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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

A

around 40

24
Q

what conditions is adenomyosis associated with

A

endometriosis

fibroids

25
Q

what hormone is adenomyosis dependent on

A

oestrogen

26
Q

what are the symptoms of adenomyosis

A

asymptomatic

if symptomatic: regular but heavy/painful periods

27
Q

what would you expect to find on examination in a patient with adenomyosis

A

tender slightly enlarged uterus

28
Q

how do you diagnose adenomyosis

A

MRI

29
Q

what is the treatment for adenomyosis

A

Progesterone IUS/COCP
+/- NSAIDS for menstrual symptoms

hysterectomy is often required

30
Q

what is an intrauterine polyp

A

small benign tumour in the uterine cavity, mostly endometrial but may be submucosal

31
Q

what is the worry with intrauterine polyps

A

they sometimes contain endometrial carcinoma

32
Q

what is the peak age for intrauterina polyps

A

40-50

33
Q

what factors are thought to increase the risk of intrauterine polyps

A

high oestrogen levels
post-menopausal women
tamoxifen

34
Q

if symptomatic, what can intrauterine polyps cause

A

menorrhagia and intermenstrual bleeding and very occaisonally, prolapse

35
Q

how do you diagnose intrauterine polyps

A

USS/ post hysteroscopy

36
Q

what is the treatment for intrauterine polyps

A

resection

37
Q

what is haematometroa

A

accumulation of menstrual blood in the uterus due to outflow obstruction

38
Q

what is usually the cause of congenital uterine malformations

A

failure of fusion of the mullerian ducts at 9 weeks

39
Q

what is the most common genital tract carcinoma in women

A

endometrial

40
Q

what is the peak age for endometrial carcinoma

A

60

41
Q

what kind of cancer does endometrial carcinoma tend to be

A

columnated endometrial gland cells (90%)

adenosquamous carcinoma (worse prognosis)

42
Q

what are risk factors for endometrial carcinoma

A 
high oestrogen:progesterone ratio
obesity (high peripheral conversion of androgens to oestrogen) 
PCOS
ovarian granulosa cell tumour 
tamoxifen
43
Q

what are protective factors for endometrial cancer

A

pregnancy

COCP

44
Q

what are some signs of premalignant endometrial carcinoma

A

cystic hyperplasia of the endometrium manifesting in atypical menstruation or post-menopausal bleeding

45
Q

what are the clinical features of endometrial carcinoma

A

post-menopausal bleeding
irregular/intermenstrual bleeding with occasional recent onset menorrhagia
abnormal smear

46
Q

how do you stage endometrial carcinoma

A 
1a = endometrium only 
1b = <1/2 the myometrium
1c = >1/2 myometrium 
2a = cervical glands 
2b = cervical stroma 
3 = outside uterus
47
Q

how should you investigate suspected endometrial carcinoma

A

hysteroscopy + biopsy

MRI
CXR for pulmonary spread

48
Q

how many patients with endometrial carcinoma present with stage 1

A

75%

49
Q

how do you treat endometrial carcinoma

A

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
Q

what adjuvant therapy is used to reduce the risk of local recurrence in endometrial carcinoma

A

vaginal vault radiotherapy

51
Q

what is the prognosis of endometrial carcinoma

A

stage 1 = 95% 5 year survival
2 = 66%
3 = 25%

52
Q

what are some poor prognostic factors for endometrial carcinoma

A 
older age
advanced stage
deep myometrial invasion 
high tumour grade
adenosquamous histology
53
Q

what is the prognosis of leimyosarcoma

A

5 year survival 30%

Gynaecology (14 decks)

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