Uterus Flashcards
How do fibroids present?
Menorrhagia
Pelvic pain
Sub fertile
Bladder and bowel dysfunction
Bulky uterus
Management of fibroid
1) Myomectomy
2) hysterectomy
What is red degeneration of a fibroid?
Pregnant related complicated which usually occurs in 3rd trimester.
Due to thrombosis of vessels that supply fibroid.
Abdo pain and localised peritoneal tenderness. Associated n+v
Rx = bed rest and analgesia.
Symptoms of endometriosis ?
Cyclical deep pelvic pain
Deep dysparenuina
Menorrhagia
Subfertility
Investigation of endometruiosis’/
1) Pelvic USS
2) Diagnostic test is an explorative laparoscopy
Management of endometriosis?
Curative is a hysterectomy with bilateral oophorectomy but this should only be carried out in women who do not wish to get pregnant.
IUS is helpful, as is COCP.
Mefanamic acid for pain.
Management of atypical endometrial hyperplasia?
Total hysterecomy with bilateral scalping-oophrectomy
Management of endometrial hyperplasia without atypia?
1) Monitor and IUS
2) Oral progesterone.
What thickness of endometrium is suspicious for A POST menopausal woman?
> 5mm.
A pipelle can be carrier out during TVUS.
Dilatation and curretage requires GA and hysteroscopuy.
What is the investigation to stage pelvic disease in endometrial disease?
MRI.
Stage 1 - 4 of endometrial cancer?
1) confined to uterus
2) invasions of cervical stroke.
3) local and regional spread e.g. adnexa / para aortic nodes.
4) Invasion of the bladder, bowel or distant mets.
What is used to post op to prevent recurrence in endometrial cancer?
Vaginal bracherapy.
Note::
Radiotherapy is used more often than chemotherapy in endometrial cance.r
Meigs syndrome usually occurs on what side/
RHS
Fibroma + pleural effusion + aspires.
INvestigaion of ovarian mass?
Pelvic USS +/- FNA
Explorative laparoscopy.
What is a chocolate cyst?
Endometriosis
What is a follicular cyst/
A functional cyst that develops due to failure of a follicle to rupture during menstruatiuoin.
Risk factors for ovarian cancer?
BRCA 1
BRCA 2
Lynch syndrome .
Main tumour marker for ovarian cancer/.
CA 125
Rough 4 stages of ovarian cancer?
1) limited to ovaries
2) limited to pelvis
3) Confined to abdominal peritoneum
4) Distanst mets.
All patients with ovarian cancer should be offered what Rx?
Surgery.
Standard os Abdominal washing with TAH + BSO + omenectomy + maximal tumour debunking.
Chemotherapy is offered to ovarian cancer stage what/.
Stage 1C and above.
If fertility is required in ovarian cancer what op can be done?
Keep uterus and do a unilateral scalping-oopherctomy
Management of polycysit c ovarian syndrome?
1) COCP (controls periods and treats hirsuitiosm)
2) Merformin, improves insulin resistance and aids ovulation
Diagnostic criteria for PCOS?
1) Polycystic ovaries
2) Oligomenorrhoea or amenorrhoea
3) Hyperandrogenism, (acne , hirsuitsm, baldness)
Infertility affects how many couples?
1/6
Risk factors for inferttility’?
Age > 35
BMI < 20 or > 30
No previous pregnancies
Lifestyle: smoking, alcohol, drugs
Day 21 progesterone confirms what?
Confirms ovulation if > 30.
How do you assess tubal patency?
Hysterosalpingogram.
Screen for STIs in infertility clinic.
Screen for rubella, hiv, hep B/C.
