Lecture 19 - AUB Flashcards

Question

What are the signs and sxs of adenomyosis?

Answer 1

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

Answer 2

Dx: pelvic US MRI pathology s/p hysterectomy --if they're symptomatic

Answer 3

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

Answer 4

"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

Answer 5

``` 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 ```

Answer 6

Dx: incidental PE finding US

Answer 7

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

Answer 8

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

Answer 9

endometrial sampling = GOLD standard | endometrial biopsy --typically first line done in office

Answer 10

endometrial cancer

Answer 11

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

Answer 12

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

Answer 13

endometroid - low risk subtype | 80% of cases

Answer 14

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

Answer 15

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

Answer 16

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

Answer 17

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

Answer 18

anovulation - PCOS - Obesity ``` premature ovarian failure perimenoapuse endocrine -thyroid disorders -hypothalamic/pituitary dysfunction -hyperprolactinemia ``` lacatation amenorrhea extreme exercise/nutrition (anorexia)

Answer 19

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

Answer 20

primary endometrial dysfunction - inflammation or infectious causes of AUB - dx of exclusion

Answer 21

medication - anticoags hormone therapy - hormonal contraception - cooper IUD - HRT

Lecture 19 - AUB Flashcards

(45 cards)