Endometrial Disease Flashcards

(44 cards)

1
Q

Adenomyosis is

A

characterized by the presence of endometrial tissue within the myometrium

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2
Q

Adenomyosis is more common in

A

multiparous women towards the end of their reproductive years.

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3
Q

Adenomyosis features

A

dysmenorrhoea
menorrhagia
enlarged, boggy uterus

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4
Q

Adenomyosis mx

A

GnRH agonists

hysterectomy

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5
Q

Uterine fibroids are sensitive to

A

oestrogen

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6
Q

fibroids decrease in pregnancy

A

false

Uterine fibroids are sensitive to oestrogen and can therefore grow during pregnancy

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7
Q

What is carneous degeneration?

A

Uterine fibroids are sensitive to oestrogen and can therefore grow during pregnancy. If growth outstrips their blood supply, they can undergo red or ‘carneous’ degeneration

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8
Q

Sx carneous degeneration

A

with low-grade fever, pain and vomiting.

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9
Q

Mx carneous degeneration

A

The condition is usually managed conservatively with rest and analgesia and should resolve within 4-7 days.

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10
Q

Endometriosis is

A

common condition characterised by the growth of ectopic endometrial tissue outside of the uterine cavity.

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11
Q

10% of women of a reproductive age have a degree of endometriosis.

A

true

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12
Q

Endometriosis gynae sx

A

chronic pelvic pain
dysmenorrhoea - pain often starts days before bleeding
deep dyspareunia
subfertility

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13
Q

Endometriosis non-gynae sx

A

urinary symptoms e.g. dysuria, urgency, haematuria. Dyschezia (painful bowel movements)

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14
Q

Endometriosis pelvic exam

A

on pelvic examination reduced organ mobility, tender nodularity in the posterior vaginal fornix and visible vaginal endometriotic lesions may be seen

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15
Q

Endometriosis ix

A

laparoscopy is the gold-standard investigation

there is little role for investigation in primary care (e.g. ultrasound)- if the symptoms are significant the patient should be referred for a definitive diagnosis

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16
Q

Endometriosis first line mx

A

NSAIDs and/or paracetamol are the recommended first-line treatments for symptomatic relief

if analgesia does help then hormonal treatments such as the combined oral contraceptive pill or progestogens e.g. medroxyprogesterone acetate should be tried

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17
Q

Endometriosis management depends on laparoscopy findings

A

false
Management depends on clinical features.
There is poor correlation between laparoscopic findings and severity of symptoms.

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18
Q

Endometriosis Secondary care mx

A

Secondary treatments include:
GnRH analogues - said to induce a ‘pseudomenopause’ due to the low oestrogen levels
drug therapy unfortunately does not seem to have a significant impact on fertility rates

surgery: some treatments such as laparoscopic excision and laser treatment of endometriotic ovarian cysts may improve fertility

19
Q

Endometriosis - secondary care referal is indicated when?

A

If analgesia/hormonal treatment does not improve symptoms or if fertility is a priority the patient should be referred to secondary care.

20
Q

Endometrial hyperplasia is?

A

defined as an abnormal proliferation of the endometrium in excess of the normal proliferation that occurs during the menstrual cycle

21
Q

Majority of patients with endometrial hyperplasia may develop endometrial cancer

A

false

minority

22
Q

Types endometrial hyperplasia

A

simple
complex
simple atypical
complex atypical

23
Q

endometrial hyperplasia features

A

abnormal vaginal bleeding e.g. intermenstrual

24
Q

endometrial hyperplasia mx

A

simple endometrial hyperplasia without atypia: high dose progestogens with repeat sampling in 3-4 months. The levonorgestrel intra-uterine system may be used
atypia: hysterectomy is usually advised

25
Endometrial cancer is classically seen in
post-menopausal women but around 25% of cases occur before the menopause.
26
Endometrial cancer usually carries a bad prognosis
false | It usually carries a good prognosis due to early detection
27
The risk factors for endometrial cancer are as follows
``` obesity nulliparity early menarche late menopause unopposed oestrogen. diabetes mellitus tamoxifen polycystic ovarian syndrome hereditary non-polyposis colorectal carcinoma ```
28
unopposed oestrogen. The addition of what reduces rx endometrial cancer
progestogen to oestrogen reduces this risk (e.g. In HRT). The BNF states that the additional risk is eliminated if a progestogen is given continuously
29
Endometrial cancer sx
postmenopausal bleeding is the classic symptom premenopausal women may have a change intermenstrual bleeding pain and discharge are unusual features
30
Endometrial cancer ix
women >= 55 years who present with postmenopausal bleeding should be referred using the suspected cancer pathway first-line investigation is trans-vaginal ultrasound - a normal endometrial thickness (< 4 mm) has a high negative predictive value hysteroscopy with endometrial biopsy
31
Endometrial cancer mx
localised disease is treated with total abdominal hysterectomy with bilateral salpingo-oophorectomy. Patients with high-risk disease may have post-operative radiotherapy progestogen therapy is sometimes used in frail elderly women not consider suitable for surgery
32
Uterine fibroids are?
Fibroids are benign smooth muscle tumours of the uterus.
33
Uterine fibroids epidemiology?
They are thought to occur in around 20% of white and around 50% of black women in the later reproductive years.
34
Uterine fibroids associations
more common in Afro-Caribbean women | rare before puberty, develop in response to oestrogen
35
Uterine fibroids sx
may be asymptomatic menorrhagia may result in iron-deficiency anaemia lower abdominal pain: cramping pains, often during menstruation bloating urinary symptoms, e.g. frequency, may occur with larger fibroids subfertility
36
Uterine fibroids rare features
polycythaemia secondary to autonomous production of erythropoietin
37
Uterine fibroids diagnosis
transvaginal ultrasound
38
Asymptomatic fibroids mx
no treatment is needed other than periodic review to monitor size and growth
39
Management of menorrhagia secondary to fibroids
``` levonorgestrel intrauterine system (LNG-IUS) NSAIDs e.g. mefenamic acid tranexamic acid combined oral contraceptive pill oral progestogen injectable progestogen ```
40
Management of menorrhagia secondary to fibroids - levonorgestrel intrauterine system (LNG-IUS) is useful when
useful if the woman also requires contraception | cannot be used if there is distortion of the uterine cavity
41
Treatment to shrink/remove fibroids | medical
GnRH agonists may reduce the size of the fibroid but are typically useful for short-term treatment ulipristal acetate has been in the past but not currently due to concerns about rare but serious liver toxicity
42
Treatment to shrink/remove fibroids | surgical
myomectomy: this may be performed abdominally, laparoscopically or hysteroscopically hysteroscopic endometrial ablation hysterectomy uterine artery embolization
43
Uterine fibroids prognosis
Fibroids generally regress after the menopause.
44
Uterine fibroids complications
Some of the complications such as subfertility and iron-deficiency anaemia Other complications red degeneration - haemorrhage into tumour - commonly occurs during pregnancy