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ovarian disorders Flashcards

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1
Q

what are the types of functional ovarian cysts?

A

follicular and corpus luteal cysts

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2
Q

what are follicular cysts?

A

occur when follicles fail to rupture and continue to grow

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3
Q

what are corpus luteal cysts?

A

fail to degenerate after ovulation

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4
Q

what is theca lutein?

A

excess BHCG causes hyperplasia of the interna cells

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5
Q

when are functional ovarian cysts mc?

A

reproductive years

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6
Q

s/sx of functional ovarian cysts?

A

+usually unilateral
+most are self-limiting and reslove w. in a few wks

+mostly asx unless they rupture (RLQ and LLQ ppain)

+may see abnormal uterine bleeding
-painful sex

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7
Q

PE of ovarian cysts?

A

Unilateral pelvic pain/tenderness

May have mobile, palpable cystic adnexal mass

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8
Q

dx of functional ovarian cysts

A

Pelvic US
Follicular → Smooth, thin-walled unilocular
Luteal → Complex, thicker-walled with peripheral vascularity
β-hCG levels → To rule out pregnancy

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9
Q

tx of ovarian cysts?

A

supportive
if less than 8 cm will most likely spontaneously resolve

if > 8 cm or persist, or found post menopauses, can be removed

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10
Q

ovarian cancers

A

2 cd MC gyn after endometrial

*highest mortality of all gyn ca

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11
Q

rf for ovarian ca

A

Family Hx → 7% lifetime risk (Normal 1-2%)
↑# of ovulatory cycles → Infertility, Nulliparity, >50 yrs, late menopause
BRCA1/BRCA2 → 15-40%
Peutz-Jeghers or Turner’s Syndrome

40-60 yo

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12
Q

protective factors in ovarian ca

A

OCPs → Decreases # of ovulatory cycles

High parity or TAH

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13
Q

s/sx of ovarian ca

A

Abdominal fullness/distension, +back or abdominal pain, early satiety
+Urinary frequency
+Irregular menses, menorrhagia, +postmenopausal bleeding, +constipation → intestinal compression

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14
Q

PE of ovarian cancer/ where can it mets?

A

Palpable abdominal or ovarian mass → Solid, fixed, irregular + ascites

Sister Mary Joseph’s Node → METS to the umbilical lymph node

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15
Q

dx of ovarian ca

A

Biopsy → 90% Epithelial → Seen especially postmenopausal → Germ cell seen in pts <30 yrs
Transvaginal US → Useful screening in high-risk pts
Mammography to look for primary in breast

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16
Q

tx of early stage ovarian ca

A

AH-BSO + Selective Lymphadenectomy

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17
Q

what levels are used to monitor ovarian cysts?

A

Serum CA-125

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18
Q

what chemo can be used for ovarina ca?

A

Paclitaxel + Cisplatin or Carboplatin

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19
Q

what is the MC benign ovarian neoplasm?

A

DERMOID CYSTIC TERATOMA

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20
Q

what are most ovarian neoplasms considered in reproductive age?

A

benign

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21
Q

how are benign ovarian neoplasms tx?

A

Removal due to potential risk of torsion or malignant transformation

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22
Q

PCOS PP?

A

associated with abnormal function of hypothalamus-pituitary-ovarian axis → ↑INSULIN & ↑LH-DRIVEN ↑IN OVARIAN ANDROGEN PRODUCTION

*insulin resistance

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23
Q

what is a rf for PCOS?

A

obesity

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24
Q

what is the triad of sx for PCOS?

