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O&G > irrregular mestrual bleeding > Flashcards

irrregular mestrual bleeding Flashcards

1
Q

list the premenarchal causes of abnormal uterine bleeding

A
  1. Foreign body/ Sexual abuse=> trauma
  2. Precocious puberty=> increased estrogen
  3. Cancer e.g.
    1. vesico/cervical
    2. sarcoma butyroides
    3. adrenal tumors=> increase androgens=>increased estrogen
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2
Q

what is

Sarcoma botryoides or botryoid sarcoma is

A

a subtype of embryonal rhabdomyosarcoma, that can be observed in the walls of hollow, mucosa lined structures such as the nasopharynx, common bile duct, urinary bladder of infants and young children or the vagina in females, typically younger than age 8.

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3
Q

diagnostic procedures for premenarchal AUB

A

pelvic exam to I.D foreign body

CT/MRI of pelvis and abdomen

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4
Q

classification of postmenopausal causes of irregular menstrual bleeding

A

Benign

  • atrophy of uterus, cervix, vagina

Malignant

  • ovarian, cervical, vaginal vulva

Iatrogenic

  • HRT(increased prolif)
  • Anticoagulant medication
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5
Q

what do you expect to find in physical exam of PMP woman w/ AUB

A
  • atrophy
  • look for location of bleeding as sometunes rectal
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6
Q

investigations for AUB in PMP

A

pap smear to rule out cervical cancer

U.S of endometrium to see the endometrial stripe

biopsy of endometrium to rule out endometrial cancer

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7
Q

how would you treat AUB d/2 atrophy

A

topical estrogens

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8
Q

causes of AUB in reproductive women

(6)

A
  1. pregnancy
  2. growths
  3. iatrogenic causes
  4. infectious causes
  5. systemic diseases
  6. DUB
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9
Q

pregnancy related causes of AUB

A
  1. normal pregnancy
  2. ectopic pregnancy
  3. molar pregnancy
  4. abortion
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10
Q

growth related causes of AUB

A
  1. Leiyomyoma ==> rx w/ uterine artery embolization
  2. Endometrial polyps
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11
Q

iatrogenic causes of AUB

A
  1. IUD’s
  2. OCP
  3. Tamoxifen causes abnormal bleeds as side effect
  4. Anticoagulants causing excessive mestrual bleeds
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12
Q

Infectious causes of AUB

A
  1. Endometritis
  2. Bacterial vaginosis
  3. PID
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13
Q

Systemic causes of AUB

A
  1. Coagulopathies (vwd, Tcp, hemophillia)
  2. Liver failure=> insuff clotting factors
  3. Kidney failure=>
  4. Thyroid disorders
  • hyper: short light flow
  • hypo: long heavy flow
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14
Q

what is dysfunctional uterine bleeding (DUB)

A
  • Abnormal Uterine Bleeding w/o an identifiable cause
  • basically idiopathic
  • diagnosis of exclusion
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15
Q

how to exclude DUB

A
  • Thorough history especiallly Pharm hx (iatrogenic)
  • b-hcg test (preg)
  • urine analysis (PID)
  • Blood tests
    • CBC (coagulopathies)
    • Liver,Kidney,Thyroid func test
      • Pap smeart (cervical ca)
  • Colposcopy (cervical ca, infections)
  • US(endometrial prolf, growth)
  • D&C
  • Hysteroscopy (growth)
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16
Q

What are the 2 possible causes of DUB

A
  1. Anovulatory

corpus luteum failure:

  • no progesterone => unnopsed estrogen=>
  • excess endometrial proliferation => abnormal bleeds when func layer outgrows blood supply
  1. Ovulatory

Luteal phase deficiency:

  • v. low progesterone lvls => luteal phase can’t be maintained
  • irregular mestrual bleeding
17
Q

when is DUB common

A

at extreme reproductive ages i.e

  1. early menses
  2. perimenopause
18
Q

cause of ealrly menses DUB

A
  • immature HPO axis
  • low/ inssuficient response to hormones by target cells
  • irregular menses
19
Q

cause of perimenopausal DUB

A
  • reduced quality & no. of follices
  • reduced production and response to hormones
  • irregular menstruation
20
Q

what is the most important dx of DUB

A

PCOS

  • ammenorhea & obesity are common in both
  • dry atrophic vagina may cause bleeds similar to DUB
21
Q

CLASSES OF RX FOR DUB

A
  1. non hormonal
  2. hormonal
  3. surgical
22
Q

non hormonal rx for DUB

A

NON HORMONAL

  • NSAIDS:
    • Mefanamic acid=> cox & PgE2 inhibition => reduced bleeding(PgE2) & reduced pain (cox)
    • Naproxen
  • Antifibrinolytics
    • ​Tranexamicacid => activates plasminogen=> reduced bleeding w/o thromboembo effect
  • Iron supplementation
23
Q

hormonal rx for DUB

A

COCP:

  • reduce bleeding , provides normal cycle
    • C.I.: adolescents=> premature closure of epiphyseal plate although 95% of growth has occured by menses

ORAL PROGESTERONE

  • Dydrogesterone: no effect on HPO=> given to adolescent

IUD

  • Mirena: ↓ endo prolif ↓ dysmenorrhea
    • ↑ PID risk

ANDROGENIC STEROIDS

  • Danezol: ↓ blood loss by 50%.
    • ↑ endometrial atrophy & irreversible voice change

GnRh Agonist: reduces endometrial growth

  • cause medical menopause leading to atrophy
24
Q

surgical rx of DUB

A

endometrial ablation

  • removal of endomtroum up to basalis
  • no func layer = no proliferation

hysterectomy

  • only when all other options fail
  • used if no fertility wishes
  • can be done w/ BSO

O&G (43 decks)

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