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79 Cards in this Set
- Front
- Back
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What is it called when endometrial tissue is implanted outside the uterine cavity?
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endometriosis
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Endometrial implants proliferate under influence of what cyclic hormone?
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estrogen
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What are cysts within the ovaries filled w/ thick, chocolate-colored fluid representing hemolyzed blood and desquamted endothelium, also is associated w/ ovarian scarring?
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endometriomas
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What is characteristic triad associated w/ endometriosis?
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dysmenorrhea, dyspareunia, dyschezia
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What is difficulty w/ defecation?
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dyschezia
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What is associated w/ deep thrust penetration?
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dyspareunia
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What are the physical exam findings w/ endometriosis?
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no abnormalities, fixed and retroverted uterus, tender nodules uterosacral ligaments, tender adnexal masses, abdominal mass
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What gives definitive diagnosis for endometriosis by direct visualization?
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laparoscopy or laparotomy
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What is the medical tx for endometriosis?
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no treatment for asymptomatic, NSAIDS for dysmenorrheal, comb OCPs & depoprovera, GnRH agonist
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What are the possible surgical tx’s for endometriosis?
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abdominal hysterectomy, bilateral salpingo-oophorectomy, adhesion dissection, appendectomy, urteroplasty, small bowel obstruction repair
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What is defined as excessive, erratic, or irregular bleeding in the presence or absence of intracavitary or uterine bleeding?
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abnormal uterine bleeding (AUB)
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What is prolonged or excessive uterine bleeding that occurs at regular intervals, a loss of 80ml or more of blood per menstrual cycle or bleeding that last more than 7 days?
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menorrhagia
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What is irregular menstrual bleeding?
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metrorrhagia
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What is bleeding between menstrual cycles?
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intermenstrual bleeding
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What is a diminution of the flow or a shortening of the duration of menstruation?
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hypomenorrhea
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What is a menstrual cycle interval of more than 37 days?
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oligomenorrhea
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What is frequent menstrual bleeding or, a menstrual cycle that occurs every 21 days or less?
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polymenorrhea
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What is frequent menstrual bleeding that is excessive and irregular in amount and duration?
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menometrorrhagia
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What is bleeding that occurs more than 12 months after the last menstrual cycle?
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postmenopausal bleeding
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What are the 4 causes of abnormal uterine bleeding?
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Dysfunctional uterine bleeding (DUB), organic causes, iatrogenic causes, systemic causes
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What is AUB that occurs in women of reproductive age in the absence of demonstrable congenital or acquired causes?
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DUB
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What is excessive bleeding associated w/ cyclic progesterone withdrawal?
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ovulatory DUB
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What occurs in the absence of the cyclic production of ovarian progesterone, bleeding is erratic and patient may have amenorrhea alternating w/ metrorrhagia?
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anovulatory DUB
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What are all the different causes of anovulatory DUB?
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immaturity of hypothalamic-pituitary-ovarian axis, hypothyroidism, hyperandrogenic states, hyperprolactinemia, eating disorders, strenuous exercise, and obesity
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What are all the different hyperandrogenic states that cause anovulatory DUB?
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ovarian or adrenal tumors, congenital adrenal hyperplasia, PCOS
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What are the organic causes of AUB?
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abdnormal pregnancy, leiomyomas, polyps, endometrial hyperplasia & neoplasia, adenomyosis, inflammation by cervicitis or chronic endometritis, and coagulopathies
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What are the iatrogenic causes of AUB?
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IUDs, hormonal contraception, tamoxifen, psychotropic drugs (TCA & phenothiazines)
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What is key in determining the source of bleeding in AUB?
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presence or absence of ovulation
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What is done to determine ovulatory status?
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Menstrual diary, charting of basal body temp (BBT), luteal phase serum progesterone level > 6 mg/ml, and secretory endometrium obtained on endometrial bx
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What is done to rule out neoplasia in AUB?
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endometrial biopsy
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When is endometrial biopsy indicated in AUB?
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risk factors for endometrial hyperplasia such as anovulation, obesity, and unopposed estrogen, also postmenopausal bleeding and over 40 years
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What are all the imaging studies used in evaluating AUB?
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ultrasound, sonohysterugrams, hysterosalpingogram (HSG), MRI, hysteroscopy
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What are the medical tx for ovulatory bleeding and a normal uterus?
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NSAIDS, progestins w/ oral contraceptives, progestin releasing IUD, danazol, and antifibrinolytics
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When is surgery indicated for ovulatory bleeding and a normal uterus?
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pts who fail medical tx, have contraindication to medical tx or do not desire to continue it
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What are the surgical tx for ovulatory bleeding and a normal uterus?
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D&C, endometrial ablation, hysterectomy
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What surgery for ovulatory bleeding is adequate for tx of acute episode of bleeding and to obtain tissue diagnosis, but no long term benefit?
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D&C
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Which surgery for ovulatory bleeding has good longterm results and 90% success rate for tx of menorrhagia?
