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SG F3 E5 > uterine disorders > Flashcards

uterine disorders Flashcards

1
Q

What is endometriosis

A

presence of endometrial glands and stroms outside the endometrial cavity and uterine musculature (MC pelvis) causing inflammation

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2
Q

Endometriosis is a risk factor for

A

epithelial ovarian cancer

can also cause infertility

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3
Q

What is the suspected etiology of endometriosis

A 
Retrograde menstruation (endometrial tissue goes retrograde through fallopian tubes and peritoneum 
-Deficient cell immunity, heredity
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4
Q

RF for endometriosis are

A 
nulliparity 
heavy menstrual bleeding 
prolonged exposure to estrogen 
DES exposure in utero
>68 inches in height 
low BMI 
high unsaturated fat consumption
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5
Q

How do women with endometriosis present

A 
premenstrual pelvic pain (lesions stimulated by estrogen/progesterone) 
Pelvic pain SUBSIDES after menses 
infertility (30-40%) 
Dysmenorrhea 
Dyspareunia 
Rectal pain w/ bowel movements
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6
Q

what is the difference between vulvodynia and dyspareunia

A

Dys: pain with deep penetration
Vulvo: pain with insertion

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7
Q

PE findings indicating endometriosis incllude

A

ttp/nodules in posterior coldesac
fixed or retroverted uterus 2/2 adhesions
adnexal mass ttp

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8
Q

How do you diagnose endometriosis

A

Need laparoscopy for solid Dx

Imaging and CA-125 can help support

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9
Q

On laparoscopy, what will endometriosis show

A

erythematous, petechial lesions on peritoneum
thick, scarred surrounding peritoneum
lesions/endometriomas (chocolate cysts) on ovaries
adhesions

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10
Q

MC site of endometriosis is

A

The ovaries

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11
Q

How do you treat mild endometriosis

A

expectant management

NSAIDS +/- OCP (can skip menses all together by stringing packs)

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12
Q

How do you treat mod-severe endometriosis

A 
OCP (string)- can atrophy endometrium
Progestins (PO, IM, IUD)- prevent endometrial growth 
GnRH agonists (Depot Lupron) suppress estrogen/progesterone
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13
Q

Other endometriosis treatments are

A

Danazol
Aromatase inhibitors
Laparoscopic excision
Hysterectomy w/ b/l salpingo-oopherectomy

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14
Q

Endometriosis treatment considerations include

A 
clinical presentation 
Sx severity 
extent and location fo dz 
reproductive plans 
age
med ADE 
surgical compliance rates 
cost
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15
Q

Good effects of OCP in endometriosis are

A

40-50% pregnancy rate after d/c

decrease risk of ovarian cancer

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16
Q

What are uterine fibroids

A

proliferation of smooth muscle cells in uterine wall

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

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17
Q

What group of women typically gets uterine fibroids

A

20-25% in women of child-bearing age
50% of populaiton have them by age 50
Seen earlier and grow faster
2-3x MC in black women

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18
Q

What is the implicated etiology of uterine fibroids

A
  • Estrogen; myomas have higher concentration of estrogen receptors= increased production of extracellular matrix
  • Progesterone increases mitotic activity, suppresses apoptosis
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19
Q

How can you classify uterine fibroids

A

Submucosal: just beneath endometrium (more inwards)
Subserosal: serosal surface (more outwards)
Intramural: w/in uterine wall

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20
Q

Which uterine fibroids are associated with infertility

A

Submucosal- impinge uterine cavity

also increase surface area of endometrium and also cause menorrhagia

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21
Q

What are symptoms of uterine fibroids

A 
Abn uterine bleeding 
pain (contractions, dyspareunia) 
pelvic pressure (mass effect) 
infertility (submucosal) 
spontaneous abortion
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22
Q

On bimanual exam of uterine fibroids you may find

A

uterine enlargement
irregular shape
mass (NOT fluctuant)

