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1. Senior Block- O&G > Upper Gynaecological Problems > Flashcards

Upper Gynaecological Problems Flashcards

1
Q

Give 4 risk factors for endometrial polyps

A 
Obesity
Hypertension
Hx of cervical polyps
Tamoxifen
HRT
40-50yrs
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2
Q

What are endometrial polyps?

A

Small, benign tumours in the uterine cavity originating from the endometrial lining

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3
Q

Give 3 clinical features of endometrial polyps

A

Irregular menstrual bleeding
Post-menopausal bleeding
Menorrhagia
Post-coital bleeding

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4
Q

How are endometrial polyps diagnosed?

A

Hysteroscopy

TV ultrasound

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5
Q

How are endometrial polyps treated?

A

Surgical removal by curettage or diathermy

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6
Q

How common are fibroids?

A

1 in 3 women

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7
Q

Give 3 risk factors for fibroids?

A 
Obesity
15-50yrs old (reproductive age)
FHx
Afro-Caribbean
Nulliparous
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8
Q

What is the pathophysiology of fibroids?

A

Benign tumours of the myometrium (leiomyomata). Made up of smooth muscle and fibrous connective tissue.

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9
Q

Why are they not seen in post-menopausal women?

A

After the menopause they calcify and regress

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10
Q

Microscopically, what appearance to fibroids have?

A

‘Whorled appearance’

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11
Q

Give 5 possible clinical features of fibroids

A 
Depends on size and location of fibroid:
Menorrhagia
Abdominal pain
Painful sex
Increased urinary frequency
Decreased fertility
Bloating
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12
Q

How are fibroids diagnosed?

A

TV Ultrasound
Hysteroscopy
Can also have MRI

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13
Q

When are fibroids not treated?

A

> 45 years old
No symptoms
Not growing
Subserous (protrudes externally) or intramural (in wall with no protrusion)

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14
Q

How can fibroids be treated medically?

A 
Tranexamic acid
NSAIDs
COCP
Oral progesterone
GnRH analogues
Ulipristal acetate
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15
Q

How can fibroids be managed surgically?

A

Laparoscopic removal –> myomectomy
Hysterectomy
Hysteroscopic removal

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16
Q

Give 2 procedures which can reduce the symptoms of fibroids

A

Uterine artery embolisation –> blocks fibroid blood vessels

Endometrial ablation –> removes lining of uterus (reduces fertility)

17
Q

What is adenomyosis?

A

Presence of endometrium in the myometrium so uterus becomes enlarged.

18
Q

Give 3 risk factors for adenomyosis

A

~40 yrs
Parous
Early menarche
Hx of uterine surgery

19
Q

Give the 3 main symptoms of adenomyosis

A

Dysmenorrhea
Menorrhagia
Dyspareunia

20
Q

How is adenomyosis diagnosed?

A

Can see thickened junctional zone on MRI

21
Q

How is adenomyosis treated?

A

Hysterectomy

22
Q

Give 4 risk factors for endometriosis

A

Post menarche
Pre menopause
Nulliparous
FHx

23
Q

What is the pathophysiology of endometriosis?

A

Endometrial cells are found outside the uterus. Each month the endometrial cells sheds a period. The tissue outside the uterus has nowhere to bleed into and so causes pressure build up leading to symptoms.

No one knows why endometriosis occurs. Thought to be due to retrograde flow of period blood back into the fallopian tubes (Sampson’s theory) combined with a weaker immune system so the cells cannot fight off the implanting endometrial cells.
Genetics is also thought to have a role in the development.
Alternative theory is that multipotential cells undergo metaplasia to become endometrium (Meyer’s theory)

24
Q

What period symptoms will an endometriosis patient experience?

A

Heavy, prolonged, painful periods
Irregular
Loss of old blood before period
Intermenstrual spotting

25
Q

Other than period changes give 5 symptoms of endometriosis

A 
Pelvic pain
Pain on sex
Bloating
IBS symptoms
Painful bowel movements
Lack of energy 
Pain on urination
Pain on ovulation 
Depression
Back pain
26
Q

How is endometriosis diagnosed?

A

Only definitive diagnosis is through laparoscopy +/- biopsy

27
Q

How is endometriosis managed medically?

A 
NSAIDs
COCP
Mirena coil
Progestogen preparations ---> decrease growth of endometriosis
GnRH analogues --> temporary menopause
28
Q

How is endometriosis managed surgically?

A

Diathermy ablation done at time of laparoscopic diagnosis

Hysterectomy + BSO

29
Q

What is an ovarian endometrioma (chocolate cyst)?

A

Endometrial cells in the ovarian tissue which form cysts. The cells shed a period every month but the blood remains inside the cyst which causes inflammation.

30
Q

What is the main symptom of a ruptured ovarian endometrioma?

A

Sudden, severe abdominal pain

Medical emergency

31
Q

Other than rupture, what is the main complication of ovarian endometriomas?

A

Reduced fertility

1. Senior Block- O&G (11 decks)

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