Uterine Fibroids Flashcards
Define Uterine fibroids
Noncancerous growths of the uterus that often appear during childbearing yrs
Uterine Fibroids are derived from what layer
Myometrium
Describe the morphology of Uterine Fibroids
Well circumscribed nodules
Dense
Describe the capsule that surrounds Uterine Fibroids
Thin pseudocapsule of areolar tissue and compressed muscle fibres
What is the colour of the cut surface of a Fibroid
White - Tan
Describe the smooth muscle cells of Fibroids
Whorled anastomosing fascicles of uniform spindle shaped smooth muscle cells
Describe the nuclei of cells in fibroids
Nuclei are elongated and have finely dispersed chromatin
How many mitotic features per 10 high power fields are seen in fibroid histology
Less than 5 mitotic figures per 10 high power fields
What is the aetiology of uterine fibroids
Strong inherited components to fibroid development (tumour specific chromosomal abnormalities)
Which factors promote Tumor growth
Estrogen
Progesterone
Growth Factors
List some factors that increase the risk of developing uterine fibroids
Early Menarche Age Diet Obesity Racial differences
List factors that decrease the risk of uterine fibroid development
Smoking
Oral contraceptives
High parity
Exercise
What are the four classifications of uterine fibroids
PALM Polyp Adenomyosis Leiomyoma Malignancy and hyperplasia
What are the two sub classifications of Leiomyoma uterine fibroids
Submucosal
Other
What percentage of uterine fibroids are subserous
10%
What percentage of uterine fibroids are submucosus
15%
What percentage of uterine fibroids are intramural
75%
What is the most common solid pelvic tumor in women
Uterine fibroids
Uterine fibroids causes symptoms in what percentage of reproductive age women
25%
What is the prevalence of Uterine Fibroids in black women
70%
The average affect uterus presents with how many fibroids
6-7
Uterine Fibroids are usually detected in women in what age
30’s and 40’s
True or False Uterine Fibroids shrink after menopause
True
Are most Uterine Fibroids symptomatic or asymptomatic
Asymptomatic
List 6 clinical presentations of uterine fibroids
Abdominal Mass Pelvic pain Compression Symptoms Persistent discharge Abnormal Uterine bleeding Reproductive Dysfunction
List examples of pelvic pain associated with Uterine Fibroids
Secondary dysmenorrhea Degeneration Acute Abdominal pain Pressure on nerves Dysparunea (if vaginal protrusion)
List seven examples of compressive symptoms of Uterine Fibo
- Pelvic Heaviness and pressure
- (an anterior UL-) compresses the urinary bladder
- compress ureter leading to kidney dysfunction
- constipation
- bowel Obstruction
- lower limb oedema
- varicosities
List three examples of abnormal uterine bleeds
Menorrhagia
Cyclical bleeding excessive in amount and duration
80mls per cycle
What causes menorrhagia in Uterine Fibroids
Ulceration and Haemorrhage of endometrium overlying submucous fibroids
Inability of the musculature to contract the spiral arteries
Enlargement of total surface area of endometrium due to mechanical distortion
Mechanical compression of venous drainage leading to dilation of a venous plexus draining the endometrium
What are five reasons that uterine fibroids can cause reproductive dysfunction
Fibroid may cause compression on the fallopian tubes
A large fibroid may distort the pelvic anatomy
Acts as a mechanical barrier to implantation
Causes an alteration or reduction of blood flow to the uterine lining making it more difficult for an implanted embryo to grow and develop
Submucosal fibroids may act as a foreign body and results in an inflammatory reaction creating a hostile environment for an embryo the implant
What are the different options for imaging used to investigate uterine fibroids
Ultrasound Saline infusion sonogram Hysterosalpingogram MRI Laparoscopy Hysteroscopy
What are the seven factors that affect the management of uterine fibroids
Age Parity Pregnant status Desire for future fertility General health Symptoms Location
True or false a small asymptomatic uterine fibroids in a pt near menopause still needs treatment
False
List for types of medical management of uterine fibroids
NSAIDS OCP Progesterone Merina levonogestrel IUD Leuprolide SPRM Ulipristal Acetate
How do NSAIDS help Uterine Fibroids
Pain relief
Limits prostaglandin production (hence bleeding)
How does Progesterone help Uterine Fibroids
Thins the endometium
What is the mechanism of action of leuprolide
GNRH gonadotrophin releasing hormone agonist
How does leuprolide aid in the uterine fibrosis management
It reduces the size of the fibroids
A monthly six month treatment of the fibroid with Leuprolide reduces the volume of the fibroid by what percent
30%
What is the dosage and route of administration of leuprolide in treatment for uterine fibrosis
3.75 mg Intramuscular monthly
How does Leuprolide affect the menorrhagia symptoms of Uterine Fibroids
Decreases bleeding
Uterine Volume and menses return in 4-8 weeks
How does SPRM Ulipristal acetate aid in uterine fibroids management
Reduces the fibroid volume by 25% if treatment maintained for six months
Direct effect on endometrium control
List to non-surgical, non pharmaceutical procedures for management of uterine fibroids
Uterine artery embolization
MRI focused ultrasound
What percentage of patients are clinically improved after one year of treatments with uterine artery embolization
80% to 90%
Uterine artery embolization uses what chemical
Polyvinyl alcohol or
Endospheres
List some complications of uterine artery embolization
Bleeding/ haematoma
Allergic reaction
Ischaemic
Infection
Describe how MRI Focused ultrasound is used to treat UterineFibroids
MRI for visibility
Focused ultrasound energy
Raises the temperature to about 85 Celsius high enough causing thermal ablation, sparing normal tissue
List two complications of MRI Focused Ultrasound
Skin burns
Sciatica
List five Uterine sparing/preserve fertility treatments for Uterine Fibroids
Open myomectomy Vaginal Myomectomy Laparoscopic myomectomy Robotic Surgery Hysteroscopic resection
Which methods are used to reduce blood loss in Myomectomy
Uterine Ligation Uterine Artery Embolization Pericervical Mechanical Tourniquet Hormonal Tourniquet (Vasopressin) Uterotonics Laser& chemical dissectors Bonney Myomectomy Clamp
List three examples of Uterotonics used to reduce blood loss in open myomectomy
Ergometrine
Oxytocin/Duratocin
Prostaglandins: Misoprostol, Sulprostone
What technique/instrument is used to do preoperative inspection of Uterine Fibroids
Hysteroscopic Myomectomy
What are the steps for preoperative assessment for Hysteroscopic Myomectomy
Degree of penetration into the cavity
The amount of normal myometrium between the area of resection and the serosa
Dilate cervix +/- misoprostol
Resect with electrical loop or mechanically
Visual control with telescope
Distension medium
What are five advantages of Laparoscopic Myomectomy over open laparotomy
Faster recovery Shorter hospital stay Diminished blood loss Decreased Adhesion formation Comparable higher rate of pregnancy
What are four advantages of robotic myomectomy over laparoscopic Myomectomy
High definition 3-D image
Robotic hands broad range of movement to enhance surgeons dexterity
Increased ability to delicately remove fibroids and reconstruct uterine wall
Preserving fertility
How long are you recommended to wait before pregnancy after Myomectomy
12 weeks
MRI after Myomectomy suggests uterine healing takes 12 weeks or longer
What are some complications of Myomectomy
Hysterectomy Blood transfusions Fever Infection Intrauterine Adhesion Peritoneal adhesion Ileus Bowel Obstruction Need for caesarean delivery Possible uterine rupture in labour
List four types of Non Uterine Sparing/ Tadical Therapy for Uterine Fibroid treatment
Total abdominal hysterectomy
Vaginal hysterectomy
TLH
Robotic Hysterectomy
List 5 surgical supportive measures for Uterine Fibroid Treatment
Pap smear Endometrial Sampling Correct Hb prior to surgery Bowel prep Prophylactic heparin