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23
Q

How do you diagnose uterine fibroids

A 
#1: Transvaginal US 
saline infused sonohysterogram 
hysteroscopy 
MRI 
H&H
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24
Q

Is there one specific way to Tx uterine fibroids

A

no standard of cure, let Sx drive Tx

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25
Medical Tx options for uterine fibroids are
``` #1: Steroidal (OCP, Mirena, ortho-evra, nuvaring) COC, progestin GnRH analog (Depot Lupron) Tranexamic acid (Lysteda) ```
26
Surgical options for treating uterine fibroids are
Hysteroscopic resection Endometrial ablation Laparoscopic myomectomy Laparoscopic radiofrequency ablation
27
Other Tx for uterine fibroids are
uterine artery embolization | MRU
28
How does Depot Lupron treat uterine fibroids
decreases fibroid size (bc they are associated w/ estrogen) also helps improve anemia before, and decrease blood loss during surgery DO NOT USE >6 months
29
Who can use steroidal therapies to Tx uterine fibroids
prolonged, heavy menses | NO submucosal fibroids
30
Who can take Lysteda and how does it work
prolonged, heavy menses W/O submucosal fibroids PO anti-fibrinolytic for menorrhagia (decrease blood loss, little evidence on fibroid effects) USE ONLY during menses, two 650mg tab BID (total 1300)
31
What surgical option for uterine fibroid removal is good for preserving Fertility and the uterus
-Myomectomy- on intramural, subserosal, and pedunculated fibroids (20-50% recurrence) but, delay pregnancy 3-6 mo to avoid uterine rupture and c-section -Hysteroscopy- submucosal fubroids. has risk of fluid overload and hyponatremia
32
Wat is a laparoscopic myomectomy
robot assistance myomectomy depending on number and size of fibroids Complications: hemorrhage, re-op, adhesions
33
What uterine fibroid patients are candidates for abdominal/mini-laparotomy myomectomy
those with CI to laparoscopy (cardiopulmonary dsease) if fibroid size doesn't allow laparoscopic Hx of pelvic or abdominal radiation Severe hip dz
34
How do you perform a hysteroscopy
give a non-iodine solution to distend (1.5% glycine or 3% sorbitol) use a heated loop to resect the fibroid can be done outpt, can return to normal activity in 1-2 days, sex in 1 month
35
What is endometrial ablation
min invasive method to preserve uterus, takes 2 min. done outpt. at any time in menstrual cycle (general anesthesia or cervical block) Admin CO2 for distention Tx for menorrhagia w/o major uterine distortions (best if <9cm)
36
If you have had an endometrial ablation, can you have kids?
You should NOT bear children, but use contraceptives because if you do get pregnant it can implant into the muscle wall (placenta accreta)
37
Con's to endometrial ablation include
must first remove polyps and submucosal fibroids (does not distort the uterus) doesn't address fibroid Sx 50% experience amenorrhea
38
What is uterine artery embolization
arteriogram to ID blood supply to fibroid cath goes into uterine artery and embolizing agent flows in Preserves the uterus NOT fertility!
39
What pts are candidates for uterine artery embolization
If they do not want kids
40
Who is a uterine artery embolization contraindicate in
pts with many and large fibroids
41
ADE of uterine artery embolization are
post-embolization syndrome (overnight hospital stay) NON-purulent vag discharge uterine infection 10-15% recurrence embolization can reach ovaries (premie ovarian failure) uterine necrosis, sepsis, bacteremia, death
42
What is adenomyosis
growth of endometrial glands and stroma into MYOmetrium
43
What are suspected etiologies of adenomyoma
ovarian hormones invagination of endometrium (it weakens with degeneration) Parity (C-section)
44
