Uterus and Its Abnormalities Flashcards
What ligament carries all the ovarian vessels, and what are those vessels
suspensory ligament of the ovary
ovarian artery
ovarian nerve plexus
ovarian vein
ovarian lymph
How is the uterus fixed in the pelvis
via the cervix and endopelvic fascia forming anchoring ligaments
what is the normal position of the uterus and in what % is this seen in
name the other type + %
anteverted and retroflexed 80%
retroversion and retroflexed 20%
what does a retroverted retroflexed uterus predispose to
prolapse
what is the vascular supply of the uterus
uterine artery of the internal iliac artery, anastamosis with the uterine artery (branch at L2)
drained by the uterine vein
what is the nerve supply of the uterus
sympathetic - T12-L2 R+L hypogastric nerve
parasympathetic - L2-4 splanchnic nerve and visceral afferent
somatic - pudendal nerve
what is a fibroid
benign tumour of the myometrium
what is the prevalence of fibroids
25%
what are risk factors for fibroids
menopausal or peri-menopausal women
afro-caribbean women
women with a family history
what are some protective factors for fibroids
multiparity
COCP/Depot
How big can fibroids get
can vary massively, from mm to filling the abdomen
what is fibroid growth dependent on
oestrogen/progesterone
what proportion of fibroids are symptomatic and what are these symptoms
50%, most symptoms are due to mass effect
menorrhagia
dysmenorrhagia
bladder issues - frequency/urgency
fertility issues - block tubes/prevent implantation
what would you expect to find on examination with a patient with fibroids
solid mass palpable in the pelvis and will be continuous with the uterus
what are some complications of fibroids
enlargement + calcification
degeneration (red degeneration)
malignancy
issues with pregnanacy (premature labour, malpresentation, obstructed labour, PPH)
what is red degeneration of a fibroid
thought to be inadequate blood supply of a fibroid leading to sudden acute adominal pain
what are risk factors for red degeneration of fibroids
large size (>5cm) pregnancy
how often does a fibroid turn turn out to be a malignant growth and what kind of growth does it tend to be
0.1%
leiomyosarcoma
how do you diagnose fibroids
USS may be helpful but a laporoscopy/MRI is required to differentiate it from an ovarian mass or adenomyosis
what is the treatment for fibroids
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
how long should GnRH be used for fibroids and why, and when is it usually used
6 months due to side effects therefore it is used pre-surgery
what is adenomyosis
presence of endometrium in the myometrium
what is the most common age for adenomyosis
around 40
what conditions is adenomyosis associated with
endometriosis
fibroids
what hormone is adenomyosis dependent on
oestrogen
what are the symptoms of adenomyosis
asymptomatic
if symptomatic: regular but heavy/painful periods
what would you expect to find on examination in a patient with adenomyosis
tender slightly enlarged uterus
how do you diagnose adenomyosis
MRI
what is the treatment for adenomyosis
Progesterone IUS/COCP
+/- NSAIDS for menstrual symptoms
hysterectomy is often required
what is an intrauterine polyp
small benign tumour in the uterine cavity, mostly endometrial but may be submucosal
what is the worry with intrauterine polyps
they sometimes contain endometrial carcinoma
what is the peak age for intrauterina polyps
40-50
what factors are thought to increase the risk of intrauterine polyps
high oestrogen levels
post-menopausal women
tamoxifen
if symptomatic, what can intrauterine polyps cause
menorrhagia and intermenstrual bleeding and very occaisonally, prolapse
how do you diagnose intrauterine polyps
USS/ post hysteroscopy
what is the treatment for intrauterine polyps
resection
what is haematometroa
accumulation of menstrual blood in the uterus due to outflow obstruction
what is usually the cause of congenital uterine malformations
failure of fusion of the mullerian ducts at 9 weeks
what is the most common genital tract carcinoma in women
endometrial
what is the peak age for endometrial carcinoma
60
what kind of cancer does endometrial carcinoma tend to be
columnated endometrial gland cells (90%)
adenosquamous carcinoma (worse prognosis)
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
what are protective factors for endometrial cancer
pregnancy
COCP
what are some signs of premalignant endometrial carcinoma
cystic hyperplasia of the endometrium manifesting in atypical menstruation or post-menopausal bleeding
what are the clinical features of endometrial carcinoma
post-menopausal bleeding
irregular/intermenstrual bleeding with occasional recent onset menorrhagia
abnormal smear
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
how should you investigate suspected endometrial carcinoma
hysteroscopy + biopsy
MRI
CXR for pulmonary spread
how many patients with endometrial carcinoma present with stage 1
75%
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
what adjuvant therapy is used to reduce the risk of local recurrence in endometrial carcinoma
vaginal vault radiotherapy
what is the prognosis of endometrial carcinoma
stage 1 = 95% 5 year survival
2 = 66%
3 = 25%
what are some poor prognostic factors for endometrial carcinoma
older age advanced stage deep myometrial invasion high tumour grade adenosquamous histology
what is the prognosis of leimyosarcoma
5 year survival 30%
