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Clinical Pathology > 47 - Diseases of the female genital tract 2 > Flashcards

47 - Diseases of the female genital tract 2 Flashcards

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1
Q

Endometriosis - what is it?

A

Ectopic endometrium -> bleeding into tissues -> fibrosis

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2
Q

Endometriosis - who?

A

6-10% of women

30-40 yo

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3
Q

Endometriosis - hx

A 
25% asymptomatic
Dysmenorrhoea
Dyspareunia
Pelvic pain
Subfertility
Pain on passing stool
Dysuria
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4
Q

Endometriosis - Ix

A

Laparoscopy

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5
Q

Endometriosis - Rx

A

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

Surgical

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6
Q

Endometritis - what is it?

A

Inflammation of the endometrium?

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7
Q

Endometritis - types

A

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

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

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8
Q

Endometritis - history

A 
ab/pelvic pain
pyrexia
discharge
dysuria
abnormal vaginal bleeding
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9
Q

Endometritis - investigations

A

biochem/microbiology, USS

Histology shows lymphocytes and plasma cells

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10
Q

Endometritis - Rx

A

Analgesia, antibiotics (ABX), remove cause

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11
Q

Endometrial polyps - who

A
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12
Q

Endometrial polyps - history

A 
Often asymptomatic
Intermenstrual bleeding
Post menopausal bleeding
Menorrhagia
Dysmenorrhoea
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13
Q

Endometrial polyps - investigations

A

USS

Hysteroscopy

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14
Q

Endometrial polyps - treatment

A

Expectant, medical or surgical

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15
Q

Endometrial polyps - prognosis

A

1% are malignant

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16
Q

Leiomyomata (uterine fibroids) - who?

A

20% women 30-50s

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17
Q

Leiomyomata (uterine fibroids) - Risk factors

A 
Genetics 
Nulliparity
Obesity
PCOS
HTN
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18
Q

Leiomyomata (uterine fibroids) - history

A

Often asymptomatic
Menometrorrhagia (Fe def anaemia)
Subfertility
Pressure

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19
Q

Leiomyomata (uterine fibroids) - Investigations

A

Bimanual examination

USS

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20
Q

Leiomyomata (uterine fibroids) - treatment

A

Medical

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

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21
Q

Leiomyomata (uterine fibroids) - prognosis

A

menopausal regression, malignancy risk (0.01%)

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22
Q

Endometrial hyperplasia - risk factors

A 
Obesity
Exogenous E2
PCOS
E2 - producing tumours
Tamoxifen
HNPCC
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23
Q

Endometrial hyperplasia - History

A

Abnormal bleeding

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24
Q

Endometrial hyperplasia - investigations

A

USS

Hysteroscopy +/- biopsy

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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

Clinical Pathology (65 decks)

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