14. Benign Disorders of the Upper Genital Tract

Question 1

Congenital Mullerian Anomalies

Pathogenesis

Answer 1

Superior vagina, cervix, uterus, and fallopian tubes are formed by fusion of the paramesonephric (mullerian) ducts

Uterine anomalies arise during embryonic development, generally as a result of incomplete fusion of the ducts, incomplete development of one or both ducts, or degeneration of the ducts

Question 2

Increased incidence of mullerian anomalies in women who were exposed in utero to…

Answer 2

DES (from 1940 to 1971)

Question 3

Treatment for uterine anomalies

Answer 3

Many require no treatment. However, when the defect causes significant symptoms such as pain, menstrual irregularities, or infertility, tx options should be explored.

Question 4

Uterine leiomyomas, also called fibroids or uterine myomas, are benign proliferations of smooth muscle cells of the myometrium.

Answer 4

Question 5

Medical therapy for Uterine Leiomyomas

(GO PANAM)

Answer 5

Question 6

Indications for Surgical Intervention for Uterine Leiomyomas (7)

Answer 6

Question 7

Major Risk Factor for Endometrial Hyperplasia

Other risk factors: ENDOMETRIUM

Answer 7

Unopposed estrogen exposure

women with obesity, nulliparity, late menopause, and exogenous estrogen use with progesterone)

Question 8

Ovarian cyst types:

Answer 8

• Follicular: result from unruptured follicles –> usually asymptomatic unless torsion occurs
  
  • Mgmt: observation w/ or w/o OCPs to suppress future cyst formation, followed by repeat pelvic U/S
• Corpus luteum: result from an enlarged and/or hemorrhagic corpus luteum…
  
  • may cause a missed period or dull lower quadrant pain
  • when reuptured, these cysts can cause acute abdominal pain and intra-abdominal hemorrhage
  • should resolve spontaneously or may be suppressed with oral contraceptives if recurrent

Question 9

Which of the following tests is most commonly used for dx of uterine fibroids?

a. CT scan
b. Pelvic x-ray
c. Pelvic U/S
d. MRI
e. Hysterosalpingogram

Answer 9

c. Pelvic U/S

Question 10

Which of the following fibroid locations is most commonly associated with abnormal vaginal bleeding?

a. Submucosal
b. Intramural
c. Subserosal
d. Pedunculated
e. Parasitic

Answer 10

a. Submucosal

Question 11

Dx: ruptured hemorrhagic cyst

How to prevent further cysts from occurring?

a. Expectant mgmt
b. Removal of cyst
c. Removal of ovary
d. Progesterone-containing IUD (Mirena)
e. Combo E+P contraceptive

Answer 11

e. Combo E+P contraceptive

Prevent formation of future cysts by suppressing ovulation