Benign Disorders Of The Upper And Lower Gi Tracts

Front 1

Define: Congenital Adrenal Hyperplasia

-deficiency of?
-presents with?
-Dx made with?
-tx?

Back 1

21-hydroxylase deficiency that leads to
1) ambiguous genitalia
2) hyperandrogenism (excess sex steroids)
3) salt wasting --> hyperkalemia / hypotension (no Aldosterone)

Dx: 17-alpha hydroxyprogesterone, decreased serum cortisol


---> *all steroid precursors (cortisol, aldo) are being shunted into sex hormones!*

tx: cortisol, this will inhibit ACTH release and stop the adrenal gland from producing more sex steroids

Front 2

Labial fusion is most commonly associated with?

-2 common causes

Back 2

excess androgens

mcc: *exogenous androgen exposure*
mcc inborn: *21 hydroxylase deficiency* leading to *Congenital Adrenal Hyperplasia*

Front 3

Define: imperforate hymen

Back 3

-obstruction of outflow tract of reproduction system, leads to buildup of vaginal secretions

Front 4

Define: transverse vaginal septum

Back 4

improper canalization of the mullerian tubercle

-- the mullerian tubercle is the junction point between the mullerian system (upper vagina) and the sinovaginal bulb/UG sinus (lower vagina)

the result is a stretch of skin that goes across the vaginal canal

tx: surgery

Front 5

Define: vaginal atresia

Back 5

agenesis of lower vagina

-ovaries, uterus, cervix, upper vagina are normal but UG sinus fails to contribute to lower portion

Front 6

Primary amennorhea could be a number of benign gyn disorders, including

Back 6

vaginal atresia
imperforate hymen
transverse vaginal septum

Front 7

Define: Lichen Sclerosis

Back 7

benign epithelial disorder of the vulva. no mech known. associated with labial fusion and contracture and shrinkage and thin white epithelium.

Front 8

Define: Squamous Cell Hyperplasia AKA Atopic Eczema

Back 8

Benign epithelial disorder due to scratching and rubbing 2/2 vulvar irritation. hyperkeratosis. raised white lesions

Front 9

Define: Lichen Planus

Back 9

Eruption of purple, pruritic, papules with *white straie on mucosal membrane surfaces*

Front 10

Define: vulvar psoriasis

Back 10

Seborrheic dermatitis --- inflammation of areas w/ sebaceous glands. red, moist.

Front 11

Define: Lichen simplex chronicus

Back 11

inflammatory process 2/2 to reactive changes (scratching and rubbing)

Front 12

Define: Vaginal Adenosis

Back 12

Benign lesion of the vaginal mucosa. Associated with DES exposure in utero. spots are palpable.

Front 13

How are benign epithelial vaginal/vulvar disorders diagnosed?

Back 13

histologically - so do biopsies!

Front 14

Tx for benign epithelial disorders of vag/vulva?

Back 14

Topical steroids

Front 15

most common cause of vulvular tumors?

-type
-what is the definition?

Back 15

epidermal inclusion cysts

occluded pilosebaceous duct/ blocked hair follicle

Front 16

Where is skene's gland located?

Back 16

skene's glands are located next to the urethral meatus.

Front 17

Where are bartholin's glands located?

Back 17

"4 and 8 oclock" on the posterior aspect of the vaginal orifice. mucus secreting glands.

Front 18

What are Gartner's Ducts?

Back 18

Gartner's Duct can encyst..they are remnants of the mesonephric ducts of the Wolffian system (degenerated in females). Found anterolaterally in vagina.

Front 19

Name 3 types of benign solid tumors of the vulva/vagina

Back 19

1) lipoma: mature fat cells
2) hemangioma: most will bleed w/ trauma
3) urethral caruncles: small fleshy tumors at distal uretrhal meatus

Front 20

how do you treat benign solid tumors of vulva?

Back 20

no need to treat because asymptomatic

Front 21

A dilated retention cyst on the cervix is called...

-name
-cause?
-sx?

Back 21

...a *nabothian cyst*

-caused by blockage of endocervical glands
-asx!

Front 22

Define: Cervical polyp

-defintion
-sx
-tx

Back 22

benign growth of the cervix.

sx:asx generally, but can be associated with intermenstrual spotting

tx: removed because they can mask other irregular bleeding

Front 23

Define: Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome

Back 23

Vaginal agenesis in genetic females. normal ovarian function. normal secondary sex characteristics.

Front 24

tx for cysts?

Back 24

typically only if needed - if they become infected or symptomatic. if so you, you do an incision and drainage.

Front 25

Define: Hidradenitis supparativa

Back 25

result of abscess formation from superinfection of apocrine sweat glands and cysts

Front 26

What is the instrument used to treat an infected, large bartholin's cyst?

Back 26

A word catheter

Front 27

Name the parts of the reproductive system derived from the mullerian system (paramesonpehric ducts)

name 2 exceptions

Back 27

-superior vagina, cervix, uterus, fallopian tubes

-exceptions: lower vagina, ovaries

Front 28

The rate of uterine anomalies increasing can be attributed to what?

Back 28

DES exposure in utero. it's very rare otherwise. DES exposure increases the chance of mullerian abnormalities

Front 29

Define: septate uterus

-definition
-assocaited w/?

Back 29

collagenous, fibrous septum that usually extends vertically downwards from the to pf the uterus

associated with pregnancy loss b/c often the septum of the uterus doesn't have an adequate blood supply to keep pregnancy going

Front 30

What are the differences btw/ septate uterus and bicornuate uterus w/r/t/ mechanism of pregnancy loss?

