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Endo/Repro > Uterus - Histology, DUB, Inflammatory Disorders, Ednometriosis > Flashcards

Uterus - Histology, DUB, Inflammatory Disorders, Ednometriosis Flashcards

1
Q

What will patients complain of that may suggest that the uterus is the culprit?

A
  • Infertility or pregnancy
  • Amenorrhea, dysmenorrhea
  • Discharge –> blood
  • Pain
  • A recurrence or other medical condition
  • Systemic disease or syndrome
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2
Q

What happens to the endometrium during the menstrual cycle?

A
  • Undergoes dynamic physiologic and morphologic changes in response to sex steroid hormones produced in the ovary
  • Ovary is influenced by hormones produced by the pituitary due to signals from the hypothalamus
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3
Q

What are the two major components of the uterus?

A
  • Myometrium

- Endometrium

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4
Q

What is the myometrium composed of?

A
  • Tightly interwoven bundles of smooth muscle that form the wall of the uterus
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5
Q

What is the endometrium composed of?

A
  • Glands embedded in a cellular stroma

- Lines the internal cavity of the uterus

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6
Q

What are the most common disorders that affect the uterus?

A
  • Endocrine imbalances
  • Complications of pregnancy
  • Neoplastic proliferation
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7
Q

Why is the histology of the endometrium important?

A
  • Can be used to assess hormonal status, document ovulation, and determine causes of endometrial bleeding and infertility
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8
Q

What is the first five days of a menstrual cycle?

A
  • The menstrual phase
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9
Q

What occurs during the menstrual phase?

A
  • Initiated with the dissolution of the corpus luteum and the subsequent drop in progesterone levels –> functionalis layer degenerates/shed
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10
Q

What is the the proliferative phase?

A
  • Day 5-14
  • Marked by rapid growth of glands and stroma arising from the deeper portion of the endometrium
  • Glands are straight, tubular structures lined by regular, tall, pseudostratified columnar cells
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11
Q

What is the endometrial stroma composed of?

A
  • Spindle cells with scant cytoplasm that are also actively proliferating
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12
Q

When is ovulation?

A
  • Day 14 in the cycle
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13
Q

What marks post ovulation?

A
  • Appearance of secretory vacuoles beneath the nuclei in the glandular epithelium (subnuclear vacuoles)
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14
Q

What happens during the secretory phase?

A
  • Progesterone down-regulates the expression of estrogen receptor in both the glands and the stroma
  • The result is suppressed endometrial proliferation
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15
Q

What happens during the fourth week of the cycle, during the later half of the secretory phase?

A
  • Basal vacuoles progressively move towards the apical surface
  • Glands become more tortuous and produce a serrated appearance (saw tooth) –> accentuated by secretory exhaustion and shrinkage of the glands
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16
Q

How does the stroma change in the late half of the secretory phase?

A
  • Predominantly due to progesterone
  • Stromal cell hypertrophy
  • Increased ground substance and edema
  • Cytoplasmic eosinophilia
17
Q

What is the most common cause for dysfunctional uterine bleeding?

A
  • Anovulatory cycle
18
Q

What is dysfunctional uterine bleeding?

A
  • Bleeding that is not associated with an underlying structural abnormality
19
Q

What are some less common causes of dysfunctional uterine bleeding?

A
  • Generalized metabolic disturbances (obesity, malnutrition, other chronic systemic diseases)
  • Ovarian lesions (functioning tumors, polycystic ovary disease)
  • Endocrine disorders (thyroid, adrenal, pituitary)
20
Q

What could failure of ovulation result in?

A
  • Excessive endometrial stimulation by estrogens that is unopposed by progesterone
21
Q

What could repeated anovulation result in?

A
  • Bleeding that may prompt an endometrial biopsy
22
Q

What are some structural causes of heavy menstrual bleeding (HMB)?

A
  • PALM
  • Polyps (endometrial or cervical)
  • Adenomyosis
  • Leiomyoma
  • Malignancy and hyperplasia
23
Q

What are some nonstructural causes of HMB?

A
  • COEIN
  • Coagulopathy
  • Ovulation dysfunction
  • Endometrial (primary disorders of the endometrium)
  • Iatrogenic
  • Not yet classified
24
Q

Why is the endometrium and myometrium relatively resistant to infections?

A
  • Endocervix forms a barrier to ascending infection

- Chronic inflammation in the cervix is common and usually insignificant

25
Q

What is the cause of acute endometritis?

A
  • Uncommon but limited to bacterial infections that arise after delivery or miscarriage
26
Q

What are the predisposing factors for acute endometritis?

A
  • Retained products of conception
27
Q

What are the causative agents in acute endometritis?

A
  • Group A hemolytic strep
  • Staphylococci
  • Other bacteria
28
Q

What is chronic endometritis associated with?

A
  • Chronic pelvic inflammatory disease
  • Retained gestational tissue, postpartum or post abortion
  • Intrauterine contraceptive devices
  • TB (either from miliary spread or drainage of tuberculous salpingitis)
  • No cause identified in 15%
29
Q

What is a major diagnostic feature of chronic endometritis?

A
  • Presence of plasma cells on histology
30
Q

What are some symptoms of endometriosis?

A
  • Infertility
  • Dysmenorrhea
  • Dyspareunia
  • Pelvic pain
31
Q

What are some symptoms of adenomyosis?

A
  • Menometrorrhagia
  • Colicky dysmenorrhea
  • Dyspareunia
  • Pelvic pain
32
Q

What is endometriosis?

A
  • Presence of ectopic endometrial tissue at a site outside the uterus
  • Commonly includes both glands and stroma but sometimes could only be stroma
33
Q

What are some sites of endometriosis?

A
  • Ovaries
  • Uterine ligaments
  • Rectovaginal septum
  • Cul de sac (rectouterine pouch of Douglas)
  • Pelvic peritoneum
  • Large and small bowel of appendix
  • Mucosa of cervix, vagina, and fallopian tubes
  • Laparotomy scars
34
Q

What is adenomyosis?

A
  • Presence of endometrial tissue within the uterine wall
35
Q

What is the pathogenesis theories of endometriosis?

A
  1. Regurgitation theory - Retrograde flow of menstrual endometrium thru the fallopian tubes
  2. Benign metastasis theory - endometrial tissue spreads via blood vessels and lymphatic channels
  3. Metaplastic theory - Endometrium arises from coelomic mesothelium or mesonephric remnants that undergo endometrial differentiation
  4. Extrauterine stem/progenitor cell theory - bone marrow derived stem/progenitor cells differentiate into endometrial tissue
36
Q

What do the stromal cells in ectopic endometrial tissue produce?

A
  • Estrogen due to high levels of aromatase and increased retinoic acid
37
Q

How is endometriosis diagnosed?

A
  • Clinical/Ultrasound/Laparoscopically
  • Bleeding periodically/cyclically that produces red/blue to yellow/brown nodules on or beneath the mucosa or serosa (powder burn marks)
  • When extensive, can cause fibrous adhesions

Endo/Repro (31 decks)

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