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Gynaecology > Uterus and Its Abnormalities > Flashcards

Uterus and Its Abnormalities Flashcards

1
Q

What ligament carries all the ovarian vessels, and what are those vessels

A

suspensory ligament of the ovary

ovarian artery
ovarian nerve plexus
ovarian vein
ovarian lymph

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2
Q

How is the uterus fixed in the pelvis

A

via the cervix and endopelvic fascia forming anchoring ligaments

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3
Q

what is the normal position of the uterus and in what % is this seen in

name the other type + %

A

anteverted and retroflexed 80%

retroversion and retroflexed 20%

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4
Q

what does a retroverted retroflexed uterus predispose to

A

prolapse

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5
Q

what is the vascular supply of the uterus

A

uterine artery of the internal iliac artery, anastamosis with the uterine artery (branch at L2)

drained by the uterine vein

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6
Q

what is the nerve supply of the uterus

A

sympathetic - T12-L2 R+L hypogastric nerve
parasympathetic - L2-4 splanchnic nerve and visceral afferent
somatic - pudendal nerve

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7
Q

what is a fibroid

A

benign tumour of the myometrium

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8
Q

what is the prevalence of fibroids

A

25%

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9
Q

what are risk factors for fibroids

A

menopausal or peri-menopausal women
afro-caribbean women
women with a family history

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10
Q

what are some protective factors for fibroids

A

multiparity

COCP/Depot

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11
Q

How big can fibroids get

A

can vary massively, from mm to filling the abdomen

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12
Q

what is fibroid growth dependent on

A

oestrogen/progesterone

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13
Q

what proportion of fibroids are symptomatic and what are these symptoms

A

50%, most symptoms are due to mass effect

menorrhagia
dysmenorrhagia
bladder issues - frequency/urgency
fertility issues - block tubes/prevent implantation

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14
Q

what would you expect to find on examination with a patient with fibroids

A

solid mass palpable in the pelvis and will be continuous with the uterus

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15
Q

what are some complications of fibroids

A

enlargement + calcification
degeneration (red degeneration)
malignancy
issues with pregnanacy (premature labour, malpresentation, obstructed labour, PPH)

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16
Q

what is red degeneration of a fibroid

A

thought to be inadequate blood supply of a fibroid leading to sudden acute adominal pain

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17
Q

what are risk factors for red degeneration of fibroids

A 
large size (>5cm) 
pregnancy
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18
Q

how often does a fibroid turn turn out to be a malignant growth and what kind of growth does it tend to be

A

0.1%

leiomyosarcoma

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19
Q

how do you diagnose fibroids

A

USS may be helpful but a laporoscopy/MRI is required to differentiate it from an ovarian mass or adenomyosis

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20
Q

what is the treatment for fibroids

A

if asymptomatic - nothing

if symptomatic - 1st line NSAIDS + progestogens

transexamic acid, GnRH and HRT also are effective

surgical management:
hysteroscopy if polyps (3-4mm)
hysterectomy if large and fertility not required
myomectomy if large and fertility needs to be preserved
embolisation of the uterine artery

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21
Q

how long should GnRH be used for fibroids and why, and when is it usually used

A

6 months due to side effects therefore it is used pre-surgery

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22
Q

what is adenomyosis

A

presence of endometrium in the myometrium

23
Q

what is the most common age for adenomyosis

24
Q

what conditions is adenomyosis associated with

A

endometriosis

fibroids

25
what hormone is adenomyosis dependent on
oestrogen
26
what are the symptoms of adenomyosis
asymptomatic if symptomatic: regular but heavy/painful periods
27
what would you expect to find on examination in a patient with adenomyosis
tender slightly enlarged uterus
28
how do you diagnose adenomyosis
MRI
29
what is the treatment for adenomyosis
Progesterone IUS/COCP +/- NSAIDS for menstrual symptoms hysterectomy is often required
30
what is an intrauterine polyp
small benign tumour in the uterine cavity, mostly endometrial but may be submucosal
31
what is the worry with intrauterine polyps
they sometimes contain endometrial carcinoma
32
what is the peak age for intrauterina polyps
40-50
33
what factors are thought to increase the risk of intrauterine polyps
high oestrogen levels post-menopausal women tamoxifen
34
if symptomatic, what can intrauterine polyps cause
menorrhagia and intermenstrual bleeding and very occaisonally, prolapse
35
how do you diagnose intrauterine polyps
USS/ post hysteroscopy
36
what is the treatment for intrauterine polyps
resection
37
what is haematometroa
accumulation of menstrual blood in the uterus due to outflow obstruction
38
what is usually the cause of congenital uterine malformations
failure of fusion of the mullerian ducts at 9 weeks
39
what is the most common genital tract carcinoma in women
endometrial
40
what is the peak age for endometrial carcinoma
60
41
what kind of cancer does endometrial carcinoma tend to be
columnated endometrial gland cells (90%) adenosquamous carcinoma (worse prognosis)
42
what are risk factors for endometrial carcinoma
``` high oestrogen:progesterone ratio obesity (high peripheral conversion of androgens to oestrogen) PCOS ovarian granulosa cell tumour tamoxifen ```
43
what are protective factors for endometrial cancer
pregnancy | COCP
44
what are some signs of premalignant endometrial carcinoma
cystic hyperplasia of the endometrium manifesting in atypical menstruation or post-menopausal bleeding
45
what are the clinical features of endometrial carcinoma
post-menopausal bleeding irregular/intermenstrual bleeding with occasional recent onset menorrhagia abnormal smear
46
how do you stage endometrial carcinoma
``` 1a = endometrium only 1b = <1/2 the myometrium 1c = >1/2 myometrium 2a = cervical glands 2b = cervical stroma 3 = outside uterus ```
47
how should you investigate suspected endometrial carcinoma
hysteroscopy + biopsy MRI CXR for pulmonary spread
48
how many patients with endometrial carcinoma present with stage 1
75%
49
how do you treat endometrial carcinoma
stage 1 (75%) = hysterectomy + bilateral salpingooorphectomy above stage 1 = radiotherapy indicated high risk for nodal involvement = external beam therapy chemo has a limited role and isnt used a lot
50
what adjuvant therapy is used to reduce the risk of local recurrence in endometrial carcinoma
vaginal vault radiotherapy
51
what is the prognosis of endometrial carcinoma
stage 1 = 95% 5 year survival 2 = 66% 3 = 25%
52
what are some poor prognostic factors for endometrial carcinoma
``` older age advanced stage deep myometrial invasion high tumour grade adenosquamous histology ```
53
what is the prognosis of leimyosarcoma
5 year survival 30%

Gynaecology (14 decks)

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