Disorders of Fallopian Tube and Uterus Flashcards
What is adnexal torsion?
a rare disorder, usually occuring as a result of an ovarian cyst or neoplasm
What are the clinical manifestations of adnexal torsion?
Sudden onset of severe pain localized in one lower quadrant N/V Fever Tachycardia Tachypnea Direct tenderness in the lower quadrant Rebound tenderness (positive psoas sign, positive heel percussion sign) Adnexal mass
What goes into the differential diagnosis of adnexal torsion?
Appendicitis Ectopic pregnancy Ruptured ovarian cyst TOA Rapidly growing neoplasm
What goes into the evaluation of adnexal torsion?
HCG- exclude ectopic pregnancy Pelvic US- assess for ectpoic pregnancy CBC- assess hematocrit and WBC CT scan- assess for appendicitis and adnexal mass PCR- screen for gonorrhea and chlamydia
How do you treat an adnexal mass?
Exploratory laparotomy or operative laparoscopy
RELEASE OF TORSION
Removal of cyst
Removal of tube and ovary
What is endometriosis?
Endometrial tissue outside of the uterine cavity- most frequently on the tube, ovary, peritoneal surface
What is the etiology of endometriosis?
Tubal regurgitation
Metaplasia of mesothelium
Hematogenous dissemination
What are the clinical manifestations of endometriosis?
Classic tetrad: dysmenorrhea dyspareunia chronic pelvic pain infertility
What are some unusual manifestations of endometriosis?
Rectal bleeding
Hemoptysis
Nasal bleeding
Abnormal tissue laparotomy
How do you make a diagnosis of endometriosis?
Biopsy of visible lesion in vagina, cervix, or laparotomy scar
Direct visualization by laparoscopy
Pelvic US
What is the management of endometriosis?
Oral contraceptive- effective, inexpensive, birth control BUT delays pregnancy and has side effects
Depo-provera- effective, inexpensive, birth control BUT delays pregnancy and has side effects
GnRH agonist- Effective, birth control BUT expensive and has side effects
Laparoscopic surgery- effective, less invasive BUT expensive, risk of anesthesia, and has operative complications
Open laparotomy- effective, optimum exposure BUT expensive, risk of anesthesia, and has operative complications
What is one of the major causes of gynecologic cancer?
endometrial cancer, specifically adenocarcinoma
What are the risk factors for endometrial cancer?
increasing age early menarche late menopause positive family history obesity low parity unopposed estrogen stimulation (PCO, HRT) HTN diabetes
What are the clinical manifestations of endometrial cancer?
ABNORMAL UTERINE BLEEDING Enlarged uterus Increasing abdominal girth Ascites Signs of metastatic disease (hepatomegaly, pulmonary changes)
What goes into the evaluation for endometrial cancer?
platelet count- identify thrombocytopenia
platelet function assay- identify Von Willebrands disease
Pelvic US- assess for myoma, polyp, hyperplasia/cancer
endometrial biopsy- establish a histological diagnosis
mammogram- exclude breast cancer
hematocrit/hemoglobin- identify anemia
chest x-ray- exclude pulmonary metastasis
colonoscopy- exclude rectal carcinoma
