benign tumours

Question 1

RF for myoma

Answer 1

afro carribena women 
genetics
nulliparity(more oestroegn as more periods)
 ( NB)obsesity - increased levels of oestroegen so younger women  
early menarche
FH 
VItamin d deficiency 
nulliparity 

Question 2

tx myoma

Answer 2

gnrh agonists - antagonises estrogen which is needed for growth

Question 3

classication of myomas

Answer 3

intramural
submucosal - peducntulated
subserosal- peduncultated
cervical

Question 4

what does the texture of the myoma tell you

Answer 4

more hardness- more fibrosis

more soft- mote muscle

Question 5

symptoms

Answer 5

a lot of times its aympotmatic picked up by accident
dysfunctional uterine bleeding - prolonged menstraul bleeding mennorrhagia
pain - does not usually occur in uncomplicated myomas -
pain can occur if large enough and esp around period
feeling of pressure
early satety if big enough
distended abdo
bladder/bowel issues- freuent urination, if large enough to put pressure on bladder constipation again due to compression
pedal edeam -compression of veins
dysparenia
poist coital bledding -not common more likley to be submucosal

Question 6

indications for surgery for myoma

Answer 6

1. excessisve bleeding
   Protrusion of myoma through cervical os into vagina
    Rapid growth (may be leiomyosarcoma rather than benign leiomyoma)
    Repetitive pregnancy loss
    Infertility
    Enlarged uterine size (>12weeks pregnancy size)
    Progressive hydronephrosis

Question 7

which type of fibroid is assoiated with heavy bleeding

Answer 7

submucosal because now you are interfering with the cavity of the uterus and also interstiaial

Question 8

what would hysterocopic removal be best for which fibroid

Answer 8

submucosal

Question 9

how do know ehere the fibroid is

Answer 9

physical exam bi manual exam

ultrasound and MRI

Question 10

SECODNARY CHANGES DIVIDED INTO

Answer 10

1. degenerative
2. vascular changes
3. inflammation
4. malignant transformation

Question 11

degenerative changes

Answer 11

hyaline (most common) , fatty, red, calcification, atrophy , myoxomatous degeneration , pseudocytsic degeneration

Question 12

msot common symmptom of fibroids

Answer 12

bleeding, menorrhagia prolonged menstraul periods duratiron or heavy

intermenstraul bleding

pain if large enough

dyspareneau

Question 13

when would you experience pain

Answer 13

if the uterus is contracting to deliver the nascient myoma or if you have torsion or infarction of pedunculated myoma

Question 14

what is the tumour made up of

Answer 14

smooth muscle and fibrous tissue and its texture depends on the compositions between the 2

Question 15

which is the most common type

Answer 15

intramural

Question 16

the 2 most common causes of enlarged uterus

Answer 16

fibroids and adenomyosis

Question 17

what is adenomyseos and symptoms

Answer 17

endometrium moves into the muscular layer
it’s a diffuse thickening of uterus . When this happens in a small area, or is localized, it is called an adenomyoma.

symptoms very similar to fibroids, pain during sex, dysfunctional uterine bleeding (heavier periods) , and also painful periods

Question 18

rf dor adenomyoma

Answer 18

usually occurs in women who have had children

women who have had uterine surgery inc c - section

Question 19

other causes of enlarged uterus

Answer 19

endometrial cancer , cervical cancer

Question 20

which types of fibroids are likely to cause symmetrically enlarged uterus

Answer 20

submucosal

Question 21

whats the caution with gnrh agonists

Answer 21

not more than 24 weeks/6 months - risk of osteoproesis examples groselin and leuporelin they will shrink the fibroid

Question 22

conservative tx

non conservative tx 1.

Answer 22

if not causing problems, due to size nothing to be done but 1st line is contracept=tion (mirena coil) if fibroid is less then 3 cm

1. Abdominal myomectomy:
2. Hysteroscopic myomectomy
3. Laparoscopic myomectomy:
4. Uterine artery embolisation may provide a targeted degeneration of the fibroid. This may also preserve fertility.(not commonly done due to complications) so if you want kids its a risk -ALSO USED FOR ADENOMYOSIS-cuts off blodd supply to the fibroid so it shrinks
5. laser ablation use heat to cause necorise
6. cryomyloysis
7. defintive - hysterectomy

Myomectomy only option if want to presevre fertility but could come back

Question 23

what can a speculum exam shows you in general

Answer 23

allows you to see the cervix
test for any infections like STD
any cancers
insert an IUD, or empty the womb (if open)

Question 24

complication sof fibroids

Answer 24

1. affect fertility
2. bowel/blaldder
3. miscarriage
4. anemia due to beeding
   5.torsion if pedunculated

Question 25

enodmetrial plyps signs

Answer 25

irregar bleeding

Question 26

diagnosis of myoma

Answer 26

physcial exam - may feel an elarged uterus as a suprapubic mass uss pelvis TS uss mri if not enough detail from uss

Question 27

types of fibroids

Answer 27

intramural subserosal-grow outside into prelvis submucosal-grow inside towards womb

Question 28

fibroids vs endo

Answer 28

edno - more pain whereeas fibroids if big enough, usually asymptomatic fibro - enlarged uterus, would have it endo both can cause dyapareneau both young women both treated the same way in terms of hormones

Question 29

woman with known firboids about to go for myomectomy but hb is low what can you give to imporve hb

Answer 29

gnrh - groselin which will help witht he bleeding but has side effects of menopuase symptoms so dont take for >6 months

Question 30

post coital bleeding

Answer 30

most likely cervical pathology like ectropian cervical cancer cervicitis can be fiborids if they are near cervix so submucosal vibes rather than intramural /subseroal

Question 31

Symptomatic fibroids that are greater than 3 cm are normally treated with surgery.