Flashcards in Uterine disorders Deck (51)
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1
Where is the MC place for endometriosis?
Pelvis: Ovaries
2
What is endometriosis highly associated with?
Infertile women
3
What is endometriosis at an increased risk for?
Ovarian CA
4
endometriosis etiology
Retrograde menstruation
5
endometriosis clinical presentation
1. Premenstrual pelvic pain
2. Pain subsides after menses
3. Infertility
4. Dysmenorrhea
5. Dyspareunia
6
What is the definitive dx in endometriosis?
Laparoscopy
7
Laparoscopy findings in endometriosis
1. Petechial lesions
2. Surrounding peritoneum thickened/scarred
3. "Chocolate cysts": Endometriomas
4. Adhesions
8
endometriosis treatment in mild disease
NSAIDS +/- OCPS
9
endometriosis treatment in moderate/severe disease
1. OCP's: Causes atrophy of endometrial tissue, decreases risk of ovarian CA
2. Progestins
3. GnRH Agonists: Suppression of estrogen and progesterone d/t down-regulation of pituitary gland
10
What do you want to make sure to supplement your patient with if they are on GnRH Agonist? Why?
Norethindrone acetate to prevent bone loss
11
What ethnicity is uterine fibroids MC in?
Black Women
12
Uterine Fibroids Clinical Presentation
1. Abnormal uterine bleeding*
2. Pelvic Pressure*
3. Pain
4. Infertility
13
Bimanual exam findings in uterine fibroids
1. Enlargement
2. Irregular shape
3. Masses
14
What is the imaging of choice in uterine fibroids?
Transvaginal US
15
Pharmacologic treatment options in uterine fibroids
1. COCs/progestin
2. GnRH analogs
3. Steroid therapies: androgens
4. Tranexamic acid
16
What is the main use of GnRH in uterine fibroids? What age does this serve primary tx in?
Decrease Fibroid Size
Used prior to surgery-improve anemia
Primary role in tx near menopause
17
Who is steroidal therapies indicated in?
Prolonged, heavy menses
NO submucosal fibroids
18
steroidal therapies options
1. OCP's
2. Mirena
3. Nuvaring
19
Tranexamic acid indications
Prolonged, heavy menses
NO submucosal fibroids
20
When would you use Tranexamic acid?
During menstrual cycle ONLY
21
What does uterine fibroid surgery preserve both fertility and the uterus?
1. Myomectomy
2. Hysteroscopy
22
What type of uterine fibroids do you perform myomectomy in?
1. Intramural
2. Subserosal
3. Pedunculated fibroids
23
Myomectomy laparotomy indications (over laparoscopic)
1. CI to laparoscopic
2. Large fibroid size
3. Prior pelvic/abd radiation
4. Severe hip dz, precluding dorsolithotomy position
24
What type of uterine fibroid do you perform hysteroscopy?
Submucosal fibroids
25
Hysteroscopy risk
1. Fluid overload
2. Hyponatremia
26
What are the advantages/pro's of endometrial ablation
1. Preserves uterus
2. Outpatient/In-office procedure
3. General/paracervical block
4. No fluid overload
5. Fast: <2 min
27
What are the disadvantages/pro's of endometrial ablation
1. Must remover submucosal fibroids & polyps first
2. Amenorrhea rate=50%
3. Placenta accrete= No kids following procedure
28
Who is a candidate for uterine artery embolization?
Doesn't want kids: Procedure preserves uterus, but NOT fertility
29
CI to uterine artery embolization
Numerous and large fibroids
30
SE's in uterine artery embolization
1. Postembolization syndrome: Hospitalize for pain
2. Uterine necrosis, sepsis, death
3. Embolization in non-target tissue: Ovaries
31
Define Adenomyosis
Growth of endometrial tissue into uterine myometrium
32
Adenomyosis clinical presentation
1. Menorrhagia*
2. Dysmenorrhea
3. Hx uterine surgery: C-section, myomectomy
33
Adenomyosis bimanual exam findings
Diffuse uterine enlargement (globular)
34
Adenomyosis medication treatment
OCP's
Mirena
Nuvaring
35
What is the definitive tx for Adenomyosis
Hysterectomy
36
What is the #1 RF for Endometrial Hyperplasia?
OBESITY!!!
37
Endometrial Hyperplasia si/sx's
Bleeding:
1. Menorrhagia
2. Prolonged menses
3. Decreased menstrual intervals
38
What pelvic US findings indicated unlikely malginancy with endometrial hyperplasia?
Endometrial thickness <4 mm
39
Hyperplasia without atypia treatment
1. Mirena IUD
2. Provera x3-6 months
3. Reasses with endometrial biopsy
40
What is the TOC in atypical hyperplasia
Hysterectomy
41
What is the MC pelvic genital CA?
Endometrial CA
42
What is the mean age in endometrial CA?
50-69
43
What is the #1 RF for endometrial CA?
OBESITY
44
Which type of endometrial CA has a poor prognosis?
Type 2
45
Which type of endometrial CA is due to unopposed estrogen?
Type 1
46
What is the MC type of endometrial CA?
Adenocarcinoma
47
What types of endometrial CA are NOT associated with a hyperestrogenic state?
Serous Carcinoma
Clear Cell Carcinoma
*Poor prognosis, aggressive
48
Endometrial CA clinical presentation
1. ABNORMAL BLEEDING
2. Abd cramping
3. Weight loss
49
Endometrial CA diagnosis
1. Transvaginal US
2. Endometrial Bx
50
What will be elevated if there is extrauterine spread in endometrial CA?
CA-125
51
