4 - Fallopian tubes and uterus Flashcards Preview

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Flashcards in 4 - Fallopian tubes and uterus Deck (20)
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1

What rare disorder usually occurs as a result of an ovarian cyst or neoplasm?

Adnexal torsion

2

What IS an adnexa, exactly?

uterine appendages....aka fallopian tubes, ovaries, and surrounding connective tissue

3

Your patient presents with sudden onset LLQ pain, n/v, fever, tachycardia, and tachypnea. Her LLQ pain is exacerbated by direct palpation. You note rebound tenderness, and +psoas. You think you might feel an adnexal mass but you can't be sure because there is voluntary guarding. What is your complete DDx?

1) adnexal torsion
2) appendicitis
3) ectopic pregnancy
4) ruptured ovarian cyst
5) tubal ovarian abscess 2nd to PID
6) neoplasm with rapid growth

4

How will you narrow down your DDx? Meaning, what tests will you order?
(1) adnexal torsion
2) appendicitis
3) ectopic pregnancy
4) ruptured ovarian cyst
5) tubal ovarian abscess 2nd to PID
6) neoplasm with rapid growth)

1) HCG to r/o ectopic
2) US will also r/o ectopic and check for mass
3) CBC to check for bleed or infection
4) CT to r/o appendix and/or mass
5) PCR (polymerase chain rxn) screens for GC/CT to r/o PID

5

If you discover your patient does indeed have an adnexal torsion, what do you do now?

Arrange surgical release of torsion. (EMERGENCY)

6

Either by bx or direct visualization, you determine that your patient has some endometrial tissue that is outside of the uterus. What is your diagnosis?

Endometriosis

7

What are the 3 theories as to how endometrial tissue can end up in places where it doesn't belong?

1) Tubal regurgitation. (Menstrual tissue regurgitates back up into the fallopian tubes)
2) Metaplasia of mesothelium. (The peritoneum is pluripotent, and if it is agitated, the cells can begin to differentiate into endometrial tissue rather than peritoneal tissue)

3) Hematogenous dissemination. (Endometrial tissue gets into blood stream)**Not as common

8

What is the "classic tetrad" of endometriosis?
***Expect on exam***

1) dysmenorrhea
2) dyspareunia
3) chronic pelvic pain
4) infertility

9

What are the unusual manifestations of endometriosis?

Bleeding (rectal, nasal, hemoptysis) often a/w menses....
or abnormal tissue in laparotomy scars

10

What are the most cost effective ways to manage endometriosis in a patient who does not wish to become pregnant?

Oral contraceptives or Depo-provera

11

What type of treatment essentially induces an artificial menopause?

GnRH agonist (expensive, menopause side effects)

12

If medication management of endometriosis does not provide relief, what is another option?

Sx (laparoscopy or laparotomy)

13

What are the 3 major types of female GU cancers?

cervical, ovarian, endometrial

14

What is the MOST COMMON histology of endometrial cancer?
***Expect on exam***

Adenocarcinoma

15

What are the risk factors for endometrial cancer?

1) 50+ yoa
2) early menarche
3) late menopause
4) FHx
5) obesity (HTN/DM)
6) No pregnancies
7) Unopposed estrogen stimulation (HRT)
**More exposure to estrogen increases risk, whereas progesterone has an endometrial protective effect.

16

What are the red flags for endometrial cancer?

1) DUB (dysfunctional uterine bleed)
2) enlarged uterus
3) abd distention
4) ascites
5) Metastatic dz (splenohepatomegaly)

17

What should you do if you suspect endometrial cancer?

Do a BIOPSY. (Also a bunch of tests that I'm not memorizing, like PLT, US, Hb/Hct, CXR, MMG, colonoscopy)

18

If you were dx'ed with endometrial cancer, would you rather your cells had little differentiation or a lot of differentiation?

Lots of differentiation = good prognosis

19

What is the best course of action for early stage endometrial cancer?

total hysterectomy

20

When do you use chemotherapy as a treatment for endometrial cancer?

For palliation in late stage dz.