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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
What is most common cause of postmenopausal bleeding?
exogenous hormones [postmenopausal bleeding]
26
What is definition of post-menopausal bleeding?
bleeding occurring after 12 months of amenorrhea in middle-aged women
27
What tests should perform in post menopausal bleeding?
must do uterine biopsy --> more likely to be malignant than in pre-menopausal bleeding
28
What is endometrial hyperplasia?
abnormal growth causing thickening of endometrial mucosa and increased endometrial gland proliferation considered precancerous --> at risk for endometrial carcinoma
29
What is etiology of endometrial hyperplasia?
excess estrogen stimulation
30
What genetic changes associated with endometrial hyperplasia?
- microsatellite instability [MSI] - defects in DNA mismatch repair - PTEN tumor suppressor gene mutation
31
How does endometrial hyperplasia present?
- abnormal uterine bleeding - abnormal vaginal discharge - abnormal glandular cells on pap smear
32
What tests do you need to do if you suspect endometrial hyperplasia?
- ultrasound to assess thickening | - endometrial biopsy = gold standard for diagnosis
33
What are the 3 types of endometrial hyperplasia?
simple hyperplasia complex hyperplasia atypical hyperplasia
34
What do you see histologically with simple hyperplasia? cancer risk?
mild crowding; cystically dilated glands looks like swiss cheese 1% cancer risk
35
What do you see histologically with complex hyperplasia? cancer risk?
moderate crowding; irregular shaped glands look like animal crackers 5-7% cancer risk
36
What do you see histologically with atypical hyperplasia? cancer risk?
severely crowded round irregular shaped glands cribiforming 25% cancer risk
37
What is mnemonic for cancer risk in endometrial hyperplasia?
penny, nickel, quarter simple = 1% complex = 5% atypical = 25%
38
What is treatment for endometrial hyperplasia?
young --> endometrial curettage or progesterone therapy | older --> hysterectomy advised
39
What are the 6 risk factors for endometrial carcinoma?
- prolonged estrogen - obesity - diabetes - hypertension - nulliparity - late menopause
40
Who tends to get endometrial carcinoma?
peak 55-65 yo but can be seen in young women esp patients with polycystic ovarian syndome = unopposed estrogen stimulation
41
What are the 2 types of endometrial cancer?
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
What is gross appearance of endometrial adenocarcinoma?
uterus w/ thickened ragged mucosal lining or polypoid masses
43
What do you see histologically in endometrial adenocarcinoma?
back to back arrangement of glands = cribiforming
44
What are genetic alterations associated with type I [endometrioid] vs type 2 [serous] carcinoma?
type 1: PTEN, MSI, kras | type 2: p53
45
Is endometrioid [type 1] or serous [type 2] adenocarcinoma seen in younger patients?
type 1
46
What is precursor lesion to type II serous carcinoma?
endometrial intraepithelial carcionoma
47
What are lieomyomas?
fibroids = most common benign tumors of uterus
48
Who is at risk for leiomyomas?
``` African americans > caucasians age 20-40 yo nulliparity obesity increase tumor size with pregnancy; decrease with menopause ```
49
What is presentation of leiomyomas?
usually asymptomatic | can cause pressure effects --> urinary frequency; abnormal uterine bleeding; occassionally anemia
50
Where do leiomyomas arise from?
from smooth muscle cells of blood vessle
51
What do leiomyomas look like?
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
How can you diagnose leiomyomas?
pelvic exam; for obese pts --> ultrasound
53
What is adenomyosis?
extension of endometrial tissue into myometrium --> symmetric enlargement of uterus; enlarged soft globular uterus
54
How does adenomyosis present?
similar to leiomyoma = abnormal uterine bleeding
55
What causes adenomyosis?
hyperplasia of the basalis layer of the endometrium
56
What is treatment for adenomyosis?
hormone antagonists; hysterectomy
57
What is leiomyosarcoma?
rare malignant form of leiomyoma [but arise de novo not from leiomyoma]
58
How do leiomyosarcomas present?
- abnormal uterine bleeding | - rapid enlargement of uterus --> mass effect leading to pelivc pain and discomfort
59
What is prognosis of leiomyosarcomas?
aggressive; tend to met early to ab, liver, lungs
60
What is histologic appearance of leiomyosarcoma?
- high mitotic rate - nuclear atypia - zones of necrosis
61
How do you determine is infertility due to PID?
hysterosalpingogram
62
What is pelvic inflammatory disease?
infection of upper tract = uterus ovaries, fallopian tubes, and adjacent soft tissue
63
What bugs is major cause of PID? Other causes
- chlamydia is major cause Others: neisseria gonorrhoeae, gardnerella vaginallis, heamophilus influenzae
64
What are risk factors for PID?
- multiple sexual partners - history of previous STI - history of sexual abuse
65
What are symptoms of PID?
- lower ab pain | - abnormal vaginal discharge
66
What is differential diagnosis for PID?
- appendicitis - cervicitis - UTI - endometriosis - adnexal tumors - ectopic pregnancy
67
What should you think if fever and pelvic tenderness in sexually active young woman?
PID
68
What are some long-term sequale of PID?
chronic pelvic pain from scarring tubal infertility tubo-ovarian abscess --> extending into pelvic to cause peritonitis and fitz-hugh-curtis syndrome [perihepatitis]
69
What is treatment for PID?
antibiotics
70
What are the x segments of fallopian tube?
- interstitial portion - isthmus adjacent to uterus - ampulla - infundibulum= funne shaped end - fimbrae
71
Where does fertilization normally occur?
ampulla of fallopian tube
72
What are 2 common disease of fallopian tube?
- salpingitis | - ectopic pregnancy

Reproductive (14 decks)

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