Benign Upper Genital Tract Disorders Flashcards
(30 cards)
Upper structures formed from fusion of ______ ducts. Lower 1/3 vagina from ____.
Upper structures formed from fusion of paramesonephric = mullerian ducts. Lower 1⁄3 vagina from UG sinus
Congenital anomalies: septate uterus
Often a/w inguinal hernias & urinary tract anomalies (get imaging to eval!)
Bicornate or septate uteri complications:
2nd trim pregnancy loss, malpresentation, PTL, etc.
Generally will require no treatment unless symptomatic
Uterine leiomyomas = fibroids
Estrogen responsive monoclonal smooth muscle proliferation surrounded by pseudocapsule
Fibroid demographics
Common in women of childbearing age → can enlarge in pregnancy → regress in menopause
More common in AA pts for unknown reasons
Increased risk for fibroids:
Multip, nonsmoking, hypertensive, perimenopausal women
Protection for fibroids:
OCPs protective
Fibroids: when to treat
Only require treatment if bleeding / sx / problems with fertility
Submucosal bleed, take out under hysteroscopy. Intramural = most common, subserosal too - remove these via myomectomy.
Fibroids: diagnosis
Dx with pelvic ultrasound.
MRI if need to distinguish from adenomyosis.
Fibroid: treatment
Medical therapy: Provera, Lupron (decrease estrogen) - remember GnRH agonists can cause more bleeding initially.
Lupron usually used to shrink size / stop bleeding before surgery (fibroids will go back to previous size very quickly)
IR: can do uterine artery embolization
Surgical: myomectomy if fertility desired, but more morbid / recur. Hysterectomy definitive.
Endometrial polyps:
Benign overgrowths
Common in women 40-50 y/o
Benign, but can mask bleeding from other sources.
Endometrial polyp presentation:
Bleeding between periods (metrorrhagia, also meno / menometro)
Endometrial polyp diagnosis:
U/S & sonohystogram.
If > 35, need endometrial biopsy if bleedin
Endometrial hyperplasia:
Common cause of abnormal uterine bleeding
2/2 unopposed estrogen exposure (anovulatory cycles, etc) → can progress to carcinoma
Risk factors for endometrial hyperplasia:
Obesity, nullips, late menopause, early menarche, exogenous estrogen w/o progesterone, PCOS, chronic anovulation, estrogen producing tumors (granulosa-theca cell), tamoxifen. Also HTN / DM
Presentation of endometrial hyperplasia
P/w oligomenorrhea / amenorrhea, then excessive / irregular bleeding.
Uterine bleeding in postmenopausal women:
Endometrial hyperplasia / cancer until proven otherwise!
Endometrial hyperplasia classification:
Simple hyperplasia
Complex hyperplasia
Atypical simple hyperplasia
Atypical complex hyperplasia
If atypia, often have coexistent endometrial cancer!
Diagnosis of endometrial hyperplasia
Need tissue dx: endometrial bx is first line; can do D&C if needed afterwards / bx not possible.
Management of endometrial hyperplasia:
If just hyperplasia (simple / complex / SAH / CAH), can treat with progestin therapy (Provera to induce withdrawal bleed, or Mirena, etc) x 3 mo, then repeat endometrial bx to see regression
If CAH, often treat with hysterectomy (high risk coexistent endometrial cancer or developing it later).
Can follow closely if fertility preservation important, however.
Ovarian cysts: functional
Normal functioning cysts
Ovarian cysts: follicular
Most common. From failure of follicle to rupture. 3-8cm. Asx, unilateral but can be tender. Higher risk of torsion if greater than 4-5 cm. Resolve in 60-90d
Corpus luteum cyst
When corpus luteum fails to regress after 14d, or enlarges, or becomes hemorrhagic.
Can delay menses / cause unilateral lower quadrant pain.
Can rupture → hemoperitoneum.
Feel more firm on exam.
Theca lutein cysts
Large, bilateral cysts, clear, straw-colored fluid.
From stimulation by abnormally high B-hCG (molar pregnancy, choriocarcinoma, ovarian induction therapy)
