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Year 4 OBGYN > Uterine Pathology > Flashcards

Uterine Pathology Flashcards

(73 cards)

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1
Q

Fibroids are benign smooth muscle tumours of the Uterus. Describe the pathophysiology.

A

Growth is stimulated by oestrogen

Rarely become malignant

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2
Q

Describe the classification of Fibroids

A

Intramural: Most common, confined to myometrium
Submucosal: Develops underneath endometrium and protrudes into cavity
Subserosal: protrudes into and distends Serosal surface of Uterus

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3
Q

Give three risk factors for Fibroids

A

Obesity
Early Menarche
Increased Age

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4
Q

How do Fibroids present?

A

Most are asymptomatic
Pressure Symptoms
Heavy Menstrual Bleeding
Subfertility

Normally a non tender mass OE

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5
Q

What does acute pelvic pain on the background of Fibroids suggest?

A

Torsion

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6
Q

How are Fibroids normally imaged?

A

TV USS

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7
Q

Give three differentials for Fibroids

A

Endometrial Polyp
Ovarian Tumour
Leiomyosarcoma

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8
Q

When do Fibroids require management?

A

When symptomatic

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9
Q

Give three medical managements of Fibroids

A

Tranexamic Acid
Hormonal Contraceptives
GnRH Analogues (only used for 6 months due to Osteopenia risk - oestrogen deficient state causes regression)

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10
Q

State four possible surgical managements of Fibroids

A

Hysteroscopy and Transcervical Resection of Fibroid
Myectomy
Hysterectomy
Uterine Artery Embolisation

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11
Q

Define Endometriosis

A

Where Endometrial tissue is located at sites other than Uterine Cavity (such as Ovaries, PoD, Pelvic Peritoneum, Lungs)

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12
Q

Describe the pathophysiology of Endometriosis

A

Retrograde Menstruation - Endometrial cells travel backwards from Uterine Cavity through Fallopian tubes and deposit

Sensitive to Oestrogen so do bleed

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13
Q

Give four clinical features of Endometriosis

A

Dysmenorrhoea (Cyclical but constant if adhesions)
Dysuria
Dyspareunia
Subfertility

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14
Q

Describe the investigations for Endometriosis and what you would expect to find

A

Laparoscopy - Adhesions, Peritoneal Deposits, Chocolate Cysts

Pelvic USS

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15
Q

Describe the medical management of Endometriosis

A

If no symptoms - no treatment required

Pain: WHO analgesic ladder
Suppressing Ovulation: COCP/Mirena Coil (may cause regression)

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16
Q

Describe the surgical management of Endometriosis

A

Ablation/Excision (both may require repeated procedures)

Hysterectomy (+/- HRT)

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17
Q

Define Adenomyosis

A

Presence of functional endometrial tissue within the myometrium

A variant of endometriosis but they can occur together

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18
Q

Describe the pathophysiology of Adenomyosis

A

Endometrial stroma communicates with myometrium after Uterine Damage

Commonly in posterior wall

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19
Q

Give four causes of Adenomyosis

A

Childbirth
Caesarean Section
Pelvic Surgery
Surgical Management of Miscarriage

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20
Q

Give four clinical features of Adenomyosis

A

Menorrhagia
Deep Dyspareunia
Dysmenorrhoea (Cyclical worsening to Daily)
Irregular Bleeding

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21
Q

What three investigations can be done for Adenomyosis? What would they show?

A

MRI - endomyometrial junction zone thickened irregularly

Only definitive is histological examination post hysterectomy

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22
Q

Describe the short term management of Adenomyosis

A

Uterine Artery Embolisation

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23
Q

How can the symptoms of Adenomyosis be controlled?

A

NSAIDS

COCP/Mirena

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24
Q

What is the definitive management of Adenomyosis?

