Flashcards in Benign Disorders of the Upper Genital Tract Deck (34):
Lower one third of the vagina derives from what embryonic structure?
Ovaries derive from what embryonic structure?
Upper vagina, cervix, uterus, and fallopian tubes derive from what embryonic structure?
Fusion of the paremesonephric (Mullerian) ducts.
Most common anatomic anomaly of the uterus?
Septate uterus - from malfusion of the paremesonephric (Mullerian) ducts.
Cause for increase in mullerian anomalies in the female population? Classic presentation of this anomaly?
DES exposure in utero. T-shaped uterus.
Most common complication of having a uterine septum?
First trimester pregnancy loss (25%) - Decreased ability to perfuse the placenta.
Common complications of having a uni/bicornuate uterus (3)?
Second trimester pregnancy loss, malpresentation, and preterm labor and delivery - Decreased size of the uterine horn
What tests can distinguish between unicornuate and bicornuate uteri?
MRI or laparoscopy.
What is the most common indication for surgery for women in the US? Symptoms?
Uterine leiomyomas (fibroids). Can cause pelvic pain, urinary frequency, constipation, abnormal uterine bleeding, and secondary dysmenorrhea.
Are fibroids polyclonal or monoclonal?
Monoclonal - from from propagation of a single muscle cell.
What increases the growth rate of fibroids? What decreases the growth rate of fibroids?
ESTROGEN and progesterone (endogenous and exogenous). Menopause - decreased estrogen.
Three classes of uterine fibroids?
Most common type?
Type that causes the heaviest bleeding?
Type that causes the most pain?
Submucosal, intramural, and suberosal.
How to distinguish between fibroids and adenomyosis? Most helpful test?
Fibroids are encapsulated in pseudocapsule.
Which race of women are more likely to develop fibroids (as well as at a younger age with more severe fibroids, bleeding, and anemia)
Black women! 50% will get them by 40, only 30% of the general population will get them by 40.
Most common symptom of fibroid? Second most common symptom?
Abnormal uterine bleeding - Menorrhagia, metorrhagia, postcoital spotting, and menometorrhagia.
Most common means of diagnosing fibroids?
Best diagnostic test for submucosal fibroid?
How frequently should a woman with actively growing fibroids be assessed?
Every 6 months.
Role of GNRH agonists (Lupron) in treatment of fibroids?
Decrease size, stops bleeding, and increases hermatocrit.
What is the definitive treatment for uterine fibroids?
Issue with myomectomy?
Indications for surgery for fibroids (7)?
Bleeding causing anemia.
Growth after menopause.
Rapid increase in size.
Large uterine size (>12 weeks)
Cause of endometrial polyps?
Which age groups are most effected?
Most common symptoms?
Best diagnostic tests?
Overgrowths of endometrial glands and stroma.
40-50 year old women (especially on tamoxifen).
Metrorrhagia, menorrhagia, and menometrorrhagia.
Ultrasound and sonohysteogram.
Why is it important to remove symptomatic endometrial polyps?
They mask bleeding from another source (endometrial hyperplasia or cancer).
DDX of Abnormal bleeding (7)?
Adenomyosis, endometrial polyps, endometrial hyperplasia, endometrial cancer, dysfunctional uterine bleeding, ectopic pregnancy, and Uterine Fibroids.
What causes endometrial hyperplasia?
Exogenous - Hormone replacement therapy
Endogenous - Conversion of androgens to estrogens by aromatase in adipocyte cells.
Classifications and progression from Simple Endometrial Hyperplasia to Endometrial Cancer (4).
Simple Hyperplasia - 1% risk of progressing to cancer.
Complex Hyperplasia - 3% risk of progressing to cancer.
Atypical Simple Hyperplasia - 8% risk of progressing to cancer.
Atypical Complex Hyperplasia - 29% risk of progressing to cancer.
Treatment of Endometrial Atypical Complex Hyperplasia? Treatment in younger patients?
Hysterectomy - high risk of concurrent or incipient cancer.
Endometrial cuettage, progestin managment, and weight loss to maintain opportunity for pregnancy.
Physical exam findings for Endometrial hyperplasia?
Typically none - might see symtpoms of chronic annovulation like obesity, acanthosis, acne, or hirsutism.
Treatment of Endometrial Simple/Complex Hyperplasia?
Progestin therapy! Depo, Mirena, Provera...just give them progesterone.
75% of ovarian cysts in reproductive age women are functional ovarian cysts, what are the three types of functional cysts?
Common risk factor?
Follicular - Most common, can cause torsion if large but mostly spontaneously resolve.
Corpus Luteum - Cause delay in menstration, pain, and signs of hemoperitoneum.
Theca Lutein - Large bilateral cysts from abnormally high bHCG.
SMOKING doubles the risk of developing functional cyst.
Classic presentation of torsed adnexa from an ovarian cyst?
Waking and waning pain and nausea.
Diagnostic test for functional ovarian cysts?
Pelvic ultrasound - most will spontaneously resolve in 60-90 days.
Treatment of an 8 year old girl with a cystic adnexal mass >2cm?
It's most likely a neoplasm - Exploratory Laparotomy.
Treatment of a 30 year old woman with a cystic adnexal mass <8 cm?
What about a non resolving mass greater than 8cm?
Observation and ultrasound - put on OCP to suprress ovulation and formation of future cysts.
Ex lap or laparoscopy.