Uterus Flashcards
(48 cards)
What are the ligaments of the uterus?
Pubocervical, transverse, uterosacral ligaments (superior to anterior).
Round/broad/ovarian.
Describe the blood supply of the uterus:
Uterine arteries - supply myometrium + endometrium
Ovarian arteries - anastomose inferiorly with the uterine arteries to supply fundus of uteter as well
Where is the lymph drainage of the uterus/ovaries?
Internal and external ilian nodes.
Where is the symphathetic and parasympathetic nerve supply of the uterus?
Sympathetic (T12-L2) -> contraction and vasoconstriction
Parasympathetic (S2-4) -> Inhibit muscle spasp and cause vasodilation
What are the arteries which supply the proliferated endometrium called?
Spiral arterioles (shed each month)
What are leiomyomas?
Fibroids. Smooth muscle (myometrium) benign tumour
List 3 risk factors for fibroids:
- Black & asian
- Obese
- Higher amount of oestrogen exposure (e.g. early menarche, late menopause) parity and COCs are protective factors.
Where do fibroids form?
- Submucosal (intrauterine polyps)
- Intramural or subserosal (polyps on the outside, pushing in)
What do fibroids look like in cross section?
Whirled appearance
When and why can fibroids regress?
Can regress during pregnancy and after menopause as they are oestrogen-dependent.
On examination what would feel?
Solid mass palpable on pelvic examination
What are the main features of fibroids (symptoms)?
- Asymptomatic (50%)
- Heavy menstrual bleeding (HMB) (30%)
- IMB (especially if submucosal
pressure effects: on bladder, on ureter (hydronephrosis), sub-fertility
Identify 4 areas in which complication can develop in fibroids:
1) Enlargement - slow, stops at menopause unless HRT, pedunculated can undergo torsion -> pain.
2) Degeneration - red degeneration: decreased blood supply; haemorrhage + necrosis (usually in pregnancy)
3) Malignancy - uncommon but: pain + rapid growth + PMH + poor response to GnRH-agonist -> leiomyosarcoma
4) Pregnancy - premature labour, malpresentation, transverse lie, obstructed labour, postpartum haemorrhage
List 3 investigations which can be performed to assess someone with suspected fibroids:
1) USS - initial screening (size, number, position on fibroids)
2) MRI - greater accuracy. Can differentiate between fibroids and adenomyosis (endometrium in myometrium)
3) Hysteroscopy - used to assess distortion of uterine cavity (fertility Ix).
When would you treat fibroids?
Only if symptomatic or fertility problems
Outline medical treatment of fibroids:
- GnRH-agonist +/- HRT (overstilulation & subsequent decrease in GnRH-receptors= temporary amenorrhoea + fibroid shrinkage. Restricted to 6months Rx due to decrease in bone density)
- Ulipristal acetate (selective progesterone receptor modulator): decrease in HMB, shrink fibroids, reversible amenorrhoea -> there is no bone density loss
What common treatment is ineffective in the treatment of fibroids?
Transexamic acid and NSAIDs no goof for HMB in fibroids.
Outline the surgical Rx for fibroids:
- Smaller polyp & submucosal fibroids -> Trans-cervical resaection of fibroid (TCRF) at hysteroscopy
- Larger fibroids -> myomectomy (preceded with 2-3months Rx with GnRH-a)
- For women with complete families - radical hysterectomy
What is Adenomyosis?
Endometrium within myometrium (Endometriosis interna)
Who is typically affected by adenomyosis and when does it typically get better?
Women >40, associated with endometriosis and fibroids, gets better after menopause.
What are the features of adenomyosis (including O/E)?
- Asymptomatic
- HMB, dysmenorrhoea (menstruation regular however)
- O/E: Uterus tender and mildly enlarged
What investigation confirms adenomyosis?
MRI - Pockets of blood seen
USS can provide suspected adenomyosis but MRI confirms
What is the treatment for Adenomyosis?
- Progesterone IUS/COCs - can be used to help control HMB and dysmenorrhoea
- Hysterectomy - usually needed
What are endometritis, intrauterine polyps, haematometra and congenital uterine malformations examples of?
Benign uterine pathologies
