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Obstetrics and Gynaecology > The uterus and it's abnormalities > Flashcards

The uterus and it's abnormalities Flashcards

1
Q

What are fibroids?

A

Benign tumours of the myometrium.

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2
Q

What age are fibroids most common?

A

More common near the menopause

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3
Q

In what race are fibroids more common?

A

Afro-caribbean

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4
Q

What contraceptives decrease your risk of fibroids?

A

The combined oral contraceptive and injectable progestogens

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5
Q

What are the different sites of fibroids?

A

They can be intramural, subserosal or submucosal

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6
Q

What type of fibroid can occasionally form intracavity polyps?

A

Submucosal fibroids

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7
Q

What tissue is used to form fibroids?

A

Smooth muscle and fibrous elements are present, and in transverse section the fibroid has a ‘whorled’ appearance.

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8
Q

What happens to fibroids during pregnancy?

A

They are equally likely to grow, shrink or have no change

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9
Q

What happens to fibroids after menopause?

A

They regress due to the reduction in circulating oestrogen.

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10
Q

Is it more likely that site or size of fibroids affects symptoms?

A

Site not size

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11
Q

What are the symptoms of fibroids?

A

may be asymptomatic (50%)
menorrhagia
lower abdominal pain: cramping pains, often during menstruation
bloating
urinary symptoms, e.g. frequency, may occur with larger fibroids
subfertility

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12
Q

What type of fibroids cause intermenstrual bleeding?

A

Submucosal or polypoid

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13
Q

When would fibroids cause pain?

A

They seldom cause pain, unless torsion, red degeneration or, rarely, sarcomatous change occur.

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14
Q

When would fibroids affect fertility?

A

Fertility can be impaired if the tubal ostia are blocked or submucosal fibroids prevent implantation. Intramural fibroids not distorting the cavity also reduce fertility through the mechanism is unclear.

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15
Q

What often happens to fibroids after menopause?

A

Fibroids stop growing and often calcify after the menopause, although the oestrogen in HRT may stimulate further growth.

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16
Q

Why does fibroid degeneration take place?

A

It is normally the result of an inadequate blood supply

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17
Q

What are the symptoms of fibroid ‘red degeneration’?

A

It is characterised by pain and uterine tenderness; haemorrhage and necrosis occur.

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18
Q

What physiological thing increases the risk of red degeneration?

A

Red degeneration is common in pregnancy.

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19
Q

Should fibroids be cut out at caesarean section?

A

No, bleeding can be heavy

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20
Q

Can fibroid secrete anything, if so, what?

A

Yes, they can secrete erythropoietin, which can raise Hb levels

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21
Q

How do you treat fibroids?

A

symptomatic management with a levonorgestrel-releasing intrauterine system is recommended by CKS first-line
other options include tranexamic acid, combined oral contraceptive pill etc
GnRH agonists may reduce the size of the fibroid but are typically useful for short-term treatment
surgery is sometimes needed: myomectomy, hysteroscopic endometrial ablation, hysterectomy
uterine artery embolization

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22
Q

What is adenomyosis?

A

The presence of endometrium and its underlying storm within the myometrium

23
Q

What age is adenomyosis most common?

A

It is most common around the age of 40

24
Q

What other diseases are associated with adenomyosis?

A

Endometriosis and fibroids

25
Q

What happens to symptoms of adenomyosis after menopause?

A

They subside

26
Q

What are the symptoms of adenomyosis?

A

dysmenorrhoea
menorrhagia
enlarged, boggy uterus

27
Q

What investigation would you use to detect adenomyosis?

A

It is not easily diagnosed by ultrasound but can be seen on MRI

28
Q

What is the treatment for adenomyosis?

A

Medical treatment with the progesterone intrauterine system (IUS) or the combined oral contraceptive pill with or without NSAIDs for dysmenorrhoea and menorrhagia but often hysterectomy is needed

29
Q

What are some of the causes of secondary endometriosis?

A

Endometriosis is often secondary to sexual transmitted infections, as a complication of surgery, particularly C section and intrauterine procedure, or foreign bodies

30
Q

What are intrauterine polyps?

