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3a > WH: Uterine Disorders > Flashcards

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
Q

what is thought to be the aetiology of endometriosis ? (3)

A

not fully understood
- Retrograde menstruation
- Lympathic spread
- Metaplasia

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26
Q

what is retrograde menstruation ?

A

during menstruation: endometrial lining flows back though fallopian tubes into pelvis + peritoneum

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27
Q

To what hormone is endometrial tissue most sensitive to?

A

oestrogen

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28
Q

Endometriosis pathophysiology ?

A

endo tissue outside uterus responds to hormones same way as in uterus => endo tissue shed during menstruation => irritation + inflam of surround tissue

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29
Q

what is the main symptoms of endometriosis ?

A

cyclical pelvic pain

30
Q

what can the irritation + inflammation of surrounding tissue in endometriosis cause ?

A

localised bleeding + inflam => adhesion + scar tissue =? chronic non-cyclical pain

31
Q

describe the pain associated with endometrial adhesions ?

A

chronic non-cyclical pelvic pain

32
Q

Endometriosis presentation ?

A
  • cyclical adobo/pelvic pain
  • Dyspareunia
  • Dysmenorrhoea
  • Infertily
  • Cyclical bleeding from other sites (haematurea, haemoptysis)
33
Q

What is thought to cause infertility in endo ?

A

maybe adhesion
- in tubes => blocks eggs)

34
Q

What is treatment for infertility in endo ? (2)

A

surgical
- Clear adhesions
- Remove endometrioma

35
Q

How is endo diagnosed ? gold standard ?

A
  • Pelvic US
  • Laparoscopic surgery (gold standrad)
36
Q

Endo management over view ?

A
  • Analgesia
  • Hormonal
  • Surgery
37
Q

What analgesia used in endo?

A

NSAIDs, paracetamol (work up pain ladder)

38
Q

What hormonal managmetn in endo ? what is the aim of this/ how does it work?

A

aim to stop ovulation => reduce endometrial thickening (in utero + ectopic)
- COCP
- Merina coil

  • GnRH analogue (induce menopause like state)
39
Q

Endo surgical management ?

A
  • laparoscopic (ablate endo tissue, remove adhesions)
  • hysterectomy
40
Q

What is adenomyosis ?

A

presence of functional endometrial tissue within myometrium
- benign invasion (can occur alongside endometriosis or fibroids)

41
Q

which layer of uterus does adenomyosis affect ?

A

myometrium (middle layer)
- muscle layer of uterus

42
Q

Adenomyosis pathophysiology ?

A

cause by anything disrupting the uterine living => allowing endo to invade the myometrium => uterine damage

43
Q

why is adenomyosis cyclical symptoms

A

hormone responsive
- collection of endo glands => adenomyoma => oestrogen + progesterone + androgen receptors on ectopic tissue => responsive to cyclical hormones

44
Q

adenomysosis RF ?

A
  • increasing parity
  • uterine surgery
  • Prev CS
  • Fam Hx
  • Later reproductive yrs
45
Q

what could cause uterine damage (=> adenomyosis) ? (3)

A
  • pregnancy
  • childbirth
  • uterine surgery
46
Q

Adenomyosis presentation ?

A
  • asymptomatic
  • dysmenorrhoea
  • Menorrhagia
  • Dyspareunia
    (cyclical)
  • Fertility/pregnancy related problems
47
Q

what would be seen on examination of adenomyosis ?

A

enlarged + tender uterus

48
Q

how is adenomyosis diagnosed ?

A

TVUS

49
Q

Adenomyosis overal management categories ? (3) depends on what ?

A

depends on symptoms, age, plans for pregnancy
- Without contraception
- Contraception
- Surgical

50
Q

what non-contraceptive management options are there for adenomyosis ?

A
  • NSAIDs (pain relief)
  • Tranexamic acid (heavy bleeding)
51
Q

what contraceptive management options are there for adenomyosis ?

A
  • Mirena coil
  • COCP
52
Q

what surgical management options are there for adenomyosis ?

A
  • hysterectomy (only curative option)
  • uterine artery embolisation (can maintain fertility)
53
Q

what pregnancy associated complications are there with adenomyosis ?

A
  • Infertility
  • Miscarriage
  • Preterm birth
  • SGA
54
Q

What is ashermans syndrome ?

A

it is where adhesion (synechai) form within the uterus following damage

55
Q

what can cause ashermans syndrome ? (3)

A

damage to uterus
- ERPC (dilatation + curettage for retained products of conception management)
- uterine surgery
- Endometritis (pelvic infection)

56
Q

describe the pathophsyioloyg of ashermans ? what does this cause ?

A

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
Q

Asherman’s syndrome presentation ? when ?

A

usually following recent dilatation + curettage (RPC), uterine surgery, endometritis
- secondary amnorrhoea
- lighter periods
- Dysmenorrhoea
- infertility

58
Q

Asherman’s syndrome diagnosis + management ?

A
  • Hysteroscopy (gold standard) for diagnoses and management (dissection + treatment of adhesions)
59
Q

what is endometrial cancer ? most common type ? what hormone is it dependant on ?

A

cancer of the endometrium (lining of the uterus)
- 80% are adenocarcinomas
- oestrogen depdnat cancer (oestrogen stimulates growth of endo cancer cells)

60
Q

what is the main red flag symptom for Endometrial cancer ?

A

Post menopausal bleeding is endo cancer until proven otherwise

61
Q

what is endometrial hyperplasia ? normal prognosis/progression ?

A

pre-cancerious condition with thickening of endometrium
- most cases return to normal over time
- 5% develop to Eno canc

62
Q

what dirrernt type os of endometrial hyperplasia are there ? (2)

A
  • hyperplasia without atypia
  • atypical hyperplasia
63
Q

endometrial hyperplasia Mx ?

A
  • IUS (mirena)
  • continuous orla progestogens
64
Q

indometiral cancer RF ? (10)

A
  • diabetes, obesity
  • unopposed oes (w/o próg): increase age, early menarche, later menopause, oestrogen only HRT, no/fewer pregnancies, PCOS, tamoxifen
65
Q

how does PCOS increase endo cancer risk ? Mx ?

A

due to unopposed oestrogen (no progesterone from corpus luteum)
so Mx: COCP, mirena, cyclical progesterone

66
Q

endo cancer protective factors ? (3)

A
  • COCP, mirena, increase number of pregnancies
67
Q

endo cancer Px ? (6)

A
  • post menopausal bleeding !
  • post coital bleeding
  • IMB
  • abnormal vaginal bleeding
  • haematruria
  • anaemia
68
Q

what is the 2 week wait criteria for endo cancer ?

A

PM bleeding (>12 months after LMP)

69
Q

what are the diagnostic tests for endo cancer ?

A
  • TVUS (endo thickness)
  • Pipelle biopsy
  • hysteroscopy with endo biopsy
70
Q

endo cancer Mx ? (4)

A

total abdominal hysterectomy + bilateral sloping-oopherectomy
- radiotherapy, chemo
- progesterone

3a (43 decks)

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