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Year 3 - Repro and Sexual Health > Uterine Disorders > Flashcards

Uterine Disorders Flashcards

1
Q

What is adenomyosis?

A

Functional endometrial tissue in the myometrium of the uterus
(variant of endometriosis)

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2
Q

What are the main symptoms of adenomyosis?

A

Menorrhagia
Dysmenorrhoea
Dyspareunia
Irregular bleedings

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3
Q

Outline the pathophysiology of adenomyosis?

A

Endometrial stroma is allowed to make contact and communicate with the underlying myometrium after uterine damage

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4
Q

Which scenarios may allow communication of the endo and myometrium?

A

Pregnancy and childbirth
C-sec
Uterine surgery
Surgical management of miscarriage or TOP

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5
Q

Where is the invasion of the myometrium commonly found in adenomyosis?

A

Posterior wall of uterus

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6
Q

What is the term given to endometrial glands which form visible nodules?

A

Adenomyoma

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7
Q

What are the main risk factors for adenomyosis?

A

High parity
Uterine surgery
Prev C-sec
FHx

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8
Q

What is felt on examination in adenomyosis?

A

Symmetrically enlarged tender uterus

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9
Q

How is adenomyosis investigated?

A

Histological hysterectomy
TV USS
MRI

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10
Q

How is adenomyosis cured?

A

Only cure is hysterectomy

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11
Q

How is adenomyosis managed?

A 
NSAIDs
COCP
IUS/IUD
GnRH agonist
Aromatase inhibitors
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12
Q

Which surgical treatment can be offered in adenomyosis in women who wish to keep fertility?

A

Uterine artery embolisation

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13
Q

When is the peak incidence of endometrial cancer?

A

65-75

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14
Q

What is the most common form of endometrial cancer?

A

Adenocarcinoma

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15
Q

What is the main cause of adenocarcinoma?

A

Stimulation of endometrium by unopposed oestrogen

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16
Q

What are the risk factors for endometrial cancer?

A 
Early menarche/late menopause
Nulliparity
Age
PCOS
HRT
Obesity
Lynch syndrome
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17
Q

What are the clinical features of endometrial cancer?

A 
Post-menopausal bleeding
Discharge
(Irregular bleeding is premenopausal)
Weight loss
Abdo pain
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18
Q

Which examinations are performed on suspicion of endometrial cancers?

A

Abdo
Speculum
Bimanual

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19
Q

How is endometrial cancer investigated?

A

TV USS

Biopsy

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20
Q

What is a stage I endometrial carcinoma?

A

Confined to uterine body

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21
Q

What is a stage II endometrial carcinoma?

A

Extends to cervix but not beyond uterus

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22
Q

What is a stage III endometrial carcinoma?

A

Extends beyond uterus but still in pelvis

23
Q

What is a stage IV endometrial carcinoma?

A

Involves bladder or bowel

Mets

24
Q

How is endometrial hyperplasia treated?

A

Progestogens

IUS

25
Q

How is atypical endometrial hyperplasia treated?

A

Total abdominal hysterectomy

Bilateral salpingo-oophrectomy

26
Q

How are stage I and II endometrial cancers treated?

A

Total abdominal hysterectomy
Bilateral salpingo-oophrectomy

Stage II also take tissue around cervix away

27
Q

How is stage III endometrial carcinoma treated?

A

De-bulking surgery

Chemo/radio

28
Q

How is stage IV endometrial cancer treated?

A

De-bulking surgery

Palliative

29
Q

What is endometriosis?

A

Chronic condition in which endometrial tissue is located outwith the endometrium

30
Q

Who is most commonly affected by endometriosis?

A

women 25-50

31
Q

Which hormone is endometrial tissue sensitive to?

A

Oestrogen

32
Q

What are the main risk factors for endometriosis?

A 
Early menarche
FHs
Short men cycles
Long duration of bleeding
HMB
Structural defect
33
Q

How does endometriosis commonly present?

A 
Cyclical pelvic pain
Dysmenorrhoea
Dyspareuia
Dysuria
Dyschezia
34
Q

How is endometriosis investigated?

A

Laparoscopy gold standard

Pelvic USS

35
Q

What are the typical laparoscopic findings on laparoscopy of endometriosis?

A

Chocolate cysts
Adhesions
Peritoneal deposits

36
Q

How is endometriosis managed?

A

Analgesics
COCP
Norethisterone
Surgical removal or laser ablation

37
Q

How do COCP, IUD, IUS and norethisterone work in the management of endometriosis?

A

Supressing ovulation for 6-12 months can cause atrophy of the endometriosis lesions

38
Q

What are uterine fibroids?

A

Benign smooth muscle tumours

39
Q

What are uterine fibroids also known as?

A

Leiomyomas

40
Q

What is the most common type of fibroid?

A

Intramural

41
Q

Where is an intramural fibroid?

A

Confined to myometrium

42
Q

Where is a submucosal fibroid?

A

Develops immediately underneath the endometrium and projects into cavity

43
Q

Where is a subserosal fibroid?

A

Protudes into and distorts the surface of the uterus

44
Q

Which hormone stimulates the growth of fibroids?

A

Oestrogen

45
Q

What are common risk factors for fibroids?

A 
Obesity
Early menarche
Increasing age
FHs
African-American
46
Q

How do fibroids present?

A 
Usually asymptomatic 
May have pressure symptoms
Bloating
HMB
Acute pelvic pain - rare
47
Q

How are fibroids investigated?

A

Pelvis USS

MRI

48
Q

How are fibroids managed medically?

A

Tranexamic or mefenamic acid
COCP
GnRH analogue
Ulipristal

49
Q

How are fibroids managed surgically?

A

Myomectomy
Uterine artery embolisation
Hysterectomy
TCRF

50
Q

What is Ulipristal?

A

Selective progesterone receptor modulator

51
Q

Why can GnRH analogues only be used for 6 months in fibroid management?

A

Risk of osteoporosis (due to temporary menopausal state)

52
Q

What is the role of Zolidex in fibroid management?

A

(GnRH)

Induces temporary menopausal state to reduce fibroid size before surgery

53
Q

Which surgical option is the choice for submucosal fibroids?

A

Transcervical resection of the fibroid (TCRF)

Year 3 - Repro and Sexual Health (23 decks)

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