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Ovaries Disorders Flashcards

(51 cards)

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1
Q

What conditions are Polycystic Ovarian Syndrome associated with?

A 
Hirsutism
Obesity
Glucose intolerance/Diabetes mellitus
Cardiovascular disease
Metabolic syndrome
Dyslipidemia
NAFLD
Obstructive sleep apnea
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2
Q

What is the Pathophysiology or reasoning behind Polysystic Ovarian Syndrome?

A
  1. . Abnormal androgen and estrogen metabolism
  2. Control of androgen production is unregulated
  3. Insulin resistance and hyperinsulinemia
  4. Decreased adiponectin
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3
Q

look over slide 7

A

slide 7

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4
Q

How does Insulin resistance and Hyperinsulinemia cause POS?

A

Increased insulin alters gonadotropin effects on ovarian function

Increased insulin decreases synthesis of sex hormone binding globulin and insulin-like growth factor

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5
Q

What role does adiponectin do?

This is decreased in POS

A

Regulates lipid metabolism and glucose levels

Insulin sensitizer

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6
Q

slide 10

A

slide 10

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7
Q

Clinical Presentation of Polycystic Ovarian Syndrome?

A 
Infertility
PCOS is most common cause
Oligomenorrhea/Amenorrhea
Anovulation
Obesity
Acne
Hirsutism
Upper lip, chin
Male-pattern baldness
Acanthosis nigricans
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8
Q

What is the Diagnostic Criteria for Polycystic Ovarian Syndrome?

A

Rotterdam Criteria 2003

Two of the three below must be present after the exclusion of related disorders

  • Ovulatory dysfunction (amenorrhea)
  • Clinical or biochemical signs of hyperandrogenism
  • Polycystic ovaries
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9
Q

Which imaging would you used to diagnose POS?

What findings do you associate it with?

A

Ultrasound

-Presence of >12 follicles in either ovary measuring 2-9mm in diameter (Rotterdam Criteria)
-“String of pearls” appearance
Ovarian volume >10mL
-No evidence of dominant follicle / corpus luteum

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10
Q

To evaluate Hyperandrogenism what value must you first start to measure?

A

Elevated testosterone

If elevated continue to work up

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11
Q

What labs do you continue to order is you suspect Hyperandrogenism?

A 
17 – OH progesterone
Measure at 8AM
     > 200 ng/dL suspect CAH
DHEA-S
     > 700mcg/dL suspect adrenal source for hyperandrogenism
Cortisol
     > 10mcg/dL suspect Cushing syndrome
Prolactin
     Normal is PCOS 
     > 25 ng/dL is elevated
TSH
     Hyperthyroidism can cause oligomenorrhea/amenorrhea
β HCG 
     Order if oligomenorrhea/amenorrhea
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12
Q

What additional tests do you order for POS?

A

Fasting glucose
OGTT or HA1c
Lipid profile

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13
Q

Treatments Polycystic Ovarian Syndrome?

A
  1. Weight Loss
  2. Meformin
    Combination oral contraceptives
  3. Fertiliy consultation
  4. Provera
  5. Life-long lifestyle mod.

Fill in the rest slide 20

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14
Q

How would you treat Hisuitism?

A

1st Line: COC’s
-Add on therapy –> spirinolactone

  1. Topical elfonithine (Vaniga)
    • Add on therapy Antiprotozoal
  2. Hair removal
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15
Q

Risks for POS?

A 
Endometrial Hyperplasia/Carcinoma
Type II diabetes
Hypertension
Hyperlipidemia
Cardiovascular disease
Stroke
Infertility
Metabolic syndrome
Sleep apnea
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16
Q

What are PEARLS Evaluation of Adnexal Masses

A

Pre-menarchal
Ovaries should not be palpable

Reproductive
Palpable about 50% of the time

Peri-menopausal
Increased likelihood of residual functional cysts

Post-menopausal
Non-palpalpable within 3 years of the onset of natural menopause (most)

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17
Q

What imaging do you do for scanning adnexal mases?

A

Ultrasound

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18
Q

An Adnexal Mass is considered benign if ultrasound shows what?

What about Malignant

A
  1. Thin walled
  2. < 3cm premenopausal or < 1cm postmenopausal
  3. Hyperechoic nodule with distal acoustic shadowing
  4. Network of linear or curvilinear pattern
  5. Homogenous echos

Malignant if:

  1. Solid, nodular or papillary
  2. Blood flow to solid component
  3. Thick septations >2mm
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19
Q

What are the 3 types of Functional Ovarian cysts

A
  1. Follicular cysts
  2. Corpus Luteum Cyts
  3. Theca Lutein Cysts
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20
Q

Most common type of Benign ovarian cysts

A

Follicular cysts

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21
Q

How do Follicular cysts occur

Study These Flashcards
A

Failure of the mature follicle to rupture (release the ovum) –> causes pain and pressure

Failure of the non-dominant follicles to undergo atresia in the presence of the mature follicle

22
Q

How do Corpus Luteum cysts appear?

