Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Gynaecology > Uterus and its abnormalities > Flashcards

Uterus and its abnormalities Flashcards

(105 cards)

Start Studying
1
Q

1st

A

1st

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where does lymph drainage of the uterus go to?

A

Internal and external iliac nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What happens to the endometrium in the first half of the menstrual cycle?

A

It proliferates, the glands elongate and it thickens - under the influence of oestrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What happens to the endometrium in the second half of the menstrual cycle?

A

The glands swell and blood supply increases - luteal/secretory phase - under influence of progesterone - then progesterone levels drop and secretory endometrium disintegrates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are fibroids also known as?

A

Leiomyomata

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are fibroids?

A

Benign tumours of the myometrium (muscle of the uterus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Incidence of fibroids?

A

At least 25% of women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Who are fibroids more common in? x3

A

Women near the menopause
In Afro-caribbean women
Those with family history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Who are fibroids less common in? x2

A

Parous women

Those who have taken COC or injectable progestogens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What different types of fibroids are there?

A

Intra-mural, subserosal (under external wall of uterus), submucosal (under internal wall of uterus)- submucosal can form intracavity polyps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the aetiology of fibroids?

A

Fibroid growth is oestrogen and probably progesterone dependent
During pregnancy, fibroids equally likely to grow, shrink or show no change
Fibroids regress after menopause because of reduction in circulating oestrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Symptoms of fibroids? x6

A

50% are asymptomatic
Menorrhagia - 30%
Dysmenorrhoea
Erratic bleeding (IMB)
Pressure effects - eg. pressing on bladder
Subfertility if tubal ostia are blocked or intramural can reduce fertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Examination of fibroids

A

Solid mass may be palpable on pelvic or even abdominal examination
Multiple small fibroids can cause irregular knobbly enlargement of the uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is degeneration of fibroid?

A

Normally the result of inadequate blood supply
‘Red degeneration’ is characterised by pain and uterine tenderness - haemorrhage and necrosis occur
Hyaline degeneration or cystic degeneration - fibroid is soft and partly liquefied

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What % of fibroids are leiomyosarcomata? (malignant)

A

0.1% - may be as a result of malignant change or de novo malignant transformation of normal smooth muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What influence can fibroids have on pregnancy?x6

A 
Premature labour 
Malpresentations
Transverse lie
Obstructed labour 
PPH 
Red degeneration is common in pregnancy and can cause severe pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the effect of HRT on fibroids?

A

Can cause continued fibroid growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Investigations with fibroids

A

US
MRI or laparoscopy might be needed to distinguish fibroid from ovarian mass
Hb - anaemia due to bleeding or high as fibroids can secrete erythropoietin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When do no treatment for fibroids?

A

Asymptomatic if small or slow-growing then no treatment and no monitoring needed either as risk of malignancy is small
Larger need monitoring because remote possibility of malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Medical treatment of fibroids

A

Tranxamic acid, NSAIDs or progestogens often ineffective for menorrhagia due to fibroids but worth trying first
GnRH agonists for 6 months or with “add-back” HRT to prevent side effects and bone density problems
Often used to shrink before surgery
GnRH agonists not good for trying to conceive because decreases ovulation
Also fibroids return to previous size after stopping GnRH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Surgical treatment of fibroids

A

Hysteroscopic surgery if less than 3cm
Myomectomy (open or laparoscopic)
Hysterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Other treatment for fibroids

A

Uterine artery embolisation, 80% success rate

But readmission higher than myomectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is adenomyosis?

A

Presence of endometrium and its underlying stroma within the myometrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When is adenomyosis common, what other conditions is it associated with and prognosis?

