Uterine disorders Flashcards

1
Q

Defintion of Endometriosis?

A

The presence of endometrial glands and stroma outside the endometrial cavity and uterine musculature causes an inflammatory response

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2
Q

What is Endometriosis a risk factor for?

A

Ovarian cancers

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3
Q

What is the pathophysiology (reasoning) for endometriosis?

A

Retrograde menstruation
o Retrograde flow of endometrial tissue through fallopian tubes and peritoneum

Deficient cell immunity
Hereditary

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4
Q

Risk factors for Endometriosis?

A
−Nulliparity (never pregnant)
−Prolonged exposure to endogenous estrogen
−Heavy menstrual bleeding
−Obstruction of menstrual outflow
−DES exposure in utero (Diethyst..)
−Height greater than 68 inches
−Lower BMI
−High consumption of unsaturated fat
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5
Q

Clinical presentation of Endometriosis?

A
  1. Premenstrual pelvic pain–> pain subsides after menses
  2. Infertility in 30-40%
  3. Dysmenorrhea
  4. Dypareunia (pain with intercourse)
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6
Q

What are physical exam findings found in endometriosis?

A

Tenderness / nodules at posterior cul-de-sac

Fixed or retroverted uterus (2o to adhesions)
o Cervix displaced laterally

Endometriomas cause adnexal masses or tenderness

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7
Q

How is Endometriosis diagnosed definitively.

A

Need to see lesions with Laparoscopy

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8
Q

What is seen on Laparoscopy when diagnosing endometriosis?

A

MC site will be the ovaries

Chocolate cysts

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9
Q

Which tumor marker can support the diagnosis of endometriosis?

A

CA-125

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10
Q

Treatments for Endometriosis in mild diseases?

A

NSAIDS and OCPs

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11
Q

Treatment for MOderate to severe Endometriosis?

A

OCPs
Progestiins
GnRH agonists

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12
Q

Which population is most likely to have Uterine Fibroids?

A

African american women

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13
Q

Clinical presentation of Uterine fibroids

A

Abnormal uterine bleeding

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14
Q

What is Adenomyosis?

A

overgrowht of the endometrial glands and stroma into the uterine myometrium

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15
Q

Clinical Presentation of Adenomyosis?

A
Menorrhagia (more severe than fibroids)
 Dysmenorrhea
 Pelvic pain
 History of previous uterine surgery (C - section)
 Prior myomectomy
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16
Q

Physical exam findings of Adenomyosis?

A

Bimanuel exams reveals diffuse unterine enlargement

17
Q

What is needed to make a definitive diagnosis for Adenomyosis?

A

histologic examination after hysterectomy

18
Q

Treatments for Adenomyosis?

A

Hysterectomy - definitive treatment

19
Q

Risk factors for Endometrial Hyperplasia?

A

−Early menarche (<12yo)
−Late menopause (>52yo)
−Infertility, nulliparous
−OBESITY, OBESITY, OBESITY–> more estrogen conversion from fat
−Unopposed estrogen replacement therapy
-Diabetes
-Family history of Lynch Syndrome (colon cancer)

20
Q

WHO Classifications for Endometrial Hyperplasia

A
Hyperplasia without atypia (non-neoplastic)
Atypical hyperplasia (endometrial intraepithelial neoplasia)
21
Q

Clinical presentation of Endometrial Hyperplasia?

A

Asymptomatic
Post-menopausal bleeding
Menorrhagia (heavy bleeding)
Intermenstrual bleeding Prolonged menses (> 7d)
Decreased menstrual interval (< 21d)
Oligomenorrhea / Amenorrhea D&C, hysteroscopy (if stenosis of cervical os)

22
Q

What physical exam procedures need to be done for women with Endometrial hyperplasia?

A

Pelvic Exam
Pelvic Ultrasound
Endometrial biopsy

23
Q

Treatment of Hyperplasia without atypia?

A

− Mirena IUD
− Provera 10mg QD for 3 - 6mos, continuously or last 10 days of each month
− Reassess in another few months with EMB to ensure resolution

24
Q

Treatment for Hyperplasia with atypia

A

−Hysterectomy is treatment of choice
o Completed childbearing
o Up to 50% have underlying endometrial cancer