Uterine Leomyomata Flashcards
Exam findings consistent with uterine fibroids? Consistent with ovarian mass?
Irregular midline mass continuous with the cervix
Lateral mass apart from the cervix
Most common reason for hysterectomy in the US? Most common symptom? Hysterectomy performed in which patients?
Symptomatic uterine fibroids; menorrhagia;
Systematic fibroids that are refractory to medical therapy
Patient with menorrhagia - consider?
Metrorrhagia?
Fibroids
Endometrial hyperplasia, endometrial polyp, uterine cancer, uterine fibroids
Type of fibroid that impinges on Uterine cavity?
Submucosal
Types of fibroids?
- Subserosal
- Intramural
- Sub mucosal
- Pedunculated
- Cervical
- Prolapsed
Carneous degeneration? aka?
Changes of the fibroid due to rapid growth – Center becomes a red and causes pain
Red degeneration
Signs of a leiomyosarcoma? Risk factor?
Rapid growth (increase of more than six weeks gestational size in one year)
Radiation the pelvis
Signs of prolapsed fibroid?
Labor-like contractions and pain
Differential diagnosis for fibroids?
- Ovarian masses
- Tubo-ovarian masses
- Pelvic kidney
- Endometrioma
Initial treatment for fibroids?
Other tx?
NSAIDs or progestin
- GnRH agonist
- Hysterectomy if future pregnancy undesired
- Myomectomy if future pregnancy desired
- Uterine artery embolization
GnRH agonist – used for? Time course? downside? Use when?
GnRH agonist (take three months but after cessation, fibroids will regrow)
Tumor shrinkage or correction of anemia prior to operative treatment
Uterine artery embolization?
Cannulizing femoral artery and infusing embolization particles into uterine arteries (to float into fibroid vessels) leading to fibroid infarction
Type of fibroids associated with recurrent abortion? Why?
Submucosal – altered endometrium, and insufficient vasculature
Fibroids may present with severe pain if?
Twists on pedicle
Patient with myomectomy gets pregnant – concern?
Uterine rupture – delivered via C-section
