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Reproductive > Lec 5 Uterus > Flashcards

Lec 5 Uterus Flashcards

1
Q

What are the 3 layers of the uterus?

A
  • serosa
  • myometrium
  • endometirium
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2
Q

What are the two layers of endometrial mucosa?

A 
functionalis = upper 2/3
basilis = lower 2/3
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3
Q

What is relationship between basalis and functionalis layers of endometrium?

A

following menstrual period the basalis regenerates the functionalis

the functionalis is what grows to sustain pregnancy

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4
Q

What are the 3 phases of menstrual cycle?

A
  • menses
  • proliferative phase
  • secretory phase
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5
Q

When does ovulation occur in menstrual cycle?

A

ovulation = at day 14

always occurs 14 days before menses starts regardless of full length of cycle

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6
Q

Which days of the cycle are the proliferative phase?

A

days 4 to 14

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7
Q

What happens in proliferative phase?

A

early on glands straight and narrow but become coiled; lots of mitotic figures

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8
Q

When does corpus luteum form?

A

starts on day 14

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9
Q

What hormone dominates in secretory vs proliferative phase?

A 
secretory = progesterone
proliferative = estrogen
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10
Q

What is the appearance of glands in the secretory phase?

A

saw tooth appearance; spiral arterioles noticeable in stroma

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11
Q

What is dysmenorrhea?

A

difficult menstrual flow or painful urination

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12
Q

What are some causes of secondary dysmenorrhea?

A
  • polyps
  • fibroids
  • endometriosis
  • adenomyosis
  • pelvic inflammatory disease
  • cervical stenosis
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13
Q

What is pathogenesis of primary dysmenorrhea?

A

prostaglandin F2 alpha [PGF2alpha] = myometrial stimulant and vasoconstrictor

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14
Q

What are some tests you should do on someone that prevents with dysmenorrhea to rule out causes?

A
  • cervical culture to rule out STI

- image study to identify fibroids

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15
Q

What 4 tests should you start with in young woman with abnormal uterine bleeding?

A
  • HCG for pregnancy
  • FSH for premature ovarian failure
  • TSH for thyroid dysfunction
  • prolactin for hyperprolactinemia
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16
Q

What is metrorrhagia?

A

bleeding between periods

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17
Q

What are 3 causes of metrorrhagia?

A
  • endometrial polyps
  • endometrial or cervical caner
  • hormone replacement therapy [estrogen stimulation]
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18
Q

What is menorrhagia?

A

heavy or prolonged menstrual bleeding

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19
Q

What are 7 causes of menorrhagia?

A
  • submucosal leiomyoma
  • pregnancy complication
  • adenomyosis
  • IUD
  • endometrial hyperplasia
  • malignant tumor
  • dysfunctional uterine bleeding
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20
Q

What is menometrorrhagia?

A

bleeding at irregular intervals

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21
Q

What are 3 important tests to perform in abnormal uterine bleeding?

A
  • pelvic ultrasound to rule out masses
  • pap smear to rule out cancer
  • endometrial biopsy
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22
Q

What is dysfunctional uterine bleeding?

A

abnormal uterine bleeding with no clear pathologic cuase

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23
Q

What is a major cause of dysfunctional uterine bleeding?

A

anovulation –> leads to unopposed estrogen stimulation of uterus; endometrium outgrows ins blood supply and sloughs off

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24
Q

Who tends to get dysfunctional uterine bleeding?

A

teens and women 40

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25
Q

What is most common cause of postmenopausal bleeding?

A

exogenous hormones [postmenopausal bleeding]

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26
Q

What is definition of post-menopausal bleeding?

A

bleeding occurring after 12 months of amenorrhea in middle-aged women

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27
Q

What tests should perform in post menopausal bleeding?

A

must do uterine biopsy –> more likely to be malignant than in pre-menopausal bleeding

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28
Q

What is endometrial hyperplasia?

A

abnormal growth causing thickening of endometrial mucosa and increased endometrial gland proliferation

considered precancerous –> at risk for endometrial carcinoma

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29
Q

What is etiology of endometrial hyperplasia?

A

excess estrogen stimulation

30
Q

What genetic changes associated with endometrial hyperplasia?

A
  • microsatellite instability [MSI]
  • defects in DNA mismatch repair
  • PTEN tumor suppressor gene mutation
31
Q

How does endometrial hyperplasia present?

A
  • abnormal uterine bleeding
  • abnormal vaginal discharge
  • abnormal glandular cells on pap smear
32
Q

What tests do you need to do if you suspect endometrial hyperplasia?

A
  • ultrasound to assess thickening

- endometrial biopsy = gold standard for diagnosis

33
Q

What are the 3 types of endometrial hyperplasia?

A

simple hyperplasia
complex hyperplasia
atypical hyperplasia

34
Q

What do you see histologically with simple hyperplasia? cancer risk?

A

mild crowding; cystically dilated glands looks like swiss cheese

1% cancer risk

35
Q

What do you see histologically with complex hyperplasia? cancer risk?

A

moderate crowding; irregular shaped glands look like animal crackers

5-7% cancer risk

36
Q

What do you see histologically with atypical hyperplasia? cancer risk?

