Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

A - ObsNGynae > Uterus & its abnormalities > Flashcards

Uterus & its abnormalities Flashcards

1
Q

what is the lymph drainage of the uterus?

A

fundus - paraaortic nodes

rest - internal and external iliac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the blood supply to the uterus

A

uterine arteries

the uterine branch of the ovarian artery (forms anastomoses with uterine artery at Cornu)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what aree fibroids?

A

BENIGN tumour of thee MYOMETRIUM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are some protective factors against fibroids?

A

protective:
COCP, depot prosgestogeens
childbirth

risk factors:
afrocarribean, asian (more likely to get multiple)
Fhx - 1st degree relative
near menopause 
obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

growth of fibroids is dependent on?

how can growth change in the lifecourse of a woman./

A

oestrogen (and progesterone) dependent

In pregnancy may grow, shrink or show no change
Regress after menopause due to less oestrogens
Monoclonal origin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

which fibroids can sometimes form intracavity polyps?

A

submucosal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the presenting symptoms of a fibroid?

A
  1. 50% asymptomatic
    - can be incidental finding during US or physical exam

Symptoms related to site rather than size

  1. Heavy menstrual bleeding in 30%
  2. InterMBleeding : Submucosal or polypoid
  3. Pain
    - Only peroid pain
    - outside period if torsion, red degeneration or sarcomatous change occur
  4. Subfertility: distortion of uterine cavity
  5. Pressure symptoms- Urinary frequency or retention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

why can fibroids cause impaired fertility?

A

 Distortion of cavity - or not (intramural)
 Prevention of implantation (submucosal)
 Obstruction of tubal ostia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what symptoms will the following cause:

2 cm diameter submucosal fibroid
2 cm diameter subserosal fibroid

A

A 2 cm diameter submucosal fibroid will
often lead to abnormal menstrual bleeding:
- HeavyMB & InterMB

whereas
a 2 cm diameter subserosal fibroid will usually be
aymptomatic.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the types of uterine degeneration?

reasons they happen?

A

occur due to inadequate blood supply -perhaps fibroid has outgrown the supply

‘red degeneration’ is characterized by
pain and uterine tenderness; haemorrhage and necrosis
occur.

In ‘hyaline degeneration’ and ‘cystic degeneration’,
the fibroid is soft and partly liquefied.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the natural hx of a fibroid briefly?

A

Enlargement: slow

Degeneration

Malignancy : 0.1% .

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the complications of a fibroid?

A

Torsion of pedunculated fibroid = pain

Degenerations: Red (particularly in pregnancy) -> pain
Hyaline/cystic

Calcification (postmenopausal and asymptomatic)
- can cause new sx: all those of a normal fibroid

Malignancy Leiomyosarcoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what must be considered upon morcellatoin of a fibrod during a proceedure eg laparoscopic myomectomy?

A

if it turns out to be cancer not fibroid; leomyosarcoma, there is a small risk of tumour spread due to the morcellation - apple core piercing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what issues can fibroids cause in pregnancy? what complications can arise?

A

Associated with premature labour, malpresentations, transverse lie, obstructed labour and post
partum haemorrhage

 Red degeneration = common and can cause severe pain
 Should not remove at C-section due to heavy bleeding
 Torsion of pedunculated fibroids post-partum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

how are fibroids investigated?

A
  1. Abdominal exam
  2. Bloods : Hb for anaemia
  3. Refer for TVUS

Others:
 MRI
 Laparaoscopy
 Adenomyosis – fibroid-like mass, differentiated by MRI

 Hysteroscopy or hysterosalpingogram -> assess distortion of uterine cavitiy, particularly if fertility is an
issue. remove small fibroid polyp/submucosal fibroid.

 Hb
o Low due to bleeding
o Or high as fibroids can secrete EPO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how do you know if a fibroid is malignant?

