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Foundations III-Women's Health > uterine disorders > Flashcards

uterine disorders Flashcards

1
Q

What is endometriosis?

A

The presence of endometrial glands and stroma outside the endometrial cavity and uterine musculature

usually located in the pelvis

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2
Q

endometriosis is a risk factor for…

A

epithelial ovarian cancer

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3
Q

Risk factors for endometriosis?

A
  • Nulliparity
  • Prolonged exposure to endogenous estrogen
  • Heavy menstrual bleeding
  • Obstruction of menstrual outflow
  • DES exposure in utero
  • Height greater than 68 inches
  • Lower BMI
  • High consumption of unsaturated fat
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4
Q

Presentation of endometriosis?

A

Premenstrual pelvic pain

PAIN SUBSIDES AFTER MENSES

Infertility

Dysmenorrhea

Dyspareunia

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5
Q

What will you see on PE in pt with Endometriosis?

A

Tenderness / nodules at posterior cul-de-sac

Fixed or retroverted uterus (2ary to adhesions)

Endometriomas cause adnexal masses or tenderness

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6
Q

What diagnostic studies could you order to eval for endometriosis?

A

CA-125 > may be elevated

Imaging

*Laparoscopy
-lesions vary
-ovaries can demonstrate chocolate cysts
-may be therapeutic
-

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7
Q

Endometriosis tx for those with mild disease?

A

sxs management

NSAIDS +/- OCPs

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8
Q

Tx for mod-severe endometriosis?

A

want to interrupt stimulation of endometrial tissues

  • OCPs > continuous cycle fashion
  • Progestins (PO, IM or IUD)
  • GnRH > suppression of estrogen and progesterone by down regulation of pituitary
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9
Q

What tx options for endometriosis do you have if nothing else works?

A

Danazol (androgen)

Aromatase inhibitors

Laparoscopic excision

Hysterectomy with bilateral salpingo-oophorectomy

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10
Q

Where do uterine fibroids arise from?

A

smooth muscle cells within the uterine wall

Fibroids are made up of collagen, smooth muscle, and elastin surrounded by a pseudocapsule

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11
Q

Uterine fibroids are more common in which pts?

A

2-3x more common in black women

Seen in 50% of population by the 5th decade

Seen earlier and grow faster

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12
Q

How are uterine fibroids classified?

A

by anatomic location within the myometrium

Submucosal: Lie just beneath the endometrium

Subserosal: Lie just at the serosal surface of the uterus

Intramural: Lie within the uterine wall

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13
Q

Presentation for uterine fibroids?

A

Abnormal uterine bleeding

pain

pelvic pressure

infertility (esp. submucosal)

SAB

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14
Q

PE findings in pt with uterine fibroids?

A

On bimanual exam:
Enlargement
Irregular shape
Masses

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15
Q

Dx studies to eval for uterine fibroids?

A

Transvaginal US

Saline-infused sonohysertogram

Hysteroscopy

MRI- for surg planning

H&H- may become anemic

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16
Q

What drives tx for uterine fibroids?

A

sxs

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17
Q

medical options for uterine fibroids?

A

COCs/progestin
GnRH analogs
Steroid therapies (androgens)
Tranexamic acid

18
Q

Surgical options for uterine fibroids?

A 
Hysteroscopic resection
Endometrial ablation
Laparoscopic myomectomy
Abdominal myomectomy
Laparoscopic radiofrequency ablation
19
Q

How do GnRH analogs tx uterine fibroids?

A

will decrease fibroid size.

Improves anemia prior to surgery

Decreases blood loss during surgery

Allows minimally invasive approach

not approved >6 mo

20
Q

____are indicated for pts with prolonged heavy menses with no submucosal fibroids

A

Steroidal Therapies

  • OCP
  • IUD
  • NuvaRing

Lysteda

21
Q

Benefit for myomectomy for uterine fibroids? disadvantage?

A

Preserves fertility/uterus

high rate of recurrence, need c-section

22
Q

Complications of laparoscopic myomectomy?

A

hemorrhage, re-operation, adhesions, vascular and visceral injuries

23
Q

After hyperoscopic resection when can pts return to normal activity? Sexual activity?

A

1-2 days

1 month

24
Q

Describe endometrial ablation

A

Minimally invasive,
Preserves uterus,
Treatment of menorrhagia

no future childbearing, must continue a contraceptive

25
Q

Which pts are candidates for UAE?

A

Patient does not desire future childbearing

Numerous and large fibroids are contraindications

26
Q

What is adenomyosis?

A

Growth of endometrial glands and stroma into uterine myometrium

27
Q

Clinical presentation of adenomyosis?

A

Menorrhagia

Dysmenorrhea

Pelvic pain

History of previous uterine surgery

28
Q

PE findings in pt with adenomyosis?

A

Bimanual exam: diffuse uterine enlargement
Globular

Size doesn’t usually exceed > 12w gestation

29
Q

Definitive dx of adenomyosis?

A

histologic examination after hysterectomy

30
Q

Medical tx for dysmenorrhea/menorrhagia assoc. with adenomyosis?

A

Oral contraceptive pills
Mirena® IUD
NuvaRing®

31
Q

Surgical options for adenomyosis?

A

Hysterectomy =Definitive treatment

UAE
-44% recurrence

Endometrial ablation
-high failure rate

32
Q

Risk factors for endometrial hyperplasia?

A

OBESITY

Early menarche (<12yo)
Late menopause (>52yo)
Infertility, nulliparous

others: tx for tamoxifen for breast CA, DM, PCOS, hx breast CA, hx radiation therapy for pelvic CA, fam hx of lynch syndrome

33
Q

Classifications of endometrial hyperplasia?

A

Hyperplasia without atypia (non-neoplastic)

Atypical hyperplasia (endometrial intraepithelial neoplasia)

34
Q

presentation for endometrial hyperplasia

A

Asymptomatic

Post-menopausal bleeding!

Menorrhagia

Intermenstrual bleeding, decreased menstrual interval, oligomenorrhea/amenorrhea

35
Q

Work up for endometrial hyperplasia?

A

pelvic exam

pelvic US > asses endometrial thickening

Endometrial bx

D&C, hysteroscopy

36
Q

tx for endometrial hyperplasia without atypia?

A

Mirena IUD

Provera 10mg QD for 3 – 6mos

Reassess with EMB to ensure resolution

37
Q

Tx for endometrial hyperplasia -atypical hyperplasia?

A

Hysterectomy is treatment of choice!
-Completed childbearing

Progesterone therapy

  • Megestrol acetate (Megace) 40 – 80mg BID
  • Mirena IUD
  • if child bearing not complete
38
Q

What is the MC pelvic genital CA?

A

endometrial CA

39
Q

What are the 2 types of endometrial CA?

A

60

40
Q

Presentation for endometrial CA?

A

abn vaginal bleeding

abd cramping, back pain, weight loss, dyspareunia

screening recommended in women with Lynch syndrome

41
Q

Work up for endometrial CA?

A 
CBC 
transvag US 
Endometrial biopsy 
D &amp;C 
Pap smear 
CA-125 
MRI/CT
42
Q

Tx for endometrial CA?

A

Hysterectomy with bilateral salpingo-oophorectomy with pelvic and periaortic lymphadenectomy

Radiation/Chemo

Foundations III-Women's Health (13 decks)

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