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endometrial ablation
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What is the most common finding after hysterectomy for failed endometrial ablation?
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adenomyosis
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What are benign monoclonal smooth muscle neoplasms?
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uterine leiomyomas (fibroids)
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What are the most common solid pelvic tumor in women and leading indication for hysterectomy?
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leiomyomas
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Which type of uterine fibroids is near the external or serosal surface of the uterus, cause a distortion to the uterus, may be pedunculated and usually palpable on bimanual exam?
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subserosal
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Which type of uterine fibroid is located within the myometrium?
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intramural
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Which type of uterine fibroid is located near the endometrium and project into the uterine cavity and may be pedunculated?
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submucosal
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What are the symptoms for uterine leiomyomas?
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asymptomatic, AUB, pelvic pain, urinary frequency, increase abdominal girth, dyspareunia, constipation
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What type of AUB is most commonly associated w/ fibroids?
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menorrhagia
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What confirms diagnosis of uterine fibroids, location and rules out adnexal pathology?
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pelvic ultrasound
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What type of test for uterine fibroids is useful for evaluation of intracavitary lesions, and preoperative evaluation of submucosal fibroids?
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sonohystogram
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What is useful in uterine fibroids to rule out diagnosis adenomyosis?
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MRI
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What is used as medical tx for fibroids?
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GnRH (leuprolide acetate)
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What is used before myomectomy or hysterectomies to shrink fibroid and uterine size?
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GnRH
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What is used to induce artificial menopause to help correct anemia associated w/ fibroids?
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GnRH
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What is GnRH effects on estrogen and so should be limited to 6 months?
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decreases estrogen
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What is a surgical removal of myomas w/ subsequent uterine reconstruction, used to tx fibroids?
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myomectomy
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What is a surgical tx that definitively cures fibroids and is the single largest diagnostic category for which it is performed?
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hysterectomy
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What surgical tx for fibroids involves inserting a catheter into the femoral artery and polyvinyl particles are injected to occlude the blood supply to the myomas?
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uterine artery embolization
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What are the complications w/ uterine artery embolization?
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infection, hematoma, ovarian failure
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What is the benign uterine condition in which endometrial glands and stroma are found deep in the myometrium?
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adenomyosis
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What are the 4 causes of adenomyosis?
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heredity, trauma, hyperestrogenemia, viral transmission
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What is usually hyperemic w/ thickened walls, the foci are frequently scattered diffusely throughout the myometrium, and may be more circumscribed with the formation of a distinct nodule?
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adenomyoma
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What are the most common physical signs of adenomyosis?
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diffusely enlarged uterus, and particularly tender during mestruation
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What is done to diagnose adenomyosis?
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history, pelvic exam, ultrasonography, serum markers CA-125 increase
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How is adenomyosis tx’ed?
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hormone therapy, and hysterectomy is the only surgical tx for adenomyosis
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What is cephaled to line connecting the insertion of the fallopian tubes?
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fundus
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What are the lateral regions of the fundus associated w/ intramural fallopian tubes?
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cornua
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What is the portion of the corpus connecting with the cervix?
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isthmus/lower uterine segment
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What is the lower 1/3 of the uterus, at and below level of the internal cervical os?
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cervix
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What type of endometrial cancer is estrogen related, younger and heavier pts, low grade, background of hyperplasia, perimenopausal, and exogenous estrogen?
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type I
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Which type of endometrial cancer is aggressive, high grade, unfavorable histology, unrelated to estrogen stimulation and occurs in older thinner women?
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type II
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What symptoms do over 95% of patients w/ endometrial cancer report having?
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postmenapausal bleeding, menorrhagia, metrorrhagia, bloody discharge
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What is the main diagnostic tool for endometrial cancer and gold standard sampling method?
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D&C endometrial biopsy
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What is the most common screening test for endometrial cancer?
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transvaginal ultrasound screening (greater the endometrial strip thickness the greater the chance of cancer, normal 4-8mm)
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What are indications for endometrial biopsy?
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postmenopausal bleeding, perimenopausal intermenstrual bleeding, abnormal bleeding w/ history of anovulation, postmenopausal women w/ endo cells on pap, and thicked endo stripe via sonography
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What are the different types of hyperplasia?
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simple, complex, atypical simple, and atypical complex
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Which type of hyperplasia has the greatest chance of progressing to cancer?
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atypical complex
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How is hyperplasia w/out atypia tx for childbearing age?
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progestin or depo-provera
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How is hyperplasia w/out atypia tx for peri or postmenopausal women?
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provera or depo-provera
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What is the tx for atypical hyperplasia for childbearing women?
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complete hysterectomy (in pts wanting to preserve fertility medical tx can be attempted)
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What is done prior to medical therapy for atypical hyperplasia to rule out endo cancer?
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D&C
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What is the medical tx for atypical hyperplasia in women wanting to conserve fertility?
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megace, norethindrone; and it also says AH/ECA w/ progestins (hysterectomy after childbearing is completed)
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