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Gynae exam > Uterus > Flashcards

Uterus Flashcards

1
Q

Endometriosis - What is it?

A

Chronic inflammatory conditions
Oestrogen dpt
➤ Proliferation of functional endometrial tissue developing outside the uterine cavity (pelvic peritoneum + ovaries)

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2
Q

Endometriosis - S&S

A 
Asymptomatic
Chronic pelvic P
LBP
Dysmenorrhoea
Dyspareunia
Infertility
Menorrhagia
Urinary symptoms
Cyclical GI
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3
Q

Endometriosis - Risk factors

A 
Unknown
? Smoking
? Nulliparity
? Family Hx
? Age
? Pelvic infection
? White ethnicity
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4
Q

Endometriosis - Ix

A 
Case Hx
Increase CA125
Abdo / pelvic exam
Pelvic US
MRI
Laparoscopy
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5
Q

Endometriosis - Staging

A

➤ Based on location, depth of infiltrates, severity of adhesions

1: minimal
2: mild
3: moderate
4: severe

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6
Q

Endometriosis - Tx

A

Analgesia - NSAIDs, neuromodulators
Hormone - OCP, progestogen, GnHR agonist & antagonist
Surgery - ablation, excision

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7
Q

Endometriosis - Cx

A

Endometrioma
Infertility
Ovarian CA
Ovarian cysts / adhesions

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8
Q

Fibroids / Leiomyomas - Age?

A

Childbeating years

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9
Q

Fibroids / Leiomyomas - Types

A

Intramural
Submucosal
Subserosal
Pedonculated submucosal

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10
Q

Fibroids / Leiomyomas - S&S

A 
Anaemia
Infertility
Menorrhagia
Dysmenorrhoea
LBP
Pressure
Bowel & bladder pbs
Asymptomatic
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11
Q

Fibroids / Leiomyomas - Risk factors

A

age
ethnicity
family Hx
early puberty

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12
Q

Fibroids / Leiomyomas - What decreases risk?

A

Progestogen only

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13
Q

Fibroids / Leiomyomas - Influenced by?

A

Female H

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14
Q

Fibroids / Leiomyomas - Ix

A 
case Hx
pelvic exam
US
MRI
hysteroscopy
bloods (FBC, Hb)
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15
Q

Fibroids / Leiomyomas - Tx

A

Decrease oestrogen ➤ be careful with fertility and osteoporosis
➤ Depends on age - Menopause ➤ shrinks
Decrease menorrhagia: levonorgestrel IU, tranexamic acid, OCP, anti-inflammatories, progesterone only
Decrease fibroids: gonadotropin releasing H analogues, ulipristal acetate (synthetic selective progesterone receptor modulator), surgery (hysterectomy, myomectomy)

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16
Q

Fibroids / Leiomyomas - Cx

A 
menorrhagia
malignancy
infertility
pregnancy
degenerative fibroids
17
Q

Abnormality of the uterus - Examples

A 
absent
unicornate
double uterus
bicornate 
septated uterus
DES (T shape)
18
Q

Abnormality of the uterus - Ix

A 
case Hx
pelvic exam
US
MRI
laparoscopy 
hysteroscopy
19
Q

Endometrial hyperplasia - S&S

A

abnormal bleeding - intermenstrual, postcoital, postmenopausal

20
Q

Endometrial hyperplasia - Risk factors

A

increase BMI
unopposed oestrogen (tamoxifen)
an ovulation (PCOS)
some tumours

21
Q

Endometrial hyperplasia - What does it progress to if left untreated?

A

CA

22
Q

Endometrial hyperplasia - Ix

A 
case Hx
pelvic exam
US
CT
MRI
hysteroscopy
endometrial biopsy
23
Q

Endometrial hyperplasia - Tx

A
  • Spontaneous regression if no atypia ➤ 75% cases. Regression increase with progestogen.
  • Not wanting to maintain fertility ➤ total abdominal hysterectomy B salpingo-oophorectomy (TAHBSO)
  • Atypia + want fertility ➤ monitor, ?H
24
Q

Endometrial CA - S&S

A 
postmenopausal bleeding
dyspareunia
intermenstrual bleeding
abnormal watery discharge 
pelvic P
25
Q

Endometrial CA - Risk factors

A

age
unopposed oestrogen ➤ M (tamoxifen), obesity, PCOS, DM, irregular ovulation, malignancy
length of years menstruating
nulliparity
endometrial hyperplasia
hereditary non-polyposis colorectal CA (HNPCC)

26
Q

Endometrial CA - Stages

A

I: in uterus
II: uterus + cervix
III: spread beyond uterus but not reached rectus, bladder but involvement of pelvic LN
IV: spread past pelvis ➤ bladder, rectum, distant parts of the body

27
Q

Endometrial CA - Tx

A

surgery - total abdominal hysterectomy
radiation
M - synthetic progestin
chemo

28
Q

Uterine prolapse - Why?

A

Pelvic floor muscles & ligaments stretch & weaken ➤ inadequate support ➤ uterus protrude

29
Q

Uterine prolapse - When?

A

Any age

Post-menopausal ++

30
Q

Uterine prolapse - Causes

A 
damage of supporting tissue ➤ pregnancy, childbirth
gravity
decrease oestrogen
straining 
chronic cough
31
Q

Uterine prolapse - S&S

A 
sensation of heaviness in pelvis
tissue protruding from vagina
urinary pbs ➤ retention, incontinence
LBP
bowel pbs
32
Q

Uterine prolapse - Risk factors

A 
> 1 vaginal delivery 
large baby
increase age - decrease oestrogen
heavy lifting
chronic coughing
straining
genetic
conditions - obesity, COPD, constipation, Marfan's, hyper mobility, EDS
33
Q

Uterine prolapse - Tx

A

vaginal pessary
surgery - repair, hysterectomy
exercises
no smoking

34
Q

Uterine prolapse - Prevention

A

decrease weight
high fibre diet
pelvic floor ex

Gynae exam (11 decks)

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