Diseases of the female genital system 2 Flashcards Preview

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Flashcards in Diseases of the female genital system 2 Deck (67):
1

What is endometriosis?

ectopic endometrium

2

What is the epidiemiology of endometriosis?

6-10% of women, 30 – 40yo

3

What are the clinical features of endometriosis?

- 25% asymptomatic
- dysmenorrhoea
- dyspareunia
- pelvic pain
- subfertility
- pain on passing stool
- dysuria

4

What is the treatment for endometriosis?

Medical (COCP - GnRH agonists/antagonists, progesterone antagonists)

surgical (ablation/ TAH-BSO)

5

What other diseases is endometriosis linked to?

- Ectopic pregnancy
- ovarian cancer
- IBD

6

What is endometritis?

Inflammation of the endometrium

7

What are the acute causes of endometritis?

- Retained POC/placenta
- prolonged ROM
- complicated labour

8

What are the chronic causes of endometritis?

- PID
- retained gestational tissue
- endometrial TB
- IUCD infection

9

What is the difference in histology between acute and chronic endometritis?

Acute - neutrophils
Chronic - lymphocytes/plasma cells

10

What are the clinical features of endometritis?

- Abdominal/pelvic pain
- pyrexia
- discharge
- dysuria
- abnormal vaginal bleeding

11

What is the treatment of endometritis?

- Analgesia
- abx
- remove cause

12

What are endometrial polyps?

Sessile/polypoid E2-dependent uterine overgrowths

13

What are the clinical features of endometrial polyps?

- Often asymptomatic
- intermenstrual bleeding
- post menopausal bleeding
- menorrhagia, dysmenorrhoea

14

What is the treatment for endometrial polyps?

- medical (P4/GnRH agonists)
- surgical (curettage) 

15

What is leiomyomata?

Uterine fibroids - benign myometrial tumours with E2/P4-dependent growth

16

What is the epidemiology of leiomyomata?

~20% women 30-50’s

17

What are the risk factors for leiomyomata?

- Genetics
- nulliparity
- obesity
- PCOS
- HTN

18

What are the clinical features of leiomyomata?

- Often asymptomatic
- menometrorrhagia (Fe def. anaemia)
- subfertility/ pregnancy problems
- pressure sx

19

What are the treatments for leiomyomata.

- Medical (IUS/NSAIDs/OCP/P4/Fe2+);

- non-medical (artery embolization, ablation, TAH)

20

What is the prognosis for leiomyomata?

- menopausal regression

- malignancy risk 0.01%

21

What is endometrial hyperplasia?

Excessive endometrial proliferation (increased E2, decreased P4)

22

What are the risk factors for endometrial hyperplasia?

- obesity
- exogenous E2
- PCOS
- E2-producing tumours
- tamoxifen
- HNPCC (PTEN mutations)

23

How is endometrial hyperplasia classified?

- non-atypical hyperplasia (1-3% progress)
- atypical hyperplasia (23-48% are carcinoma on hysterectomy)

24

What are the symptoms of endometrial hyperplasia?

Abnormal bleeding - IMB/PCB/PMB

25

What is the treatment for endometrial hyperplasia?

- medical (IUS, P4),
- surgical (TAH)

26

What is the prognosis for endometrial hyperplasia?

- endometrial adenocarcinoma
- regression

27

What is the most common cancer of the female genital tract?

endometrial carcinoma

28

What are the two types of endometrial carcinoma?

- Type 1 - endometroid
- Type 2- serous

29

What is the difference in epidemiology between serous and endometroid carcinoma?

Incidence
- endometroid - 75% of cases
- serous - 25% of cases

Age
- endometroid - Pre/perimenopausal
- serous - postmenopausal

30

What mutations are found in endometroid carcinoma?

PTEN
Kras

31

What mutations are found in serous carcinoma?

p53

32

What is the E2 status of endometroid cancer?

E2 +ve

33

What is the E2 status of serous cancer?

E2 -ve

34

What are the grades of endometroid cancer?

Grades 1,2,3

35

What are the grades of serous cancer?

3

36

How is endometrial carcinoma staged?

FIGO (1 - 4)

37

What are the treatments for endometrial cancer?

- medical (P4), surgery (TAH-BSO), adjuvant therapy (chemo-/radiotherapy)

38

What is the prognosis for endometrial cancer?