A

Most common around age 40
Associated with endometriosis and fibroids
Symptoms subside after menopause (oestrogen dependent)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Clinical features of adenomyosis
Asymptomatic Or painful, regular, heavy menstrual bleeding Uterus is mildly enlarged and tender on examination
26
Investigation of adenomyosis
Not easily diagnosed by ultrasound but can be seen on MRI
27
Treatment of adenomyosis
IUS or COC without/with NSAIDs may control menorrhagia and dysmenorrhoea - but hysterectomy is often required
28
What is endometritis?
Infection confined to the cavity of the uterus alone | Spread to pelvis is common if untreated
29
Cause of endometritis?
Often secondary to sexually transmitted infections, as a complication of surgery (C-sections or intrauterine procedure) or foreign tissue (IUD or retained products of conception)
30
What is cause of endometritis in post-menopausal uterus commonly due to?
Malignancy
31
Presentation of endometriris?
Persistent and heavy vaginal bleeding with pain Tender uterus Cervical os open Septicaemia/systemic infection can ensue
32
Investigations in endometritis?
Vaginal and cervical swab | FBC
33
Treatment of endometritis?
Antibiotics and occasionally evacuation of retained products of conception are required
34
What are intrauterine polyps?
Small, usually benign tumours that grow in the uterine cavity - most are endometrial in origin
35
When are polyps common? x2
Women aged 40-50 years and when oestrogen levels are high
36
In which post-menopausal women are polyps commonly found?
Those on tamoxifen for breast cancer
37
Presentation of polyps
Can be asymptomatic Often cause menorrhagia and intermenstrual bleeding Occasionally prolapse through the cervix
38
Diagnosis of polyps
Normally with US or hysteroscopy
39
Treatment of polyp
Resection with cutting diathermy or avulsion
40
What is didelphys?
Total failure of fusion of two Mullerian ducts leading to two uterine cavities and cervices - sometimes longitudinal vaginal septum
41
What do women with congenital uterine anomaly have increased incidence of?
Renal anomalies
42
What is the most common genital tract cancer?
Endometrial cancer
43
When is prevalence of endometrial cancer highest?
Age 60 | Only 15% occur premenopausally
44
Prognosis of endometrial cancer
Usually presents early therefore good prognosis but actually has same stage for stage prognosis as ovarian cancer
45
What sort of cancer is endometrial cancer cellularly normally?
Adenocarcinoma of columnar epithelial gland cells - accounts for >90%
46
What are the risk factors for endometrial cancer?
High ratio of oestrogen to progestogen - PCOS (unopposed oestrogens) - Obesity - Oestrogen secreting tumours - Nulliparity or late menopause - Tamoxifen
47
What is protective against endometrial cancer? x2
COC or pregnancy
48
What is the premalignant disease of endometrial cancer?
Endometrial hyperplasia with atypical hyperplasia | - can cause menstrual abnormalities or postmenopausal bleeding
49
Management of premalignant endometrial hyperplasia
If uterus must be conserved then progestogens with 6-monthly endometrial biopsy - otherwise hysterectomy
50
Clinical features of endometrial cancer?
Postmenopausal bleeding IMB or irregular bleeding in premenopausal women Occasionally recent onset menorrhagia
51
Examination findings in endometrial cancer? x2
Pelvis appears normal and atrophic vaginitis may coexist
52
Where does endometrial cancer directly spread to?
Through the myometrium to the cervix and upper vagina | Ovaries may be involved
53
Where does endometrial cancer spread to lymphatically?
To pelvic and then para-aortic lymph nodes
54
What is Stage 1 endometrial cancer?
Lesions confined to the uterus 1a - less than 1/2 myometrium invasion 1b - more than 1/2 myometrium invasion
55
What is Stage 2 endometrial cancer?
Cervix involvement but not beyond uterus
56
What is Stage 3 endometrial cancer?
``` Tumour invades through uterus 3A - serosa or adnexae 3B - vaginal or parametrial involvement 3Ci - pelvic node involvement 3Cii - para-aortic node involvement ```
57
What is Stage 4 endometrial cancer?
Further spread 4A - bowel or bladder 4B - distant metastases
58
What stage of endometrial cancer do most patients present with?
75% present with Stage 1 disease
59
Treatment of endometrial cancer?
Hysterectomy and bilateral salpingophorectomy is first line treatment
60
When is staging done in endometrial cancer
After hysterectomy - can see if lymph nodes were involved
61
When is further treatment needed for endometrial cancer following hysterectomy?
Patients considered high risk for lymph node involvement - radiotherapy
62
Prognosis of endometrial cancer post-surgery
Recurrence is common in vaginal vault in the first 3 years
63
How common are uterine sarcomas?
Rare!! 150 cases in UK per year
64
What is the blood supply to the cervix?
Upper vaginal branches and uterine artery
65
Where do cervix lymphatics drain to?
Obturator and internal/external iliac nodes - then to the common iliac and para-aortic nodes
66
What is cervical ectropion?