A

Amenorrhea → Chronic Anovulation
Obesity
Hirsutism → Androgen Excess

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25
s/sx of PCOS?
Menstrual Irregularity → Secondary amenorrhea (50%), oligomenorrhea (70%) Increased Androgen → Hirsutism (50%) - Coarse hair growth on midline structures (face, neck, abd), acne, + male pattern baldness Insulin Resistance → Type II DM, Obesity (80%), Hypertension
26
PE of PCOS pt?
Bilateral enlarged, smooth, mobile ovaries on bimanual exam Acanthosis Nigricans Cysts are immature follicles w/arrested development due to abnormal ovarian fxn
27
dx of PCOS?
Exclude other disorders → Thyroid (TSH), Pituitary Adenoma (Prolactin Levels), Ovarian Tumors, Cushing’s Syndrome (Dexamethasone Suppression Test)
28
what labs should you order if suspecting PCOS?
↑testosterone, ↑DHEA-S (Intermediate of Testosterone), LH:FSH ratio>3:1 (Normal 1.5:1) lipid panel,
29
what specific lab test can you do for PCOS?
GnRH Agonist Stimulation Test → Rise in Serum Hydroxyprogesterone
30
what characteristic signs are seen on US with PCOS?
string of pearls Bilateral enlarged ovaries with peripheral cysts
31
what complications can occur with PCOS?
Chronic Anovulation → ↑Risk for infertility, ↑endometrial hyperplasia & endometrial carcinoma due to unopposed estrogen Insulin Resistance → ↑Risk of atherosclerosis & HTN
32
what may been seen in a pt with PCOS as they progress through maturity?
usually have normal puberty and adolescence, followed by progressively longer episodes of amenorrhea
33
tx of PCOS (mainstay)
combo OCP lifestyle change, surgery can be done to restore ovulation in pts who want kids but clomiphene doesn't work
34
how does estrogen help in PCOS?
stimulates hepatic production of sex-hormone binding globulin → reducing androgen levels
35
how does progesterone help in PCOS?
Progesterone decreases action of testosterone at target organs by receptor antagonism
36
what OCP should you avoid in PCOS?
androgenic progesterone → Norgestrel and Levonorgestrel
37
what can be used to tx hirsutism?
Spironolactone → Structurally similar to testosterone but blocks testosterone receptors Spironolactone = Teratogenic → Must be used with OCPs May be added if sxs persist after OCPs Leuprolide & Finasteride → Other Anti-Androgenics
38
how can infertility in the PCOS pt be tx?
Clomiphene
39
how does clomiphene work?
Selective Estrogen Receptor Modulator → Gonadotropin re-establishes ovulation in anovulatory women who with to get pregnant
40
how can metformin help in a PCOS pt?
with abnormal LH:FSH ratios may improve menstrual frequency by reducing insulin
41
common side effects of clomiphene?
hot flashes, pelvic pain *increased risk of twins
42
which population is most at risk for ovarian torsion and why?
prepubertal girls Based on the abdominal location of the ovary and the long utero-ovarian ligament the adnexa
43
s/sx of ovarian torsion
bdominal pain & ovarian enlargement on the same side demonstrated by sonography *pretty vague sx
44
dx of ovarian torsion?
Doppler flow studies may further contribute to the diagnosis but even in presence of flow the ovarian vessels should not preclude the clinical impression
45
tx of ovarian torsion?
operative laparoscopy
46
what is a leiomyoma?
Benign uterus smooth muscle tumor → Most common benign gynecologic lesion
47
what is the growth of a leiomyoma related to?
ESTROGEN PRODUCTION → Regresses after menopause | If it grows after menopause think other causes
48
what population is most likely to be affected by leiomyomas?
30s (especially > 35y) → 5x more common in African Americans
49
what are the 4 types of leiomyomas?
Intramural, Submucosal, Subserosal, Parasitic
50
s/sx of leiomyomas?
Most are asymptomatic Bleeding most common presentation → Menorrhagia, Dysmenorrhea Abdominal pressure/pain related to size of tumors & location Bladder → Frequency, urgency
51
what are PE findings for leiomyomas?
Large, irregular hard palpable mass in the abdomen or pelvis during bimanual exam
52
dx of leiomyomas?
elvic US → Focal heterogeneous masses with shadowing → Also used to observe for growth
53
tx of leiomyomas?
Observation → Majority don’t need treatment → Decision to treat is determined by symptoms, size/rate of tumor growth & the desire for fertility
54
medical tx of leiomyomas?
*think estrogen inhibitor--> decreased endometiral growth
55
what specific med can be used for leiomyomas?
leuprolide or progestins like medroxyprogesterone (causes endometrial atrophy, shrink uterus temporarily)
56
MOA of leuprolide?
GnRH agonist that causes GnRH inhibition when given continuously → Shrinks the uterus temporarily until natural menopause *only used if near menopause or preoperatively → Prior to hysterectomy
57
surgical tx of leiomyomas?
Hysterectomy → Definitive treatment → Fibroids = Most common cause for hysterectomy Myomectomy → Used especially to preserve fertility Endometrial ablation, artery embolization → Both may affect ability to conceive
58
what is adenomyosis?
Islands of endometrial tissue within the myometrium → muscular layer of uterine wall
59
PP of adenomyosis?
ectopic endometrial tissue induces hypertrophy & hyperplasia of the surrounding myometrium → Diffusely enlarged uterus
60
when does adenomyosis MC present?
later in the reproductive years
61
s/sx of adenomyosis?
Menorrhagia → Progressively worsens Dysmenorrhea + Infertility
62
PE findings of adenomyosis?
TENDER, SYMMETRICALLY/uniformly | enlarged “BOGGY UTERUS” → “Globular enlargement”
63
dx of adenomyosis?
Dx of exclusion of secondary amenorrhea → Rule out pregnancy first MRI
64
what is the definitive dx of adenomyosis?
Post-total hysterectomy examination of uterus
65
what is the only effective tx of adenomyosis?
Total abdominal hysterectomy
66
what are some conservative tx of adenomyosis?
sed to preserve fertility Analgesics Low dose OCPs mifepristone, GnRH agonist
67
what is the classic adenomyosis pt?
middle aged and parous w/ sever secondary dysmenorrhea and menorrhagia and symmetrically enlarged uterus
68
Leiomyoma vs adenomyosis: asymmetric?
leiomyoma
69
L vs A: symmetric?
adenomyosis
70
L vs A: firm uterus?
LEIOMYOMA
71
L vs A: soft uterus?
adenomyosis
72
L vs A: tender uterus?
adenomyosis
73
L vs A: nontender uterus?
adenoomyosis

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