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1. Foundations III > Uterine disorders > Flashcards

Uterine disorders Flashcards

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1
Q

What is endometriosis?

A

Endometrial glands & stroma outside endometrial cavity & uterine musculature

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2
Q

What is the cause of endometriosis?

A

Unknown, but maybe:

  • Retrograde menstruation
  • Deficient cellular immunity
  • Hereditary
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3
Q

What are RFs of endometriosis?

A
  • Nulliparity
  • Prolonged exposure to endogenous estrogen
  • Heavy menstrual bleeding
  • Obstruction of outflow
  • DES exposure in utero
  • Height > 68 in
  • Low BMI
  • High consumption of unsaturated fat
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4
Q

What is the clinical presentation of endometriosis?

A
  • Premenstrual pelvic pain (SUBSIDES AFTER MENSES)
  • Infertility
  • Dysmenorrhea
  • Dyspareunia
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5
Q

What does endometriosis look like on PE?

A
  • Tenderness/nodules at posterior cul-de-sac
  • Fixed or retroverted uterus
  • Endometriomas –> adnexal masses or tenderness
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6
Q

How do you dx endometriosis?

A

CA-125
Imaging
Laparoscopy

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7
Q

What is seen on laparoscopy in endometriosis?

A
  • Erythematous, petechial lesions on peritoneum
  • Peritoneum thickened/scarred
  • Endometriomas on ovaries
  • Adhesions
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8
Q

How do you treat mild endometriosis?

A

Expectant management w/ NSAIDs +/- OCPs

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9
Q

What meds help to interrupt stimulation of endometrial tissue?

A

OCPs
Progestins
GnRH agonists

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10
Q

What are more drastic tx options for endometriosis?

A

Danazol
Aromatase inhibitors
Laparoscopic excision
Hysterectomy w/ B/L salpingo-oophorectomy

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11
Q

Where do uterine fibroids arise?

A

From SM cells within te uterine wall

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12
Q

What are uterine fibroids made of?

A

Collagen, SM, & elastin surrounded by pseudocapsule

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13
Q

What population experiences uterine fibroids?

A

20% childbearing age

MC in black women

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14
Q

What causes uterine fibroids?

A

Unknown

  • Estrogen is implicated in growth
  • Progesterone increases mitotic activity & possibly suppresses apoptosis within the tumor
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15
Q

How are uterine fibroids classified? (3)

A

By anatomic location within myometrium

  • Submucosal: beneath endometrium
  • Subserosal: at serosal surface
  • Intramural: within uterine wall
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16
Q

What is the clinical presentation of uterine fibroids?

A

Sx present in 35-50%
Sx occur due to location & size

  • Abnormal uterine bleeding
  • Pain
  • Pelvic pressure
  • Infertility
  • Spontaneous abortion
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17
Q

What uterine abnormalities are seen on the bimanual exam w/ respect to uterine fibroids?

A

Enlargement
Irregular shape
Masses

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18
Q

What labs & imaging are used to dx uterine fibroids?

A

Transvaginal u/s

Saline-infused sonohysterogram

Hysteroscopy

MRI

H&H

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19
Q

How do you treat uterine fibroids?

A

No standard of care. Sx drive tx of choice

Medical & surgical options available. See slide 27

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20
Q

What are 3 medical options for uterine fibroid tx?

A
  • Depot Lupron
  • Steroidal therapy
  • Lysteda
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21
Q

What are surgical options for tx of uterine fibroids?

A
  • Myomectomy (Laparoscopic or abdominal/mini-laparotomy)
  • Hysteroscopy
  • Endometrial ablation
  • Uterine artery embolization
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22
Q

