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Foundations-Women's Health > Uterine disorders > Flashcards

Uterine disorders Flashcards

1
Q

Where is the MC place for endometriosis?

A

Pelvis: Ovaries

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2
Q

What is endometriosis highly associated with?

A

Infertile women

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3
Q

What is endometriosis at an increased risk for?

A

Ovarian CA

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4
Q

endometriosis etiology

A

Retrograde menstruation

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5
Q

endometriosis clinical presentation

A
  1. Premenstrual pelvic pain
  2. Pain subsides after menses
  3. Infertility
  4. Dysmenorrhea
  5. Dyspareunia
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6
Q

What is the definitive dx in endometriosis?

A

Laparoscopy

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7
Q

Laparoscopy findings in endometriosis

A
  1. Petechial lesions
  2. Surrounding peritoneum thickened/scarred
  3. “Chocolate cysts”: Endometriomas
  4. Adhesions
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8
Q

endometriosis treatment in mild disease

A

NSAIDS +/- OCPS

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9
Q

endometriosis treatment in moderate/severe disease

A
  1. OCP’s: Causes atrophy of endometrial tissue, decreases risk of ovarian CA
  2. Progestins
  3. GnRH Agonists: Suppression of estrogen and progesterone d/t down-regulation of pituitary gland
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10
Q

What do you want to make sure to supplement your patient with if they are on GnRH Agonist? Why?

A

Norethindrone acetate to prevent bone loss

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11
Q

What ethnicity is uterine fibroids MC in?

A

Black Women

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12
Q

Uterine Fibroids Clinical Presentation

A
  1. Abnormal uterine bleeding*
  2. Pelvic Pressure*
  3. Pain
  4. Infertility
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13
Q

Bimanual exam findings in uterine fibroids

A
  1. Enlargement
  2. Irregular shape
  3. Masses
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14
Q

What is the imaging of choice in uterine fibroids?

A

Transvaginal US

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15
Q

Pharmacologic treatment options in uterine fibroids

A
  1. COCs/progestin
  2. GnRH analogs
  3. Steroid therapies: androgens
  4. Tranexamic acid
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16
Q

What is the main use of GnRH in uterine fibroids? What age does this serve primary tx in?

A

Decrease Fibroid Size
Used prior to surgery-improve anemia
Primary role in tx near menopause

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17
Q

Who is steroidal therapies indicated in?

A

Prolonged, heavy menses

NO submucosal fibroids

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18
Q

steroidal therapies options

A
  1. OCP’s
  2. Mirena
  3. Nuvaring
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19
Q

Tranexamic acid indications

A

Prolonged, heavy menses

NO submucosal fibroids

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20
Q

When would you use Tranexamic acid?

A

During menstrual cycle ONLY

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21
Q

What does uterine fibroid surgery preserve both fertility and the uterus?

A
  1. Myomectomy

2. Hysteroscopy

22
Q

What type of uterine fibroids do you perform myomectomy in?

A
  1. Intramural
  2. Subserosal
  3. Pedunculated fibroids
23
Q

Myomectomy laparotomy indications (over laparoscopic)

A
  1. CI to laparoscopic
  2. Large fibroid size
  3. Prior pelvic/abd radiation
  4. Severe hip dz, precluding dorsolithotomy position
24
Q

What type of uterine fibroid do you perform hysteroscopy?

A

Submucosal fibroids

25
Q

Hysteroscopy risk

A
  1. Fluid overload

2. Hyponatremia

26
Q

What are the advantages/pro’s of endometrial ablation

A
  1. Preserves uterus
  2. Outpatient/In-office procedure
  3. General/paracervical block
  4. No fluid overload
  5. Fast: <2 min
27
Q

What are the disadvantages/pro’s of endometrial ablation

A
  1. Must remover submucosal fibroids & polyps first
  2. Amenorrhea rate=50%
  3. Placenta accrete= No kids following procedure
28
Q

Who is a candidate for uterine artery embolization?

A

Doesn’t want kids: Procedure preserves uterus, but NOT fertility

29
Q

CI to uterine artery embolization

A

Numerous and large fibroids

30
Q

SE’s in uterine artery embolization

A
  1. Postembolization syndrome: Hospitalize for pain
  2. Uterine necrosis, sepsis, death
  3. Embolization in non-target tissue: Ovaries
31
Q

Define Adenomyosis

A

Growth of endometrial tissue into uterine myometrium

32
Q

Adenomyosis clinical presentation

A
  1. Menorrhagia*
  2. Dysmenorrhea
  3. Hx uterine surgery: C-section, myomectomy
33
Q

Adenomyosis bimanual exam findings

A

Diffuse uterine enlargement (globular)

34
Q

Adenomyosis medication treatment

A

OCP’s
Mirena
Nuvaring

35
Q

What is the definitive tx for Adenomyosis

A

Hysterectomy

36
Q

What is the #1 RF for Endometrial Hyperplasia?

A

OBESITY!!!

37
Q

Endometrial Hyperplasia si/sx’s

A

Bleeding:

  1. Menorrhagia
  2. Prolonged menses
  3. Decreased menstrual intervals
38
Q

What pelvic US findings indicated unlikely malginancy with endometrial hyperplasia?

A

Endometrial thickness <4 mm

39
Q

Hyperplasia without atypia treatment

A
  1. Mirena IUD
  2. Provera x3-6 months
  3. Reasses with endometrial biopsy
40
Q

What is the TOC in atypical hyperplasia

A

Hysterectomy

41
Q

What is the MC pelvic genital CA?

A

Endometrial CA

42
Q

What is the mean age in endometrial CA?

A

50-69

43
Q

What is the #1 RF for endometrial CA?

A

OBESITY

44
Q

Which type of endometrial CA has a poor prognosis?

A

Type 2

45
Q

Which type of endometrial CA is due to unopposed estrogen?

A

Type 1

46
Q

What is the MC type of endometrial CA?

A

Adenocarcinoma

47
Q

What types of endometrial CA are NOT associated with a hyperestrogenic state?

A

Serous Carcinoma
Clear Cell Carcinoma

*Poor prognosis, aggressive

48
Q

Endometrial CA clinical presentation

A
  1. ABNORMAL BLEEDING
  2. Abd cramping
  3. Weight loss
49
Q

Endometrial CA diagnosis

A
  1. Transvaginal US

2. Endometrial Bx

50
Q

What will be elevated if there is extrauterine spread in endometrial CA?

A

CA-125

51
Q

endometrial CA treatment?

A

TAH-BSO + Lymphadenectomy (pelvic & periaortic)

Foundations-Women's Health (8 decks)

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