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Repro. Med 2 > Uterine D/O > Flashcards

Uterine D/O Flashcards

1
Q

What are congenital uterine anomalies? (hint: defect)

A

Mullerian fusion defects

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2
Q

What are acquired uterine anomalies? (hint: syndrome)

A

Asherman’s syndrome

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3
Q

Benign uterine disorders (x6)

A 
Endometritis
Endometrial polyp
Endometriosis
Adenomyosis
Leiomyoma uteri
Endometrial hyperplasia w/o atypia
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4
Q

Malignant/pre-malignant uterine d/o

A

Endometrial hyperplasia with atypia
Endometrial carcinoma
Uterine Sarcoma

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5
Q

____ is the most common uterine septum d/o seen w/ pregnancy loss
Resection may result in higher delivery rates

A

Mullerian fusions

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6
Q

___ or ___ are shapes of the uterus that are more frequently associated w/ mid-trimester loss or preterm birth

A

Bicornuate

Unicornuate

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7
Q

___ results from incomplete canalization of the Mullerian tubercle

A

Vaginal septum

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8
Q

When is a vaginal septum usually dx’d?

A

At puberty

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9
Q

___ is an intrauterine synechiae (adhesions) usually occurring after recurrent curettage

A

Asherman’s Syndrome

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10
Q

___ is inflammation of the endometrial lining of the uterus

It occurs in the obstetrical population and in the non-pregnant population

A

Benign Endometritis

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11
Q

How does Benign Endometritis occur? Is it an ascending or descending infection?

A

Ascending infection from the lower genital tract

Polymicrobial from normal vaginal flora or associated cervicitis with GC/Chl

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12
Q

What are risk factors of Endometritis?

A

Invasive gyne procedures (IUD)
High risk sexual behavior/STD exposure
Douching

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13
Q

In non-pregnant population, endometritis is most commonly associated with ___ disease

A

Pelvic Inflammatory Disease (PID)

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14
Q 
\_\_\_ are overgrowths of endometrial cells attached to the inner wall of the uterus that extends into the uterine cavity 
Typically benign (occasionally atypical or malignant)
A

Benign Endometrial Polyps

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15
Q

When do Benign Endometrial Polyps usually occur?

A

peri and post-menopausal women, occasionally younger

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16
Q

What are sx of Benign Endometrial Polyps?

A
  • Asymptomatic
  • Irregular/intermenstrual
  • bleeding or menorrhagia
  • Post-coital bleeding
  • Post-menopausal bleeding
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17
Q

How are Benign Endometrial Polyps dx’d and tx’d?

A

Dx: Sonohysterogram (SHGM)
Tx: Hysteroscopic resection

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18
Q

DDx of an enlarged uterus (5)

A 
Pregnancy
Uterine adenomyosis
Leiomyoma uteri
Hematometra (cervical stenosis/vaginal septum)
Malignancy
19
Q

What are the uterus CA types?

A

Uterine sarcoma
Uterine carcinosarcoma
Endometrial carcinoma
Metastatic dz (other reproductive tract primary)

20
Q

____ is the presence of ectopic endometrial glands and stroma in the myometrium

A

Benign Adenomyosis

21
Q

What is the epidemiology for Benign Adenomyosis?

A

Parous women, usually presents 35-50 y/o

22
Q

What are some S/s of Benign Adenomyosis?

A

Often asymptomatic, discovered incidentally

  • Secondary dysmenorrhea
  • Abd pressure
  • Bloating
  • Menorrhagia
  • Chronic pelvic pain, dysparenuia
23
Q

What are signs of Benign Adenomyosis on PE?

How do you dx Benign Adenomyosis?

A

Diffusely enlarged, globular, tender uterus

Characteristic findings on US (SHGM) and MRI

24
Q

What are tx options for a pt with Benign Adenomyosis? (hint: medical and surgical)

A

Medical: NSAID, Hormonal, Await menopause

Surgical: Hysterectomy, UAE (uterine artery embolization), ablation, resection, electro-coagulation

25
Q

____ are benign tumors of smooth muscle origin that arise in the myometrium of the uterus
They are considered the most common solid pelvic tumor in women and are the most frequent indication for ___

A

Leiomyomata Uteri (fibroids)

benign hysterectomy

26
Q

What is the epidemiology for Leiomyomata Uteri (fibroids)?