-mechanism
-differential presentations

Back 30

bicornuate uterus: limited by *size* of uterine horn, rather than blood supply, which is the limiting factor for septated uteri.

-so...bicornuate nuclues leads to 2nd trimester pregnancy loss and PTL, whereas septated uterus leads to 1st term pregnancy loss

Front 31

What is the difference between unicornuate, bicornuate, and didelphys uteri?

Back 31

Unicornuate: only connects to one tube

Bicornuate: connects to both tubes, but the two ends connect to themselves very low down in the uterus

Didelphys: both fallopian tubes have uterine attachments/connections, but they never fuse and thus there are two separate openings to the vagina

Front 32

How are kidney and uterine anomalies related?

Back 32

the mullerian system is responsible for both their developments, so a defect in this system can produce:

-renal agenesis
-rudimentary fallopian tube
-unicornuate (on the other side) uterus)

Front 33

Tx: Uterine anomalies?

Back 33

most require none

Front 34

Define: Uterine Leiomyoma

Back 34

Fibroids! Benign proliferations of smooth muscle cells of the myometrium that occur in women of childbearing age and regress during menopause.

Front 35

the most common indication for surgery for women in the US is?

Back 35

fibroids

Front 36

What are the three types of fibroids?'

-most common type?

Back 36

-submucosal (beneath endometrium)
-intramural (muscular wall)* most common
-subserosal (beneath uterine serosa)

Front 37

define: parasitic leiomyoma

Back 37

pedunculated fibroid that attaches to pelvic viscera an develops its own blood supply

Front 38

Discuss the risk of getting fibroids

-overall risk
-racial differences

Back 38

overall risk: 30% of american women

50% of african american women, with larger fibroids, heavier bleeding, and more severe anemia

Front 39

effect of smoking on endometrial cancer risk?

Back 39

actually decreases it...

Front 40

most common symptom of fibroids?

Back 40

abnormal uterine bleeding

Front 41

a woman in her late 30's presents with dysmenorrhea, pelvic pressure and bloating, and abnormal uterine bleeding. she has been unable to become pregnant. also, her periods are longer and heavier than usual. what is this, probably?

Back 41

fibroids!

Front 42

define: dysfunctional uterine bleeding

Back 42

abnormal bleeding that is due to changes in hormone levels

Front 43

List the Ddx for abnormal uterine bleeding

Back 43

-fibroids
-adenomyosis
-endometrial polyps
-endometrial hyperplasia
-endometrial cancer
-dysfunctional uterin bleeding

Front 44

List the Ddx for pelvic mass/uterine enlargement

Back 44

-fibroids (leiomyoma)
-pregnancy
-leiomyosarcoma
-ovarian cyst/cancer
-fallopian tube abscess
-adenomyosis
-

Front 45

Estrogen makes fibroids ____, which is why ______ therapies are used to treat them by effectively __________

Back 45

grow

GnRH agonist or progesterone

decreasing circulating estrogen levels

Front 46

Describe: Uterine Artery Embolization

Back 46

treatment method for symptomatic fibroids

Front 47

What are some treatment options for fibroids

Back 47

-myomectomy: for pts who want to remain fertile
-medical therapy
-high intensity ultrasound
-hysterectomy
-expectant management

Front 48

define: endometrial polyp

Back 48

overgrowth of endometrial glands and stroma

Front 49

define: metrorrhagia

Back 49

bleeding between periods

Front 50

What is the cause of endometrial hyperplasia?

-cause
-symptoms

Back 50

-cause is continuous endogenous (peripheral conversion of androgens to estrogens by aromatase in adipocytes) or exogenous (hormone replacement) estrogen stimulation without progesterone

-symptoms: *common cause of abnormal uterine bleeding*

Front 51

What is the Penny, nickel, dime, quarter rule?

Back 51

progression of endometrial hyperplasia to endometrial cancer

simple- 1%
complex 5%
simple w/ atypia 10%
complex w/ atypla 25%

Front 52

Define: simple vs. complex hyperplasia

Back 52

simple: proliferation of glands and stroma
complex: proliferation of just the glands, with crowding

Front 53

a patient with long periods of oligomenorrhea followed by irregular/excessive uterine bleeding in a postmenopausal women is highly suspicious for?

Back 53

endometrial hyperplasia/carcinoma

Front 54

How does one dx endometrial hyperplasia?

Back 54

EMB

Front 55

Typical treament of endometrial hyperplasia includes?

Back 55

progesterone therapy, whihc reverses the hyperplasia by inducing stromal decidualization and a thinning of the endometrium.

Front 56

Define: Functional ovarian cyst

Back 56

an ovarian mass that derives from normal physiologic fxning of the ovaries (as opposed to neoplastic growth)

Front 57

Define: follicular cyst

Back 57

most common type of ovarian cyst. arise after failure of follicle to rupture during follicular maturation phase.

Front 58

Define: Corpus luteum cyst

Back 58

occur during luteal phase of menstrual cycle. formed when corpus luteum fails to regress after 14 days, and becomes enlarged and/or hemorrhagic

Front 59

Define: theca lutein cyst

Back 59

large bilateral cysts filled with fluid that result from stimulation by abnormally high beta-HCG (from molar pregnancy/choriocarcinoma)

Front 60

What is the Ddx for ovarian cysts?

Back 60

ectopic pregnancy
PID
torsed adnexa
tuboovarian abscess
endometriosis
fibroids
ovarian neoplasm

Front 61

you palpate an ovarian/adnexal mass suggestive of an ovarian neoplasm. next step?

Back 61

investiage w/ exploratory laparoscopy

Front 62

cysts that don't spontaneously resolve 60-90 days after (like most do) require...?

Back 62

cysteoctomy, oophorectomy via laparoscope