A

fibroid growth in postmenopausal women not on HRT

or rapidly enlarging fibroids + pain

or sudden onset of pain in women of any age.

poor response to GnRH agonists or ulipristal acetate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how are fibroids managed?

A
  1. None if asymptomatic or slow growing
    B. Larger fibroids should be kept under surveillance as
    higher malignant potential
  2. Medical
    For HeavyMB: Tranexamic acid, NSAIDs (mefenamic acid),
    Progestogen - IUS: not great evidence for fibroids ( surely you cant place an ius into a distorted cavity?)

GnRH agonists
 Can be used if woman is near menopause or to shrink fibroid before surgery.
Max 6 months use. Loss of BMD. Not for teens

COCPs too no?

  1. Surgery
    - Hysteroscopy: Fibroid polyp or small (<3cm) submucous fibroid
    - Myomectomy: if medical tx failed but preservation of reproductive function is required
    - Hysterectomy: high patient satisfaction

others:
Uterine artery embolization - 80% success rate
Ablation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are the caveats of GnRH use for fibroids?

A

Restrict use to 6months due to loss of bone mineral density

 Not appropriate for women trying to conceive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are the caveats and. the considerations for the following in fibroid mx:

Hysterescopy
Uterine artery embolization
Hysterectomy

A

Hysterescopy:
Pretreatment with GnRH agonist for 1-2m shrinks fibroid, reduces vascularity and thins endometrium to make resection easier and safer

Uterine artery embolization :
Higher readmission rates than with myomectomy or hysterectomy
 Unclear affect on fertility

Hysterectomy:
GnRH/ Ulipristal acetate : 2-3 months prior. can allow less invasive method. to be used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are the caveats and. the considerations for the following in fibroid mx:

Myomectomy

A

Myomectomy:

  • risk heavy blood loss -> hysterectomy/blood transfusion
  • inc risk uterine rupture during labour
  • Adhesions form at surgivcal site - reduced fertility
  • GnRH preteatment needed if open
  • Perioperative injection of vasopressin directly into myometrium can reduce blood loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is adenomyosis, how does it present, and its aetiology?

A

Formerly endometriosis interna

Presence of endometrium and underlying stroma within the myometrium. Endometrium grows into myometrium to form adenomyosis. severe: pockets of blood in myometrium.

common around 40 years old
Associated with endometriosis and fibroids

Sx: painful, regular and heavy menstruation (or no symptoms)
Ex: mildly enlarged, tender uterus.
Symptoms subside after menopause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How is adenomyosis ivx and MX?

A

Ivx: MRI
- only way to distinguish from fibroid

Mx:
mirena IUS, COCP + NSAIDs
 Hysterectomy often required
 GnRH analogues 
 Oestrogen dependent condition but cause not fully known – effects on fertility unclear
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is ulipristal acetate?

uses?

A

Selective progesterone receptor modulators (SPRMs)
(e.g. oral ulipristal acetate) are a new class of drug that
reduce HMB,

commonly cause reversible amenorrhoea
and shrink fibroids (volume reduced by 50%, similar to
GnRH agonists) without causing bone density loss and
menopausal side effects

used short term in
preparation for surgery or long term intermittently to
control fibroid symptoms and avoid surgery altogether

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are the indications for c-section use in all future pregnancies after treatment for fibroids?

