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403- O&G > Uterine pathologies > Flashcards

Uterine pathologies Flashcards

1
Q

Leiomyoma classifications

A

Intramural (most common)

Submucosal
- Growing in the uterine cavity

Subserosal
- Growth outwards from uterine

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2
Q

Symptoms of fibroids

A
  • Menorrhagia
  • Dysmennorhea/ pelvic pain
  • Intermenstrual bleeding
  • Abdominal bloating
  • Recurrent miscarriage
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3
Q

Risk factors of fibroids

A
  • Family history
  • Afro-Caribbean
  • Age 30 +
  • Increased oestrogen exposure: early menarche, obesity.
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4
Q

Signs of fibroids

A

Pressure on urinary tract

  • Frequency/ urgency
  • Incotinence
  • Hydronephrosis

Anaemia

Abominal mass

Fibrotic uterus

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5
Q

Findings for bimanual palpation in fibroids

A

Uterus that is

  • Irregular
  • Firm
  • Non-tender
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6
Q

Investigation for fibroids

A

1st line
- Ultrasound

Other imaging
- Hysteroscopy with biopsy

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7
Q

Complications of fibroids

A

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
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8
Q

Non pharamacological management of fibroids

A

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

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9
Q

Complications of hysterectomy

A

Damage to adjacent organs

  • Ovaries, fallopian tubes
  • Ureter, bladder

Bleeding, infection.

Pyschological
- Especially if fertilitiy is desired

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10
Q

Risk factors for endometriosis

A

Prolonged oestrogen exposure

  • Early menarche
  • Late menopause

Low BMI

Nulliparity

White ethnicity

Smoking

Family history

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11
Q

Symptoms of endometriosis

A

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
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12
Q

Signs of endometriosis

A

Adenexal mass

Palpable, blueish haemorrhagic nodules in posterior fornix

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13
Q

Symptoms of adenomyosis

A

Menorrhagia

Dysmenorrhea

Dyspareuia

Subfertility

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14
Q

Sign of adenomyosis

A

Uterus that is

  • Enlarged
  • Less firm than fibroids
  • Tender
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15
Q

Investigations for endometriosis

A

Gold-standard
- Diagnostic laparoscopy= brown deposits under peritoneum is diagnostic

Transvaginal ultrasound

MRI
- Carried out after diagnosis is confirmed

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16
Q

Complications of endometriosis

A

Subfertility

Adhesions
- Affects fallopian function

Ovarian cancer

  • Clear cell
  • Low-grade serous
  • Invasive endometrial
17
Q

Pain management in endometriosis/ Adenomyosis

A
  1. Paracetamol + NSAIDs
  2. Hormonal therapy- improves pain (if fertility not desired)
    - COCP
    - progesterone formulations: injection, POP, IUS
    - GnRH analogues

Transcutaneous electrical nerve stimulation (TENS)

18
Q

Surgical management in endometriosis

A

Fertility preserving

  • Ablation
  • Ovarian cystectomy

Oophorectomy/ hysterectomy

Adhesiolysis

19
Q

Most common type of endometrial cancer is _______

A

Adenocarcinoma

20
Q

Protective factors against endometrial cancer

A

Progesterone

  • COCP
  • Mirena coil

Multigravida

Cigarette smoking

Coffee drinkers

21
Q

Risk factors for endometrial cancer

A

Increased age

Things that increase oestrogen exposure

  • Unopposed oestrogen
  • Obesity
  • Tamoxifen
  • Early menarche, late menopause

PCOS

Nulligravida

Endometrial hyperplasia

22
Q

Genetic conditions that increase risk of endometrial cancer

A

Lynch syndrome
- DNA mismatch repair mutation

Cowden syndrome
- PTEN mutation (tumour suppression)

23
Q

Presentation of endometrial cancer

A

PV bleeding

  • Post-menopausal
  • Intermenstrual

Pelvic mass

Menorrhagia

Abnormal vaginal discharge

24
Q

First line investigation of endometrial cancer

A

Transvaginal ultrasound
- Assesses endometrial thickness

Hysteroscopy with endometrial biopsy

25
Q

Gold standard First line management of endometrial cancer

A

Total abdominal hysterectomy with bilateral salpingoophrectomy

26
Q

Management of endometrial hyperplasia

A

Progestogens

  • Mirena coil
  • Medroxyprogesterone/ Levonorgestrel.
27
Q

An endometrial thicken less than ______ has a high predictive value for endometrial cancer

A

4mm

28
Q

Surgical management of fibroids is indicated when _____

A

Medical therapies have been trailed.

In fibroids >3cm.

29
Q

Medical management of fibroids is indicated when____

A

Fibroids are <3cm

30
Q

Medical management of fibroids options

A

COCP

IUS

Oral progesterone (medroxyprogesterone, levonorgestrel)

Menorrhagia

  • Mefenamic acid
  • Tranexamic acid
31
Q

_______ are used to shrink fibroids before surgery

A

GnRH agonists

32
Q

Diagnositc investigation for adenomyosis

A

1st line
- Transvaginal ultrasound

2nd line
- Pelvic MRI/ abdominal USS

33
Q

______ is a GnRH agonist used by specialist to control endometriosis-related pain

A

Leuprorelin

34
Q

First line management of primary dysmenorrhea

A

NSAID + paracetamol

- Mefanamic acid

403- O&G (21 decks)

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