Benign disorders of the upper genital tract Flashcards Preview

OB/GYN > Benign disorders of the upper genital tract > Flashcards

Flashcards in Benign disorders of the upper genital tract Deck (34):
1

why do women w/uterine septums have recurrent pg'y losses? bicornate uterus?

uterine septum has poor blood supply, cannot facilitate proper placentation.
Bicornate uterus is simply too small (plenty of blood supply)

2

when to tx uterine anomalies?

when symptomatic or when causing probs w/childbearing

3

uterine anomalies result from problems in fusion of what ducts?

paramesonephric (mullerian)

4

how do fibroids change throughout life?

form during childbearing years, regress during menopause

5

when is a fibroid problematic?

when it causes heavy/irregular bleeding or infertility, or by mass effect cause urinary or bowel sx's

6

fibroids are monoclonal, meaning what?

arise from propagation of a single smc cell

7

what are the 3 types of fibroids?

submucosal
intramura
subserosal

8

what is a parasitic leiomyoma?

pedunculated fibroid that becomes attached to pelvic viscera and dvps its own blood supply

9

leiomyoma vs. adenomyosis:

leiomyoma has a pseudocapsule made of a compressed layer of smc's w/little or no blood supply.
adenomyosis is presence of endometrium in myometrium

10

what can happen to a fibroid when it grows too large?

outgrows its blood supply, infarcts and degenerates. Painful.

11

RFs for fibroid formation:

AfAm
nonsmokers
perimenopausal
ob

12

CP of fibroids:

menorrhagia
may have secondary dysmenorrhea if not enough bf to fibroid
maybe constip
maybe urinary frequency
maybe urinary retention
maybe infertility

13

how to dx fibroids?

maybe can feel them on physical exam
otherwise, u/s

HSG and sonohysterogram (saline infusion sonography) to see submucosal ones and to distinguish them from polyps

14

mgt of pt w/fibroids?

m/definitively r/o other pelvic masses
follow q6mos

if perimenopausal, bridge to menopause with:
medroxyprogesterone (Provera)
danazol (modified TS)
Lupron (GnRH agonist)

uterine a. embolization

myomectomy (maintain fertility)
hysterectomy

15

do fibroids become malignant?

rarely

if rapidly growing in a postmenopausal woman, eval for leiomyosarcoma (rare)

16

is endometrial hyperplasia premalignant?

yes, can be.

17

simple vs. complex endometrial hyperplasia:

simply = abnl prolif of both stroma and glands
complex = abnl prolif of glands only (crowded back-to-back), but no cellular atypia is present.

18

what makes a hyperplasia atypical?

if there is cytologic atypia

19

what type of endometrial hyperplasia has highest rate of conversion to endometrial carcinoma

atypical complex hyperplasia

20

RFs for endometrial hyperpl

unopposed ES:
ob
nulliparity
late menopause
exogenous ES w/o PG
chronic anovulation
PCOS
tamoxifen use
DM

21

CP of endometrial hyperplasia:

periods of oligo or amenorrhea then excessive bleeding
pelvic exam is normal.
signs of chronic anovulation - ab'l ob, acanthosis, acne, hirsutism

22

tx of endometrial hyperplasia

progestin (Depo-Provera, Provera) for 3 mos
repeat bx to confirm regression

if there is no cytologic atypia (aka, just simple or complex, not atypical) then don't need progestin. Just bx again in 3-6 mos

Atypical complex => hysterectomy due to risk of progression to cancer

23

2 types of ovarian masses:

fct'l cysts
neoplastic

24

2 types of functional cysts:

follicular
corpus luteum

25

what is a follicular cyst:
what problems can arise from them?

failure of a follicle to rupture during follicular phase.
Usually asx'c but can be tender if large.
Can => ovarian torsion of > 4cm

26

what is a CL cyst?

when CL becomes large and hemorrhagic, or doesn't regress after 14d

27

cp of CL cyst?

delay in menstruation
dull lower quadrant pain

28

what is a theca lutein cyst?

large bilateral cysts filled w/clear, straw-colored fluid
grow in response to beta-hCG levels from molar pg'y, choriocarcinoma, or Clomid

29

what is the most common form of ovarian mass in a reproductive-age pt?

functional

30

what is a RF for functional cysts?

smoking

31

CP of ovarian torsion?

waxing & waning pain
nausea

32

what is a Ca-125 level used for?

to eval a response to chemotherapy, obtained at baseline in high-risk pts. Not a dx'c or screening tool.

33

an adnexal mass in what age group suggests neoplasm?

premenarcheal
postmenopausal
or reproductive-age but cyst > 8cm or persists beyond 60d

34

mgt of cysts in reproductive age pts?

serial u/s to look for resolution
most resolve on their own in 2-3 mos
can start an OCP to prevent formation of additional ones
cystectomy if they don't regress after 60d