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Y3 - Repro > Uterine Pathology > Flashcards

Uterine Pathology Flashcards

1
Q

What is endometritis?

A

Inflammation of the endometrium

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2
Q

What is the most common cause of endometritis?

A

Childbirth

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3
Q

What is the aetiology of acute endometritis?

A

Usually bacterial

More common in caesarian section

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4
Q

What does chronic endometritis cause?

A

Pelvic inflammatory disease

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5
Q

What organisms can cause endometritis?

A 
Neisseria gonorrhoea
Chlamydia
TB
CMV 
Anaerobes (clostridium)
Aerobic (strep, enterococci, staph, klebsiella, proteus, e coli)
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6
Q

What are the causes of endometritis?

A 
Post-partum
Post-abortion
Post-curretage
Intrauterine contraceptives
Granulomatous disease (sarcoidosis, foreign body post-ablation)
Leiomyomata or polyps
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7
Q

What are risk factors for endometritis?

A 
Caesarian section
Prolonged labour
Retained products of conception
Chorioamnionitis
Low socioeconomic status
Multiple cervical examinations
Young maternal age
Meconium stained amniotic fluid
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8
Q

What are the symptoms of endometritis?

A

Lower abdomen pain
Fever
Abnormal discharge - foul smelling and purulent
Abnormal bleeding

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9
Q

What are signs of endometritis?

A

Increased temperature
Tachycardia
Hypogastric tenderness
Signs of sepsis

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10
Q

What is seen on histology in endometritis?

A

Abnormal pattern of inflammatory cells and plasma cells

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11
Q

What is seen in blood tests in endometritis?

A

Leucocytosis

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12
Q

What is the treatment for endometritis?

A

Broad spectrum antibiotics - co-amoxiclav and metronidazole for 7 days
Co-trimoxazole and metronidazole if pen allergic)

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13
Q

What are the complications of endometritis?

A

Sepsis

Placenta praevia

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14
Q

What are uterine polyps?

A

Benign growth of the endocevix

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15
Q

Do uterine polyps have a risk of malignancy?

A

Yes - rarely

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16
Q

What are risk factors for uterine polyps?

A

Increasing age
Hypertension
Obesity
Tamoxifen use

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17
Q

What are symptoms of uterine polyps?

A

Abnormal uterine bleeding (intermenstrual, post-coital, post-menopausal)
Discharge - watery, non-smelly, non-itchy
Can be asymptomatic

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18
Q

What investigations are done in uterine polyps, and what do they show?

A

Transvaginal USS - hyperechoic lesion, sometimes cystic spaces within
Colour doppler - may delineate the feeding vessel
Hysteroscopy and biopsy - diagnostic and can treat

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19
Q

What is the management for uterine polyps?

A

Hysteroscopic polypectomy

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20
Q

What is endometrial hyperplasia?

A

Proliferation of the endometrial layer of the uterus

Precursor for endometrial cancer

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21
Q

What are risk factors for endometrial hyperplasia?

A

Increased oestrogen

  • PCOS
  • obesity
  • oestrogen-only HRT
  • tamoxifen
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22
Q

What are the types of endometrial hyperplasia, and their chance of progression of cancer?

A

Simple - 0% risk of cancer
Complex - 1-2% risk of cancer
Atypical - 10-20% risk of cancer

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23
Q

What are the symptoms of endometrial hyperplasia?

A

Abnormal bleeding (especially post-menopausal)

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24
Q

What investigations are done for endometrial hyperplasia?

A

PV and speculum examination
TVUS
Hysterocopy and biopsy

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25
Q

What does TVUS allow you to assess?

A

Endometrial thickness

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26
Q

What size of endometrial thickness is suspicious in endometrial hyperplasia?

A

> 4mm in post-menopausal women

>16mm in pre-menopausal women

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27
Q

What is the management of endometrial hyperplasia if atypia are seen on hysteroscopy and biopsy?

A

Hysterectomy

28
Q

What is the management of endometrial hyperplasia if simple hyperplasia is seen on hysteroscopy and biopsy?

A 
Monitor
Mirena coil
Progestin therapy
Repeat sampling in 3/4 months
Decrease oestrogen exposure
29
Q

What are the 2 types of endometrial cancer?

A

Endometroid (type 1)

Serous (type 2)

30
Q

What is the difference between the 2 types fo endometrial cancer?

A 
Endometroid (type 1)
- precursor is atypical endometrial hyperplasia
- oestrogen  driven
- good prognosis
- more common
Serous (type 2)
- atypical endometrial hyperplasia is not precursor
- not oestrogen driven
- worse prognosis
- TP53 mutation
31
Q

What is the spread of serous endometrial carcinoma, and what implication does this have?

