uterus Flashcards
1
Q
dysfunctional uterine bleeding occurs when and why
A
shortly after menarche and during perimenopause d/t increased anovulatory cycles
2
Q
main reason for dysfunctional uterine bleeding
A
absence of anatomic lesion; problem with the hypothalmic-pituitary-ovarian hormonal axis
3
Q
other 3 causes of dysfunctional uterine bleeding
A
PCOS, exogenous obesity, adrenal hyperplasia
4
Q
clinical feature of dysfunctional uterine bleeding
A
abnormal bleeding with an unremarkable physical exam in a very young or perimenopausal woman
5
Q
abnormal bleeding with an unremarkable physical exam in a very young or perimenopausal woman
A
think dysfunctional uterine bleeding
6
Q
initial test for abnormal bleeding
A
B-hCG
7
Q
postmenopausal bleeding
A
cancer until proven otherwise; do endometrial bx
8
Q
reasons for these tests for abnormal bleeding
- CBC
- pap smear
- G/C probe
- TFTs and prolactin
- Platelet count, PT/PTT
- Ultrasound
A
- CBC: anemia
- pap smear: rule out cervical cancer
- G/C probe: cervitis
- TFTs and prolactin: hypo/hyperthyroidism and hyperprolactinemia
- Platelet count, PT/PTT: Willebrand d/s and factor XI def-primarily in adolescents
- Ultrasound: uterine masses, PCOS, endometrial thickness
9
Q
DUB: do what trial test
A
prolactin. If the bleeding stops, then anovulatory cycles are confirmed.
10
Q
DUB: who to give oral contraceptives to
A
older women w/out risk factors.
avoid in smokers, HTN, DM, hx of vascular d/s, breast cancer, liver disease, focal headaches
11
Q
DUB: what to use in younger pts
A
cyclic progestins
12
Q
DUB: what is diagnostic and curative
A
D and C
13
Q
DUB: tx for refractory cases
A
endometrial ablation or vaginal hysterectomy
14
Q
tx for acute heavy bleeding
- 1st line
- 2nd line
- if bleeding is not controlled w/in 12-24 hrs
A
- high dose estrogen IV stabilizes the endometrial lining and typically stops bleeding w/in 1 hr.
- if estrogen contraindicated, do high dose progestin therapy alone
- if bleeding is not controlled w/in 12-24 hrs: Do a D&C
15
Q
tx for ovulatory bleeding
A
- NSAIDs to decrease blood loss
- tranexamic acid 5 days during menses
- if hemodynamically stable, do OCPs, progestin po or inj, or insert a progestin IUD
16
Q
tx for anovulatory bleeding
A
- progestins x 10 days to stimulate withdrawal bleeding
- OCD
- progestin IUD
17
Q
goal for tx for anovulatory bleeding
A
goal to convert proliferative endometrium to secretory endometrium(to decrease risk of endometrial hyperplasia/cancer)
18
Q
75% endometrial cancer type and type of women/race too
A
adenocarcinoma; post menopausal women; white more than black women
19
Q
worse prognostic factor in endometrial cancer
A
the older the worse
20
Q
4th most common malignancy in women in the U.S.
