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WH: Uterine Disorders Flashcards

1
Q

what are fibroids ?

A

benign tumours of the smooth muscle of the uterus
- rarely become malignant

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2
Q

another name for fibroids ?

A

uterine leiomyomas

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3
Q

to what hormone are fibroids sensitive to? what does this do?

A

oestrogen sensitive
- grow in response to oestrogen (without oestrogen, they shrink)

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4
Q

what different types of fibroids are there?

A
  • intra mural
  • submucosal
  • subserosal
  • pedunculated
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5
Q

what is the most common type of fibroid ?

A

intramural

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6
Q

describe an intramural fibroid?

A

within myometrium (change shape e+ distort uterus as they grow)

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7
Q

describe submucosal fibroids ?

A

just below lining of uterus (endometrium)

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8
Q

describe pedunculated fibroids

A

on a stalk

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9
Q

describer subserosal fibroids ?

A

just below outer layer of uterus
- they grow outwards (if large => fill abdominal cavity)

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10
Q

fibroids affect what percentage of women ?

A

40 - 60 % women in later reproductive yrs

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11
Q

Fibroids presentation ? most frequent presentation ?

A
  • often asymptomatic
  • menorrhage (most frequent presentation)
  • prolonged menstruation
  • bloating/fullness
  • urinary or bowel symptoms
  • reduced fertility
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12
Q

how to fibroids cause reduced fertility ?

A

due to obstructive effect of fibroid

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13
Q

what investigations for fibroids ?

A
  • pelvic US (first line, gold standard)
  • Hysteroscopy
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14
Q

Fibroids management ?

A
  • non-contraceptive: NSAIDs
  • Contraceptive: mirena (1st line), COCP
  • surgical: endometrial ablation, hysterectomy, uterine artery embolisation
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15
Q

complications of fibroids ?

A

depends where its pessing
- Heavy bleeding => anaemia
- Reduced fertility
- Pregnancy complications
- constipation
- Red degeneration

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16
Q

name some pregnancy complications associated with fibroids ?

A
  • Miscarriage
  • Premature labour
  • Obstructed delivery
  • red degeneration more likely (I think)
  • Placenta praevia more likely (I think)
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17
Q

Pregnancy woman with Hx of fibroids presenting with sever abdo pain + low grade fever. what likely diagnosis ?

A

Red degeneration

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18
Q

what is red degeneration ? due to what ?

A

ischaemia, infarction + necrosis of fibroid
- due to disrupted blood (more likely in 2nd/3rd trimester pregnancy)

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19
Q

red degeneration presentation ?

A
  • sever abdo pain
  • low grade fever
  • tachycardia
  • vomiting
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20
Q

red degeneration management ?

A

supportive with rest, fluid + analgesia

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21
Q

What is endometriosis ?

A

chronic condition in which endometrial tissue is located at sites other than the uterine cavity
)ectopic endometrial tissue outside the uterus)

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22
Q

What is endometrioma ?

A

a lump of endometrial tissue outside of the uterus

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23
Q

where might you find ectopic endometrial tissue ?

A

(endometrioma)
- Ovaries, pouch of Douglas, bladder, rectum, lungs

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24
Q

what is its called when there are endometrioma in the ovaries ?

A

chocolate cysts

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25
what is thought to be the aetiology of endometriosis ? (3)
not fully understood - Retrograde menstruation - Lympathic spread - Metaplasia
26
what is retrograde menstruation ?
during menstruation: endometrial lining flows back though fallopian tubes into pelvis + peritoneum
27
To what hormone is endometrial tissue most sensitive to?
oestrogen
28
Endometriosis pathophysiology ?
endo tissue outside uterus responds to hormones same way as in uterus => endo tissue shed during menstruation => irritation + inflam of surround tissue
29
what is the main symptoms of endometriosis ?
cyclical pelvic pain
30
what can the irritation + inflammation of surrounding tissue in endometriosis cause ?
localised bleeding + inflam => adhesion + scar tissue =? chronic non-cyclical pain
31
describe the pain associated with endometrial adhesions ?
chronic non-cyclical pelvic pain
32
Endometriosis presentation ?
- cyclical adobo/pelvic pain - Dyspareunia - Dysmenorrhoea - Infertily - Cyclical bleeding from other sites (haematurea, haemoptysis)
33
What is thought to cause infertility in endo ?
maybe adhesion - in tubes => blocks eggs)
34
What is treatment for infertility in endo ? (2)
surgical - Clear adhesions - Remove endometrioma
35
How is endo diagnosed ? gold standard ?
- Pelvic US - Laparoscopic surgery (gold standrad)
36
Endo management over view ?
- Analgesia - Hormonal - Surgery
37
What analgesia used in endo?
NSAIDs, paracetamol (work up pain ladder)
38
What hormonal managmetn in endo ? what is the aim of this/ how does it work?
aim to stop ovulation => reduce endometrial thickening (in utero + ectopic) - COCP - Merina coil - GnRH analogue (induce menopause like state)
39
Endo surgical management ?
- laparoscopic (ablate endo tissue, remove adhesions) - hysterectomy
40
What is adenomyosis ?
presence of functional endometrial tissue within myometrium - benign invasion (can occur alongside endometriosis or fibroids)
41
which layer of uterus does adenomyosis affect ?
myometrium (middle layer) - muscle layer of uterus
42
Adenomyosis pathophysiology ?
cause by anything disrupting the uterine living => allowing endo to invade the myometrium => uterine damage
43
why is adenomyosis cyclical symptoms
hormone responsive - collection of endo glands => adenomyoma => oestrogen + progesterone + androgen receptors on ectopic tissue => responsive to cyclical hormones
44
adenomysosis RF ?
- increasing parity - uterine surgery - Prev CS - Fam Hx - Later reproductive yrs
45
what could cause uterine damage (=> adenomyosis) ? (3)
- pregnancy - childbirth - uterine surgery
46
Adenomyosis presentation ?
- asymptomatic - dysmenorrhoea - Menorrhagia - Dyspareunia (cyclical) - Fertility/pregnancy related problems
47
what would be seen on examination of adenomyosis ?
enlarged + tender uterus
48
how is adenomyosis diagnosed ?
TVUS
49
Adenomyosis overal management categories ? (3) depends on what ?
depends on symptoms, age, plans for pregnancy - Without contraception - Contraception - Surgical
50
what non-contraceptive management options are there for adenomyosis ?
- NSAIDs (pain relief) - Tranexamic acid (heavy bleeding)
51
what contraceptive management options are there for adenomyosis ?
- Mirena coil - COCP
52
what surgical management options are there for adenomyosis ?
- hysterectomy (only curative option) - uterine artery embolisation (can maintain fertility)
53
what pregnancy associated complications are there with adenomyosis ?
- Infertility - Miscarriage - Preterm birth - SGA
54
What is ashermans syndrome ?
it is where adhesion (synechai) form within the uterus following damage
55
what can cause ashermans syndrome ? (3)
damage to uterus - ERPC (dilatation + curettage for retained products of conception management) - uterine surgery - Endometritis (pelvic infection)
56
describe the pathophsyioloyg of ashermans ? what does this cause ?
damaged tissue heals abnormally => scar tissue (adhesions) => connect areas of uterus that are not normally connected (e.g. binding uterine walls together) => physical obstructions => menstrual abnormalities + infertility + recurrent misscairage
57
Asherman's syndrome presentation ? when ?
usually following recent dilatation + curettage (RPC), uterine surgery, endometritis - secondary amnorrhoea - lighter periods - Dysmenorrhoea - infertility
58
Asherman's syndrome diagnosis + management ?
- Hysteroscopy (gold standard) for diagnoses and management (dissection + treatment of adhesions)
59
what is endometrial cancer ? most common type ? what hormone is it dependant on ?
cancer of the endometrium (lining of the uterus) - 80% are adenocarcinomas - oestrogen depdnat cancer (oestrogen stimulates growth of endo cancer cells)
60
what is the main red flag symptom for Endometrial cancer ?
Post menopausal bleeding is endo cancer until proven otherwise
61
what is endometrial hyperplasia ? normal prognosis/progression ?
pre-cancerious condition with thickening of endometrium - most cases return to normal over time - 5% develop to Eno canc
62
what dirrernt type os of endometrial hyperplasia are there ? (2)
- hyperplasia without atypia - atypical hyperplasia
63
endometrial hyperplasia Mx ?
- IUS (mirena) - continuous orla progestogens
64
indometiral cancer RF ? (10)
- diabetes, obesity - unopposed oes (w/o próg): increase age, early menarche, later menopause, oestrogen only HRT, no/fewer pregnancies, PCOS, tamoxifen
65
how does PCOS increase endo cancer risk ? Mx ?
due to unopposed oestrogen (no progesterone from corpus luteum) so Mx: COCP, mirena, cyclical progesterone
66
endo cancer protective factors ? (3)
- COCP, mirena, increase number of pregnancies
67
endo cancer Px ? (6)
- post menopausal bleeding ! - post coital bleeding - IMB - abnormal vaginal bleeding - haematruria - anaemia
68
what is the 2 week wait criteria for endo cancer ?
PM bleeding (>12 months after LMP)
69
what are the diagnostic tests for endo cancer ?
- TVUS (endo thickness) - Pipelle biopsy - hysteroscopy with endo biopsy
70
endo cancer Mx ? (4)
total abdominal hysterectomy + bilateral sloping-oopherectomy - radiotherapy, chemo - progesterone

3a (43 decks)

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