- Stage 1 = 90% 5yr survival
- Stage 2-3 =

39

What is polycystic ovary syndrome?

Complex endocrine disorder; hyperandrogenism, menstrual abnormalities and polycystic ovaries

40

What is the epidemiology of polycystic ovary syndrome?

6-10% women (20-30% have polycystic ovaries)

41

What investigations are performed for PCOS?

- USS
- fasting biochemical screen (↓FSH, ↑LH, ↑testosterone, ↑DHEAS )
- OGTT

42

How is PCOS diagnosed?

Rotterdam criteria 2/3 of:
- polycystic ovaries
- hyperandrogenism (hirsuitism/ biochemical)
- irregular periods (>35 days)

43

What are the treatments for polycystic ovary syndrome?

- lifestyle (weight loss)
- medical (metformin, OCP, clomiphene)
- surgical (ovarian drilling)

44

What other conditions are linked to PCOS?

- infertility
- endometrial hyperplasia/ adenocarcinoma

45

What is hypergonadotrophic hypogonadism?

Primary failure of gonads

46

What are the congenital causes of hypergonadotrophic hypogonadism?

- Turner syndrome (XO)
- Klinefelter’s syndrome (XXY)

47

What are the acquired causes of hypergonadotrophic hypogonadism?

- Infection
- surgery
- chemo-radiotherapy
- toxins/drugs

48

What is hypogonadothrophic hypogonadism?

Hypothalamic/ pituitary failure -> secondary failure of gonads

49

What are the causes of hypogonadothrophic hypogonadism?

- Sheehan’s syndrome
- pituitary tumours
- brain injury
- empty sella syndrome
- PCOS

50

What is the presentation of hypogonadothrophic hypogonadism?

- amenorrhoea/absent menarche; delayed puberty
- decreased sex hormone levels +/-
- increased LH and FSH levels

51

What investigations are used in suspected hypogonadothrophic hypogonadism?

- Hormonal profiling
- karyotyping

52

What is the treatment for hypogonadothrophic hypogonadism?

- Difficult - address cause
- HRT

53

What are the origins of ovarian neoplasms?

Sex-cord stromal tumours
- Granulosa cell thecomas
- fibrothecomas
- Sertoli-Leydig cell tumours

Surface epithelial stromal tumours
- Serous
- Mucinous
- Endometroid
- Transitional cell
- Clear cell

Germ cell tumours
- Teratomas
- Yolk sac tumours
- Dysgerminomas

54

What is the most common group of epithelial neoplasms?

Epithelial tumours

55

What are the three major histological types of epithelial ovarian tumours?

- Serous (tubal)
- Mucinous (endocervical)
- Endometroid (endometrium)

56

What are sex cord stromal tumours?

- Rare; arise from ovarian stroma, which was derived from sex cord of embryonic gonad
- Can generate cells from the opposite sex

57

What are thecoma/ fibrothecoma/ fibromas?

- Benign, thecomas and fibrothecomas produce E2 (also rarely androgens)
- Fibromas hormonally inactive
- Comprised of spindle cells (plump spindle cells with lipid droplets = thecoma appearance)

58

What are granulosa cell tunours?

Low grade malignant, produces E2

59

What are Sertoli-Leydig cell tumours?

Produces androgens; 10-25% malignant

60

What is the 2nd commonest gynae cancer?

Ovarian cancer

61

What are the risk factors for ovarian cancer?

- Fx
- ↑age
- PMHx
- breast cancer
- smoking
- E2-only HRT
- Lynch II syndrome
- obesity (weak)
- nulliparity (weak)

62

What are the protective factors for ovarian cancer?

- OCP
- breastfeeding
- hysterectomy

63

What is the typical history for ovarian cancer?

- non-specific symptoms
- pain
- bloating
- weight loss
- PV bleeding
- urinary frequency
- anorexia

64

What is the treatment for ovarian cancer?

- Stage

65

What is the prognosis for ovarian cancer?

Overall 5 years 43% survival

66

What is the most common type of metastatic ovarian tumour and where do they spread from?

Mullerian
- Uterus
- Fallopian tube
- Pelvic peritoneum
- Contralateral ovary

67

What are the site of spread for extra-mullerian tumours?

Lymphatic/ haematogenous spread:
- GI tract: Large bowel, stomach
- (Krukenberg tumour), pancreatobiliary
- Breast
- Melanoma
- kidney
- lung

Direct extension
- bladder
- rectal

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