How does adenomyoma present
menorrhagia dysmenorrhea pelvic pain Hx of previous uterine surgery (c-section, myomectomy)
45
On adenomyoma bimanual exam, you are likely to see
diffuse uterine enlargement, symmetric (globular), not larger than 12 wk gestation
46
Definitive Dx of adenomyosis is based on
histology after hysterectomy | imaging only AIDS Dx (US, MRI)
47
Medical Tx options for adenomyoma are
OCP, Mirena, Nuvaring | -improve dysmenorrhea and menorrhagia
48
Durgical Tx options for adenomyoma are
Definitive Tx: hysterectomy Uterine artery embolization endometrial ablation (high fail rate), painful
49
RF for endometrial hyperplasia are
``` OBESITY!!!!!!!! high fat= high estrogen early menarche, late menopause (estrogen exposure) infertility nulliparous Hx of Tamoxifen Tx (breast cancer) unopposed estrogen Tx diabetes PCOS PMHx breast or ovarian cancer, or radiation for pelvic CA FHx lynch syndrome ```
50
Current WHO classification for endometrial hyperplasia is
hyperplasia without atypia (non-neoplastic) | atypical hyperplasia
51
What is the pathophys behind endometrial hyperplasia
estrogen stimulates endometrial proliferation progesterone is anti-proliferative (shedding) unoposed estrogen= hyperplasia and atypia
52
How does endometrial hyperplasia typically present
``` asymptomatic! post-menopausal bleeding menorrhagia intermenstrual bleeding prolonged menses (>7d) decreased menstrual interval (<21 days) oligomenorrhea, amenorrhea ```
53
What PE is important to do for endometrial hyperplasia
``` pelvic exam pelvic US (thick endometrium) endometrial biopsy D&C hysteroscopy ```
54
what endometrial thickness is a good sign
<4mm, malignancy is NOT likely
55
How do you treat endometrial hyperplasia W/O atypia
Mirena (progestin) Depo-Provera -reassess with EMB to ensure resolution
56
How do you treat atypical endometrial hyperplasia
#1: hysterectomy (if done having kids)- bc 50% have cancer -Progesterone therapy- megestrol acetate, Mirena (reassess q3 mos until resolved)
57
What is the MC pelvic genital cancer
endometrial cancer 4th MC female cancer Typical onset: 50-69 White>Black
58
RF for endometrial cancer are (hint: same as hyperplasia)
``` Obesity early menarche, late menopause infertility nulliparous Tamoxifen Tx Dm, PCOS PMHx breast or ovarian cancer, radiation FHx lynch syndrome unopposed estrogen therapy ```
59
What is the pathophys behind endometrial cancer
estrogen is implicated usually evolves from hyperplasia -Exogenous estrogen, anovulatory cycles, altered estrogen metabolism
60
What are the types of endometrial cancer
I: arise from unopposed estrogen. good prognosis. well differentiated II: arise independent of estrogen, seen w/ endometrial atrophy. poorly differentiated. poor prognosis
61
What are the classifications of endometrial cancer
- Adenocarcinoma (MC) - adenocarcinoma w/ squamous differentiation - Serous carcinoma (not estrogen associated)- bad prognosis - Clear cell carcinoma (not estrogen associated)- high grade, deep invasion
62
Endometrial cancer staging is based on
FIGO (international federation of gyno and obs)
63
How does endometrial cancer present
``` ***abnormal vaginal bleeding (menorrhagia, intermenstrual, PMB) abd cramping back pain weight loss dyspareunia ```
64
When is endometrial cancer screening recommended
in women with Lynch syndrome (HNPCC)
65
How do you diagnose endometrial cancer
``` CBC Transvaginal US Endometrial biopsy D&C pap smear CA-125 (high w/ extra-uterine spread) MRI/CT ```
66
How do you treat endometrial cancer
Hysterectomy w/ b/l salpingo-oopherectomy radiation (if surgery CI, pr advanced pelvic dz) Chemo (not common, good for advanced dz)

SG F3 E5 (23 decks)

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