O&G written - Uterine abnormalities Flashcards

1
Q

Risk factors for fibroids

A
Oestrogen - early menarche
Afro-Caribbean
Obese
Nulliparity
First degree family hx
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2
Q

Classification of fibroids

A

Intramural - within uterine wall
Submucosal - within myometrium, project into uterine cavity
Subserosal - may be intraligamentary (broad ligament folds) or pedunculated

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3
Q

Medical Tx of fibroid

A

IUS, COCP, oral POP, injectable progesterone
NSAIDs
Tranexamic acid

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4
Q

Surgical management of fibroids

A

For larger fibroid or failed medical Tx (or distorting cavity –> infertility)

Hysteroscopic surgery - small, submucosal
Myomectomy
Hysterectomy

+/- GnRh agonist pre-surgery to shrink fibroids

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5
Q

Complications of fibroids in pregnancy

A

Abnormal lie, malpresentation
Pre-tem labour
PPH

Red degeneration - fibroid grows rapidly + outstrips blood supply

  • low grade fever
  • abdo pain
  • vomiting
  • Tx = rest, analgesia, resolves in 4-7 days
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5
Q

Complications of fibroids in pregnancy

A

Abnormal lie, malpresentation
Pre-tem labour
PPH

Red degeneration - fibroid grows rapidly + outstrips blood supply

  • low grade fever
  • abdo pain
  • vomiting
  • Tx = rest, analgesia, resolves in 4-7 days
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6
Q

Endometrial cancer staging

A

Stage 1: 1A = <50% myometrial invasion, 1B = >50%

Stage 2: + cervical stromal invasion but not beyond uterus

Stage 3: 3A = serosa or adnexae, 3B = vaginal and/or parametrial, 3Ci = pelvic lymph nodes, 3cii = para-aortic lymph nodes

Stage 4: 4A = bowel or bladder, 4B = distant mets

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7
Q

Management of endometrial cancer

A

Total (abdominal) hysterectomy with bilateral oophorectomy
+/- pelvic/para-aortic lymph node dissection

Adjunctive radiotherapy and/or chemotherapy for Stage II Type 1 and any Type 2 tumours

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8
Q

Presentation of leiomyosarcoma

A

Painful, rapid uterine enlargement

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9
Q

Tx of leiomyosarcoma

A

Hysterectomy+/- radiotherapy, chemotherapy

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10
Q

Presentation of endometrial ca.

A

Post-menopausal bleeding
If pre-menopause, abnormal bleeding - heavy, frequent, IMB

Enlargement of uterus - pain
Unusual discharge
Dyspareunia

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11
Q

Risk factors for endometrial hyperplasia/cancer

A

Oestrogen exposure

  • early menarche, late menopause
  • nulliparity
  • Tamoxifen
  • unopposed oestrogen HRT
  • Diabetes, PCOS, high BMI
  • family Hx including HNPCC (Lynch syndrome)
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12
Q

Investigation of PMB

A

TV USS

  • endometrium <4mm = ca. umlikely
  • endometrium >4mm = need second line Ix

Hysteroscopy +/- pipette biopsy

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13
Q

Management of endometrial hyperplasia WITHOUT atypia

A

Reverse RF

1st line = LNG-IUS 5 years (or oral progestogens for min 6 months)
2nd line = hysterectomy

If wanting fertility –> endometrial surveillance (TV USS) every 6 months + biopsies if high risk

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14
Q

Management of endometrial hyperplasia WITH atypic

A

Fertility preserving:
1st line = LNG-IUS
2nd line = Oral progestogens
+ endometrial surveillance + biopsies every 3 months

Not fertility preserving = total hysterectomy + bilateral salpingo-oophorectomy if post-menopausal

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