
Q

What transition occurs during pregnancy with a fibroid?

A

Red degeneration - when the fibroid outgrows its blood supply in pregnancy, leading to ischemia, infarction and necrosis.

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9
Q

How does a pt with fibroid red degeneration present?

A

Pregnant
Severe abdo pain
Low grade fever

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10
Q

What percentage of fibroids become malignant?

A

Less than one percent

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11
Q

Risk of myomectomy

A

Life threatening bleeding needing a hysterectomy

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12
Q

Endometrial ablation risk

A

Future infertility

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13
Q

Best option for preserving fertility

A

Myomectomy

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14
Q

Why isn’t goserelin given long term?

A

Can cause menopause like symptoms such as hot flushes and vaginal dryness

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15
Q

How would you describe uterine artery embolisation to a patient?

A

Under x ray guidance, a small tube is passed into the uterine arteries and some small particles are delivered to block off the blood supply to the fibroid.

NO scars
Minimally invasive
Done under LA

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16
Q

Abdominal myomectomy vs laproscopic vs vaginal/hysteroscopic myomectomy - stay in hospital + anaesthesia

A

Abdominal:
GA
3-4days

Laproscopic:
LA
1-2 days

Local or general
Hysteroscopic

Same day

17
Q

Post surgery care

A

PV bleeding expected up to 7 days
Recommended to not use tampons due to infection risk
If fowl smelling discharge, seek attention
Don’t have sex until the bleeding has stopped
Periods might be heavier/delayed/lighter