Uterine D/O Flashcards by Lauren Lover

What are congenital uterine anomalies? (hint: defect)

Mullerian fusion defects

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What are acquired uterine anomalies? (hint: syndrome)

Asherman’s syndrome

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Benign uterine disorders (x6)

Endometritis
Endometrial polyp
Endometriosis
Adenomyosis
Leiomyoma uteri
Endometrial hyperplasia w/o atypia

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Malignant/pre-malignant uterine d/o

Endometrial hyperplasia with atypia
Endometrial carcinoma
Uterine Sarcoma

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____ is the most common uterine septum d/o seen w/ pregnancy loss
Resection may result in higher delivery rates

Mullerian fusions

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___ or ___ are shapes of the uterus that are more frequently associated w/ mid-trimester loss or preterm birth

Bicornuate

Unicornuate

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___ results from incomplete canalization of the Mullerian tubercle

Vaginal septum

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When is a vaginal septum usually dx’d?

At puberty

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___ is an intrauterine synechiae (adhesions) usually occurring after recurrent curettage

Asherman’s Syndrome

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___ is inflammation of the endometrial lining of the uterus

It occurs in the obstetrical population and in the non-pregnant population

Benign Endometritis

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How does Benign Endometritis occur? Is it an ascending or descending infection?

Ascending infection from the lower genital tract

Polymicrobial from normal vaginal flora or associated cervicitis with GC/Chl

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What are risk factors of Endometritis?

Invasive gyne procedures (IUD)
High risk sexual behavior/STD exposure
Douching

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In non-pregnant population, endometritis is most commonly associated with ___ disease

Pelvic Inflammatory Disease (PID)

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\_\_\_ are overgrowths of endometrial cells attached to the inner wall of the uterus that extends into the uterine cavity 
Typically benign (occasionally atypical or malignant)

Benign Endometrial Polyps

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When do Benign Endometrial Polyps usually occur?

peri and post-menopausal women, occasionally younger

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What are sx of Benign Endometrial Polyps?

Asymptomatic
Irregular/intermenstrual
bleeding or menorrhagia
Post-coital bleeding
Post-menopausal bleeding

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How are Benign Endometrial Polyps dx’d and tx’d?

Dx: Sonohysterogram (SHGM)
Tx: Hysteroscopic resection

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DDx of an enlarged uterus (5)

Pregnancy
Uterine adenomyosis
Leiomyoma uteri
Hematometra (cervical stenosis/vaginal septum)
Malignancy

What are the uterus CA types?

Uterine sarcoma
Uterine carcinosarcoma
Endometrial carcinoma
Metastatic dz (other reproductive tract primary)

____ is the presence of ectopic endometrial glands and stroma in the myometrium

Benign Adenomyosis

What is the epidemiology for Benign Adenomyosis?

Parous women, usually presents 35-50 y/o

What are some S/s of Benign Adenomyosis?

Often asymptomatic, discovered incidentally

Secondary dysmenorrhea
Abd pressure
Bloating
Menorrhagia
Chronic pelvic pain, dysparenuia

What are signs of Benign Adenomyosis on PE?

How do you dx Benign Adenomyosis?

Diffusely enlarged, globular, tender uterus

Characteristic findings on US (SHGM) and MRI

What are tx options for a pt with Benign Adenomyosis? (hint: medical and surgical)

Medical: NSAID, Hormonal, Await menopause

Surgical: Hysterectomy, UAE (uterine artery embolization), ablation, resection, electro-coagulation

____ are benign tumors of smooth muscle origin that arise in the myometrium of the uterus They are considered the most common solid pelvic tumor in women and are the most frequent indication for ___

Leiomyomata Uteri (fibroids) benign hysterectomy

What is the epidemiology for Leiomyomata Uteri (fibroids)?

20-50% Higher in African American women (possibly as high as 70-80% by 50 y/o) Increases w/ age—peak in 40’s w/ sharp decrease post-menopause Genetic component

Where are pedunculated leiomyomata Uteri (fibroids) located?

Outside of the uterus

A very large uterus can compress the ureters and affect ___ and ___

renal fxn | ureteral patency

What are common sx of Leiomyomata Uteri (fibroids)?

``` Asymptomatic (majority) Bleeding abnormalities Abdominopelvic pressure/bloating Urinary pressure/frequency Constipation Reproductive complications ```

How is Leiomyomata Uteri (fibroids) dx'd?

Abd examination - uterus above pubic symphysis (pregnancy sizing, >12 weeks) Pelvic examination - enlarged, firm, and multinodular mass ``` Transvaginal ultrasound (TUS) - mass and confirm no adnexal mass ```

What is the tx for Asymptomatic Leiomyomata Uteri (fibroids)?

Most fibroids do not require tx! Education of pt Short-interval surveillance after initial dx to confirm stability of findings

What are sx of symptomatic Leiomyomata Uteri (fibroids)?

- Abnormal bleeding not responsive to medical management - Pain or pressure sxs that interfere w/ QOL - Urinary tract sx (urgency, frequency, obstruction/hydronephrosis) - Infertility or recurrent pregnancy loss

What are medication options for Symptomatic Leiomyomata Uteri (fibroids)?

Control the hormonal environment and minimize unopposed E OCP/oral, injectable/IDU progestins (correct ovarian dysfxn) GnRH agonist: reduce uterine bulk by 50% w/in 3 mo

What are procedural/surgical tx options for Symptomatic Leiomyomata Uteri (fibroids)?

``` Endometrial ablation Resection of intracavitary fibroids Uterine Artery Emolization (UAE) Myomectomy Hysterectomy ```

What option can be used for women who have symptomatic Leiomyomata Uteri (fibroids) and want to preserve fertility?

Myomectomy

____ is the overgrowth of proliferative endometrium resulting from protracted Estrogen stimulation in the absence of Progestin --> “unopposed E”

Endometrial Hyperplasia

When is a women most likely to have Endometrial Hyperplasia?

Typically peri/postmenopausal

What are RF for Endometrial Hyperplasia?

``` Obesity Nulliparity Early menarche/late menopause onset Anovulation (PCOS) Postmenopausal Estrogen therapy w/o Progestin DM, HTN, hypothyroidism Breast CA/Tamoxifen use Caucasian FHX of ovarian, colon, or uterine CA Smoking ```

What are the types of Endometrial Hyperplasia?

Simple w/ or w/o atypia | Complex w/ or w/o atypia

What are sx of Endometrial Hyperplasia?

Asymptomatic (high risk based on hx) Abnormal uterine bleeding pre/peri-menopausal Post-menopausal bleeding

When examining a woman w/ Endometrial Hyperplasia, will the uterus size be (enlarged/normal/small)?

normal

How do you dx endometrial hyperplasia?

- Pap smear may show glandular cells - Endometrial bx - TUS/SHGM: endometrial thickness >5 mm in post-menopausal pt, may show polypoid mass or fluid in cavity - Hysterocopy w/ D and C

What is the management for endometrial hyperplasia w/o atypia? When would a repeat endometrial sampling be recommended?

Cyclical Progestin therapy Medroxyprogesterone acetate Continuous Progestin therapy Repeat endometrial sampling in 3-6 months

What is the management for endometrial hyperplasia w/ atypia?

Hysteroscopy/D and C to rule out/in coexisting adenocarcinoma Hysterectomy for definitive dx and tx High dose Progestin, repeat bx in 3 months—poor surgical candidates LNR-IUD—option in poor surgical candidates who are not good candidates for systemic P, follow-up bx