Uterine Disorders- Dobbs Flashcards
Discrete, round, firm, often multiple uterine tumor with well-defined border composed of smooth muscle and connective tissue found within the uterus on bi-manual exam
Leiomyoma (uterine fibroid)
_______ is the mc presenting symptom of a uterine fibroid
bleeding
A patient comes in complaining of pressure or fullness in her pelvis with increased bleeding when she is not on her period. What is the most likely dx?
Uterine fibroid
What is the best way to dx a uterine fibroid?
Pelvic u/s
What is the treatment for a uterine fibroid?
Depends on how severe it is. Observation, myomectomy, D&C or Depo-provera can be used to stop the bleeding
Condition where endomitreal tissue is found outside of the endometrial cavity
Endometriosis
On ovaries, you may see “chocolate cysts”
Endometriosis
3 D’s:
Dysmenorrhea, dyspareunia, Dyschezia (painful bleeding, painful intercourse, painful stools)
How to dx endometriosis?
Tissue bx with labrascopy
Treatment for endometriosis?
Depends on the severity of symptoms, location and desire for childbearing
- Expectant (watch and wait)
- NSAIDs for pain
- Can try oral contraceptives to control menses to know when the pain will occur
T/F: Pregnancy cures endometriosis?
False preg does not cure endometriosis. It may temporarily improve or worsen symptoms
A middle aged woman comes into the clinic with severe dysmenorrhea, hx of childbearing, symmetric enlarged uterus and menorrhagia. What is the most likely dx?
Adenomyosis (this is where the endometrial cells end up in the uterine musculature)
How to diagnose Adenomyosis?
Pelvic U/S or MRI
Treatment for Adenomyosis?
- NSAID
- Hormones (trying to control hormonal fluctuation to suppress/irregulate menstrual cycle
This is a bladder prolapse of the anterior (front) vaginal wall where the bladder dalls towards the vagina and creates a bulge
Cystocele
This is a prolapse of the rectum or large bowel
Rectocele (feels full during intercourse- difficulty passing stool)
A patient states that she feels vaginal fullness and lower abdominal pain that is worse with prolonged standing and she feels a “falling out sensation.” What could the possible cause be?
Uterine prolapse
What grade uterine prolapse is this?
normal- no prolapse
Grade 0 uterine prolapse
What grade uterine prolapse is this?
Descent is >1cm above the hymen
Grade 1
What grade uterine prolapse is this?
Descent to hymen
Grade 2
What grade uterine prolapse is this?
Protrudes, but no less than 2cm total vaginal length
Grade 3
What grade uterine prolapse is this?
Total eversion of lower genital tract
Grade 4
Uterine prolapse management?
Refer to gyn!
Bleeding between periods, bleeding after intercourse, spotting anytime in the menstrual cycle, bleeding heavier for more days than normal and bleeding after menopause. NOrmal?
NO! Abnormal uterine bleeding (AUB)
What are structural causes of AUB?
PALM Polyp Adenomyosis (when the muscle of the uterus breaks through the uterus) Leiomyoma Malignancy & hyperplasia
Nonstructural Causes of AUB?
COEIN Coagulopathy Ovarian dysfunction Endometrial process Iatrogenic Not yet classified
What is the gold standard way of figuiring out AUB cause?
hysterocopy (where they look into the uterus)
Treatment of AUB?
Primary goal is to determine the underlying cause and resume regular shedding of the endometrium
-Could give progesterone or oral contraceptives
What FSH and estradiol level is suggestive of menopause?
FSH >30 and estradiol below 20
Is postmenopausal bleeding in a woman normal?
No- endometrial cancer until proven otherwise
What is the most common cause of postmenopausal bleeding?
The use of exogenous hormones
What is the most common type of endometrial cancer?
adenocarcinoma
Abnormal uterine bleeding is the cardinal symptom of what disease?
endometrial cancer
How to dx endometrial cancer?
U/S and bx
**Refer to GYN
Treatment for endometrial cancer?
Total hysterectomy with salpingo-oophrectomy because we dont want any chance that we missed anything)