A
endometrial cancer
21
Q
what is endometrial cancer not related to
A
sexual history
22
Q
protective effect in endometrial cancer
A
oral contraceptives
23
Q
unopposed estrogen stimulation, chronic tamoxifen use, nulliparity, infertility, late menopause, DM, HTN, gallbladder d/s,
A
all risk factors for endometrial cancer
24
Q
cardinal symptom and 3 other symptoms in endometrial cancer
A
- 90% will have inappropriate uterine bleeding
- obesity, HTN, DM
25
testing for postmenopausal bleeding to rule out endometrial cancer
pap smear, endocervical curettage, endometrial biopsy
26
endometrial biopsy accuracy rate
90-95%
27
other 2 tests for postmenopausal bleeding to rule out endometrial cancer
fractional D&C, transvaginal ultrasonography
28
tx of endometrial cancer
1) for basis of tx and staging
2) radiotherapy vs chemo
3) recurrence tx
1) total hyst with bil salpingo-oophorectomy with peritoneal lymphnode and tissue sampling
2) radiotherapy maybe. chemo for advanced stages
3) recurrence treated w/ high dose progestins or anti-estrogens
29
pap smear for endometrial cancer
negative
30
metrorrhagia
bleeding which occurs at any time during the menstrual cycle
31
bleeding which occurs at any time during the menstrual cycle
metrorrhagia
32
menometrorrhagia
heavy bleeding which occurs at any time during the menstrual cycle
33
heavy bleeding which occurs at any time during the menstrual cycle
menometrorrhagia
34
dysmenorrhea
menstrual pain which interferes with ADLs
35
menstrual pain which interferes with ADLs
dysmenorrhea
36
oligomenorrhea
menstrual periods which occur at intervals greater than 35 days
37
endometriosis is usually found where
pelvis or ovary(60%)
38
endometriosis occurs in who and what age
nulliparous women in late 20s or early 30s
39
infertility and endometriosis
infertility is common. It is found in 25-34% of infertile women
40
endometriosis symptoms
dysmenorrhea, deep thrust dyspareunia, dyschezia, spotting, pelvic pain, infertility
41
dyschezia
difficulty passing bowel movement
42
dysmenorrhea, deep thrust dyspareunia, dyschezia, spotting, pelvic pain, infertility
endometriosis symptoms
43
endometriosis signs
tender nodularity of the cul de sac and uterine ligaments and a fixed uterus
44
tender nodularity of the cul de sac and uterine ligaments and a fixed uterus
endometriosis signs
45
endometriosis symptoms and degree of disease
they do not correlate
46
endometriosis testing(2)
ultrasonography and laparoscopy
47
medical tx of endometriosis
NSAIDs, prostaglandin synthetase inhibitors, combined oral contraceptives or progestins, GnRH agonist, danazol
48
surgical tx of endometriosis
laparoscopic fulguration(destruction of tissue using high voltage electricity) or total hyst
49
chocolate cysts
endometriomas
50
NSAIDs, prostaglandin synthetase inhibitors, combined oral contraceptives or progestins, GnRH agonist, danazol
medical tx of endometriosis
51
what is adenomyosis
extension of endometrial glands into the uterine musculature
52
adenomyosis and endometriosis relation
not related
53
adenomyosis symptoms
severe secondary dysmenorrhea OR most pts asymptomatic
54
adenomyosis triad
pain, menorrhagia, enlarged-boggy-symmetric uterus
55
adenomyosis tests
- pelvic U/S to detect it, r/o pregnancy.
| - endometrial bx, fractional D&C, hysteroscopy all to rule out endometrial cancer
56
avoid what tx in adenomyosis
hormonal treatment
57
tx of adenomyosis
- definitive
- other tx (3)
- hysterectomy definitive
| - others: D&C, GnRH agonist, mifepristone
58
- hysterectomy definitive
| - others: D&C, GnRH agonist, mifepristone
tx of adenomyosis
- definitive
- other tx (3)
59
uterus is irregular and mobile
uterine myomas
60
if a uterine mass continues to grow after menopause
consider malignancy
61
fibroids occur at what age, race, FH
occur in 4th decade, blacks, +FH
62
fibroids
- depend on what
- appear in increased frequency in women who have what (3)
depend on estrogen and appear with increased frequency in women who have endometrial hyperplasia, anovulatory states, and estrogen producing ovarian tumors
63
women with fibroids...