A

20-50%
Higher in African American women (possibly as high as 70-80% by 50 y/o)
Increases w/ age—peak in 40’s w/ sharp decrease post-menopause
Genetic component

27
Q

Where are pedunculated leiomyomata Uteri (fibroids) located?

A

Outside of the uterus

28
Q

A very large uterus can compress the ureters and affect ___ and ___

A

renal fxn

ureteral patency

29
Q

What are common sx of Leiomyomata Uteri (fibroids)?

A 
Asymptomatic (majority)
Bleeding abnormalities
Abdominopelvic pressure/bloating
Urinary pressure/frequency
Constipation
Reproductive complications
30
Q

How is Leiomyomata Uteri (fibroids) dx’d?

A

Abd examination
- uterus above pubic symphysis (pregnancy sizing, >12 weeks)

Pelvic examination
- enlarged, firm, and multinodular mass

Transvaginal ultrasound (TUS)
-  mass and confirm no adnexal mass
31
Q

What is the tx for Asymptomatic Leiomyomata Uteri (fibroids)?

A

Most fibroids do not require tx!

Education of pt
Short-interval surveillance after initial dx to confirm stability of findings

32
Q

What are sx of symptomatic Leiomyomata Uteri (fibroids)?

A
  • Abnormal bleeding not responsive to medical management
  • Pain or pressure sxs that interfere w/ QOL
  • Urinary tract sx (urgency, frequency, obstruction/hydronephrosis)
  • Infertility or recurrent pregnancy loss
33
Q

What are medication options for Symptomatic Leiomyomata Uteri (fibroids)?

A

Control the hormonal environment and minimize unopposed E

OCP/oral, injectable/IDU progestins (correct ovarian dysfxn)

GnRH agonist: reduce uterine bulk by 50% w/in 3 mo

34
Q

What are procedural/surgical tx options for Symptomatic Leiomyomata Uteri (fibroids)?

A 
Endometrial ablation 
Resection of intracavitary fibroids
Uterine Artery Emolization (UAE)
Myomectomy
Hysterectomy
35
Q

What option can be used for women who have symptomatic Leiomyomata Uteri (fibroids) and want to preserve fertility?

A

Myomectomy

36
Q

____ is the overgrowth of proliferative endometrium resulting from protracted Estrogen stimulation in the absence of Progestin –> “unopposed E”

A

Endometrial Hyperplasia

37
Q

When is a women most likely to have Endometrial Hyperplasia?

A

Typically peri/postmenopausal

38
Q

What are RF for Endometrial Hyperplasia?

A 
Obesity
Nulliparity
Early menarche/late menopause onset
Anovulation (PCOS)
Postmenopausal Estrogen therapy w/o Progestin
DM, HTN, hypothyroidism
Breast CA/Tamoxifen use
Caucasian
FHX of ovarian, colon, or uterine CA
Smoking
39
Q

What are the types of Endometrial Hyperplasia?

A

Simple w/ or w/o atypia

Complex w/ or w/o atypia

40
Q

What are sx of Endometrial Hyperplasia?

A

Asymptomatic (high risk based on hx)
Abnormal uterine bleeding pre/peri-menopausal
Post-menopausal bleeding

41
Q

When examining a woman w/ Endometrial Hyperplasia, will the uterus size be (enlarged/normal/small)?

A

normal

42
Q

How do you dx endometrial hyperplasia?

A
  • Pap smear may show glandular cells
  • Endometrial bx
  • TUS/SHGM: endometrial thickness >5 mm in post-menopausal pt, may show polypoid mass or fluid in cavity
  • Hysterocopy w/ D and C
43
Q

What is the management for endometrial hyperplasia w/o atypia? When would a repeat endometrial sampling be recommended?

A

Cyclical Progestin therapy
Medroxyprogesterone acetate

Continuous Progestin therapy

Repeat endometrial sampling in 3-6 months

44
Q

What is the management for endometrial hyperplasia w/ atypia?

A

Hysteroscopy/D and C to rule out/in coexisting adenocarcinoma

Hysterectomy for definitive dx and tx

High dose Progestin, repeat bx in 3 months—poor surgical candidates

LNR-IUD—option in poor surgical candidates who are not good candidates for systemic P, follow-up bx

Repro. Med 2 (12 decks)

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