A

Hysterectomy

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25
Endometrial Cancer is the most common gynaecological cancer of the developed world. Describe the pathophysiology
Most commonly adenocarcinoma Often preceded by Endometrial Hyperplasia
26
Give four risk factors for Endometrial Cancer
High Oestrogen Exposure Age Obesity Genetic (Lynch)
27
Give three clinical features of Endometrial Cancer
Post Menopausal Bleeding (or intermenstrual if pre menopausal) Abdominal pain Weight Loss
28
Give three differentials for Endometrial Cancer
Vulval Atrophy Cervical Cancer Endometrial Hyperplasia
29
How is Endometrial Cancer investigated?
1) Transvaginal USS (of if high risk then skip to 2) 2) If thickness >4mm then referred for Hysteroscopy with Pipelle Biopsy 3) MRI/CT Staging if cancerous
30
Describe the FIGO staging of Endometrial Cancer
I- Confined to Uterine Body II - May extend to cervix but not beyond uterus III - Beyond Uterus but confined to Pelvis IV - Bladder/Bowel/Distant Sites
31
How is Endometrial Hyperplasia managed?
With Progesterones such as Mirena Any sign of atypical features then full hysterectomy and bilateral salpingo-oophorectomy
32
How is Stage 1 Endometrial Cancer managed?
Hysterectomy with Bilateral Oophorectomy | the most commons stage presentation and procedure
33
How is Stage 2 Endometrial Cancer managed?
Radical Hysterectomy (including parts of the vagina and lymph node dissection)
34
How is Stage 3 Endometrial Cancer managed?
Maximal Debulking | Chemoradiotherapy
35
How is Stage 4 Endometrial Cancer managed?
Maximal Debulking
36
Define Dysmenorrhoea
Pain associated with the onset of menstruation, can be Primary (no underlying pathology) or Secondary (underlying pathology)
37
Describe the proposed pathophysiology of Primary Dysmenorrhoea
When the corpus luteum regresses there is a drop in progesterone and rise in PG PGs cause myometrial contractions and spiral artery vasospasm An exaggerated response of the above is thought to be the cause of the pain
38
Give four clinical features of Dysmenorrhoea
Crampy abdominal pain Radiating down anterior thighs Lasting 48-72 hours Dizziness and Nausea
39
Give three causes of Secondary Dysmenorrhoea
Adenomyosis Endometriosis Adhesions (PID)
40
How can a Primary Dysmenorrhoea be distinguished from Secondary?
- Onset of secondary is normally a few days before starting period - Secondary typically starts many years after initial menarche
41
How would you manage Dysmenorrhoea non pharmacologically?
TENS | Local application of heat
42
How could you manage Dysmenorrhoea pharmacologically?
1) Mefanamic Acid (NSAID - PG antagonist - in theory reduces the physiological effects) 2) COCP
43
What is Mittleshmerz?
Unilateral ovarian pain associated with ovulation, on around day 14 of cycle
44
Define Primary Amenorrhoea
- Failed to start periods by age of 16 but has secondary sexual characteristics - Failed to start periods by age of 14 but has no secondary sexual characteristics
45
Define Secondary Amenorrhoea
Cessation of periods for>6m when previously started (pregnancy excluded)
46
Give two Hypothalamic causes of Amenorrhoea
Eating disorders | Chronic illness
47
Give four pituitary causes of Amenorrhoea
Sheehans Syndrome Hyperprolactinaemia Depot - Provera Radiation
48
Give an adrenal cause of Amenorrhoea
Late/Mild Congenital Adrenal Hyperplasia
49
Give three Ovarian causes of Amenorrhoea
PCOS Turners Syndrome Primary Ovarian Failure
50
Give three genital causes of Amenorrhoea
Imperforate Hymen Ashermans Syndrome MRKH
51
Define Oligomenorrhoea
Less than 9 periods a year, or >35d between periods
52
Give three causes of Oligomenorrhoea
Thyroid disease PCOS Medications (including anti epileptics)
53
Name 5 bloods you would do for Amenorrhoea/Oligomenorrhoea
``` FSH/LH Oestrogen/Progesterone/Testosterone Thyroid Function Prolactin Hydroxylase enzymes (CAH) ```
54
Other than bloods, name three investigations you would do for Oligo/Anovulation
Pregnancy Test! Swabs/Smear Transvaginal USS
55
What is the Progesterone challenge test in Oligo/Anovulation
Giving 5-10d Progesterone to aim to induce a withdrawal bleed Bleed - the problem was with ovulation (PCOS, Thyroid) No bleed - the problem is with lack of oestrogen priming OR structural issue (imperforate hymen, hypopituitarism, hyperprolactinaemia)
56
How would you manage Oligo/Anovulation?
COCP/POP
57
How to Thyroid Abnormalities affect menstruation?
Hypothyroidism - by feedback increases TRH, which also acts to increase prolactin (inhibiting FSH and LH) \it also reduces SHBG - increasing free circulating oestrogen and therefore causes menorrhagia
58
Define Menorrhagia
Excess menstrual loss at a level enough to affect woman’s QoL
59
Give four structural causes of Menorrhagia
PALM Polyps Adenomyosis Leiomyoma (Fibroid) Malignancy
60
Give 5 non structural causes of Menorrhagia
COEIN ``` Coagulopathies Ovarian Pathology Endometrial Pathology Iatrogenic Not Specified ```
61
Give 2 associated symptoms with Menorrhagia
Dizziness | Fatigue
62
How is Menorrhagia investigated?
Bloods (FBC, Clotting, TFTs, Hormones) Pregnancy Test! Transvaginal USS Swabs and smear where relevant
63
How is Menorrhagia managed medically?
1) IUS (Mirena) 2) Tranexamic Acid or COCP 3) POP
64
How is Menorrhagia managed surgically?
Endometrial Ablation Hysterectomy (subtotal or total)
65
Give 5 causes of Post Coital Bleeding
``` Vaginal Atrophy STIs Polyps Cervical Ectropian Cervical Cancer ```
66
Give 5 causes of Intermenstrual Bleeding
``` Tamoxifen STIs Pregnancy related Missed Pill Perimenopause ```
67
Give 5 causes of Post Menopausal Bleeding
``` Endometrial Hyperplasia Endometrial Cancer HRT Vaginal Atrophy Cervical cancer ```
68
Who should be on 2WW for Post Menopausal Bleeding?
Anyone over 55 For Transvaginal USS
69
How would you manage PMB?
Treat underlying cause Vaginal Atrophy - Topical Oestrogen, Lubrication, HRT Endometrial Hyperplasia - Dilation and Curettage to remove excess tissue
70
How would you investigate PCB?
Full Menstrual and Gynae History PV Exam and Swabs Pregnancy Test Transvaginal USS
71
When should you refer a patient with PCB?
Abnormal Cervix with Cancer Suspicion Cervical Polyp that is not easily removed Pelvic Mass/USS abnormality Those at high risk of endometrial cancer
72
Give 5 causes of Chronic Pelvic Pain
``` Endometriosis Adenomyosis Adhesions IBS Interstitial Cystitis MSK/nerve ```
73
How is Chronic Pelvic Pain investigated?
STI screen Transvaginal USS Laparoscopy

Year 4 OBGYN (15 decks)

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