- have how much of an increase of endometrial cancer
- risk of what is else is increased
- 4 fold
| - spontaneous abortion
64
fibroids locations
- subserous
- intramural
- submucous
- what causes uterine bleeding
fibroids locations
- subserous (deforming external serosa)
- intramural (w/in uterine wall)
- submucous (deforming uterine cavity)
- what causes uterine bleeding- submucous
65
firm, enlarged irregular uterine mass
fibroids; could also be asymptomatic
66
menorrhagia, metorrhagia, intermenstrual bleeding, dysmenorrhea
fibroids
67
common symptom of fibroid
bleeding
68
fibroid dx tests (5)
pelvic U/S, pelvic MRI, D&C, hysterectomy, and laparoscopy
69
fibroid symptomatic tx
myomectomy, hysterectomy, or D&C
70
what can reduce fibroids tumor size (2)
| and length of treatment
GnRH agonists and mifepristone; tx limited to 6 months
71
fibroids tx
- restore fertility
- no desire of fertility
- final step
- GnRH agonists
- uterine arterial embolization or endometrial ablation
- hysterectomy
72
leuprorelin
- GnRH agonist
| - causes a decrease in LH and FSH and thereby a decrease in estrogen
73
cobblestone uterus on exam
fibroids
74
fibroids size will increase and decrease with what
increase with pregnancy and decrease after menopause
75
endometrial cancer relation to vaginal bleeding
vaginal bleeding is present in 80% of women with endometrial cancer
only 5-10% of women with abnormal vaginal bleeding have endometrial cancer
76
when to perform a biopsy for endometrial cancer in postmenopausal women
any bleeding or spotting
77
when to perform a biopsy for endometrial cancer in premenopausal women
[after initial workup and in the setting of unopposed estrogen- obesity, DM]
- sustained intermenstrual bleeding
- menorrhagia
- amenorrhea
78
when to do a transvaginal and endometrial stripe
postmenopausal women. under 4 mm unlikely cancer
79
uterine prolapse
- increases 50% after what
- race
- menopause
| - less common in asian and black women
80
obesity, asthma, COPD, pelvic tumor, ascities
predisposes pts to prolapse
81
cystocele
bladder herniating into vagina
82
rectocele
rectum herniating into vagina
83
enterocele
small intestine herniating into vagina
84
uterine prolapse symptoms
- worse with what
- relieved with what
- worse after prolonged standing or late in day
| - relieved by lying down
85
uterine prolapse symptoms (3)
vaginal fullness, lower abdominal aching, low back pain
86
* vaginal fullness, lower abdominal aching, low back
- worse after prolonged standing or late in day
- relieved by lying down
prolapse symptoms
87
uterine prolapse grading
0 is no descent; 4 is through the hymen
88
falling out sensation or feeling of sitting on a ball
moderate uterine prolapse
89
most uterine prolapses accompanied by what (3)
cystocele, rectocele, or enterocele
90
non surgical tx for uterine prolapse
wt reduction, smoking cessation, pelvic muscle exercises, vaginal pessary
91
surgical tx for uterine prolapse
mesh, hyst, sacrocolpopexy, or uterosacral ligament suspension may also be necessary
92
PID includes what 5 disorders
acute salpingitis, IUD related pelvic cellulitis, tuboovarian abscess, pelvic abscess
93
PID definition
polymicrobial infection of fallopian tubes and pelvis
94
2 complications of PID
ectopic and infertility
95
PID symptoms (4)
purulent vaginal discharge, BILATERAL PELVIC/ABD PAIN, n/v, fevers
96
pain sign of PID, next sign
cervical motion tenderness; friable cervix
97
cervical motion tenderness/chandelier sign
PID or cervicitits
98
purulent vaginal discharge, BILATERAL PELVIC/ABD PAIN, n/v, fevers
PID
99
2 main organisms with PID
G/C
100
dx PID
- what to find G/C (2)
- imaging
- invasive
- if no improvement in 48 hrs then order what
- DNA probe and gram stain
- transvaginal ultrasonography to differentiate acute and chronic inflammation or presence of adnexal masses
- culdocentesis- needle to transvaginal space to culture fluid
- laparoscopy to visualize abdominal and pelvic structure
