The Uterus and Problems

Question 1

What are the there layers of the uterus? (3)

Answer 1

Endometrium, myometrium and serosa.

Question 2

What is removed in a total hysterectomy + BSO? (3)

Answer 2

Uterus, cervix, bilateral fallopian tubes and ovaries.

Question 3

What is removed in a subtotal hysterectomy? (1)

Answer 3

Uterus. (Cervix is left)

Question 4

What si the term for a fibroid? (1)

Answer 4

Leiomyomata

Question 5

What is a fibroid? (1)

What are the three types? (3)

Answer 5

Benign tumour of the myometrium of varying sizes.

Can be classified according to location:
Subserosal
Intramural
Submucosal

Question 6

What hormone is linked to the growth of fibroids? (1)

Answer 6

Growth is oestrogen-dependent

Many regress after menopause

Question 7

What is the malignancy that is a rare complication of fibroids? (1)

Answer 7

Leiomyosarcoma

Question 8

Name 3 risk factors associated with fibroid development. (3)

Answer 8

FH
Afro-caribbean
Age near menopause
Nulliparity

Question 9

What symptoms might be caused by fibroids? (3)

Answer 9

(50% are asymptomatic)

Menorrhagia, IMB, subfertility, pressure effects e.g. urinary frequency or urinary retention

Question 10

Regina has large fibroids but has managed to conceive.

Name 3 complications of pregnancy caused by fibroids. (3)

Answer 10

Premature labour, malpresentation, transverse lie, obstructed labour, PPH.
Post-partum, a pedunculated fibroid may tort.

Question 11

What are the medical and surgical options of management for fibroids? (3)

Answer 11

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.

Question 12

Define adenomyosis. (1)

Answer 12

Growth of endometrium into myometrium causing painful, irregular, heavy periods.

Question 13

What is endometrial cancer? (1)

Answer 13

90% are adenocarcinoma of the columnar endometrial gland cells.

Question 14

Name 3 risk factors for developing endometrial cancer. (3)

Answer 14

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.

Question 15

Where does endometrial cancer metastasise to? (3)

Answer 15

Locally: cervix and upper vagina, sometimes ovary
Lymphatic: pelvic, then para-aortic nodes

Question 16

What is the staging of endometrial cancer? (4)

Answer 16

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

Question 17

What is the treatment for endometrial carcinoma? (2)

Answer 17

Total hysterectomy and bilateral salpingo-oophorectomy

Radiotherapy if lymph nodes likely to be positive.

Question 18

Define endometriosis. (2)

Answer 18

Presence and growth of tissue similar to endometrium outside of the uterus.

Question 19

Why does endometriosis tend to regress during pregnancy and after the menopause? (1)

Answer 19

Oestrogen-dependent

Question 20

Name 3 symptoms of endometriosis. (3)

Answer 20

Dysmenorrhoea, chronic pelvic pain, deep dyspareunia, subfertility, dysuria, dyschezia (pain on defecation)

Question 21

What is the gold-standard diagnostic investigation for endometriosis? (1)

Answer 21

Laparoscopy

Question 22

What is the management for endometriosis? (3)

Answer 22

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.

Question 23

Define chronic pelvic pain. (2)

Answer 23

Intermittent or constant pain n the lower abdomen and pelvis of at least 6 months duration, not occurring exclusively during menstruation or intercourse.