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Gynaecology > Uterine Disorders > Flashcards

Uterine Disorders Flashcards

1
Q

What is endometriosis?

Give some examples of sites which may be affected

A

The presence of endometrial tissue at sites other than the uterine cavity, for example:

  • Ovaries
  • Pouch of Douglas
  • Pelvic peritoneum
  • Bladder
  • Bowel
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2
Q

Describe the pathophysiology of endometriosis

A

Exact mechanism is unknown - several theories have been proposed:

  • Retrograde menstruation theory
  • Metaplastic theory (cells of peritoneum undergo spontaneous metaplasia to form endometrial cells)
  • Benign metastases theory (endometrial cells can travel to distant organs, e.g. lungs, via blood/lymphatics)
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3
Q

Give some risk factors for developing endometriosis

A
  • Family history
  • Early menarche
  • Nulliparity
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4
Q

What are the clinical features of endometriosis?

A
  • Pelvic pain (cyclical - worse at time of menstruation)
  • Dysmenorrhoea
  • Dyspareunia
  • Dysuria
  • Dyschezia
  • Subfertility
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5
Q

What is the ‘gold standard’ investigation for diagnosing endometriosis?

A

Laparoscopy

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6
Q

Describe the medical and surgical management of endometriosis

A

Medical:

  • Analgesia
  • Hormonal therapy, i.e. COCP

Surgical:

  • Only in severe cases
  • Excision/fulguration of ectopic endometrial tissue (relapses are common)
  • Alternatively if the woman does not want to have children, total hysterectomy + BSO (with subsequent HRT until age of menopause if necessary)
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7
Q

What is adenomyosis?

A

The presence of endometrial tissue within the myometrium of the uterus

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8
Q

Give some risk factors for adenomyosis

A

Associated with uterine damage:

  • C-section
  • Uterine surgery
  • Surgical management of miscarriage or abortion
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9
Q

What is the most common symptom of adenomyosis?

A

Dysmenorrhoea

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10
Q

Describe the investigation of adenomyosis

A

Imaging:

  • Transvaginal USS
  • MRI

The definitive diagnosis is histological following hysterectomy

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11
Q

Describe the medical and surgical management of adenomyosis

A

Medical:

  • Analgesia
  • Hormonal therapy, i.e. OCP

Surgical:
- Curative therapy is hysterectomy

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12
Q

What are fibroids?

A

Fibroids are benign smooth muscle tumours arising from the myometrium

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13
Q

How can fibroids be classified?

A

Fibroids can be classified according to their position within the uterine wall:

  • Intramural: confined to myometrium
  • Submucosal: develops immediately beneath the endometrium and protrudes inwards (into uterine cavity)
  • Subserosal: develops immediately under serosa and protrudes outwards (may be ‘pedunculated’ - on a stalk)
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14
Q

Give some risk factors for developing fibroids

A
  • Family history
  • Early menarche
  • Increasing age
  • Obesity
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15
Q

What are the clinical features of fibroids?

A
  • Majority of women with fibroids are asymptomatic

Potential symptoms include:

  • Menorrhagia
  • Subfertility

If fibroids are particularly large:

  • Pressure symptoms, e.g. urinary frequency, urinary retention
  • Abdominal distension
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16
Q

Describe the investigation of fibroids

A

Pelvis USS

17
Q

Describe the conservative, medical and surgical management of fibroids

A

Conservative:
- Watchful waiting

Medical:

  • IUS (1st line, if indicated) or tranexamic acid for menorrhagia
  • Hormonal therapy, i.e. COCP to lessen symptoms (menorrhagia)
  • GnRH analogues can be used to reduce fibroid size pre-operatively

Surgical:

There are a few options:

  • Myomectomy: for those wishing to preserve fertility
  • Hysteroscopy with TCRF (transcervical resection of fibroid): useful to remove submucosal fibroids
  • Hysterectomy: for those who do not wish to preserve fertility
18
Q

What are uterine polyps?

A

Uterine polyps are benign growths arising from the endometrium

19
Q

What are the clinical features of uterine polyps?

A

Abnormal vaginal bleeding:

  • Irregular menstrual bleeding
  • Inter-menstrual bleeding (IMB)
  • Post-menopausal bleeding (PMB)
  • Menorrhagia

Can also cause subfertility

20
Q

Describe the investigation of uterine polyps

A

Transvaginal USS then hysteroscopy and biopsy

21
Q

Describe the management of uterine polyps

A

Endometrial polyps have a small chance of undergoing malignant transformation therefore management is removal by hysteroscopy with TCRP (transcervical resection of polyp)

22
Q

i) The most common form of endometrial cancer is… (+ definition)
ii) What is the pathophysiology?

A

i) Adenocarcinoma (malignant neoplasm of epithelial tissue)

ii) Stimulation of the endometrium by oestrogen, without the protective effects of progesterone (‘unopposed’ oestrogen)

23
Q

Give some risk factors for developing endometrial cancer

A

Exposure to ‘unopposed’ oestrogen:

  • Anovulation: early menarche/late menopause (cycles more likely to be anovulatory at extremes of age) and PCOS (with oligomenorrhoea, cycles more likely to be anovulatory)
  • Iatrogenic (HRT with oestrogen only, tamoxifen use)
  • Obesity: the greater the amount of subcutaneous fat, the faster the rate of peripheral aromatisation of androgens to oestrogen (increased levels of ‘unopposed’ oestrogen)

Age is also a risk factor (peak incidence is 65-75 years)

24
Q

What are the clinical features of endometrial cancer?

A

Post menopausal bleeding = endometrial cancer until proven otherwise!

25
Q

What is the differential diagnosis of PMB?

A

Endometrial causes:

  • Endometrial cancer
  • Endometrial polyps

Cervical causes:

  • Cervical cancer
  • Cervical polyps

Vulvo-vaginal causes:

  • Vulval/vaginal cancer
  • Vulval/vaginal atrophy
26
Q

Describe the investigation of endometrial cancer

A
  • Transvaginal USS to assess endometrial thickness

- If endometrial thickness > 4 mm identified, take endometrial biopsy

27
Q

Describe the management of endometrial cancer

A
  • Total hysterectomy + bilateral salpingo-oophorectomy (BSO) with peritoneal washings
  • Patient may also need de-bulking surgery, radiotherapy or chemotherapy if cancer has advanced past stage 1

Gynaecology (8 decks)

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