Uterine D/O Flashcards
What are congenital uterine anomalies? (hint: defect)
Mullerian fusion defects
What are acquired uterine anomalies? (hint: syndrome)
Asherman’s syndrome
Benign uterine disorders (x6)
Endometritis Endometrial polyp Endometriosis Adenomyosis Leiomyoma uteri Endometrial hyperplasia w/o atypia
Malignant/pre-malignant uterine d/o
Endometrial hyperplasia with atypia
Endometrial carcinoma
Uterine Sarcoma
____ is the most common uterine septum d/o seen w/ pregnancy loss
Resection may result in higher delivery rates
Mullerian fusions
___ or ___ are shapes of the uterus that are more frequently associated w/ mid-trimester loss or preterm birth
Bicornuate
Unicornuate
___ results from incomplete canalization of the Mullerian tubercle
Vaginal septum
When is a vaginal septum usually dx’d?
At puberty
___ is an intrauterine synechiae (adhesions) usually occurring after recurrent curettage
Asherman’s Syndrome
___ is inflammation of the endometrial lining of the uterus
It occurs in the obstetrical population and in the non-pregnant population
Benign Endometritis
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
What are risk factors of Endometritis?
Invasive gyne procedures (IUD)
High risk sexual behavior/STD exposure
Douching
In non-pregnant population, endometritis is most commonly associated with ___ disease
Pelvic Inflammatory Disease (PID)
\_\_\_ 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
When do Benign Endometrial Polyps usually occur?
peri and post-menopausal women, occasionally younger
What are sx of Benign Endometrial Polyps?
- Asymptomatic
- Irregular/intermenstrual
- bleeding or menorrhagia
- Post-coital bleeding
- Post-menopausal bleeding
How are Benign Endometrial Polyps dx’d and tx’d?
Dx: Sonohysterogram (SHGM)
Tx: Hysteroscopic resection
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