Describe Depot Lupron

A

GnRH agonist

Decreases fibroid size

Decreases blood loss during surgery & improves anemia prior to surgery

Don’t use over 6mos

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23
Q

Steroidal therapies & Lysteda are indicated for patients w/…

A

prolonged, heavy menses w/ no submucosal fibroids

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24
Q

Describe Lysteda

A

Oral antifibrinolytic

50% decrease in menorrhagia

Use only during menstrual cycle

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25
What is the benefit of a myomectomy or hysteroscopy?
Both PRESERVE FERTILITY/UTERUS
26
What is the disadvantage of a myomectomy?
Delays pregnancy 3-6mos
27
What are complications of a laparoscopic myomectomy (robot assisted)?
Hemorrhage Re-operation Adhesions Vascular/visceral injury
28
What procedure is used for patients w/ contraindications to laparoscopy?
Abdominal or mini-laparotomy myomectomy
29
What are contraindications to laparoscopy?
Large fibroid size Prior pelvic or abd radiation Severe hip disease
30
What type of fibroids are removed during myomectomy vs hysteroscopy?
Myomectomy = intramural, subserosal, & pedunculated Hysteroscopy = submucosal only
31
What are 2 risks of hysteroscopy?
Fluid overload Hyponatremia
32
What are hysteroscopy post op instructions ?
Return to normal activities 1-2 days later Sex after one month
33
What are disadvantages of endometrial ablation?
No future childbearing MUST CONTINUE CONTRACEPTIVE Amenorrheic rate = 50%
34
What are benefits to endometrial ablation?
Outpatient or in-office w/ general or paracervical block Small amt of CO2 Takes less than 2 mins & pt can go home in 1-2 hrs Can be performed at anytime during cycle
35
Describe uterine artery embolization (UAE)
Preserves uterus, but not fertility Catheter placed into uterine artery & infused w/ embolizing agent
36
Who are candidates for UAE?
Those who don't want kids
37
What is a contraindication to UAE?
Numerous or large fibroids
38
What are side effects & complications of UAE?
- Postembolization syndrome - Non-purulent vaginal discharge - Endometriosis & uterine infection - Recurrence - Embolization agent found in other tissues - Uterine necrosis, sepsis, bacteremia, death
39
What is adenomyosis?
Growth of endometrial glands & stroma into uterine myometrium
40
What causes adenomyosis?
Unknown - Ovarian hormones - Invagination of endometrium - Parity
41
What is the clinical presentation of adenomyosis?
Menorrhagia Dysmenorrhea Pelvic pain Hx of uterine surgery
42
What does adenomyosis look like on PE?
Diffuse uterine enlargment on bimanual exam
43
What does the definitive diagnosis require in adenomyosis?
Histologic exam after hysterectomy
44
What imaging is used to aid in the dx of adenomyosis?
U/S | MRI
45
What are medical options for treating adenomyosis? What do they do?
OCPs, Mirena, NuvaRing Improve dysmenorrhea/menorrhagia
46
What are surgical options for adenomyosis?
Hysterectomy (definitive tx) UAE Endometrial ablation
47
What are RFs for endometrial hyperplasia?
``` Early menarch Late menopause Infertility, nulliparous OBESITY!!!! DM, PCOS Tamoxifen Estrogen replacement Hx of ovarian CA Prior pelvic radiation Fam hx of lynch syndrome ```
48
How does WHO classify endometrial hyperplasia?
Hyperplasia w/out atypia Atypical hyperplasia
49
What is the pathophys of endometrial hyperplasia?
Unopposed estrogen --> endometrial hyperplasia & atypia
50
What is the clinical presentation of endometrial hyperplasia?
``` Asx Post-menopausal bleeding Menorrhagia Intermenstrual bleeding Prolonged menses Decreased menstrual interval Oligomenorrhea/amenorrhea ```
51
What does endometrial hyperplasia look like on u/s?
> 4mm of endometrial thickness
52
Besides u/s, what are other dx tests of endometrial hyperplasia?
Pelvic exam Endometrial biopsy D&C, hysteroscopy
53
How do you treat hyperplasia w/out atypia?
Mirena Provera Reassess w/ EMB
54
How do you treat atypical hyperplasia?
Hysterectomy = tx of choice Progesterone therapy
55
What is the MC pelvic genital CA?
Endometrial CA
56
What population is most affected by endometrial CA?
50-69 yo | White women
57
What are RFs of endometrial CA?
Same RFs as endometrial hyperplasia! | OBESITY = #1
58
Describe type I vs type II endometrial CA
Type I: arise due to unopposed endo/exogenous estrogen, better prognosis Type II: seen w/ endometrial atrophy, poor prognosis
59
What is the MC type of endometrial CA?
Adenocarcinoma
60
What 2 types of endometrial CA are NOT associated w/ hyperestrogenic state?
Serous carcinoma Clear cell carcinoma
61
What is the clinical presentation of endometrial CA?
``` Abnormal vag bleeding Abd cramping Back pain Wt loss Dyspareunia ```
62
Who should you screen for endometrial CA?
Women w/ lynch syndrome
63
How do you dx endometrial CA?
- CBC - Transvag u/s - Endometrial biopsy - D&C - Pap - CA-125 (elevated extrauterine spread) - MRI/CT
64
How do you treat endometrial CA?
Hysterectomy w/ B/L salpingo-oophorectomy w/ pelvic & periaortic lymphadenectomy Chemo & radiation

1. Foundations III (20 decks)

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