The Uterus and Problems Flashcards
What are the there layers of the uterus? (3)
Endometrium, myometrium and serosa.
What is removed in a total hysterectomy + BSO? (3)
Uterus, cervix, bilateral fallopian tubes and ovaries.
What is removed in a subtotal hysterectomy? (1)
Uterus. (Cervix is left)
What si the term for a fibroid? (1)
Leiomyomata
What is a fibroid? (1)
What are the three types? (3)
Benign tumour of the myometrium of varying sizes.
Can be classified according to location:
Subserosal
Intramural
Submucosal
What hormone is linked to the growth of fibroids? (1)
Growth is oestrogen-dependent
Many regress after menopause
What is the malignancy that is a rare complication of fibroids? (1)
Leiomyosarcoma
Name 3 risk factors associated with fibroid development. (3)
FH
Afro-caribbean
Age near menopause
Nulliparity
What symptoms might be caused by fibroids? (3)
(50% are asymptomatic)
Menorrhagia, IMB, subfertility, pressure effects e.g. urinary frequency or urinary retention
Regina has large fibroids but has managed to conceive.
Name 3 complications of pregnancy caused by fibroids. (3)
Premature labour, malpresentation, transverse lie, obstructed labour, PPH.
Post-partum, a pedunculated fibroid may tort.
What are the medical and surgical options of management for fibroids? (3)
Med: none if small and slow growing; or GnRH analogue for max of 6 months can shrink. (Can be used pre-surgery)
Surg:
-hysteroscopy
-myomectomy (if medical treatment has failed and pt wishes to remain fertile. note risk of adhesions)
-hysterectomy (last resort)
-uterine artery embolisation (effect on fertility unknown)
-ablation.
Define adenomyosis. (1)
Growth of endometrium into myometrium causing painful, irregular, heavy periods.
What is endometrial cancer? (1)
90% are adenocarcinoma of the columnar endometrial gland cells.
Name 3 risk factors for developing endometrial cancer. (3)
Excess endogenous oestrogen: early menarche, late menopause, nulliparity, PCOS, obesity
Excess exogenous oestrogen: Oestrogen only HRT, Tamoxifen (anatagonist in breast tissue, agonist in uterine)
Other: DM and HTN, increasing age.
Where does endometrial cancer metastasise to? (3)
Locally: cervix and upper vagina, sometimes ovary
Lymphatic: pelvic, then para-aortic nodes
What is the staging of endometrial cancer? (4)
FIGO staging (surgical and histological)
1: uterus only. A: 1/2
2: Cervix also
3. Pelvic or para-aortic lymph nodes
4. Bowel/bladder or distant spread
What is the treatment for endometrial carcinoma? (2)
Total hysterectomy and bilateral salpingo-oophorectomy
Radiotherapy if lymph nodes likely to be positive.
Define endometriosis. (2)
Presence and growth of tissue similar to endometrium outside of the uterus.
Why does endometriosis tend to regress during pregnancy and after the menopause? (1)
Oestrogen-dependent
Name 3 symptoms of endometriosis. (3)
Dysmenorrhoea, chronic pelvic pain, deep dyspareunia, subfertility, dysuria, dyschezia (pain on defecation)
What is the gold-standard diagnostic investigation for endometriosis? (1)
Laparoscopy
What is the management for endometriosis? (3)
Medical: NSAIDs, suppression of ovulate (COC, IUS, progesterones , GnRH analogues)
Surgical: laparoscopic ablation/excision of lesions, adhesiolysis, ovarian cystectomy, rarely TAH/BSO as last resort.
NB medical treatment does not improve fertility.
Define chronic pelvic pain. (2)
Intermittent or constant pain n the lower abdomen and pelvis of at least 6 months duration, not occurring exclusively during menstruation or intercourse.
