The Uterus And Cervix Flashcards
1
Q
Leiomyomata
A
- Fibroids - benign tumours of the myometrium.
- Present in 25% of women.
- More common near menopause, Afro-caribbeans and in those with a family history.
- Less common in parous women and with cocp.
2
Q
Fibroids - in menopause and pregnancy
A
- They are oestrogen and progesterone dependant so shrink following the menopause.
- Variable in pregnancy - can shrink, stay the same or grow in size - difficult to predict.
3
Q
Fibroids - Symptoms
A
- 50% are asymptomatic and only discovered during abdo or pelvis examination.
- Cause menorrhagia, dysmenorrhoea, pain if torsion occurs, urinary frequency if pressure on the bladder, hydronephrosis if pressure on ureter.
- Fertility is affected if tubal ostia are blocked or if fibroids affect implantation.
4
Q
Fibroids - Complications
A
- Red degeneration - caused by inadequate blood supply - pain, uterine tenderness, haemorrhage and necrosis.
- Hyaline or cystic degeneration can occur after the menopause.
- 0.1% are leiomyosarcoma - malignant tumour.
5
Q
Fibroids - investigations
A
- Ultrasound is helpful but MRI or laparoscopy can sometimes be required to distinguish fibroids from an ovarian mass.
- Hysteroscopy can be used to assess distortion if fertility is an issue.
- Hb can be low due to bleeding or high as some fibroids produce erythropoetin.
6
Q
Fibroids - Medical Management
A
- Large fibroids that remain in situ should be monitored regularly for malignant change.
- Tanexamic acid, nsaids or progesterones can be tried but often ineffective for menorrhagia.
- GnRH agonists cause amenorrhoea and fibroid shrinkage - induce temporary menopause. Use is limited for a maximum of 6 months due to side effects e.g. loss of bone density.
7
Q
Fibroids - Surgical Management
A
- Hysteroscopic - 3-4cm fibroids can be removed following pretreatment with GnRH agonist.
- Uterine artery embolisation by radiologists - reduces fibroid volume by 50%.
- Myomectomy if fertility to be preserved.
- Hysterectomy if fertility not required.
8
Q
Adenomyosis
A
- Presence of endometrium in the myometrium.
- Associated with fibroids and endometriosis.
- Sx - can be asymptomatic but usually painful, regular and heavy menstruation.
- Ix - adenomysis can be identified on MRI.
9
Q
Adenomyosis - Management
A
- IUD, cocp and nsaids can be used to control sx.
- GnRH agonists can help but max use is 6 months due to side effects - can be used to see if a hysterectomy would be beneficial.
10
Q
Endometritis
A
- Infection of the uterine cavity - can potentially spread to the pelvis if left untreated.
- Organisms - Chlamydia, gonococcus, E Coli, Staphylococcus or clostridia.
11
Q
Endometritis - Causes and Features
A
- Causes - secondary to STI, as a complication of surgery e.g. C section or TOP, due to foreign tissue e.g. IUD or malignancy.
- Features - painful and tender uterus, pv bleeding, open cervical os and systemic upset.
12
Q
Endometritis - Ix and Mx
A
- Ix - high vaginal and cervical swabs and bloods.
- Mx - broad spectrum abx and ERPC (evacuation of retained products of conception) if required.
13
Q
Intrauterine Polyps
A
- Small and usually benign tumours commonly found in women aged 40-50 years especially when oestrogen levels are high e.g. tamoxifen.
- Sx - can cause menorrhagia or IM bleeding.
- Ix - diagnosed on ultrasound or hysteroscopy.
- Mx - resection with cutting diathermy or avulsion.
14
Q
Endometrial Carcinoma
A
- The most common genital tract malignancy.
- Only 15% cases in premenopausal women.
- >90% are adenocarcinoma and the next most common is adenosquamous carcinoma.
15
Q
Endometrial Ca - Risk Factors
A
Principle is high ratio of oestrogen to progesterone - exogenous unapposed oestrogen, obesity (androgen converted to oestrogen), PCOS, nulliparity, late menopause, ovarian granulose cell tumour or use of Tamoxifen.
