Week 6 part 1 Flashcards
What do the majority of arteries of pelvis and perineum arise from?
Internal iliac artery
What are the exceptions for arteries supplying perineum coming from internal iliac?
Gonadal artery - L2 abdo aorta
Superior rectal artery - continuation of inferior mesenteric
wHAT Divisions does internal iliac split into?
[psterioor and anterior division (anterior usually visceral and posterior usually parietal)
What is the median umbilical ligament a remnant of which connected internal iliac to placetna through umbilical cord?
Umbilical artery
What artery of perineum is only present in males and its alternative in females is vaginal artery?
Inferior vesical artery
Internal iliac splits into anterior and posterior divisions - what comes from posterior division?
PILLS - posterior, iliolubar artery, lateral sacral arteries, superior gluteal artery
A branch of what artery goes to supply prostate?
Prostatic branch of inferior vesical artery
What are the trhee umbilical folds?
- Lateral umbilical fold - inferior epigastric vessels
- Medial umbilical fold - remnant of umbilical artery
- Median umbilical fold - urachus
What does anterior scrotal artery branch form?
External iliac artery
What artery does middle rectal artery come off?
Internal pudendal artery
What is the uterine artery in females a homolog of?
Artery to vas deferens
Between whast two female arteries does an anastomosis occur between?
Uterine artery and ovarian artery
Uterine artery and vaginal artery
What two branches does ovarian artery split into?
Tubual branch
Ovarian branch - gives ovaries dual blood supply
Where does venous drainage from pelvis mainly drain to?
Internal iliac vein - some via superior rectal to hepatic protal system, some via lateral sacral veins to internal vertebral venous plexus
Sciatic nerve roots?
L4-S3, splits into tibial and common fibular
What lymph nodes does superior pelvic viscera go to?
External iliac nodes
Common liac, aortic, thoracic duct, venous system
What lymph nodes does inferior pelvic viscera go to?
Internal iliac nodes
Common iliac, aortic, thoracic duct, venous system
What lymph nodes does superficial perineum go to?
Superficial inguinal nodes
What nerve supplies perineum?
Pudendal
What is the commonest investigation n gynaecology/
Ultrasound - no ionising radiation
Does the patient need a full bladder for transabfdomnal ultrasound?
YES - Acts as an acoustic window, distended bladder displaceds gas filled bowel loops out of pelvis (gas scatters ultrqsound beam and degrades image wuality)
Higher frequency ultrasound has a shorter wavelength and better spatial resolution, but…….
…. Higher frequencies are more likely to be scattered in the body and the ultrasound transducer has to be close to the target organ
Transvaginal scanning - need empty bladder
Young Patient who gets admitted to a&e with acute abdominal pain that passes after 6 hours.
Ruptured ovarian cyst
What is second line investigation after ultrasound in patients presenting with acute abdominal pain?
CT scan
What imaging is used for staging of gynaecological malignancy, especially ovarian and endometrial cancers?
CT
What is the only fatty lesion in dermatology?
Dermoid cyst - confirmed on CT
wHAT ENERGY does MRI use?
Radiofrequency energy
What does MRI give poor depiction of?
Lung parenchyma - CT scan instead
What cancer is staged using MRI?
Cervical
Endometriosis is difficult to diagnose so patients may need what?
Diagnostic laparoscopy
What is used for assessment of tubal patency in patients with infertility?
Hysterosalpingography
What cancer are ascites, omental and peritoneal noduels common in?
Ovarian cancer
StGING of ovarian cancer uses what imaging?
CT
What is best method for extablishing abnormally thickened endometrium in post menopausal patient with PMB?
Transvaginal ultrasound
Average age of menopause?
51
Early menopause definition?
LESS than 45, premature is less than 40
Late menopause defnition?
Over 54
What cells secrete oestrogens?
Granulosa cells
What hormone proliferates endometrium, secondary sexual characteristics, hair distribution, body shape and fat distribution?
Oestrogen
What three factors can raise FSH and LH?
Prior to ovulation
Raised with stopping COCOP or dep
Raised with breastfeeding or SSRIs
Hot flushes - 60-80% women, average 2 yrs, last 3-5 mins Night sweats Palpitations Insomnia Joint aches Headaches
Menopause
6 treatments for menorrhagia in menopause?
- Mefenamic acid
- Tranexamic acid
- Protesterones
- Intrauterine system
- Endometrial ablation
- Hysterectomy
List some benefits of HRT in menopause?
- Symptom control
- Reduced osteoporotc fracture
- Reduced bowel cancer
- Possibly protective alzheimers
List some disadvantages of HRT for menopause?
Breast cancer
Gallbladder disease
Give two uterine causes for DUB?
- Endometrial polyps
2. Endometrial hyperplasia
When do endometrial [polpys often occur?
Around/after menopause
What might persistent oestrogen stimulation cause?
Endometrial hyperplasia
Peak incidence of endometrial carcinoma?
50-60 years - in young women consider underlying predisposition e.g. PCOS or lynch syndrome
What are most endometrial carcinomas/
Adenocarcinomas
What are the two main clinico-pathological types of endometrial carcinoma?
