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35 Cards in this Set
- Front
- Back
What is the most common benign neoplasm of the female genital tract?
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Leiomyoma
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What is a uterine leiomyoma?
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• localized proliferation of smooth muscle and connective tissue
• originates from the myometrium |
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What is the effect of estrogen on leiomyomas?
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• tumors are estrogen sensitive
• induces rapid growth in high estrogen states (like pregnancy) • menopause brings about cessation of tumor growth & atrophy |
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Where in the female reproductive system are most leiomyomas found?
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• uterus (95%)
• cervical (5%) |
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What are the different classifications of uterine leiomyomas?
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• submucosal (immediately beneath the endometrium)
• intramural OR interstitial (within the uterine wall) • subserosal (beneath the serosa) |
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Although most leiomyomas are asymptomatic, what is their most common presenting symptom?
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bleeding
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What are other symptoms of leiomyomas, besides bleeding?
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• fever (usually secondary due to infection)
• pain (due to vascular compromise, torsion, or infection) • pelvic pressure (can place pressure on rectum or ureters) • spontaneous abortion/infertility (if myoma significantly distorts the uterine cavity) |
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How do uterine leiomyomas present on abdominopelvic exam?
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• large, midline, irregular-contoured mobile pelvic mass
• characteristics "hard-feel" or solid qaility |
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What is the most commonly used imaging study for confirmation of leiomyomas?
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pelvic ultrasound
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What are surgical treatment options for patients with leiomyomas?
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• myomectomy (warranted for patients who want to become pregnant)
• hysterectomy |
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What is medical treatment of leiomyomas?
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• GnRH agonist (ex. Lupron)
• reduces estrogen secretion by suppressing HPO axis |
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What are complications of leiomyomas?
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• recurrance
• infertility • malignancy (ex. leiomyosarcoma) • spontaneous abortions |
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What are specific complications of leiomyomas in pregnant women?
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• dysfunctional labor
• dystocia • increased preterm labor • premature rupture of membrane (PROM) |
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What are symptoms of leiomyosarcoma?
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• increase in vaginal discharge
• pelvic pain • postmenopausal bleeding • uterine enlargement |
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What is adenomyosis?
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• local invasion of endometrial tissue in the myometrium
• more the 3 mm beneath the endometrium • associated w/ muscular hypertrophy |
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When does adenomyosis growth occur?
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• occurs only during reproductive years
• usually in parous women, increases in age and usually regresses w/ menopause |
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What is a Halban's sign?
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uterine tenderness on palpation
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What are clinical findings of adenomyosis?
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• can present with anemia
• chronic pelvic pain • dysmenorrhea • menorrhagia |
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What are treatment options for adenomyosis?
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• hysterectomy (used for confirmations and also is the treatment of choice)
• GnRH agonist (provide temporary relief of symptoms) |
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Endometrial polps occurs most often in what type of women?
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peri-menopausal or immediately post-menopausal women
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What are risk factors for endometrial polyps?
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• hypertension
• tamoxifen therapy • obesity |
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What is the most common presenting symptoms of endometrial polyps?
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abnormal bleeding (menorhagia)
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What presentation might indicate that infarction of endometrial polyps?
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• sudden occurrence of bleeding accompanied by uterine pain in postmenopausal women
• exam may reveal ulceration of the distal tip of the polyp |
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What are treatment options for uterine polyps?
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• hysteroscopic resection (dilitation & curettage)
• progestin (may cause regression) • hysterectomy (for malignant changes) |
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What is the definition of endometriosis?
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aberrant growth of endometrial tissue outside the uterus
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What is the most common site of endometriosis?
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ovary
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What is Sampson's theory of endometriosis?
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endometriosis is caused by direct implantation of endomtrial cells by retrograde menstruation
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What are chocolate cysts?
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• cysts associated with endometriosis
• filled with thick, chocolate-appearing fluid (primarily old blood) |
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What are clinical findings of endometriosis?
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• dysmennorrhea
• dyspareunia • infertility • pelvic pain |
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What is the key symptom in differentiating endometriosis from dysmenorrhea?
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dysparenunia
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Which lab value is often elevated with extensive endometriosis?
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CA 125
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What is the only way to definitively diagnose endometriosis?
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laproscopy with tissue biopsy
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What are medical treatment options for endometriosis?
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• birth control pills
• Depo-Provera (progestins) • Danazol (suppresses FSH & LH) • GnRH agonists (Lupron or Nafarelin acetate nasal spray) |
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What is the effect of pregnancy on endometriosis?
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• pregnancy has traditionally been recommended as a way to prevent or minimize the effects of endometriosis
• the prolonged progestational effect of pregnancy suppressed endometriosis |
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Describe the 2 types of surgical treatment options for endometriosis
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• Conservative surgery
- laproscopic excision, cauterization or ablation of endometriotic lesions - preserves the uterus (pregnancy is still possible) • Extirpative surgery - total abdominal hysterectomy - bilateral salpingo-oophorectomy followed by HRT - future pregnancy is not possible |