A

These are small, usually benign tumours that grow into the uterine cavity.

31
Q

What age are intrauterine polyps most common?

A

They are common in women aged 40-50 years and when oestrogen levels are high.

32
Q

What are the symptoms of intrauterine polyps?

A

Although sometimes asymptomatic, they often cause menorrhagia and intermenstrual bleeding and very occasionally prolapse through the cervix

33
Q

What is the treatment of intrauterine polyps?

A

Resection of the polyp with cutting diathermy or avulsion normally cures bleeding problems

34
Q

What is haematometra?

A

This is menstrual blood accumulating in the uterus because of outflow obstruction.

35
Q

What normally causes a haematometra?

A

The cervical canal is usually occluded by fibrosis after endometrial resection, cone biopsy or by a carcinoma

36
Q

What other organs are associated with congenital uterine malformations?

A

Women with a congenital uterine anomaly have an increased incidence of renal anomalies and should undergo renal tract imaging

37
Q

What is the most common genital tract cancer?

A

Endometrial carcinoma

38
Q

What age is endometrial cancer most common?

A

Prevalence is highest at the age of 60 years, with only 15% of cases occurring premenopausally and <1% under 35

39
Q

Does endometrial cancer normally present early or late?

A

Early

40
Q

What is the pathology of endometrial cancer?

A

Adenocarcinoma os columnar endometrial gland cells accounts for >90%

41
Q

What hormones are linked with endometrial cancer?

A

High ratio of oestrogen:progestogen so it is most common when oestrogen production is high

42
Q

What are the risk factors for endometrial carcinoma?

A 
obesity
nulliparity
early menarche
late menopause
unopposed oestrogen. The addition of a progestogen to oestrogen reduces this risk (e.g. In HRT). The BNF states that the additional risk is eliminated if a progestogen is given continuously
diabetes mellitus
tamoxifen
polycystic ovarian syndrome
hereditary non-polyposis colorectal carcinoma
43
Q

What is protective against endometrial carcinoma?

A

The combined oral contraceptive

44
Q

What are the symptoms of endometrial carcinoma?

A

Postmenopausal bleeding is the most common presentation. Premenopausal symptoms have irregular or intermenstrual bleeding, or, occasionally, only recent-onset menorrhagia
Pain and discharge are unusual features

45
Q

What would a cervical smear show during endometrial carcinoma?

A

A cervical smear may contain abnormal columnar cells(cervical glandular intraepithelial neoplasia)

46
Q

What staging is used to stage endometrial cancer?

A

FIGO 2009, it is surgical and histological and, in contrast to cervical carcinoma, includes lymph node involvement

47
Q

What is stage 1 of endometrial cancer?

A

Lesions confined to the uterus

48
Q

What is stage 2 of endometrial cancer?

A

Lesions confined to the uterus and the cervix

49
Q

What is stage 3 of endometrial cancer?

A

Tumour invades through the uterus

50
Q

What is stage 4 of endometrial cancer?

A

Further spread into the bowel, bladder or distant metastases

51
Q

What is the treatment of endometrial cancer?

A
  1. localised disease is treated with total abdominal hysterectomy with bilateral salpingo-oophorectomy.
  2. Patients with high-risk disease may have post-operative radiotherapy
  3. progestogen therapy is sometimes used in frail elderly women not consider suitable for surgery
52
Q

What is the prognosis of endometrial cancer?

A

Recurrence is most common in the vaginal vault, normally in the first 3 years

53
Q

What are poor prognostic features of endometrial cancer?

A

Older age, advanced clinical stage, deep myometrial invasion, high tumour grade and adenosquamous histology

54
Q

What ix are done in endometrial cancer?

A
  1. women >= 55 years who present with postmenopausal bleeding should be referred using the suspected cancer pathway
  2. first-line investigation is trans-vaginal ultrasound - a normal endometrial thickness (< 4 mm) has a high negative predictive value
  3. hysteroscopy with endometrial biopsy

Obstetrics and Gynaecology (27 decks)

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