A

Spreads along fallopian tube mucosa and peritoneal surfaces

- Can present with extrauterine disease

32
Q

What are the risk factors for endometrial carcinoma?

A 
Unopposed oestrogen or oestrogen excess
- obesity
- nulliparity
- early menarche/late menopause
- tamoxifen
- PCOS
- Lynch syndrome
Increasing age (50-60)
33
Q

When should you consider Lynch syndrome?

A

Family history of endometrial or colorectal cancer, particularly when this ahs happened at a young age

34
Q

What factor is protective for endometrial carcinoma?

A

COCP

35
Q

What is the staging of endometrial carcinoma?

A

Stage 1 - confine two uterus
Stage 2 - cervical involvement
Stage 3 - ovaries/tubes involved
Stage 4 - other organs involved

36
Q

What is the spread of endometrial carcinoma?

A

Direct into myometrium and cervix
Lymphatic
Haematogenous

37
Q

What are the symptoms of endometrial carcinoma?

A

Post-menopausal bleeding
Late features
- pain
- discharge

38
Q

What is the examination finding in endometrial carcinoma?

A

Large uterus

39
Q

What investigations are done in endometrial carcinoma?

A

Transvaginal ultrasound scan
Hysteroscopy and endometrial biopsy
CT for mets and staging

40
Q

What is the treatment for endometrial carcinoma?

A

Hysterectomy and bilateral salpingo-oophorectomy

+/- radio/chemotherapy

41
Q

What is the other name for fibroids?

A

Leiomyoma

42
Q

What are fibroids?

A

Benign smooth muscle tumour in the myometrium of the uterus

43
Q

What stimulates the growth of fibroids?

A

Oestrogen

44
Q

What are the complications of fibroids?

A

Torsion of pedunculate fibroid

Red degeneration

45
Q

What is red degeneration?

A

Haemorrhagic infarction of fibroids causing ischaemia and necrosis

46
Q

What causes red degeneration?

A

Fibroid growth increases in the 3rd trimester, outgrowing its blood supply causing ischaemia
The blood supply to the fibroid can be kinked due to increasing size of baby

47
Q

What factors predispose to red degeneration of fibroids?

A

Pregnancy
COCP
Atrophy after menopause

48
Q

How is red degeneration of fibroids managed?

A

Bed rest and analgesia

Resolves in 4-7 days

49
Q

Who are fibroids more common in?

A

Afro-Caribbean women
Later reproductive years
Rare before puberty

50
Q

What is the presentation of fibroids?

A

Menorrhagia
Bulky uterus
Subfertility
Pain - lower abdominal cramping, often worse in menstruation
Bloating, pressure symptoms on bowel, bladder
May be asymptomatic

51
Q

What is the presentation of red degeneration of fibroids?

A

Low grade fever
Abdo pain
Vomiting

52
Q

What investigation is done for fibroids?

A

Transvaginal ultrasound

53
Q

What is the medical management for fibroids?

A

Mirena USS
Tranexamic acid
COCP
GnRH agonists

54
Q

What are examples of GnRH agonists?

A

Goserelin

Leuprolide

55
Q

What effect do GnRH agonists have on fibroids, and when are they used?

A

May reduce size

Used for short-term management pre-op

56
Q

What is a complication of using GnRH agonists for fibroids?

A

Red degeneration

57
Q

What are the surgical options for fibroids?

A

Myomectomy
Hysterectomy
Hysteroscopic endometrial ablation

58
Q

When is a myomectomy done for fibroids?

A

If desire to conceive in the future

59
Q

What are the complications of surgical management of fibroids?

A

Myomectomy - adhesions, uterine perforation, bladder injury

Hysterectomy - urinary retenttion, enterocoele, vaginal vault prolapse

60
Q

What is adenomyosis?

A

Outpouches of endometrium growing into the myometrium

61
Q

What is the pathophysiology of adenomyositis?

A

Blood produced during the menstrual cycle saturates surrounding tissue causing swelling and intense pain

62
Q

Who most commonly present with adenomyositis?

A

Multiparous women

End of reproductive years

63
Q

What is the presentation of adenomyosis?

A

Enlarged, boggy and tender uterus
Menorrhagia
Dysmenorrhoea

64
Q

What is the diagnostic investigation for adenomyositis?

A

MRI

65
Q

What is the management of adenomyositis?

A

Mirena coil
COCP
GnRH agonists
Hysterectomy (only curative option)

Y3 - Repro (13 decks)

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