A

If the endometrial cavity is opened during myomectomy

or if the fibroids are multiple and/or large

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Endometrial tissue in myometrium is called?
adenomyosis
26
what is the difference between Adenomyosis and endometriosis?
endometriosis is when endometrial cells (the lining of the uterus) are in a location outside of the uterus. Adenomyosis is when these cells are within the uterus, in the uterine wall. hence Formerly: endometriosis interna
27
How does endometritis present and What are some causes ?
Presentation: Fever, Lower abdo pain, vaginal bleeding/discharge Causes: A few weeks post childbirth, Long labour Miscarriage C-section + intrauterine proceedures eg surgical termination, hysteroscopy, dilation & curettage etc IUD placement BASICALLY: anything that can place uterus at risk of infection
28
treatment for endometritis?
Antibiotics possible Evacuation of Retained PC
29
Name 2 origins of intrauterine polyps? where can they be found? What is the ivx?
endometrial submucous fibroids found: intracavity proalpsed through cervix ivx: Ultrasound, Hysteroscopy (can remove them as you do this)
30
name some risk factors for intrauterine polyp growth?
Women aged 40-50 -High oestrogen Tamoxifen- breast cancer tx but pro-oestrogen effects in the uterus
31
name some sx of IU polyps? What is the treatment?
Heavy MB/ Menorrhagia Inter menstraul bleeding treatment: Resection with cutting diathermy or avulsion
32
list some causes of haematometra?
Acquired: fibrosis (after endometrial resection, cone biopsy or by a carcinoma). Congenital: imperforate hymen blind rudimentary uterine horn,
33
a septate vagina is present in which congenital uterine malformation?
uterus didelphys
34
what causes Congenital uterine malformations? epidemiology?
Abnormalities result from differing degrees of failure of fusion of the two Mullerian ducts at about 9 weeks epidemiology: common but often NOT clinically important
35
what is the aetiology of uterus didelphys? how can this present?
Total failure of fusion of mullerian ducts: leads to two uterine cavities and cervices (didelphys) with sometimes a longitudinal vaginal septum; or one duct may fail, causing a ‘unicornuate’ uterus. If one duct develops better than the other one, a smaller ‘rudimentary horn’ is formed
36
what are the risks of Congenital uterine malformations?
renal anomalies - get imaging! 25% -> pregnancy-related problems eg malpresentations or transverse lie, preterm labour, recurrent miscarriage (<5% of these) or retained placenta.
37
how are Congenital uterine malformations treated?
Simple septa can be resected hysteroscopically; rudimentary horns need removal at either open or laparoscopic surgery. Bicornuate uteri are not treated surgically
38
after labour, if a woman is retaining the placenta, what are possible causes? (at this stage of card making lol)
Congenital uterine malformation
39
what is the pathology of Endometrial cancer?
Type 1: Adenocarcinoma of columnar endometrial gland cells = >90% cases - low grade, less aggressive - E2 sensitive, obesity related ``` Type2: adenosquamous carcinoma (malignant squamous + glandular tissue), clear cell, serous or carcinosarcoma ``` - high grade - not E2 sensitive - poorer prognosis
40
what is the epidemiology of Endometrial cancer EC?
Higherst prevalence at age 60 15% get it before menopause. <1% get under age 35 1% lifetime risk
41
which is most common gynae cancer?
Endometrial cancer
42
what is most common risk factor/ cause of EC? protective factors?
exposure to endogenous and exogenous oestrogens: obesity, diabetes, early age at menarche, nulliparity, late-onset menopause, older age (>55 years), unopposed oestrogen HRT and use of tamoxifen. protective: COCP + pregnancy
43
A woman comes in for the results of pipelle biopsy and subsequent histology of the endometrium atypical hyperplasia is found. what does this mean? how do we proceed?
Endometrial hyperplasia with atypia is a pre-malignant presentation in ECancer. it is due to E2 exposure Treatment: 1. no fertility wanted / menopausal: hysterectomy + BSO 2. Fertility preserved: progestogens (IUS or continuous oral) if no atypia : 1st line - progestogens + 3–6-monthly hysteroscopy and endometrial biopsy (repeat sample again) +referral to a fertility specialist
