Fibroids Flashcards
1
Q
what are they?
A
benign tumours of smooth muscle of uterus aka leiomyoma
2
Q
Risk factors?
A
- oestrogen sensitive so anything which increases oestrogen
- increasing age
- black ethnicity
3
Q
Types?
A
- submucous
- subserosal
- grow outwards
- intramural
- pedunculated= polyp
4
Q
what happens as intramural fibroids grow?
A
they change shape & distort uterus
5
Q
presentation?
A
- often asymptomatic
- menorrhagia
- pressure symptoms: urinary or bowel
- subfertility, miscarriage
- O/E:
- firm, non-tender, enlarged uterus
- palpable mass O/E
6
Q
Ix?
A
- TVUS
- MRI gold standard
- hysteroscopy for submucous fibroids
7
Q
Mx?
A
- conservative if asymptomatic
- medical
- mirena coil (if <3cm)
- cyclical oral progestogens
- NSAID/ tranexamic acid
- surgical
- if small
- endometrial ablation
- resection
- if big
- myomectomy
- hysterectomy
- uterine artery embolisation
- if small
8
Q
what drug is given prior to surgery?
A
GnRH agonists which shrink them down prior to surgery
9
Q
complications?
A
- pregnancy
- miscarriage, obstructive delivery & premature labour
- red degeneration of fibroid
- torsion of fibroid
- malignant change to leiomyosarcoma
10
Q
which type of fibroid mainly torts?
A
pedunculated
11
Q
what is red degeneration
A
- infarction, ischaemia and necrosis of fibroid, which mainly occurs in 2nd and 3rd trimester of pregnancy, due to:
- fibroid grows fast during pregnancy and may out grow its’ blood supply
- blood vessels may kink due to uterus changing shape
12
Q
presentation of red degeneration & mx
A
- severe abdo pain
- tachycardia
- low grade fever
- may vomit
mx= supportive