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Obs and Gynae > Uterine Disease > Flashcards

Uterine Disease Flashcards

1
Q

What is endometriosis?

A

foci of endometrial glands and stoma outside uterine body

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2
Q

Where can endometrial tissue be in endometriosis?

A

on an ovary, in rectovaginal pouch, uterosacral ligaments, pelvic peritoenum

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3
Q

What is a chocolate cyst?

A

endometrial tissue on an scary in endometriosis

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4
Q

When is the term adenomyosis used, instead of endometriosis?

A

when these foci of endometrial glandular tissue are found in the uterine wall muscle

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5
Q

What is the presentation of endometriosis?

A 
asymptomatic 
pelvic pain - classically cyclical 
secondary dysmenorrhea 
deep dyspareunia 
sub fertility
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6
Q

What are some complications of endometriosis?

A 
cyst formation 
infertility 
malignancy 
ectopic pregnancy 
adhesions
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7
Q

What do you find on vaginal examination in endometriosis?

A

fixed retroverted uterus
uterosacral ligament nodules
general tenderness
enlarged, boggy tender uterus - adenomyosis

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8
Q

What is the first line investigation in endometriosis?

A

laparoscopy - find adhesions, cysts, peritoneal deposits

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9
Q

What is the treatment of endometriosis?

A 
asymptomatic - no treatment 
support - join a society 
reduce stress
analgesia/NSAIDs
hormonal therapy: to suppress ovulation - CCP, progestogens (not in adolescents, reduce bone density)
surgery, laparoscopy
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10
Q

What is endometritis?

A

uterine infection

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11
Q

When can endometritis occur?

A

is uncommon unless barrier to ascending infection is broken e.g. after miscarriage, TOP, childbirth, IUS or IUD insertion

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12
Q

What can endometritis also involve apart from uterus?

A

tubes and ovaries

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13
Q

What is the presentation of endometritis?

A

lower abdominal pain
fever
uterine tenderness on bimanual palpation

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14
Q

What are the investigations for endometritis?

A

cervical swabs and blood cultures

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15
Q

What is the treatment of endometritis?

A

antibiotics e.g. doxycycline with metronidazole, 7 days

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16
Q

What are uterine fibroids?

A

leiomyomas - benign smooth muscle tumours of the uterus

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17
Q

What happens to uterine fibroids in pregnancy, on the combined pill and during menopause?

A

pregnant and combined pill - enlarge
menopause - atrophy
as they are oestrogen dependent

18
Q

What is a uterine fibroid called if its under the peritoneum?

A

subserosal

19
Q

What is a uterine fibroid called if its under the endometrium?

A

submucosal

20
Q

What are symptoms of a uterine fibroid?

A 
asymptomatic 
menorrhagia 
fertility problems 
pain 
mass
pressure symptoms
21
Q

How are uterine fibroids diagnosed?

A

USS
MRI - precise localisation
Hb if heavy bleeding

22
Q

How are uterine fibroids treated?

A

often no treatment needed
hysterectomy (menorrhagia) - if family complete
myomectomy, uterine artery embolisation, hysteroscopic resection

23
Q

What is more common, endometrial or cervical cancer?

A

cervical

24
Q

What are the majority of endometrial cancers?

A

adenocarcinoma

25
Q

What are the 2 main groups of endometrial carcinomas?

A

type 1: endometroid/mucinous carcinoma

type 2: serous/clear cell carcinoma

26
Q

What is the precursor for endometroid/mucinous carcinoma?

A

atypical hyperplasia

27
Q

What is the precursor for serous/clear cell carcinoma?

A

serious intraepithelial carcinoma

28
Q

What mutations are found in type 1 endometrial carcinomas?

A

PTEN
KRAS
PIK3CA

29
Q

What mutations are found in type 2 endometrial carcinomas?

A

TP53

30
Q

What are risk factors for endometrial carcinoma?

A 
early menarche 
late menopause 
HRT
tamoxifen 
obesity 
smoking 
PCOS
breast cancer 
nulliparity
31
Q

What is the presentation of endometrial carcinoma?

A

usually after menopause

abnormal bleeding - PMB, IMB

32
Q

What are the investigations for endometrial carcinoma?

A

examination usually normal
transvaginal USS
uterine sampling - depending on endometrial thickness on USS
pipelle biopsy or dilatation and curettage

33
Q

At what thickness on USS should you sample the endometrium?

A

post menopause: >5mm thick (<5mm normal in postmenopausal women)
pre menopause: >16mm

34
Q

What is the treatment of endometrial carcinoma?

A

total hysterectomy with bilateral sapling-oopherectomy and or radiotherapy

35
Q

What is Lynch syndrome?

A

cancer predisposition syndrome - increased risk of colorectal, endometrial and ovarian cancers

36
Q

What is the inheritance pattern of Lynch syndrome?

A

autosomal dominant

37
Q

Describe serous endometrial carcinoma

A

post menopausal women
aggressive
spreads along fallopian tubes/peritoneum

38
Q

Describe endometriod endometrial carcinoma

A

associated with Lynch syndrome

associated with high oestrogen - HRT, early menarche , late menopause

39
Q

What is protective against endometrial cancer?

A

CCP

having children

40
Q

What 3 cancers does Lynch syndrome predispose to?

A

colorectal - HNPCC
endometriod endometrial cancer
clear cell ovarian cancer

Obs and Gynae (27 decks)

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