Study These Flashcards
A

Following ovulation, blood accumulates within the cavity of the corpus luteum which stimulates resorption. If resorption doesn’t occur and the corpus luteum is greater than 3cm it is considered a cyst

23
Q

If corpus luteum continues to persist without popping what can happen

Study These Flashcards
A

Prolonged menstrual cycle due to continued progesterone secretions from the CL

24
Q

What is the least common Benign ovarian cysts?

Study These Flashcards
A

Theca Lutein Cysts

25
What is the etiology behind Theca Lutein Cysts? How does it present
Seen with elevated chorionic gonadotropin levels Presents: Bilaterally Fluid is clear, straw colored Cysts regress spontaneously with treatment of underlying disorder
26
Most common nonfunctional epithelial cell ovarian tumor? Treatment?
Serous cystadenoma Mostly benign Surgery: Cystectomy vs oophorectomy
27
2nd most common nonfunctional epithelial cell ovarian tumor? How does it present? Treatment
Mucinous cystadenoma Present: Ultrasound= multilocular septations Treatment: Surgery
28
Benign cystic teratomas are considered what type of tumors What are these composed of?
Germ cell Ovarian Tumors Any part of the three germ layers 1. Ectoderm 2. Mesoderm 3. Endoderm
29
What is the histology behind Germ cells ovarian tumors? Germ cell ovarian tumors originate from which type of tumors?
The cyst is lined with keratinized squamous epithelium with abundant sebaceous and apocrine glands Hair, teeth
30
How do Germ cell teratomas present?
1. Asymptomatic 2. Pelvic pain 3. Urinary frequency or urgency 4. Back pain
31
Physical Exam findings for Germ Cell Ovarian tumors? Imagine used? Labs tested?
PE: Pelvic mass on bimanual exam Imagine Tranvaginal Ultrasound- unilateral, complex cysts Labs: CEA, CA-125, AFP, βHCG -All should be within normal limits
32
Treatment for Germ Cell Ovarian Tumors
Surgery Laprotomy Ovarian cystectomy
33
What are the two types of Stromal Ovarian Tumors? Who are they common in? What do they secrete?
Granulose Theca cell tumors - Females - Produce estrogens Sertoli-Leydig cell tumors - Males - Produce androgens
34
How do Ovarian Fibromas occur?
Result from spindle cell collagen production
35
Risk factors for Ovarian Cancer
Family history of breast, ovarian or colorectal cancer BRCA1 and BRCA2 - Nullparity (never pregnant = more ovulations) - Early menarche - Late menopause - Infertility (+/- treatment Diets high in sat fat or animal fats
36
What are risk reductions for ovarian cancer?
``` -Multiparty Breastfeeding -Long-term oral contraceptive use -At least 5yrs of use reduces the relative risk of developing ovarian cancer by 50% compared to non-users -Bilateral tubal ligation -Low fat diet -Bilateral salpingectomy ```
37
What are the 4 types of Ovarian cancers?
Epithelial Germ Cell Sex cord and strromal Neoplasms metastatic to ovary
38
Ovarian Cancer Pathophysiology: What is the Incessant Ovulation theory
Repeated ovarian epithelial trauma by follicular rupture and subsequent epithelial repair results in invagination of surface epithelium into the ovarian cortex creating cortical inclusion cysts Constant epithelial “repair” leads to malignant transformation
39
Ovarian Cancer Pathophysiology: What is the Fallopian tube theory
p53 is a tumor suppressor gene Mutant p53 creates a “p53 signature” Signature is located at the distal fallopian tube -Location of epithelial stem cells
40
What are the types of Epithelial Neoplasms? Where do they arise
1. High grade serous carcinomas (70-80%) - arise from fallopian tube 2. Enodmetroid carcinomas - arise from the ovary 3. Clear cell carcinomas - arise from ovaries 4. Mucinous carcinomas - arise from ovaries
41
What are the 4 types of Germ Cell ovarian cancers?
Dysgerminoma Endodermal sinus Immature teratoma Mixed Embryonal tumors
42
Etiology behind Germ cell ovarian cancers? What age group is this most common in?
Highest incidence in women 20-30 years old Etiology unknown
43
Most common type of Germ cell ovarian tumors? How does it present and What does it secrete
Dysgerminomas Present unilaterally 85-90% Secrete lactate dehydrogenas, some produce hCG
44
How do Endodermal Sinus Tumors (rare) present? What do they secrete?
Bilateral Produce alpha fetoprotein
45
Most common symptoms of Ovarian cancers?
1. Abdominal bloating 2. Abdominal/pelvic pain 3. Decreased energy or lethargy 4. Early satiety 5. Urinary urgency
46
What are some acute symptoms that occur in Ovarian cancers
Pleural effusions | Bowel obstructions
47
What are Physical Exam findings ovarian cancers
Ascites Inguinal lymphadenopathy Pelvic mass
48
What imaging used to detect ovarian cancers
``` Transabdominal / vaginal ultrasound Mammogram/Colonoscopy CT MRI CXR ```
49
What labs are used to detect ovarian cancers
1. CA-125 elevated- Suspected epithelial ovarian cancer | 2. Elevated hCG, AFP, LDH- Suspected germ cell tumor
50
Treatment for Epithelial ovarian cancers?
Consult gynecologic oncologists
51
Treatment for Germ cell ovarian cancers
Consult gynecologic oncologists

Foundations 3 (25 decks)

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