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Womens Health > ovarian disorders > Flashcards

ovarian disorders Flashcards

1
Q

what are the types of functional ovarian cysts?

A

follicular and corpus luteal cysts

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2
Q

what are follicular cysts?

A

occur when follicles fail to rupture and continue to grow

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3
Q

what are corpus luteal cysts?

A

fail to degenerate after ovulation

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4
Q

what is theca lutein?

A

excess BHCG causes hyperplasia of the interna cells

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5
Q

when are functional ovarian cysts mc?

A

reproductive years

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6
Q

s/sx of functional ovarian cysts?

A

+usually unilateral
+most are self-limiting and reslove w. in a few wks

+mostly asx unless they rupture (RLQ and LLQ ppain)

+may see abnormal uterine bleeding
-painful sex

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7
Q

PE of ovarian cysts?

A

Unilateral pelvic pain/tenderness

May have mobile, palpable cystic adnexal mass

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8
Q

dx of functional ovarian cysts

A

Pelvic US
Follicular → Smooth, thin-walled unilocular
Luteal → Complex, thicker-walled with peripheral vascularity
β-hCG levels → To rule out pregnancy

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9
Q

tx of ovarian cysts?

A

supportive
if less than 8 cm will most likely spontaneously resolve

if > 8 cm or persist, or found post menopauses, can be removed

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10
Q

ovarian cancers

A

2 cd MC gyn after endometrial

*highest mortality of all gyn ca

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11
Q

rf for ovarian ca

A

Family Hx → 7% lifetime risk (Normal 1-2%)
↑# of ovulatory cycles → Infertility, Nulliparity, >50 yrs, late menopause
BRCA1/BRCA2 → 15-40%
Peutz-Jeghers or Turner’s Syndrome

40-60 yo

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12
Q

protective factors in ovarian ca

A

OCPs → Decreases # of ovulatory cycles

High parity or TAH

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13
Q

s/sx of ovarian ca

A

Abdominal fullness/distension, +back or abdominal pain, early satiety
+Urinary frequency
+Irregular menses, menorrhagia, +postmenopausal bleeding, +constipation → intestinal compression

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14
Q

PE of ovarian cancer/ where can it mets?

A

Palpable abdominal or ovarian mass → Solid, fixed, irregular + ascites

Sister Mary Joseph’s Node → METS to the umbilical lymph node

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15
Q

dx of ovarian ca

A

Biopsy → 90% Epithelial → Seen especially postmenopausal → Germ cell seen in pts <30 yrs
Transvaginal US → Useful screening in high-risk pts
Mammography to look for primary in breast

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16
Q

tx of early stage ovarian ca

A

AH-BSO + Selective Lymphadenectomy

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17
Q

what levels are used to monitor ovarian cysts?

A

Serum CA-125

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18
Q

what chemo can be used for ovarina ca?

A

Paclitaxel + Cisplatin or Carboplatin

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19
Q

what is the MC benign ovarian neoplasm?

A

DERMOID CYSTIC TERATOMA

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20
Q

what are most ovarian neoplasms considered in reproductive age?

A

benign

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21
Q

how are benign ovarian neoplasms tx?

A

Removal due to potential risk of torsion or malignant transformation

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22
Q

PCOS PP?

A

associated with abnormal function of hypothalamus-pituitary-ovarian axis → ↑INSULIN & ↑LH-DRIVEN ↑IN OVARIAN ANDROGEN PRODUCTION

*insulin resistance

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23
Q

what is a rf for PCOS?

A

obesity

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24
Q

what is the triad of sx for PCOS?

A

Amenorrhea → Chronic Anovulation
Obesity
Hirsutism → Androgen Excess

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25
Q

s/sx of PCOS?

A

Menstrual Irregularity → Secondary amenorrhea (50%), oligomenorrhea (70%)

Increased Androgen → Hirsutism (50%) - Coarse hair growth on midline structures (face, neck, abd), acne, + male pattern baldness

Insulin Resistance → Type II DM, Obesity (80%), Hypertension

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26
Q

PE of PCOS pt?

A

Bilateral enlarged, smooth, mobile ovaries on bimanual exam

Acanthosis Nigricans

Cysts are immature follicles w/arrested development due to abnormal ovarian fxn

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27
Q

dx of PCOS?

A

Exclude other disorders → Thyroid (TSH), Pituitary Adenoma (Prolactin Levels), Ovarian Tumors, Cushing’s Syndrome (Dexamethasone Suppression Test)

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28
Q

what labs should you order if suspecting PCOS?

A

↑testosterone, ↑DHEA-S (Intermediate of Testosterone),

LH:FSH ratio>3:1
(Normal 1.5:1)

lipid panel,

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29
Q

what specific lab test can you do for PCOS?

A

GnRH Agonist Stimulation Test → Rise in Serum Hydroxyprogesterone

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30
Q

what characteristic signs are seen on US with PCOS?

A

string of pearls

Bilateral enlarged ovaries with peripheral cysts

31
Q

what complications can occur with PCOS?

A

Chronic Anovulation → ↑Risk for infertility, ↑endometrial hyperplasia & endometrial carcinoma due to unopposed estrogen
Insulin Resistance → ↑Risk of atherosclerosis & HTN

32
Q

what may been seen in a pt with PCOS as they progress through maturity?

A

usually have normal puberty and adolescence, followed by progressively longer episodes of amenorrhea

33
Q

tx of PCOS (mainstay)

A

combo OCP
lifestyle change,

surgery can be done to restore ovulation in pts who want kids but clomiphene doesn’t work

34
Q

how does estrogen help in PCOS?

