Uterine pathologies Flashcards
Leiomyoma classifications
Intramural (most common)
Submucosal
- Growing in the uterine cavity
Subserosal
- Growth outwards from uterine
Symptoms of fibroids
- Menorrhagia
- Dysmennorhea/ pelvic pain
- Intermenstrual bleeding
- Abdominal bloating
- Recurrent miscarriage
Risk factors of fibroids
- Family history
- Afro-Caribbean
- Age 30 +
- Increased oestrogen exposure: early menarche, obesity.
Signs of fibroids
Pressure on urinary tract
- Frequency/ urgency
- Incotinence
- Hydronephrosis
Anaemia
Abominal mass
Fibrotic uterus
Findings for bimanual palpation in fibroids
Uterus that is
- Irregular
- Firm
- Non-tender
Investigation for fibroids
1st line
- Ultrasound
Other imaging
- Hysteroscopy with biopsy
Complications of fibroids
Abnormal uterine bleeding
- Most common in submucosal
Compression of adjacent surrounding structures
- Occurs with larger fibroids
- Causes pain, urinary symptoms
Rarer complications
- Subfertility (most common in submucosal)
- Torsion of pendulated fibroids
- Pregnancy complications: pain, miscarriage, preterm birth
Non pharamacological management of fibroids
Myomectomy
- Good for retaining ferility
Uterine artery embolisation
- Identification of causative arteries before insertion of embolus to reduced bleeding
Endometrial ablation
- Cauterising the endometrial lining
- Pregnancy must be avoided post-procedure
Hysterectomy
Complications of hysterectomy
Damage to adjacent organs
- Ovaries, fallopian tubes
- Ureter, bladder
Bleeding, infection.
Pyschological
- Especially if fertilitiy is desired
Risk factors for endometriosis
Prolonged oestrogen exposure
- Early menarche
- Late menopause
Low BMI
Nulliparity
White ethnicity
Smoking
Family history
Symptoms of endometriosis
Bleeding
- Dysmennorhea/ abdominal/ pelvic pain= Especially around menstruation
- Intermenstrual bleeding
Pain
- Dysmenorrhea
- Dyspareunia/ pain during internal examination
- Abdominal/ pelvic pain
GI/ GU
- Dyschezia
- Dysuria
- IBS symptoms
- GI bleed
Others
- Leg / back pain
- Lethargy
- Depression
Signs of endometriosis
Adenexal mass
Palpable, blueish haemorrhagic nodules in posterior fornix
Symptoms of adenomyosis
Menorrhagia
Dysmenorrhea
Dyspareuia
Subfertility
Sign of adenomyosis
Uterus that is
- Enlarged
- Less firm than fibroids
- Tender
Investigations for endometriosis
Gold-standard
- Diagnostic laparoscopy= brown deposits under peritoneum is diagnostic
Transvaginal ultrasound
MRI
- Carried out after diagnosis is confirmed
Complications of endometriosis
Subfertility
Adhesions
- Affects fallopian function
Ovarian cancer
- Clear cell
- Low-grade serous
- Invasive endometrial
Pain management in endometriosis/ Adenomyosis
- Paracetamol + NSAIDs
- Hormonal therapy- improves pain (if fertility not desired)
- COCP
- progesterone formulations: injection, POP, IUS
- GnRH analogues
Transcutaneous electrical nerve stimulation (TENS)
Surgical management in endometriosis
Fertility preserving
- Ablation
- Ovarian cystectomy
Oophorectomy/ hysterectomy
Adhesiolysis
Most common type of endometrial cancer is _______
Adenocarcinoma
Protective factors against endometrial cancer
Progesterone
- COCP
- Mirena coil
Multigravida
Cigarette smoking
Coffee drinkers
Risk factors for endometrial cancer
Increased age
Things that increase oestrogen exposure
- Unopposed oestrogen
- Obesity
- Tamoxifen
- Early menarche, late menopause
PCOS
Nulligravida
Endometrial hyperplasia
Genetic conditions that increase risk of endometrial cancer
Lynch syndrome
- DNA mismatch repair mutation
Cowden syndrome
- PTEN mutation (tumour suppression)
Presentation of endometrial cancer
PV bleeding
- Post-menopausal
- Intermenstrual
Pelvic mass
Menorrhagia
Abnormal vaginal discharge
First line investigation of endometrial cancer
Transvaginal ultrasound
- Assesses endometrial thickness
Hysteroscopy with endometrial biopsy
