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PANCE- OB/GYN > Uterus > Flashcards

Uterus Flashcards

(56 cards)

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1
Q

Dysfunctional Uterine Bleeding (DUB) Definition

A

ABN bleeding w/o evidence of underlying cause

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2
Q

Post-menopausal bleeding is cancer until proven otherwise

A

:)

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3
Q

Oligomenorrhea

A

Increased length of time between menses (35-90 days)

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4
Q

Polymenorrhea

A

Frequent menstruation (<21 d cycle), anovulatory

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5
Q

Menorrhagia

A

Increased amount of flow (>80mL) or prolonged bleeding (>8 days) –> may lead to anemia

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6
Q

Metorrhagia

A

Bleeding between periods

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7
Q

Menometorrhagia

A

Excessive bleeding at irregular intervals

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8
Q

DUB Exam: look for…

A

palpable uterus, cervical mass, polyps to assess for cervical cancer, myoma or pregnancy

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9
Q

DUB Diagnostic labs

A

BhCG to R/O pregnancy
CBC: r/o anemia
Thyroid function tests
Platelets/PT/PTT: r/o Von Willebrands disease, Factor XI deficiency

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10
Q

DUB Diagnostic procedures

A

Pap: r/o cervical CA
US: polycystic ovaries, uterine mass, endometrial thickness

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11
Q

DUB Endometrial Biopsy is indicated WHEN

A

Endometrium is >4mm in a POSTMENOPAUSAL women
OR
Pt is >35 yo w/ RF of endometrial hyperplasia (obesity, diabetes)

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12
Q

Pregnancy is the most common cause of ABN uterine bleeding

A

:)

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13
Q

TX of heavy bleeding

A

High-dose estrogen IV - stabilizes uterine lining, controls bleeding w/in one hour.
D/C indicated if bleeding not controlled w/in 24 hours

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14
Q

TX of ovulatory bleeding

A

NSAIDs to decrease blood loss

If hemodynamically unstable, OCPs or Mirena IUD

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15
Q

Anemia and endometrial hyperplasia are the main complications of DUB

A

:)

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16
Q

TX of anovulatory bleeding

A

goal is to convert proliferative endometrium into secretory endometrium (decr. risk of hyperplasia and CA)
Progestin x10d –> stimulates withdrawal bleeding
Desmopressin –> increases Von WIllebrand and FactorVIII
OCP or Mirena

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17
Q

Surgical TX of DUB

A

D&C

Hysteroscopy: direct visualization of endometrium for biopsy

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18
Q

DUB Hysterectomy IF

A

Fail or do not want hormone treatment,

Symptomatic anemia or decreased QOL

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19
Q

Type 1 endometrial CA is derived from

A

atypical endometrial hyperplasia

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20
Q

Type 2 endometrial CA is derived from

A

serous or clear cell histology

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21
Q

Type 1 endometrial CA is the most common F reproductive CA

A

(%75)

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22
Q

Estrogen’s role in type 1 endometrial CA

A

High - from unopposed estrogen stimulation

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23
Q

Estrogen’s role in type 2 endometrial CA

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A

Unrelated - mostly from p53 gene mutation

24
Q

Precursor lesions - Type 1 endometrial CA

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A

endometrial hyperplasia and atypical hyperplasia

25
Precursor lesions - Type 2 endometrial CA
None
26
Prognosis - Type 1 endometrial CA
favorable
27
Prognosis - Type 2 endometrial CA
poor - very agressive
28
Mean age Type 1 endometrial CA
55 yo
29
Mean age Type 2 endometrial CA
67 yo
30
Post-menopausal vaginal bleeding is an early PE finding of endometrial CA
:(
31
Abdominal pain is a late PE finding in endometrial CA
:(
32
DX of endometrial CA
endometrial/endocervical biopsy | U/S will show thickened endometrium
33
Child bearing age TX of endometrial CA
High dose progestin
34
TX of endometrial CA
total hysterectomy, bilateral salpingo-oophrectomy +/- radiation or chemotx
35
Definition of endometriosis
functional endometrial glands and stroma outside the uterus
36
HX/PE - endometriosis
cyclical pelvic pain and/or rectal pain, dyspareunia
37
classic lesions of endometriosis
dark brown or blue-black in color, "chocolate cysts" on ovaries (endometriomas)
38
DX of endometriosis
direct visualization with laparoscopy or laparotomy
39
TX (pharm) endometriosis
``` inhibit ovulation! Combo OCP - 1st line GnRH analogue NSAIDs Progestins ```
40
TX (surgery) of endometriosis
Excision, cauterization, cauterization, ablation of lesions and adhesions
41
TX (definitive) of endometriosis
Total hysterectomy - bilateral salpingo-oophrectomy +/- lysis of adhesions
42
Uterine fibroids are the most common benign OBGYN tumor
:)
43
Fibroids are...
discrete, round, firm and often multiple tumors made up of smooth muscle and connective tissue
44
Uterine fibroids are sensitive to these hormones
Estrogen and Progesterone - will grow in pregnancy and decrease in size at menopause
45
Malignant transformation of fibroids into leiomyosarcoma is RARE
:)
46
SSx of fibroids may include
``` Uterine bleeding Pelvic pressure bloating/constipation urinary frequency/retention firm, non-tender, "bumpy" uterus on pelvic exam ```
47
DX of fibroids
CBC (r/o anemia) U/S (exclude ovarian mass) MRI (delineate cell source of growth)
48
Pharm TX of fibroids
NSAIDs. Combo OCPs. Medroxyprogesterone acetate (DEPO) or danazol to slow/stop bleeding. GnRH analog to decrease size, growth and vasculature.
49
Surgical TX of fibroids
Emergency if torsion occurs Child bearing age: myomectomy Otherwise: hysterectomy
50
If a uterine mass continues to grow after menopause - suspect malignancy
:)
51
Uterine fibroid prevalence
25% Caucasian | 50% African American
52
Uterine prolapse risk factors
vaginal birth, genetics, adv. age, Hx of pelvic surgery, CT disorders, increased intra-abdominal pressure secondary to obesity or straining
53
Prolapse HX/PE
sensation of bulge or protrusion in vagina urinary or fecal incontinence sense of incomplete bladder emptying Dyspareunia
54
DX of uterine prolapse
Bare down in stirrups and visualize
55
Supportive TX - uterine prolapse
increased fiber diet, weight reduction, limit straining/lifting Pessary if unable to or not interested in surgery
56
Surgical TX - Uterine prolapse
hysterectomy w/ vaginal vault suspension

PANCE- OB/GYN (9 decks)

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