- Endometriod - type I 80%
2. Serous (and clear cell) - type II
What are endometrioid carcinomas related to and associated with?
Related to unopposed oestrogen
Associated with atypical hyperplasia
What type of endometrial carcinoma: Not associated with unopposed oestrogen
Affect elderly post‐menopausal women
TP53 often mutated
Serous (and all clear cell, type II tumours)
What endometrial type tumours have PTEN, KRAS and PIK3CA mutations, associated with atypical hyperplasia as precurosr lesion, microsatellite instability
Type I tumours - endometrioid and micunous
Known risk factor for endometrial cancer?
Obesity - associated with endocrine and infalmmatory effects of adipose tissue, adipocytes express aromatase that converts ovarian androgens into oestrogens - inducing proliferation of endometrium
What is Lynch syndrome?
Cancer predisposition syndrome - high risk of colorectal cancer, endometrial cancerand ovarian.
What is inheritance like in Lynch syndrome?
Due to defective DNA mismatch repair gene, autosomal dominant inheritance
What do lynch syndrome tumours show which is a characteristic of defective mismatch repair?
Microsatellite instability MSI
wHAT TYPE of endometrial carcinoma has TP53 mutation and overexpression?
Type II - serous and clear cell phenotypes
What is precursor lesion for endometrial carcinoma type II ?
Serous endometrial intraepithelial carcinoma
Which type of endometrial carcinoma is more aggressive?
Type II - serous and clear cell
Characterised by a complex papillary and/or glandular archietecture with diffuse, marked nuclear pleomorphism
Serous carcinoma of endometrium
Treatment of endometrial carcinoma?
Hysterectomy: chemo/radiotherapy
Endometrioid carcinoma are primarily graded by architecture - what are the three grades?
- 5% or less solid growth
- 6-50% solid growth
- > 50% solid growth
What is description of stage I endometrial cancer?
COnfiend to uterus
What stage of endometrial cancer does it involve vaginal or parametrial involvement?
IIIB, IIIC is metastases to pelvic and/or paraaortic lymph nodes
What endometrial cancaer? Heterologous elements commonly seen in about 50% cases (rhabdomyosarcoma, chrondrosarcoma, osteosarcoma)
The presence of a rhabdomyosarcomatous component has the worst prognosis
Carcinosarcoma
A malignant smooth muscle tumour commonly displaying a spindle cell morphology
Leiomyosarcoma - the most common uterine sarcoma
What type of ovarian cysts are polycyctic ovaries?
Follicular
Chocolate cyst?
Endometriosis on ovary
Peritoneal spots or nodules
Fibrous adhesions
Chocolate cysts
Ovarian endometriosis
What are epithelial ovarian tumours catogorised as?
Benign, borderline or malignant
What epithelial ovarian tumour class is this: no cytological abnormalities, proliferative activity absent, no stromal invasion?
Benign
What epithelial ovarian tumour class is this: cytological abnomralities, proliferative, no stromal invation
Borderline
What epithelial ovarian tumour class is this: stromal invasion?
Malignant
What are the two types of serous carcinoma of ovary?
High grade
Low grade
What grade of serous carcinoma of ovary involves serous tubal intraepithelial carcinoma?
hIGH grade
What are endometrioid and clear cell carcinoma of ovary strongly associated iwth?
Endometriosis of ovary
Lynch syndrome
What is the diagnosis of endometrioiud and clear cell ovarian carcinoma often made on?
Ascitic fluid
An ovarian tumour of transitional type epithelium, usually benign
Brenner tumour
Give two types of germ cell ovarian tumours?
Dermoid cyst - mature, benign, cystic
Teratoma
What are 95% of ovarian germ cell tumours?
Dermoid cysts - cystic, containing sebum and hair
most common malignant primitive germ cell tumour
1-2% of all malignant ovarian tumours
Almost exclusively children and young women, average age 22
Dysgerminoma
A type of ovarian sex cord/stromal tumour which is benign, may produce oestrogen causing uterine bleeding?
Fibroma/thecoma
What ovarian sex cord/stromal tumours are rare and may produce androgens?
Sertoli-Leydig cell tumours
What must be considered in all cases of ovarian tumours if they are bilateral and small?
Metastatic tumours - stomach, colon, breast, pancreas
In FIGO staging of ovarian cancer - what is IA
tumour confined to one ovary
In FIGO staging of ovarian cancer - what is IB
tumour confined to both ovaries
In FIGO staging of ovarian cancer - what is IC
Cancer involving ovarian surface/rupture/siurgical split/tumour in washings
In FIGO staging of ovarian cancer - what is 2A
extension or implants on uterus/fallopian tube
In FIGO staging of ovarian cancer - what is 2b
Extension to other pelvic intraperitoneal
In FIGO staging of ovarian cancer - what is 3A
Cancer cells in lining of abdomen, retroperitoneal lymph node metastasis
In FIGO staging of ovarian cancer - what is 3b
tumours of 2cm or smaller in lining of abdomen
In FIGO staging of ovarian cancer - what is 4
Distant metastasis