When the columnar epithelium of the endocervix is visible as a red area around the os of the cervix
67
What causes cervical ectropion?
Due to eversion of cervix - normal finding in young women, esp. taking pill or who are pregnant
68
Symptoms of cervical ectropion
Normally asymptomatic | Can cause vaginal discharge or PCB
69
Treatment of symptomatic cervical ectropion
Freezing with cryotherapy - but only once smear has been done and carcinoma excluded
70
Risk associated with cervical ectropion?
Exposed columnar epithelium is prone to infection
71
Details of acute cervicitis
Rare - often results from STIs Ulceration and infection occasionally found Severe cases can have prolapse
72
Details of chronic cervicitis?
Chronic inflammation or infection often of an ectropion Common cause of vaginal discharge Cryotherapy is used with or without antibiotics
73
What is cervical intraepithelial neoplasia (CIN) also called?
Cervical dysplasia
74
What is CIN?
Presence of atypical cells within squamous epithelium
75
What is the grading for CIN?
CIN 1 - mild dysplasia - cells only found in lower 1/3 of epithelium CIN 2 - moderate dysplasia - cels only found in lower 2/3 of epithelium CIN 3 - severe dysplasia - cells occupy full thickness of epithelium
76
What is CIN 3?
Cervical carcinoma in situ - cells are the same as those found in malignant lesions but there is no invasion
77
How does CIN 3 or carcinoma in situ become cervical malignancy?
Invasion of the cells through the basement membrane
78
Prognosis of untreated CIN II/III?
1/3 of women will develop cervical cancer over next 10 years
79
Prognosis of CIN I?
Least malignant potential - CIN I can progress to CIN II/III but usually regresses spontaneously
80
Peak incidence of CIN III
90% are under 45 years | Peak incidence in those 25-29years
81
Most important risk factor for CIN
HPV which is sexually transmitted - therefore number of sexual partners
82
What strains of HPV does the vaccine target?
Types 16 and 18 - responsible for 75% of cervical cancers in the UK
83
What are other risk factors for CIN?
Oral contraceptive use Smoking Immunocompromised patients are also at increased risk and have increased risk of early progression to malignancy
84
Symptoms of CIN
CIN causes no symptoms and is not visible on the cervix - therefore done with cervical smears
85
Age and frequency of cervical smears in UK
25 (or after first intercourse) then repeated every 3 years until age 49 From 50-64 every 5 years
86
Management of low-grade cellular abnormalities found on smear test
eg. dyskaryosis or borderline changes - Sample tested for HPV - if high-risk HPV type then colposcopy If low-risk HPV then back to routine smear tests
87
Management of abnormal columnar cells on smear
Colposcopy (speculum and operating microscope) with biopsy
88
Management of CIN II and III
Transformation zone is excised with cutting diathermy - large loop excision of transformation zone (LLETZ)
89
Consequence of LLETZ
May have postoperative haemorrhage rarely | Risk of subsequent preterm delivery is slightly higher
90
Peak incidences of cervical carcinoma
During 30s and during 80s but majority of cases are in women aged 25-49
91
Risk factors for cervical carcinoma
Same as for CIN - HPV, sexual partners | Not familial
92
What is occult cervical carcinoma?
When there are no symptoms but diagnosis is made by biopsy or LLETZ
93
Clinical features of cervical carcinoma x3
PCB Offensive vaginal discharge IMB or PMB Pain is not an early feature
94
Clinical features of late stage cervical cancer?
Involvement of ureters (uraemia), bladder (haematuria), rectum (rectal bleeding) and nerves (pain)
95
Examination findings in cervical cancer
May see/palpate ulcer or mass on cervix
96
What is an early feature of spread of cervical cancer?
Spread locally to parametrium and vagina | Lymphatic spread to pelvic nodes is early feature
97
What is Stage 1 cervical cancer?
Lesions confined to cervix
98
What is Stage 2 cervical cancer
Invasion into vagina but not lower vagina or pelvic side wall
99
What is Stage 3 cervical cancer?
Invasion of lower vagina or pelvic wall or causing ureteric obstruction
100
What is Stage 4 cervical cancer?
Invasion of bladder or rectal mucosa - or beyond true pelvis
101
Investigations in cervical cancer?
Tumour biopsy for diagnosis Vaginal and rectal exams to assess size and local invasion Cystoscopy - bladder invovlement MRI - tumour size spread and LN involvement
102
Treatment of stage 1 a i cervical cancer
Small diagnosed microscopically - can do cone biopsy or simple hysterectomy
103
Treatment of cervical cancer stage 1 a ii - 1 b i (clinically visible but less than 20mm)
Laparoscopic lymphadenectomy and radical trachelectomy (removal of 80% of cervix and upper vagina)
104
Treatment of cervical cancer stage 1 b ii - 2a (up to invasion of vagina but not pelvic side wall)
Radical hysterectomy or chemo-radiotherapy
105
Treatment of stage 2b cervical cancer (invasion of parametrium) and worse or positive lymph nodes at any stage
Chemo-radiotherapy

Gynaecology (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions