Uterine, Vag and Cervix Disorders Flashcards
Another name for uterine fibroids
Leiomyomas
What makes a fibroid
Smooth muscle cells and fibroblasts. Form a round, benign tumour in the myometrium
Location and different types of fibroids
Subserosal - near outer serial surface of uterus and can pressurise adjacent structures e.g. bladder. Mostly asymptomatic.
Intramural - within myometrium. Cause menorrhagia and dysmenorrhea.
Submucosal - Near inner mucosal surface and can extend into uterine cavity. Menorrhagia, sub fertility and dysmenorrhea
Pedunculated
Intracavitary
Risk factors for fibroids
Afro-carribean ethnicity. Family Hx Increasing age Early puberty Obesity
Complications of fibroids
Can create their own blood supply which can lead to torsion of a pedunculate fibroid.
Abnormal uterine bleeding.
Compression of adjacent organs = urinary frequency, pelvic pain, constipation.
Infertility.
Pregnancy problems e.g. malpresentation, miscarriage, pre-term.
Clinical features of fibroids
Asymptomatic! Menorrhagia, dysmenorrhea. Pelvic pain. Pelvic pressure or discomfort. Subfertility. Urinary symptoms. Abdo and bimanual pelvic exam = Firm, enlarged, irregular shaped non-tender uterus. Mass able to be moved from side to side.
Differentials for a pelvic mass on bimanual palpation
Ovarian cancer. Endometrial carcinoma Uterine sarcoma e.g. leiomyosarcoma. Endometrial polyp Endometrial hyperplasia Adenomyosis Pregnancy.
Management of fibroids
No treatment if minimal symptoms.
Treat menorrhagia e.g. IUS.
Ulipristal acetate = progesterone receptor modulator. Need to monitor LFT!
GnRG analogues to shrink fibroid before surgery (return to original size when stop medication).
Surgery = myomectomy, hysterectomy, eterine artery ablation.
Pharmacology of GnRH analogues
Bind to Gonadotropin-releasing hormone receptor, cause increase in FSH and LH - initial flare-up of symptoms. Continued activation however causes LH and FSH levels to decrease as receptors desensitise.
Side effects = hot flush, mood swings, vaginal dryness, low libido, headache, low BMD.
Adenomyosis
Ectopic endometrial tissue in the myometrium (a type of endometriosis?)
Endometriosis pathophys
Endometrial tissue and stroma outside the uterine cavity. Commonly deposits occur in the peritoneum, pouch of Douglas, ovary and uterosacral ligament.
The tissue is responsive to oestrogen and causes cyclical problems.
Causes of endometriosis
Unknown cause.
Genetic predisposition.
Retrograde menstruation?
Mostly affects women between 30-40yrs.
Complications of endometriosis
Endometriomas = ovarian cysts with blood and endometrial-like tissue. They can rupture causes abnormal pelvic anatomy.
Subfertility.
Adhesions
Bowel obstruction.
Clinical features of endometriosis
Infertility.
Chronic and cyclical pelvic pain.
Dysmenorrhea, Dyspareunia and menorrhagia.
Lethargy.
Constipation.
Bimanual pelvic exam will be normal unless severe endometriosis which can cause tendernesss, palpable nodules or visible nodules.
Investigating and diagnosing endometriosis
TVUS - can be normal.
Laproscopy + biopsy. Diagnose endometriosis and rule out malignancy.
Management of endometriosis
1st line - simple analgesia e.g. NSAID
2nd line - hormone therapy e.g. COCP back-to-back.
3rd line - GnRG analogues, surgical.
Surgical - laparoscopic: diathermy, laser ablation or excision.
Best imaging for adenomyosis
MRI
Red degeneration
Fibroid (which is sensitive to oestrogen) grows during pregnancy. Blood supply is not proportionate to growth and the fibroid degenerates.
Symptoms of red degeneration
Low grade fever, pain and vomiting, pregnant and Hx of fibroids. Mx = conservative as most resolve in 4-7days
Malignant fibroid
Leimyosarcoma
Causes of cervical excitation
Pain on contact with cervix. PID and ectopic.
Adenomyosis V endometriosis
Adenomyosis = young and nulliparous Endometriosis = older, multiparous.
Bartholin’s cyst
Blockage of Bartholin’s glands and ducts. Lie under labia minora and secrete mucous on sexual excitation. Can become infected = abscess.
Cervical polyp
Pedunculated, benign tumours. Increase mucus and PV discharge. Ix = TVUS and hysteroscopy to exclude malignancy.
Endometritis aetiology
Miscarriage (septic) Termination of pregnancy Childbirth: C-section and vaginal, prolonged rupture of membranes, long labour, retained products of conception. IUD or IUS insertion Gynae surgery.
Clinical features of endometritis
Lower abdo pain Fever Dyuria Dyspareunia Uterine tenderness on bimanual. Offensive PV discharge
Investigations and treatment of endometritis
FBC, blood cultures.
High vaginal swab
Rx = Cefalexin and metronidazole.
Cervical ectropion pathophys
Glandular epithelium from inside the cervical cancer extends onto the outer squamous cells of the cervix
Clinical features of ectropions
Asymptomatic Picked up on cervical screening as appears red PV discharge Dyspareunia Post-coital bleeding Infection
Aetiology of ectropion
Hormonal influence - pregnancy, COCP or POCP, puberty
Management of an ectropion
Expectant
Change contraception
Silver nitrate or diathermy to remove cells.
Teratoma
Contains hair and teeth
