Ovarian Flashcards
3 layers of ovarian tissue
epithelian
stromal
germ
each layer of ovarian tissue can produce what kinds of tumor
cysts
benign
malignant
solid
what are risk factor for ovarian cyst
Infertility Tx Tamoxifen Pregnancy in 2nd trimester when hCG peaks Hypothyroidism Cigarette smoking Tubal ligation
what is the most common type of functional cyst
follicular
characteristics of endometriomas
blood filled cysts from ectopic edometrium
called chocolate cysts
Triad: Dysmenorrhea, dysparenuia, menorrhagia
malignant cells most oftenly arise from what tissue layer?
epithelium (mesothelium)
what will the history of a person with ovarian cysts be like
torsion or rupture that causes severe pain: sudden sharp unilateral pain. This may be brought on by exercise, trauma, coitis
May have difficult bowel movements, frequent urination, irrgeular menses, dysparenuia
Can cause puberty to happen early in girls
Abdominal bloating or fullness
what will the history of a woman with polycystic ovary syndrome be like
hirsutism, infertility, oligomenorrhea, obesity, acne tenesmus
what will exam be like for ovarian cysts
may be tender to palpation
what is the cancer antigen for ovaries
CA125
what is ovarian torsion
occurs when the ovary flips over
cuts off blood supply to ovary
what is the median age for ovarian torsion
28 years old
what is presentation like for ovarian torsion
2/3 on the right side
acute unilateral sharp pain, vomiting with onset of pain, pelvic mass, leukocytosis and fever
what type of test would you want to do for ovarian torsion
U/S with color doppler
what is the Tx for ovarian torsion
removal of ovary
can untwist if done immediately
women with PCOS have abnormalities with what?
metabolism of androgen and estrogen
what will PCOS look like on the ovaries
bilaterally enlarged
spherical rather than ovoid
multiple 1cm follicles
string of pearls appearance
How is PCOS dx made
2 of the following:
Polycystic ovaries
signs of androgen excess: acne, hirsutism, temporal balding, male pattern hair loss
menstrual irregulatieis: oligomenorrhea or polymenorrhea
what will PE be like for a pt with PCOS
excess body hair, acne, alopecia, increased muscle mass, deepening voice Obesity Acanthosis nigricans, HTN Enlarged ovaries
what is the Tx for PCOS
diet and exercise Meds for anovulation hirsutism Acne Endocine consult surgery
what is the meigs syndrome triad
ascities
pleural effusion
benign ovarian fibroma
what guides the diagnosis and tx of patient
type of mass and age of the patient
why is it hard to diagnose ovarian cancer
presentation is vague
RF for ovarian cancer
older age
early menarch 50
Caucasian>Hispan>African Americans
Infertility
what factors are protective for ovarian cancer
OCP
breast feeding
how is ovarian cancer dx’d
U/s
elevated CA-124
elevated Inhibin B
which causes increased risk for familial ovarian cyst?
Fm Hx BRCA 1 BRCA 2 Ashkenazi Jews, French Canadians Icelandic descent
what is the Tx of ovarian cancer
Surgery
Chemo
Marker Ca-125
uterine prolapse stage 0
no prolapse
uterine prolapse stage 1
cervix is in the upper 1/2 of vagina
uterine prolapse stage 2
cervix is 1cm above or below hymen remnants
uterine prolapse stage 3
cervix is >1cm below hymen remnants but the uterus is still at least 2cm in the vagina canal
uterine prolapse stage 4
uterus is outside the vaginal canal
what are RF for uterine prolapse
more than 2 vaginal deliveries
age, obesity, chronic cough, repetitive heavy lifting
what are the symptoms of uterine prolapse
vaginal fullness, pressure, heaviness, presence of soft reducible mass in vagina, urinary complaints
Leiomyoma
commmon in women over 40, african american
menorrhagia is usually due to submucosal firboids
Leiomyoma pathology
arise from smooth muscle
usually benign tumors
tissue exam need for dx
Leiomyoma presentation
menorrhagia fullness in pelvic area increased abdominal girth Freq. urination low back pain
how are leiomyoma dx’d
U/S MRI CT hyterosalpingogram Sonohyterogram
what is the Tx for leiomyoma
watchful waiting
operative hysterectomy
Embolization
monitor 3mth, 6mths, yearly
How is embolization used to tx fibroids
using arterial catherization, synthetic emboli are introduced to the artery feeding the fibroid
What uterine cancer has what
precursor lesion
endometrial hyperplasia that thickens endometrium and causes heavier period
how does uterine cancer present
menorrhagia
metrorrhagia
post menopausal bleeding
risk factors for endometrial hyperplasia
obesity Anovulation DM HTN Age Nulliparity
What affects endometrial hyperplasia
unopposed estrogen w/o estrogen which can progress to cancer
how is endometrial hyperplasia tx’ed
add extra progesterone during luteal phase
(methoxyprogesterone) during days 16-25 for 3 months
what is the MC endometrial cancer
uterine cancer
has good prognosis d/t being found in early stages
what are the 2 types od uterine cancer pathology
80% are type 1 d/t unopposed estrogen stimulation, endometrial hyperplasia
type II estrogen independent
what are the RF for uterine cancer
age, obesity, DM, HTN, Nulliparity, Late menopause, Early menarch Hx of Breast CA Tamoxifen Estrongen alone PCOS
what are the Sx of uterine cancer
abnormal menses 80%
postmenopausal bleeding
classic presentation: obese, nuliparous, infertile, HTN, DM, white
how is uterine cancer dx’d
U/S
endometrial biopsy
D&C-definitive procedure
what is the treatment for uterine cancer
surgery: Hysterectomy B/L salpingoopherectomy Radiation progesterone therapy
how often should a patient with uterine cancer follow up
every 3-4 mths for first 2yrs
then 6mths for next 3yrs then annually
what should each post cancer tx include
pelvic exam
pap smear
lymph node survery
Cxry annually
