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Foundations III > Uterine Disorders > Flashcards

Uterine Disorders Flashcards

1
Q

Endometriosis is a risk factor for what type of cancer

A

epithelial ovarian cancer

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2
Q

Endometriosis: risk factors

A
  • No pregnancies
  • Prolonged endogenous estrogen
  • Heavy menses
  • DES exposure in utero
  • Taller than 68 inches
  • Lower BMI
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3
Q

Endometriosis: clinical presentation

A

Premenstrual pelvic pain, that subsides after menses**

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4
Q

Endometriosis: Physical exam

A
  • Tenderness/nodules at posterior cul-de-sac*

- Fixed or retroverted uterus (from adhesions)

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5
Q

What cancer marker may be elevated in the blood with endometriosis

A

CA-125

can help diagnosis, but not definitive

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6
Q

What is the best method for diagnosing endometriosis?

A

Laproscopy

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7
Q

Where is the most common site of endometriomas (“chocolate cysts”)

A

ovaries

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8
Q

For a patient with mild endometriosis, what is the preferred management?

A
  • Be observant

- NSAIDS +/- oral contraception

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9
Q

For a patient with moderate to severe endometriosis what is the preferred treatment?

A

Oral contraception** (continuous cycle)

or

  • Progestins (PO, IM, IUD)
  • GnRH agonists (ex. Lupron, Norethindrone (6-12 month therapy to prevent bone loss))
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10
Q

Uterine fibroids: etiology

A
  • black women (2-3x more common)

- 50% of all women by 50s

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11
Q

What influences the growth of the myoma?

A

estrogens implicated in growth since this tissue has more estrogen receptors than normal

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12
Q

Fibroid classifications (3)

A
  1. Submucosal (inner)
  2. Intramural (within uterine wall)
  3. Subserosal (outer)
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13
Q

Fibroids: clinical presenation

A
  1. Abnormal uterine bleeding *** (esp. submucosal)
  2. Pain* (compression of surrounding organs)
  3. Infertility* (submucosal)
  4. Spontaneous abortion
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14
Q

If on bimanual examination of the uterus you appreciate irregular hard mass what imaging is most appropriate initially?

A

Transvaginal ultrasound**

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15
Q

Fibroids: Medical tx

A
  1. GnRH analogs (Lupron)
    - decrease fibroid size
    - improve anemia prior to surgery
    - NOT approved for over 6 months of use
  2. Tranexamic Acid (Lysteda)
    - for heavy menses
    - ONLY use during menstrual cycle
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16
Q

Fibroid: Surgerical Tx

A
  1. Myomectomy (preserves fertility)
    - Perform on all but submucosal
    - MUST have C-section to avoid uterine rupture**
  2. Hysteroscopy
    -Preserves fertility
    -Only perform on submucosal
    ADE: can cause fluid overload and hyponatremia
17
Q

Endometrial ablation: key points

A
  • Good tx for menorrhagia
  • No future childbearing
  • Must continue contraceptive (to avoid placenta accreta - placenta can’t separate from uterine wall
18
Q

Uterine Artery Embolization: Key points

A

contraindication: numerous or large fibroids

- No future childbearing

19
Q

Adenomyosis: clinical presentation

A
  • History of previous C-section or a myomectomy***

- Severe menorrhagia**

20
Q

Adenomyosis: PE

A

-Diffuse uterine enlargement**

21
Q

Adenomyosis: Tx

A
  1. Hormonal contraception

2. Hysterectomy

22
Q

What are the main risk factors for endometrial hyperplasia?

A

-basically too much estrogen

OBESITY

23
Q

What will a patient most often present with if they have endometrial hyperplasia?

A
  • post-menopausal bleeding
  • menorrhagia*
  • Intermenstrual bleeding
  • Prolonged bleeding
24
Q

If an obese patient presents with heavy bleeds, more frequent bleeds and prolonged bleeding what imaging will help you best rule out malignancy?

A

Pelvic ultrasound

if endometrium is <4mm malignancy is unlikely

25
Q

What are the treatments for endometrial hyperplasia?

A

If no atypia –>oral or IUD Progestin (reassess in 3 months)

If atypia –>hysterectomy

26
Q

What is the most common pelvic genital cancer?

A

endometrial cancer

  • MC between 50-69
  • MC in whites
27
Q

What are the risk factors?

A

same as hyperplasia, too much estrogen

Obesity

28
Q

Endometrial Cancer: Type I

A

due to unopposed endogenous/exogenous estrogen

  • favorable prognosis
  • well-differentiated
29
Q

Endometrial cancer: Type II

A

Independent of estrogen

  • Poorly differentiated
  • Poor prognosis
30
Q

What is the most common type of endometrial cancer?

A

Adenocarcinoma (~80%)
-associated with estrogen type 1

Type II: serous, clear cell

31
Q

What is the most common clinical presentation for Endometrial cancer?

A

Abnormal vaginal bleeding

-Screen for Lynch Syndrome (Colaris testing)

Foundations III (34 decks)

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