Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Med - Repro > Lecture 19 - AUB > Flashcards

Lecture 19 - AUB Flashcards

1
Q

AUB

A

Abnormal Uterine Bleeding

abnormal in regularity, volume, frequency, or duration in the absence of pregnancy

this is a sx, not a dx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Who most commonly presents with AUB?

A

adolescents and women >40y/o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What do we call an increase in frequency of menstrual bleeding?

A

polymenorrhea

decrease: oligomenorrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Metrorrhagia

A

irregular intervals of periods

this term is getting replaced by HMB - heavy menstrual bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Menormetrorrhagia

A

irregular intervals with excessive bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

FIGO

A

FIGO classification for causes of AUB in reproductive years

structural (PALM) vs non structural (COEIN)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

PALM

A

polyp
adenomyosis
leiomyoma
malignancy and hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

COEIN

A 
Coagulopathy 
Ovulatory dysfunction
endometrial 
Iatrogenic
Not yet classified
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are some red flags for AUB?

A

hemodynamically unstable?

post menopause –> endometrial cancer

pregnant –> ectopic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is a red flag for menstrual history?

A

soaking two are more pads/hour for >2 hours

unfortunately there is no conversion to how much this might be for tampons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are secondary causes of AUB?

A 
pregnancy 
ectopic pregnancy 
bleeding disorder 
cancer
thyroid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What physical exams do you do for a pt with AUB?

A

look for signs of anemia, active bleeding, and secondary causes of AUB

Pelvic exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which imaging study can be used for both dx and tx of uterine polyps?

A

hysteroscoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When do you order prolactin?

A

galactorrhea and irregular cycles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What 3 imaging studies are also used as treatment?

A

hysteroscopy
hysterosalpinogram (HSG)
laparoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

SIS

A

sonohysterogram

saline infused sonogram (SIS)

better visualization of endometrial lining and polyps

used a lot in infertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Endometrial biopsy?

A

minimally invasive, office procedure for sampling endometrial tissue
manually dilate the os (this is what causes the most pain)

used to aid in dx of endometrial cancer, hyperplasia, and other endometrial pathology

suction catheter inserted through cervix to obtain specimen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Hysteroscopy

A

a scope used in the office to see the endometrium

dx and therapeutic

  • lysis of adhesions
  • polypectomy
  • resent submucosal fibroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Endometrial Polyps

A

structural abnormality

hyperplastic overgrowth of endometrial lining that projects from the endometrium

usually <1cm
MC >50yo
95% benign
–malignant risk higher in post-menopausal women

sxs:
-intermenstrual bleeding
-post coital bleeding
-post menopausal bleeding
signs
-usually none
-may prolapse through cervix

Dx:

  • US
  • hysteroscopy
Tx: 
-expectantly manage 
--symptomatic polyps should be removed 
-surgical excision via hysteroscopy 
asymptomatic polyps should be removed if >1cm in diameter, multiple, prolapse through cervix, infertility
20
Q

What are the signs and sxs of endometrial polyps?

A

sxs:
-intermenstrual bleeding
-post coital bleeding
-post menopausal bleeding
signs
-usually none
-may prolapse through cervix

21
Q

How do you dx endometrial polyps?

A

Dx:

  • US
  • hysteroscopy
22
Q

How do you treatment endometrial polyps?

A

-expectantly manage
–symptomatic polyps should be removed
-surgical excision via hysteroscopy
asymptomatic polyps should be removed if >1cm in diameter, multiple, prolapse through cervix, infertility

23
Q

When should asymptomatic endometrial polyps be removed?

A

asymptomatic polyps should be removed if >1cm in diameter, multiple, prolapse through cervix, infertility

24
Q

Adenomyosis

A

barrier between endometrium and myometrium breaks, allowing endometrial cells to invade myometrium
ectopic endometrial glands and stroma extend within the myometrium

occurs in 30% of women
30-50 y/o MC
can co-exist with fibroids
ectopic endometrial tissues does not respond to hormones (vs. endometriosis)

sxs: 
heavy menstrual bleeding
pelvic pain (noncyclical) 
progressive dysmenorrhea
asymptomatic 
signs: 
diffusely enlarged globular "boggy" uterus (soft) 
symmetrical uterine enlargement

Dx:
pelvic US
MRI
pathology s/p hysterectomy –if they’re symptomatic

Tx:
not a whole lot we can do, hyperectomy an option for post-menopausal
hormones used to control bleeding (LNG IUD)
hysterectomy = definitive treatment

25
Q

What are the signs and sxs of adenomyosis?

A 
sxs: 
heavy menstrual bleeding
pelvic pain (noncyclical) 
progressive dysmenorrhea
asymptomatic 
signs: 
diffusely enlarged globular "boggy" uterus (soft) 
symmetrical uterine enlargement
26
Q

How do you dx adenomyosis?