44
what are the presenting sx of EC? examniatoin findings
Post-menopausal bleeding (MOST COMMON - 10%) Intermenstraul bleeding or recent HMB/menorrhgia - in premenopausal examination: atrophic vaginitis cervical smear: abnormal columnar cells possible - CGIN
45
what are the characteristics of EC: metastesis etc?
Spreads directly through myometrium to the cervix and upper vagina  Ovares may be involves  Lymphatic spread = pelvic, then para-aortic  Late blood-borne spread
46
How is EC staged/graded?
 FIGO staging used (Stage for Spread)  Histological grading: G1-3, G1 = well differentiated
47
charcterise a stage 1 EC?
Stage 1 Lesions confined to uterus: 1 endometrium only 1a ½ of myometrial invasion 75% present with stage I disease
48
charcterise a stage 2 EC?
Stage 2 As above but in cervix also: | 2 Cervical stromal invasion, but not beyond uterus
49
charcterise a stage 3 EC?
Stage 3 Tumour invades through the uterus: 3a Invades serosa or adnexae 3b Vaginal and/or parametrial involvement 3Ci Pelvic node involvement 3cii Para-aortic involvement
50
charcterise a stage 4 EC?
Stage 4 Further spread: 4a In bowel or bladder 4b Distant metastases
51
what are the ivx for EC?
1. US and or Endometrial biopsy - required for diagnosis - pipelle/hysteroscopy 2. MRI if spread suspected – high risk histology seen or symptoms before these: ivx cuase of abnormal bleed are they on menopause?
52
woman is stage 3 EC, what is her prognosis?
depends on grade!
53
How is EC treated?
1. Surgical - TAH + BSO performed - use this for staging then determine nxt step: - any lymph spread ? - debatable benefit in lymphadenectomy Adjuvants: 2. Radiotherapy a. External beam o Following hysterectomy in patients with or at high risk of LN involvement b. Vaginal vault radiotherapy o Reduces local recurrence. Does not prolong survival 3. Chemotherapy - high-risk early stage disease and advanced stage disease
54
what are the risk factors of LN involvement in EC?
o Risk factors = deep myometrial spread, poor tumour histology/grade or cervical stromal involvement (stage 2)
55
what are prognostic indicators in EC?
Recurrence is most common at vaginal vault in first 3 years Poor prognostic fx = older age, advanced stage, deep myometrial invasion in stage 1 and 2, high tumour grade and adenosquamous histology
56
what are the indications for radiotherapy in EC?
High risk for extrauterine disease: deep myometrial or cervical stromal spread, poor grade Proven extrauterine disease Inoperable and recurrent disease Palliation for symptoms, e.g. bleeding
57
what is the prognosis of ec?
5 year survival: OVERALL 75% stage 1v- 90 stage 4 -25
58
give exampels of uterine sarcomas?
Leiomyosarcoma - malignant fibroid - fast growing and painful Mixed mullerian tumours Endomeetrial stromal tumours
59
what condition can present similarly to EC with IMB or Post menopausal bleeding?
Leiomyosarcoma - uterine sarcoma
60
Someone presents with HMB/PMB. TVUS shows thickened endometrium (>5). What do you do next?
Hysteroscopy + biopsy - if failed pipelle OR suspected polyp OR unknown cause - higher specificity than pipelle OR pipelle biopsy alone
61
Kissing ovaries are caused by what condition?
It’s an US sign seen in endometriosis
62
most common causes of Heavy meeenstrual bleeding?
1. Fibroids 2. Polyps Others Endometrial, cervical cancer etc
63
What are the different ways a biopsy of the endometrium can be done? indications?
Pipelle Hysteroscopy - when pipelle cant get sufficient sample of lining or cant get through cervix. can do it as outpatient or inpatient procedure. or in cases where there is endometrial thickening on TVUS and cause is unknown - do this so if there is polyp can remove straight away.
64
what is the main presenting triad in endometriosis? what are other key sx?
Triad: Dysmenorrhea, Dyspareunia, Subfertility Others: Dyschezia (pain with stools), asymptomatic
65
How would endometriosis be most accurately diagnosed in her case?
Hx Laparoscopy with biopsy (need histology for confirmation)

A - ObsNGynae (37 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions