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WH1 > Uterine Leiomyomas > Flashcards

Uterine Leiomyomas Flashcards

1
Q

MC pelvic tumor in women

A

leiomyoma aka fibroids

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2
Q

leiomyoma

A

smooth muscle pelvic tumor

benign in myometrium

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3
Q

epidemiology of leiomyoma

A

30-40 y.o

AA younger

2-3x more common in AA women

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4
Q

risk factors of leiomyoma

A

early menarche** (<10)

DES tx, obesity, fHTN

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5
Q

protective factors of leiomyoma

A

parity (20+ weeks)

long acting progestin only contraception

smoking

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6
Q

fibroids and reproductive hormones

A

nonexistent in pre puberty, found in reproductive age , and regress after menopause

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7
Q

intramural myxomas

A

developing within uterine wall

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8
Q

submucosal myomas

A

derive from myometrial cells

below endometrium

protrurde into uterine cavity

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9
Q

subserosal myomas

A

OG at myometrium at SEROSAL surface of uterus

extend OUTWARD

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10
Q

cervical myoma

A

located in cervix

rare

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11
Q

clinical presentation

A
  1. heavy/prolonged menstrual bleeding
  2. pelvic pressure and pain
  3. reproductive dysfunction
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12
Q

heavy bleeding in CP

A

can cause IDA, increased PMS symptoms

this is NOT intermenstrual and post menopausal

heavy, PROLONGED, menarche (nml)

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13
Q

menorrhagia is most associated with

A

submucosal fibroids that protrude into uterine wall (O and I)

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14
Q

type 0 submucosal

A

not located within uterine wall

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15
Q

type I submucosal

A

<50% invasion of uterine wall

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16
Q

type II submucosal

A

> 50% invasion of uterine wall

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17
Q

degeneration of fibroid

A

fibroid gets so large that blood supply is inefficient so it undergoes necrosis

should be on DDX

low fever, leukocytosis, peritoneal signs

18
Q

bimanual exam findings fibroid

A

enlarged, mobile uterus w/irregular contour and firmness

19
Q

evaluation fibroid

A
  1. hCG + TVUS
  2. hystroscopy
  3. MRI
20
Q

necrosed fibroid US looks like?

A

calcifications with posterior shadowing

21
Q

TVUS of fibroid

A

initial tool for eval

whorled appearance + hypoechoic

22
Q

reproductive dysfunction fibroid

A

difficulty conceiving, increased miscarriage

placental abruption, IUGR, malpresentation, pre term labor risk

23
Q

tx of fibroid

A

relief of symptoms and prevention of complications

typically not removed

24
Q

medication management leiomyoma

A

NSAIDs (decrease cramping)

combo OC (decreased bleeding, not size)

progestin only pills (increase size, decrease bleeding)

GnRH agonist (debulking, bridge to sx)

iron replacement

25
Q

asymptomatic fibroids tx

A

watchful waiting

26
Q

postmenopausal fibroid tx

A

typically shrink and stop symptoms

no tx

27
Q

when to consider sx of leiomomya

A

desires fertility
complications arise
declines to take medicine
symptoms progress.fail to improve

28
Q

surgical options if pt does NOT desire fertility

A

hysterectomy

MRgFUS

29
Q

surgical tx if pt DOES desire fertility

A

hystroscopy (submucosal)

intramural or subserosal - abdominal myomectomy (increased risk fo uterine rupture)

myolysis

UAE

30
Q

uterine artery embolisation

A

IR, not optimal for preserving fertility

endometritis and PES risl

31
Q

PES

A

acute pain, fever, malaise, n/v, night sweats following UAE sx

resolves by 48 hrs

32
Q

leiomyosarcoma

A

smooth muscle malignant neoplasm

ss as myxomas but post menopausal bleeding MC

60 y.o., AA women

33
Q

BBW due to risk of leiomyosarcoma

A

tamoxifen

34
Q

adenomyosis

A

glands in muscle

endometrial glands and storm present in uterine musculature

35
Q

adenomyosis

A

hypertrophy and hyperplasia in myometrium

uterus becomes enlarged (same as prego 12 weeks)

MC in porous

36
Q

symptoms of adenomyosis

A

heavy menstrual bleeding (AUB)

painful menstruation

pelvic fullness, chronic pelvic pain

NO indication increased risk of miscarriage/OB outcome

37
Q

PE adenomyosis

A

uterus TTP

enlarged and boggy uterus (diffuse)

38
Q

adenomyosis w.u.

A

TVUS = TOC

39
Q

diagnostic criteria on MRI of adenomyosis

A

asymmetric thickening (> 12 mm)

if <8mm = excluded

40
Q

definitive dx of adenomyosis

A

histology of hysterectomy

presence of endometrial tissue within myometrium

41
Q

definitive tx of adenomyosis

A

hysterectomy

if completed childbearing

WH1 (6 decks)

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