A

severely crowded round irregular shaped glands cribiforming

25% cancer risk

37
Q

What is mnemonic for cancer risk in endometrial hyperplasia?

A

penny, nickel, quarter
simple = 1%
complex = 5%
atypical = 25%

38
Q

What is treatment for endometrial hyperplasia?

A

young –> endometrial curettage or progesterone therapy

older –> hysterectomy advised

39
Q

What are the 6 risk factors for endometrial carcinoma?

A
  • prolonged estrogen
  • obesity
  • diabetes
  • hypertension
  • nulliparity
  • late menopause
40
Q

Who tends to get endometrial carcinoma?

A

peak 55-65 yo but can be seen in young women esp patients with polycystic ovarian syndome = unopposed estrogen stimulation

41
Q

What are the 2 types of endometrial cancer?

A

type 1 = more common; associated with excess estrogen stimulation and endometrial hyperplasia = low grade, good prognosis

type 2 = less common; estrogen-independent; higher grade and more aggressive

42
Q

What is gross appearance of endometrial adenocarcinoma?

A

uterus w/ thickened ragged mucosal lining or polypoid masses

43
Q

What do you see histologically in endometrial adenocarcinoma?

A

back to back arrangement of glands = cribiforming

44
Q

What are genetic alterations associated with type I [endometrioid] vs type 2 [serous] carcinoma?

A

type 1: PTEN, MSI, kras

type 2: p53

45
Q

Is endometrioid [type 1] or serous [type 2] adenocarcinoma seen in younger patients?

A

type 1

46
Q

What is precursor lesion to type II serous carcinoma?

A

endometrial intraepithelial carcionoma

47
Q

What are lieomyomas?

A

fibroids = most common benign tumors of uterus

48
Q

Who is at risk for leiomyomas?

A 
African americans > caucasians
age 20-40 yo
nulliparity
obesity
increase tumor size with pregnancy; decrease with menopause
49
Q

What is presentation of leiomyomas?

A

usually asymptomatic

can cause pressure effects –> urinary frequency; abnormal uterine bleeding; occassionally anemia

50
Q

Where do leiomyomas arise from?

A

from smooth muscle cells of blood vessle

51
Q

What do leiomyomas look like?

A

multiple well-define white whorled masses –> whorled pattern of smooth muscle bundles with well-demarcated borders
low mitotic activity
bundles of smooth muslce cells with cigar shaped nuclei and spindle shaped cytoplasm

52
Q

How can you diagnose leiomyomas?

A

pelvic exam; for obese pts –> ultrasound

53
Q

What is adenomyosis?

A

extension of endometrial tissue into myometrium –> symmetric enlargement of uterus; enlarged soft globular uterus

54
Q

How does adenomyosis present?

A

similar to leiomyoma = abnormal uterine bleeding

55
Q

What causes adenomyosis?

A

hyperplasia of the basalis layer of the endometrium

56
Q

What is treatment for adenomyosis?

A

hormone antagonists; hysterectomy

57
Q

What is leiomyosarcoma?

A

rare malignant form of leiomyoma [but arise de novo not from leiomyoma]

58
Q

How do leiomyosarcomas present?

A
  • abnormal uterine bleeding

- rapid enlargement of uterus –> mass effect leading to pelivc pain and discomfort

59
Q

What is prognosis of leiomyosarcomas?

A

aggressive; tend to met early to ab, liver, lungs

60
Q

What is histologic appearance of leiomyosarcoma?

A
  • high mitotic rate
  • nuclear atypia
  • zones of necrosis
61
Q

How do you determine is infertility due to PID?

A

hysterosalpingogram

62
Q

What is pelvic inflammatory disease?

A

infection of upper tract = uterus ovaries, fallopian tubes, and adjacent soft tissue

63
Q

What bugs is major cause of PID? Other causes

A
  • chlamydia is major cause

Others: neisseria gonorrhoeae, gardnerella vaginallis, heamophilus influenzae

64
Q

What are risk factors for PID?

A
  • multiple sexual partners
  • history of previous STI
  • history of sexual abuse
65
Q

What are symptoms of PID?

A
  • lower ab pain

- abnormal vaginal discharge

66
Q

What is differential diagnosis for PID?

A
  • appendicitis
  • cervicitis
  • UTI
  • endometriosis
  • adnexal tumors
  • ectopic pregnancy
67
Q

What should you think if fever and pelvic tenderness in sexually active young woman?

A

PID

68
Q

What are some long-term sequale of PID?

A

chronic pelvic pain from scarring
tubal infertility
tubo-ovarian abscess –> extending into pelvic to cause peritonitis and fitz-hugh-curtis syndrome [perihepatitis]

69
Q

What is treatment for PID?

A

antibiotics

70
Q

What are the x segments of fallopian tube?

A
  • interstitial portion
  • isthmus adjacent to uterus
  • ampulla
  • infundibulum= funne shaped end
  • fimbrae
71
Q

Where does fertilization normally occur?

A

ampulla of fallopian tube

72
Q

What are 2 common disease of fallopian tube?

A
  • salpingitis

- ectopic pregnancy

Reproductive (14 decks)

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