Uterine disorders Flashcards Preview

Foundations-Women's Health > Uterine disorders > Flashcards

Flashcards in Uterine disorders Deck (51)
Loading flashcards...
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

endometrial CA treatment?

TAH-BSO + Lymphadenectomy (pelvic & periaortic)