Fibroids Flashcards

1
Q

what are they?

A

benign tumours of smooth muscle of uterus aka leiomyoma

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2
Q

Risk factors?

A
  • oestrogen sensitive so anything which increases oestrogen
  • increasing age
  • black ethnicity
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3
Q

Types?

A
  • submucous
  • subserosal
    • grow outwards
  • intramural
  • pedunculated= polyp
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4
Q

what happens as intramural fibroids grow?

A

they change shape & distort uterus

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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
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6
Q

Ix?

A
  • TVUS
  • MRI gold standard
  • hysteroscopy for submucous fibroids
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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
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8
Q

what drug is given prior to surgery?

A

GnRH agonists which shrink them down prior to surgery

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9
Q

complications?

A
  • pregnancy
    • miscarriage, obstructive delivery & premature labour
  • red degeneration of fibroid
  • torsion of fibroid
  • malignant change to leiomyosarcoma
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10
Q

which type of fibroid mainly torts?

A

pedunculated

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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
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12
Q

presentation of red degeneration & mx

A
  • severe abdo pain
  • tachycardia
  • low grade fever
  • may vomit

mx= supportive

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