A

Dx:
pelvic US
MRI
pathology s/p hysterectomy –if they’re symptomatic

27
Q

How do you treat adenomyosis?

A

Tx:
not a whole lot we can do, hyperectomy an option for post-menopausal
hormones used to control bleeding (LNG IUD)
hysterectomy = definitive treatment

28
Q

Leiomyomas

A

“fibroids”
benign proliferation of smooth muscle cells of the myometrium
most common benign uterine tumor
subserosal is the most common location

RF: 
2-3X greater in AA women than white 
early menarche 
Diet (red meat, ham) 
EtOH 
sxs: 
50-60% are asymptomatic 
HMB is MC presenting sx 
dysmenorrhea; pelvic pain or pressure 
infertility 
compressive sx: urinary frequency, difficulty with bowel movement 
signs: 
enlarged firm, irregular uterus 
non-tender

Dx:
incidental PE finding
US

Tx:
hormonal therapy
(LNG IUD, implant, OCP, GnRH analogues)
Expectantly manage

nothing you need to do unless you are trying to get pregnant

29
Q

What are the signs and sxs of leiomyomas?

A 
sxs: 
50-60% are asymptomatic 
HMB is MC presenting sx 
dysmenorrhea; pelvic pain or pressure 
infertility 
compressive sx: urinary frequency, difficulty with bowel movement 
signs: 
enlarged firm, irregular uterus 
non-tender
30
Q

How do you dx leiomyomas?

A

Dx:
incidental PE finding
US

31
Q

What is the treatment for leiomyomas?

A

Tx:
hormonal therapy
(LNG IUD, implant, OCP, GnRH analogues)
Expectantly manage

nothing you need to do unless you are trying to get pregnant

hysterectomy is the definitive treatment

32
Q

Malignancy and hyperplasia

A

hyperplasia

proliferation of endometrial glands or irregular size and shape

classified as:
hyperplasia without atypia - non neoplastic
atypical hyperplasia - endometrail intraepithelial neoplasm (EIN)

dx:
endometrial sampling = GOLD standard
endometrial biopsy –typically first line done in office

tx:
surveillance
progestin therapy - to shed lining
hysterectomy

33
Q

What is the gold standard for detecting endometrial hyperplasia?

A

endometrial sampling = GOLD standard

endometrial biopsy –typically first line done in office

34
Q

What is the most common gynecologic malignancy in the US?

A

endometrial cancer

35
Q

Risk factors of endometrial malignancy?

A 
50-70 yo 
unopposed estrogen (endogenous)  
PCOS 
endometrial hyperplasia 
obesity 
nulliparity 
Lynch syndrome: polyps in the colon
36
Q

Sxs of malignancy

A

80-90% present with AUB - cardinal sxs
post menopausal bleeding of any type
meno-metrorragia in premenopausal women

signs:
usually no PE findings
uterus may be normal size
atypical glandular cells on pap

37
Q

What is the most common tumor type of malignancy?

A

endometroid - low risk subtype

80% of cases

38
Q

How is endometrial cancer staged?

A

surgically

the spread of tumor in the uterus
the degree of myometrial invasion
the presence of extrauterine tumor spread

grade is determined by histology
-well, moderate, and poorly differentiated

39
Q

What is the treatment for malignancy?

A

stages 1 and 2
total hysterectomy with bilateral salpingoophorectomy (TAH - BSO)
+/- pelvic radation

Stages 3 and 4
pelvic and para-aortic lymphadenoectomy
omentectomy in type 2

40
Q

Leiomysarcoma

A

uterine sarcoma
separate classification from endometrial cancer

most cases are dx at time of fibroid surgery

poor prognosis

fibroids rarely advance to cancer but this is that one case it will

41
Q

Coagulopathy

A

underlying cause for AUB in 18% of white women and 7% of black women

inherited
von willebrand - must r/o in adolescent girls with AUB, particularly at menarche

ITP

platelet dysunfciton

42
Q

Ovulatory Dysfunction

A

anovulation

  • PCOS
  • Obesity
premature ovarian failure 
perimenoapuse 
endocrine 
-thyroid disorders
-hypothalamic/pituitary dysfunction 
-hyperprolactinemia

lacatation amenorrhea

extreme exercise/nutrition (anorexia)

43
Q

Anolulatory vs ovulatary AUB

A

anovulatory
-excess estrogen in absence of progesterone
incomplete sloughing of endometrium

ovulatory
prolonged progesterone secretion
irregular shredding of endometrium
tends to cause excessive menstrual bleeding

44
Q

Endometrial

A

primary endometrial dysfunction

  • inflammation or infectious causes of AUB
  • dx of exclusion
45
Q

Iatrogenic

A

medication - anticoags

hormone therapy

  • hormonal contraception
  • cooper IUD
  • HRT

Clin Med - Repro (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions