Uterine Leiomyomas/Fibroids Flashcards

1
Q

What are uterine leiomyomas?

A
  • Benign tumours of myometrium

- Very common

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

Who gets uterine leiomyomas/risk factors?

A
  • Increasing age
  • Obesity
  • African American
  • Nulliparity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Types of fibroids?

A
  • Intramural fibroids
  • Subserosal fibroids
  • Submucosal fibroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Most common fibroids? And where they lie?

A

Intramural fibroids

-Lie within myometrium

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

Where are subserosal fibroids situated?

A

Serosal outer surface and extend outwards

-These deform normal contour of uterus

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

Where do submucosal fibroids develop?

A

Near inner surface of endometrium and extend into endometrial cavity either causing distortion of cavity or filling the cavity if they are pedunculated

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

Effect of different fibroids?

A
  • Very dependant on site and size of fibroid
  • Subserosal fibroids can put pressure on adjacent organs and cause bowel/bladder symptoms
  • Submucosal and intramural fibroids= more likely to cause heavy menstrual bleeding, infertility and pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Main symptoms of fibroids?

A
  • Heavy and/or painful periods
  • Abdo pain
  • Lower back pain
  • Urinary frequency
  • Constipation
  • Dyspareunia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pathology of fibroids?

A
  • Tumour is firm, round, white with a whorled (spiral) structure
  • Cells are typical long spindle muscle cells arranged in interlacing bodies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Management of asymptomatic fibroids?

A

-No further investigation of treatment unless there is rapid growth or reason to suspect malignancy

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

Management of symptomatic fibroids with heavy bleeding?

A
  • NSAIDs
  • Tranexamic acid
  • COCP
  • Progesterone pill
  • Mirena coil

(These all may help with symptoms)

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

What treatments are effective at shrinking fibroids?

A
Ulipristal acetate 
GnRH analogues (only licensed for 6 months use though)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why are GnRH analogues only licensed for 6 months use?

A

Risk of osteoporosis

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

Surgical management of fibroids?

A
  • Hysteroscopic resection good for relatively small fibroids up to ~4cm
  • Myectomy: not common because challenging blood supply of fibroid (but possibility for woman wanting to keep fertility)
  • Uterine artery embolization: for someone unfit for surgery, not recommended for maintaining fertility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is gold standard surgical treatment for someone not wanting to maintain fertility?

A

Hysterectomy

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

Medical treatment options of fibroids?

A
  • NSAIDs
  • Tranexamic acid
  • COCP
  • Progesterone pill
  • Mirena coil
  • GnRH analogues or ulipristal shrink them
17
Q

Option for someone unfit for surgery?

A

Uterine artery embolization

18
Q

What is red degeneration of a fibroid?

A

Fibroid degeneration with haemorrhage due to acute shrinkage of fibroid blood supply

19
Q

Fibroid degeneration is?

A

Any shrinkage of fibroid

20
Q

How is red degeneration likely to present?

A

Emergency

- Acute abdomen