Uterus Flashcards
What is endometritis? Presentation?
Uterine infection usually following after miscarriage, TOP, childbirth, IUCD insertion or surgery
Lower abdominal pain
Fever
Uterine tenderness on bimanual palpation
Offensive vaginal discharge
What Ix and Mx in endometritis
High vaginal swabs and blood cultures if septic
Cefalexin with metronidazole for 7d
What is endometrial proliferation?
Oestrogen stimulates endometrial proliferation in first half of menstrual cycle, then influenced by progesterone and is shed at mesntration
Continuous high oestrogen levels (e.g. obesity) make endometrium hyper plastic
Eventually breaks down causing irregular heavy bleeding
What is pyometra? Association?
Pus distended uterus
Associated with salpingitis or secondary to outflow blockage
What is presentation for endometrial TB?
Acute salpingitis Subfertility Pelvic pain Menstrual disorders Pyosalpinx
What is treatment for endometrial TB? Side effects?
Rifampicin + Isoniazid + Pyrazinamide + Ethambutol for 2 months
Rifampicin + Isoniazid for further 4 months
R (orange secretions, altered LFTs)
I (peripheral neuropathy, give with vitamin B6)
P (Hepatotoxic)
E (colour blindness, optic neuritis)
Total abdominal hysterectomy with bilateral saplingo-oophorectomy if there are adnexal masses
What is normal endometrial thickness?
<5mm early cycle
11mm in proliferative phase
7-16mm late cycle
Endometrial cancer should be ruled out if endometrial thickness > 20mm or >4mm postmenopausal
Heterogenous appearance
Hypoechoic areas
What should endometrial thickness be if post-menopasual
Not on HRT - < 5mm
5-8.5 if on HRT
What is adenomyosis? Risk factors?
Functional endometrial tissue within the myometrium of the uterus
Benign invasion of the uterine wall
Pregnancy and childbirth
Caesarean section
Uterine surgery
Surgical management of miscarriage or TOP
What are clinical features of adenomyosis?
Menorrhagia
Dysmenorrhoea - progressive
Deep dyspareunia
Irregular bleeding
Symmetrically enlarged tender uterus
What investigation in adenomyosis?
Histological diagnosis after hysterectomy
TVUS - globular uterine configuration
MRI - endometrial-myometrial junctional zone
What is management for adenomyosis?
Definitive: Hysterectomy
Uterine artery embolisation - preserves fertility and blocks blood supply to adenomyosis to shrink it
NSAIDs for analgesia
Hormonal therapy for reduction of bleeding and cycle control:
What are hormonal treatments for adenomyosis?
COCP
Progestogens
Goserelin GnRH agonist
Reduce the proliferation of ectopic endometrial cells, reducing their mass and decreasing size of uterus and volume of blood lost
