47 - Diseases of the female genital tract 2 Flashcards Preview

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Flashcards in 47 - Diseases of the female genital tract 2 Deck (67):
1

Endometriosis - what is it?

Ectopic endometrium -> bleeding into tissues -> fibrosis

2

Endometriosis - who?

6-10% of women
30-40 yo

3

Endometriosis - hx

25% asymptomatic
Dysmenorrhoea
Dyspareunia
Pelvic pain
Subfertility
Pain on passing stool
Dysuria

4

Endometriosis - Ix

Laparoscopy

5

Endometriosis - Rx

Medical (COCP, GnRH agonists/antagonists, progesterone antagonists)

Surgical

6

Endometritis - what is it?

Inflammation of the endometrium?

7

Endometritis - types

Acute - retained placenta, prolonged rupture of membranes, complicated labour

Chronic - pelvic inflam disease, retained gestational tissue, endometrial TB, IUCD (intrauterine contraceptive device) infection

8

Endometritis - history

ab/pelvic pain
pyrexia
discharge
dysuria
abnormal vaginal bleeding

9

Endometritis - investigations

biochem/microbiology, USS

Histology shows lymphocytes and plasma cells

10

Endometritis - Rx

Analgesia, antibiotics (ABX), remove cause

11

Endometrial polyps - who

12

Endometrial polyps - history

Often asymptomatic
Intermenstrual bleeding
Post menopausal bleeding
Menorrhagia
Dysmenorrhoea

13

Endometrial polyps - investigations

USS
Hysteroscopy

14

Endometrial polyps - treatment

Expectant, medical or surgical

15

Endometrial polyps - prognosis

1% are malignant

16

Leiomyomata (uterine fibroids) - who?

20% women 30-50s

17

Leiomyomata (uterine fibroids) - Risk factors

Genetics
Nulliparity
Obesity
PCOS
HTN

18

Leiomyomata (uterine fibroids) - history

Often asymptomatic
Menometrorrhagia (Fe def anaemia)
Subfertility
Pressure

19

Leiomyomata (uterine fibroids) - Investigations

Bimanual examination
USS

20

Leiomyomata (uterine fibroids) - treatment

Medical
Non-medical - art. emboli, ablation, TAH)

21

Leiomyomata (uterine fibroids) - prognosis

menopausal regression, malignancy risk (0.01%)

22

Endometrial hyperplasia - risk factors

Obesity
Exogenous E2
PCOS
E2 - producing tumours
Tamoxifen
HNPCC

23

Endometrial hyperplasia - History

Abnormal bleeding

24

Endometrial hyperplasia - investigations

USS
Hysteroscopy +/- biopsy

25

Endometrial hyperplasia - treatment

Medical
Surgical (TAH)

26

Endometrial hyperplasia - prognosis

Endometrial adenocarcinoma

Regression

27

Endometrial carcinoma - history

PMB/IMB pain if late

28

Endometrial carcinoma- investigations

USS
Biopsy
Hysteroscopy

29

Endometrial carcinoma - staging

FIGO (1-4)

30

Endometrial carcinoma - treatment

Medical
Surgery - TAH
Chemo+radio

31

Endometrial carcinoma - prognosis

Stage one of figo - 90% 5 yr survival
Stage 2-3 -

32

Polycystic ovary syndrome - summary

Complex endocrine disorder
Hyperandrogenism
Menstrual abnormalities
Polycystic ovaries

33

Polycystic ovary syndrome - who?

6-10% of women

34

Polycystic ovary syndrome - investigation

USS
Fasting biochemical screen (low FSH, high LH, high test. high DHEAS), OGTT

35

Polycystic ovary syndrome - diagnosis

Rotterdam criteria (2/3 polycystic ovaries)
Hyperandrogenism
Irregular periods (>35 days)

36

Polycystic ovary syndrome - treatment

weight loss, medical, surgical

37

Gonadal failure - primary causes

Congenital - Turner's, Klinefelter's

Acquired - infection, surgery, chemo-radiotherapy, toxins/drugs

38

Gonadal failure - secondary causes

Hypogonadatrophic hypogonadism (pit/hypothalamus failure)

39

Gonadal failure - clinical presentation

Amenorrhoea
Delayed puberty
Low sex hormone levels, high LD, high FSH

40

Gonadal failure - investgations

hormonal profiling, karyotyping

41

Gonadal failure - prognosis

difficult - address cause
HRT

42

Origins of ovarian neoplasms

Sex-cord stromal tumours

Surface epithelial stromal tumours

Germ cell tumours

43

Epithelial tumours - prevalence

90% of ovarian neoplasms

44

Epithelial tumours - histological types

Serous (tubal)
Mucinous (endocervical)
Endometroid (endometrium)

45

Epithelial tumours - benign tumours subclassification

Cystic (cystadenomas)
Fibrous (adenofibromas)
Cystic and fibrous (cystadenofibromas)

46

Epithelial tumours - malignant types

Cystadenocarcinomas

47

Germ cell tumours - types

15-20% of all ovarian tumours

Germinomatous - dysgerminomas

Non-germinomatous - teratomas (mature, immature (malignant), yolk sac tumours, choriocarcinomas)

48

Germ cell tumours - treatment

Surgical +/- chemo/radio

49

Sex cord stromal tumours -

Rare, from ovarian stroma

Can generate cells of opposite sex

50

Sex cord stromal tumours - types

Thecoma/fibrothecoma/fibroma - benign, produce E2, fibromas hormonally inactive. Comprised of spindle cells. Meig's syndrome

Granulosa cell - low grade malignant, produces E2

Sertoli-Leydig - produces androgens, 10-25% malignant

51

Ovarian cancer -

2nd commonest gynae cancer

52

Ovarian cancer - risk factors

FH
Elderly
PMH breast cancer
Smoking
E2-only HRT
Lynch II syndrome
Obesity
Nulliparity

53

Ovarian cancer - protective factors

OCP
Breast feeding
Hysterectomy

54

Ovarian cancer - history

Non-specific
Pain
Bloating
Weight loss
PV bleeding
Urinary freq.
Anorexia

55

Ovarian cancer - staging

FIGO

56

Ovarian cancer - treatment

Stage TAH/BSO
Omentectomy, appendectomy, lymphadenectomy & adjuvant chemo
Chemo is only done in sensitive germ tumours

57

Ovarian cancer - prognosis

5 years 43% survival

58

Ovarian cancer - metastatic tumour types

Mullerian tumours (most common): uterus, fallopian, pelvic peritoneum, contralateral ovary

Extra-mullerian tumours: lymph/haem spread - GI, breast, melanoma, less commonly kidney and lung. Direct extension: bladder, rectal

59

Endometriosis summary

Spread of endometrium into the pelvis

60

Endometritis summary

Acute/chronic inflammation (usually due to infection)

61

Endometrial polyps summary

Local endometrial overgrowth

62

Leiomyomata summary

Benign smooth muscle tumours of the myometrium

63

Endometrial hyperplasia summary

Oestrogenic stimulation of endometrial proliferation; continuous stimulation may lead to atypical hyperplasia and carcinoma

64

Endometrial cancer summary

Commonest gynae cancer with increasing incidence; two types

65

PCOS summary

Common, multiple follicular cysts, hyperandogenism, menstrual irregularity

66

Gonadal failure summary

Primary (ovarian) and secondary (hypothalamus/pituitary)

67

Ovarian neoplasms summary

90% epithelial and based on cell type; benign cystadenoma -> borderline -> malignant cystadenocarcinoma progression; germ cell tumours; sex cord stromal tumours

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