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SG F3 E5 > Uterine Disorders COPY COPY > Flashcards

Uterine Disorders COPY COPY Flashcards

1
Q

The presence of endometrial glands and stroma outside the endometrial cavity and uterine musculature

Causes an inflammatory response

Usually located in the pelvis

Which condition?

A

endometriosis

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2
Q

_______ is a RF for epithelial ovarian CA.

A

Endometriosis is a RF for epithelial ovarian CA.

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3
Q

endometriosis pathophys

A

Retrograde menstruation

Retrograde flow of endometrial tissue through fallopian tubes and peritoneum

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4
Q

žNulliparity

žProlonged exposure to endogenous estrogen

žHeavy menstrual bleeding

žObstruction of menstrual outflow

žDES exposure in utero

žHeight greater than 68 inches

žLower BMI

žHigh consumption of unsaturated fat

RF of what condition?

A

endometriosis

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5
Q

žPremenstrual pelvic pain: Lesion growth stimulated by estrogen and progesterone. Lesions grow and are secretory but expansion is inhibited by surrounding fibrosis —> pressure and inflammation leads to pain

**PAIN SUBSIDES AFTER MENSES**

žInfertility

Dysmenorrhea

Dyspareunia

Clinical px of what dz

A

endometriosis

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6
Q

what will be present on physical exam of endometriosis (3)

A

žTenderness / nodules at posterior cul-de-sac

žžFixed or retroverted uterus (secondary to adhesions)

žžEndometriomas cause adnexal masses or tenderness

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7
Q

endometriosis dx

A

CA-125

žImaging

žLaparoscopy:

  • Erythematous, petechial lesions on peritoneal surface
  • Surrounding peritoneum thickened and scarred
  • MC site of dz: Ovaries can demonstrate lesions or endometriomas (“chocolate cysts”)

​ Adhesions

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8
Q

what is this showing

A

“chocolate cysts” on laporoscopy

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9
Q

what must you consider when thinking about how to tx endometriosis

A

Clinical presentation

Symptom severity

Extent and location of disease

Reproductive plans

Age

Medication side effects

Surgical complication rates

Cost

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10
Q

mild endometriosis tx

A

Expectant management

NSAIDS +/- OCPs

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11
Q

mod-severe endometriosis tx

A

main goal interrupt stimulation of endometrial tissue

Combo OCP’s

Progestins (PO, IM or IUD)

Gonadotropic-releasing hormone agonists (GnRH): Depot Lupro

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12
Q

What do the combination OCP’s do?

A

Continuous cycle fashion

Causes atrophy of endometrial tissue

40-50% pregnancy rate after discontinuation

↓ risk of ovarian cancer

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13
Q

What do the GnRH agonists do?

A

Suppression of estrogen and progesterone by down-regulation of pituitary gland

6 - 12 month therapy –> add Norethindrone acetate to prevent bone loss

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14
Q

Other endometriosis txq

A

žDanazol (androgen)

žAromatase inhibitors

žLaparoscopic excision

žHysterectomy with bilateral salpingo-oophorectomy

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15
Q

žArise from smooth muscle cells within the uterine wall

ž Made up of collagen, smooth muscle, and elastin surrounded by a pseudocapsule

What dz?

A

uterine fibroid

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16
Q

uterine fibroids are 2-3x MC in which demographic & gender?

A

black women

seen earlier and grow faster

17
Q

žNo evidence suggests estrogen causes myomas

žžEstrogen is implicated in growth

Myomas contain higher concentration of estrogen receptors than what is observed in the surrounding myometrium

May cause enlargement by increased production of extracellular matrix

žžProgesterone increases mitotic activity and possibly suppresses apoptosis within the tumor

Which dz pathophys?

A

uterine fibroids

18
Q

uterine fibroids classification:

submucosal

subserosal

intramural

A

classified by anatomic location within the myometrium

Submucosal: Lie just beneath the endometrium

Subserosal: Lie just at the serosal surface of the uterus

Intramural: Lie within the uterine wall

19
Q

What are these?

A

uterine fibroids

20
Q

Abnormal uterine bleeding: increased surface area of endometrium leading to menorrhagia (+/- Fe anemia)

Pain: Degeneration, myometrial contractions, dyspareunia

Pelvic Pressure: Mass effect, compression of surrounding organs

Infertility: Submucosal fibroids impingement of intrauterine cavity

Spontaneous abortion

Clinical px of what?

A

uterine fibroids

21
Q

physical exam of uterine fibroids

A

Bimanual exam reveals uterine abnormalities: Enlargement, Irregular shape, Masses

22
Q

labs/imaging for uterine fibroids

A

žTransvaginal US

žSaline-infused sonohysertogram

žHysteroscopy

žMRI

žH&H

23
Q

T/F: žThere is no standard of care for fibroid treatment in the United States.

A

True

24
Q

Medical tx options for uterine fibroids (4)

A

COCs/progestin

GnRH analogs

Steroid therapies (androgens)

Tranexamic acid

25
Q

surgical tx options for uterine fibroids (5)

A

Hysteroscopic resection

Endometrial ablation

Laparoscopic myomectomy

Abdominal myomectomy

Laparoscopic radiofrequency ablation

26
Q

Other tx options for uterine fibroids

A

Uterine artery embolization

Magnetic resonance-guided focused ultrasonography (MRgFUS)

27
Q

How will Depot Lupron (GnRH agonist) help tx uterine fibroids?

A

Decreases fibroid size

Improves anemia prior to surgery

Decreases blood loss during surgery

Allows minimally invasive approach

May play primary role in treatment near menopause

_Not approved for use over 6 months**_

28
Q

steroidal therapies indicated for which patients?

A

Indicated for patients with prolonged, heavy menses with no submucosal fibroids:

Oral contraceptive pills

¢Mirena® IUD

¢Ortho Evra ®

¢NuvaRing ®

29
Q

when is Lysteda indicated for tx?

A

Indicated for patients with prolonged, heavy menses with no submucosal fibroids

30
Q

Which medication is an oral antifibrinolytic for menorrhagia and is used only durng the menstrual cycle?

A

Lysteda (tranexamic acid)

31
Q

What is the main functionof the myomectomy

A

preserves fertility/uterus

32
Q

Performed on intramural, subserosal and pedunculated fibroids

Perform when Pressure symptoms present

Which procedure?

A

Uterine fibroids

33
Q

Imp information to rmr regarding myomectomy

A

Delay pregnancy 3-6 mos: C-section 2o to uterine rupture

34
Q

complications of laparoscopic myomectomy

A

hemorrhage

re-operation

adhesions

vascular and visceral injuries

35
Q

žAbdominal or Mini-laparotomy Myomectomy: Candidates

A
  • Perform on patients with contraindications to laparoscopy (Cardiopulmonary disease)
  • Fibroid size does not permit laparoscopic approach
  • Prior pelvic or abdominal radiation therapy
  • Severe hip disease precluding dorsolithotomy position
36
Q

Hysteroscopy indications

A

Preserves fertility/ uterus

Only performed on submucosal fibroids

Type 0 or 1 associated with menorrhagia

SG F3 E5 (23 decks)

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