A

stimulates hepatic production of sex-hormone binding globulin → reducing androgen levels

35
Q

how does progesterone help in PCOS?

A

Progesterone decreases action of testosterone at target organs by receptor antagonism

36
Q

what OCP should you avoid in PCOS?

A

androgenic progesterone → Norgestrel and Levonorgestrel

37
Q

what can be used to tx hirsutism?

A

Spironolactone → Structurally similar to testosterone but blocks testosterone receptors
Spironolactone = Teratogenic → Must be used with OCPs
May be added if sxs persist after OCPs

Leuprolide & Finasteride → Other Anti-Androgenics

38
Q

how can infertility in the PCOS pt be tx?

A

Clomiphene

39
Q

how does clomiphene work?

A

Selective Estrogen Receptor Modulator → Gonadotropin re-establishes ovulation in anovulatory women who with to get pregnant

40
Q

how can metformin help in a PCOS pt?

A

with abnormal LH:FSH ratios may improve menstrual frequency by reducing insulin

41
Q

common side effects of clomiphene?

A

hot flashes, pelvic pain

*increased risk of twins

42
Q

which population is most at risk for ovarian torsion and why?

A

prepubertal girls

Based on the abdominal location of the ovary and the long utero-ovarian ligament the adnexa

43
Q

s/sx of ovarian torsion

A

bdominal pain & ovarian enlargement on the same side demonstrated by sonography

*pretty vague sx

44
Q

dx of ovarian torsion?

A

Doppler flow studies may further contribute to the diagnosis but even in presence of flow the ovarian vessels should not preclude the clinical impression

45
Q

tx of ovarian torsion?

A

operative laparoscopy

46
Q

what is a leiomyoma?

A

Benign uterus smooth muscle tumor → Most common benign gynecologic lesion

47
Q

what is the growth of a leiomyoma related to?

A

ESTROGEN PRODUCTION → Regresses after menopause

If it grows after menopause think other causes

48
Q

what population is most likely to be affected by leiomyomas?

A

30s (especially > 35y) → 5x more common in African Americans

49
Q

what are the 4 types of leiomyomas?

A

Intramural, Submucosal, Subserosal, Parasitic

50
Q

s/sx of leiomyomas?

A

Most are asymptomatic
Bleeding most common presentation → Menorrhagia, Dysmenorrhea

Abdominal pressure/pain related to size of tumors & location

Bladder → Frequency, urgency

51
Q

what are PE findings for leiomyomas?

A

Large, irregular hard palpable mass in the abdomen or pelvis during bimanual exam

52
Q

dx of leiomyomas?

A

elvic US → Focal heterogeneous masses with shadowing → Also used to observe for growth

53
Q

tx of leiomyomas?

A

Observation → Majority don’t need treatment → Decision to treat is determined by symptoms, size/rate of tumor growth & the desire for fertility

54
Q

medical tx of leiomyomas?

A

*think estrogen inhibitor–> decreased endometiral growth

55
Q

what specific med can be used for leiomyomas?

A

leuprolide

or progestins like medroxyprogesterone (causes endometrial atrophy, shrink uterus temporarily)

56
Q

MOA of leuprolide?

A

GnRH agonist that causes GnRH inhibition when given continuously → Shrinks the uterus temporarily until natural menopause

*only used if near menopause or preoperatively → Prior to hysterectomy

57
Q

surgical tx of leiomyomas?

A

Hysterectomy → Definitive treatment → Fibroids = Most common cause for hysterectomy

Myomectomy → Used especially to preserve fertility

Endometrial ablation, artery embolization → Both may affect ability to conceive

58
Q

what is adenomyosis?

A

Islands of endometrial tissue within the myometrium → muscular layer of uterine wall

59
Q

PP of adenomyosis?

A

ectopic endometrial tissue induces hypertrophy & hyperplasia of the surrounding myometrium → Diffusely enlarged uterus

60
Q

when does adenomyosis MC present?

A

later in the reproductive years

61
Q

s/sx of adenomyosis?

A

Menorrhagia → Progressively worsens
Dysmenorrhea
+ Infertility

62
Q

PE findings of adenomyosis?

A

TENDER, SYMMETRICALLY/uniformly

enlarged “BOGGY UTERUS” → “Globular enlargement”

63
Q

dx of adenomyosis?

A

Dx of exclusion of secondary amenorrhea → Rule out pregnancy first
MRI

64
Q

what is the definitive dx of adenomyosis?

A

Post-total hysterectomy examination of uterus

65
Q

what is the only effective tx of adenomyosis?

A

Total abdominal hysterectomy

66
Q

what are some conservative tx of adenomyosis?

A

sed to preserve fertility
Analgesics
Low dose OCPs

mifepristone, GnRH agonist

67
Q

what is the classic adenomyosis pt?

A

middle aged and parous w/ sever secondary dysmenorrhea and menorrhagia and symmetrically enlarged uterus

68
Q

Leiomyoma vs adenomyosis: asymmetric?

A

leiomyoma

69
Q

L vs A: symmetric?

A

adenomyosis

70
Q

L vs A: firm uterus?

A

LEIOMYOMA

71
Q

L vs A: soft uterus?

A

adenomyosis

72
Q

L vs A: tender uterus?

A

adenomyosis

73
Q

L vs A: nontender uterus?

A

adenoomyosis

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